2014 Practice Changers and Important Topics in Hospital Medicine

Larry Beresford


December 26, 2014

Antibiotics for VAP: Short vs Long Duration

Short- vs Long-Duration Antibiotic Regimens for Ventilator-Associated Pneumonia: A Systematic Review and Meta-analysis
Dimopolous G, Poulakou G, Pneumatikos IA, Armaganidis A, Kollef MH, Matthaiou DK
Chest. 2013;144:1759-1767

This meta-analysis of four randomized controlled trials concluded that a short course is reasonable for most patients with ventilator-associated pneumonia, Dr Mourad said. Generally speaking, "less antibiotics is good. People should feel empowered to use the short term course, which is 7 to 8 days," she added.

COPD Exacerbations in the Critically Ill

Outcomes Associated With Corticosteroid Dosage in Critically Ill Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Kiser TH, Allen RR, Valuck RJ, Moss M, Vandivier RW
Am J Respir Crit Care Med. 2014;189:1052-1064

High-dose corticosteroids can produce worse outcomes and side effects, raising physicians' interest in determining the appropriate dose and duration of this treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD), Dr Mourad said. Authors of one study attempted to determine whether low-dose corticosteroids could be used in place of high-dose steroids in critically ill patients with COPD exacerbations.

"This was a large observational cohort of patients in the ICU, comparing low-dose vs high dose. The arbitrary cutoff for the low dose was 100 mg/day," she said.

"The lower dose [of corticosteroids resulted in] less fungal infections and less mortality," Dr Mourad said. The authors don't offer guidelines, she added, but the implication is that most patients should get the low dose of steroids.

How About We Shake, er, Knuckle on It?

The Fist Bump: A More Hygienic Alternative to the Handshake
Mela S, Whitworth DE
Am J Infect Control. 2014;42:916-917

Infection control remains a hot button issue in hospital medicine, with prevention of nosocomial infections a priority in the care of hospitalized patients.

Both Dr Mourad and her UCSF colleague, Bradley Sharpe, MD, highlighted a curious study comparing the conventional handshake as a greeting gesture in the hospital with the so-called high five and colloquially known knuckle-to-knuckle fist bump, all three of which are usually performed as a sign of greeting, friendship, celebration, or agreement.

Researchers used an experimental model to assay transfer of bacteria during meeting exchanges, concluding that adopting the fist bump could substantially reduce transmission of infectious diseases between doctors and patients.


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