In the Literature: HM-Related Research You Need to Know

The Hospitalist. 2011 January;2011(01):

January 1, 2011|The Hospitalist

Alexis E. Shanahan, MD;Chad R. Stickrath, MD;Mel L. Anderson, MD;Section OF

In This Edition

Literature at a Glance

A guide to this month’s studies

Characteristics of CA-MRSA
Association of gurgling with morbidity and mortality
Antibiotics for active ulcerative colitis
TIPS for cirrhosis-induced variceal bleeding
Steroid dose, route in COPD exacerbations
Effect of reminders and stop orders on urinary catheter use
Outcomes of chest-compression-only CPR
Albumin levels and risk of surgical-site infections

Characteristics of Community-Acquired methicillin-resistant Staphylococcus aureus Pneumonia in an Academic Medical Center

Clinical question: What are the clinical features and epidemiology of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia?

Background: CA-MRSA is an emerging cause of pneumonia. The genetic makeup of most CA-MRSA strains is different than that of nosocomial MRSA. Typically, CA-MRSA is resistant to methicillin, beta-lactams, and erythromycin, but it retains susceptibility to trimethoprim-sulfamethoxazole (TMP/sulfa) and clindamycin.

In addition, the most common strain of CA-MRSA carries the Panton-Valentine leukocidin (PVL) toxin, which is associated with necrotizing pneumonia and high mortality rates.

Study design: Retrospective case series.

Setting: A 1,100-bed teaching hospital in Chicago.

Synopsis: Of the 5,955 discharges with a diagnosis-related group (DRG) code of pneumonia, 15 met criteria for CA-MRSA, or <1% of all inpatient community-acquired pneumonia cases. All 15 CA-MRSA strains were positive for PVL.

Seven of the 15 patients never were admitted to the ICU, while seven patients required mechanical ventilation. Seven patients were immunocompromised; one patient presented with preceding influenza; seven patients presented with hemoptysis; and eight patients demonstrated findings of lung necrosis on CT scan. Two patients died; both were immunocompromised.

Although the initial antibiotic regimen varied considerably, 14 patients ultimately received either clindamycin or linezolid.

Bottom line: CA-MRSA pneumonia is an uncommon subset of community-acquired pneumonia admissions. Approximately half the patients admitted with CA-MRSA presented with features of severe pneumonia. Nearly all were treated with antibiotics that inhibit exotoxin production, and the associated mortality rate of 13% was lower than previously reported.

Citation: Lobo JL, Reed KD, Wunderink RG. Expanded clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus pneumonia. Chest. 2010;138(1):130-136.

Clinical Shorts

INTRAVENOUS ASPIRIN MIGHT BE EFFECTIVE TREATMENT FOR SEVERE HEADACHES IN THE INPATIENT SETTING

Retrospective case review of 168 patients treated with IV aspirin in a large European hospital for severe, mostly medication rebound, headaches showed that 85% of patients had a moderate or good response to treatment. Side effects occurred in 5.9% of patients and were all considered minor.

Citation: Weatherhall MW, Telzerow AJ, Cittadini E, Kaube H, Goadsby PJ. Intravenous aspirin (lysine acetylsalicylate) in the inpatient management of headache. Neurology. 2010;75(12):1098-1103.

SIGNIFICANT DIFFERENCES BETWEEN PATIENTS’ AND PHYSICIANS’ IMPRESSIONS ABOUT PATIENT KNOWLEDGE AND CARE RECEIVED

Surveys of inpatients and the resident and attending physicians caring for them demonstrated widely differing perceptions between the groups regarding patient knowledge of doctor in charge, primary diagnosis, and new medications or potential side effects.

Citation: Olson DP, Windish DM. Communication discrepancies between physicians and hospitalized patients. Arch Intern Med. 2010;170(15):1302-1307.

Gurgling Breath Sounds in Hospitalized Patients Might Predict Subsequent Pneumonia Development

Clinical question: Can gurgling sounds over the glottis during speech or quiet breathing predict hospital-acquired pneumonia (HAP)?

Background: HAP is a relatively frequent complication of hospitalization. HAP usually portends an increase in morbidity and mortality. Patients in the hospital might have disease states that inhibit the reflexes that normally eliminate secretions from above or below their glottis, increasing the risk of pneumonia.