In the Literature: The latest research you need to know

Bottom line: Early supported discharge may increase the proportion of patients living at home five years after stroke.

Citation: Fjaertoft H, Rohweder G, Indredavik B. Stroke unit care combined with early supported discharge improves 5-year outcome: a randomized controlled trial. Stroke. 2011;42:1707-1711.

Criteria May Help Identify Patients at Risk for Infective Endocarditis

Clinical question: Which patients with Staphylococcus aureus bacteremia benefit the most from transesophageal echocardiography?

Background: Infective endocarditis is a serious complication of S. aureus bacteremia (SAB), occurring in 5% to 17% of patients with documented SAB. It has been recommended to perform transesophageal echocardiography (TEE) in all patients with SAB. Large variation exists in rates of TEE, and identifying patients at low risk for endocarditis may help with more appropriate utilization of this test.

Study design: Retrospective cohort analysis.

Setting: Two university-based German tertiary hospitals (INSTINCT cohort) and one North American university-based hospital from October 1994 to December 2009 (SABG cohort).

Synopsis: A total of 736 cases of nosocomial SAB were analyzed. Age, source of infection, and 30-day and 90-day case fatality rates were similar between the two cohorts. Patients were followed during the index hospitalization and for three months after discharge.

Patients with infective endocarditis were more likely to have prolonged bacteremia; a permanent intracardiac device, such as a pacemaker or a heart valve; be recipients of hemodialysis; and have osteomyelitis. Of the 83 patients who did not fulfill any of the prediction criteria, no cases of infective endocarditis were found.

Bottom line: A set of simple criteria may help identify patients with nosocomial SAB who are at risk for infective endocarditis. The subset of patients who do not meet any of these criteria may not need diagnostic evaluation with TEE.

Citation: Kaasch, AJ, Fowler VG Jr., Rieg S, et al. Use of a simple criteria set for guiding echocardiography in nosocomial Staphylococcus aureus bacteremia. Clin Infect Dis. 2011;53:1-9.

CLINICAL SHORTS

PULMONARY NODULE NEEDLE BIOPSIES FREQUENTLY RESULT IN SERIOUS COMPLICATIONS

In a discharge database analysis, pneumothorax complicated 15% of all biopsies, with 44% requiring chest tube placement. Pulmonary hemorrhage occurred 1% of the time with 18% needing blood transfusions.

Citation: Wiener RS, Schwartz LM, Woloshin S, Welch HG. Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records. Ann Intern Med. 2011;155:137-144.

CUMULATIVE ANTIBIOTIC EXPOSURES ASSOCIATED WITH RISK OF CLOSTRIDIUM DIFFICILE INFECTION

Retrospective cohort study of 7,792 patients during 10,154 hospitalizations found that cumulative dose, number, and duration of antibiotics were independently associated with the development of Clostridium difficile infection.

Citation: Stevens V, Dumyati G, Fine LS, Fisher SG, van Wijngaarden E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis. 2011;53:42-48.

NESIRITIDE IN ACUTE HEART FAILURE HAS NO SIGNIFICANT EFFECT ON DYSPNEA, MORTALITY, OR RENAL FAILURE

A trial of 714 patients with acute heart failure randomized to receive nesiritide or placebo found no difference in death, rehospitalization, renal failure, or dyspnea. The nesiritide group experienced significantly more hypotension.

Citation: O’Connor CM, Starling RC, Hernandez AF, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Eng J Med. 2011;365:32-43.

PROTON PUMP INHIBITOR THERAPY IS MODESTLY ASSOCIATED WITH INCREASED RISK OF HIP AND VERTEBRAL FRACTURES

A meta-analysis of 10 controlled observational studies found that use of proton pump inhibitors is associated with a modest increase in the risk of hip (OR 1.25; 95% CI, 1.14-1.37) and vertebral fractures (OR 1.50; 95% CI, 1.32-1.72). These results should be interpreted with caution as it is unclear if this represents causation or unmeasured confounding.

Citation: Ngamruengphong S, Leontiadis GI, Radhi S, Dentino A, Nugent K. Proton pump inhibitors and risk of fracture: a systematic review and meta-analysis of observational studies. Am J Gastroenterol. 2011;106:1209-1218.

STROKE PATIENTS HAVE HIGHER RATES OF REHOSPITALIZATION

One- and five-year mortality in Medicare stroke patients is six times and two times higher, respectively, than in non-stroke patients. Readmission rates for stroke patients are 2.5 and 1.3 times higher, respectively.

Citation: Lakashminarayan K, Schissel C, Anderson DC, et al. Five-year rehospitalization outcomes in a cohort of patients with acute ischemic stroke: Medicare linkage study. Stroke. 2011;42:1556-1562.

PROTON PUMP INHIBITORS REDUCE THE RISK OF GASTROINTESTINAL BLEEDING IN THE GENERAL POPULATION AND IN PATIENTS ON ANTITHROMBOTIC OR ANTI-INFLAMMATORY THERAPY

A population-based, nested case-control study found that proton pump inhibitor use is associated with a 20% lower risk of upper gastrointestinal bleeding in the general population. The risk reduction increases to 50% to 80% in users of gastrotoxic agents.

Citation: Lin KJ, Hernandez-Diaz S, Garcia Rodriguez LA. Acid suppressants reduce risk of gastrointestinal bleeding in patients on antithrombotic or anti-inflammatory therapy. Gastroenterology. 2011;141:71-79