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

Study design: Prospective cohort.

Setting: A 350-bed community teaching hospital in Bridgeport, Conn.

Synopsis: All patients admitted to a respiratory-care unit and general medical ward from December 2008 to April 2009 underwent auscultation over their glottis by study personnel. Patients with gurgles heard during speech or quiet breathing on auscultation and patients without gurgles were entered into the study in a 1:3 fashion, until 20 patients with gurgles and 60 patients without gurgles had been enrolled. Patients were followed for the development of clinical and radiographic evidence of HAP, ICU transfer, and in-hospital death.

Both dementia and treatment with opiates were independent predictors of gurgle in multivariate analysis. HAP occurred in 55% of the patients with gurgle versus 1.7% of patients without gurgle. In addition, 50% of the patients with gurgle required transfer to the ICU, compared with only 3.3% of patients without gurgle. In-hospital mortality was 30% among patients with gurgle versus 11.7% among patients without gurgle.

Bottom line: In patients admitted to the medical service of a community teaching hospital, gurgling sounds heard over the glottis during speech or quiet inspiration are independently associated with the development of HAP, ICU transfer, and in-hospital mortality.

Citation: Vazquez R, Gheorghe C, Ramos F, Dadu R, Amoateng-Adjepong Y, Manthous CA. Gurgling breath sounds may predict hospital-acquired pneumonia. Chest. 2010;138(2):284-288.

Treatment of Active Ulcerative Colitis with Triple Antibiotic Therapy Provides Better Response than Placebo

Clinical question: Does combination antibiotic therapy induce and/or maintain remission of active ulcerative colitis (UC)?

Background: Mouse models and other experimental evidence have suggested a pathogenic role for microbes in the development and/or exacerbation of ulcerative colitis, although antibiotic human trials have produced conflicting results. Recently, Fusobacterium varium was shown to be present in the gastrointestinal (GI) tract of most UC patients, and a pilot study using targeted antibacterials demonstrated efficacy in treating active UC.

Study design: Randomized, double-blind, placebo-controlled, multicenter trial.

Setting: Eleven hospitals in Japan.

Synopsis: Patients with mild to severe chronic relapsing UC were randomly assigned to either combination antibiotic therapy or placebo. All previous UC treatment regimens were continued in study patients, with the exception of steroids, which were tapered slowly if possible. Patients in the antibiotic group received a two-week combination therapy of amoxicillin, tetracycline, and metronidazole. Patients were followed weekly or monthly and underwent periodic exams and colonoscopies to assess clinical and endoscopic improvement for 12 months.

One hundred five patients were enrolled in each group. The clinical response rate at one year in patients treated with antibiotics was 44.8% versus 22.8% in the placebo group. Remission at one year was achieved in 26.7% of patients treated with antibiotics versus 14.9% of placebo patients. Endoscopic response rates and steroid discontinuation rates were higher in the antibiotic-treated groups. Effects were most pronounced in the group of patients with active disease.

Bottom line: Triple antibiotic therapy with amoxicillin, tetracycline, and metronidazole, when compared with placebo, was associated with improvement in clinical symptoms, endoscopic findings, remission rates, and steroid withdrawal in patients with active ulcerative colitis.

Citation: Ohkusa T, Kato K, Terao S, et al. Newly developed antibiotic combination therapy for ulcerative colitis: a double-blind placebo-controlled multicenter trial. Am J Gastroenterol. 2010;105(8):1820-1829.

Clinical Shorts

MACROLIDE AND QUINOLONE ANTIBIOTICS HAVE SIMILAR RATES OF TREATMENT FAILURE AMONG PATIENTS WITH ACUTE EXACERBATIONS OF COPD

This large, retrospective cohort study of nearly 20,000 patients across 375 U.S. centers found no difference, after multivariate adjustment, between macrolides and quinolones across a variety of outcomes: treatment failure, adjusted length of stay, or adjusted cost. Curiously, diarrhea was more common with quinolones.

Citation: Rothberg MB, Pekow PS, Lahti M, Brody O, Skiest DJ, Lindenauer PK. Comparative effectiveness of macrolides and quinolones for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). J Hosp Med. 2010;5(5):261-267.

MORNING ALBUMIN-TO-CREATININE RATIO ACCURATELY PREDICTS SUBSEQUENT RENAL EVENTS

This study reviewed four different methods of measuring proteinuria in 700 patients: 24-hour urine albumin excretion, 24-hour urine protein excretion, first-morning void urine albumin concentration, and first-morning void urine albumin-to-creatinine ratio. The first morning void urine albumin-to-creatinine ratio offered the strongest predictor of subsequent doubling of serum creatinine or progression to end-stage renal disease.

Citation: Lambers Heerspink HJ, Gansevoort RT, Brenner BM, et al. Comparison of different measures of urine protein excretion for prediction of renal events. J Am Soc Nephrol. 2010;21(8):1355-1360.