Published in the August 2007 issue of Today’s Hospitalist.
Higher MRSA infection rates now being reported
A new study reports much higher infection rates for methicillin-resistant Staph aureus in U.S. hospitals than previous estimates had found. The study, released in June, found that 34 out of every 1,000 patients in hospitals and nursing homes have an active MRSA infection.
The figures suggest that as many as 1.2 million hospital patients are infected every year. That rate is almost nine times higher than previous CDC estimates, which were based on 1999-2000 hospital discharge data.
The new tally is the result of a survey of more than 20% of U.S. hospitals. Results were released at an Association for Professionals in Infection Control and Epidemiology meeting.
Other findings included:
“¢ 67% of infections were found in non-surgical medical units. That’s a big shift from previous research, which concluded that most infections arise in ICUs.
“¢ 77% of those identified with MRSA were found to be infected within two days of admission, suggesting they were infected before being hospitalized.
“¢ 63% of patients had blood, urinary tract or pneumonia MRSA cases, which are more common among hospital-acquired infections.
More results are online.
Risk factors can help predict upper GI hemorrhage outcomes
In a prospective, multi-site study, researchers identified several risk factors they say can help predict poor outcomes in patients hospitalized with acute upper GI bleeding. The prediction rules make it possible to identify low-risk patients who may be discharged early.
The study defined two types of poor outcomes: re-bleeding, need for urgent surgery or hospital death; and bleeding-specific outcomes plus new or deteriorating co-morbidity.
Independent predictors of the first poor outcome included:
“¢ an APACHE II score of 11 or higher;
“¢ esophageal varices; and
“¢ stigmata of recent hemorrhage.
Predictors of the second poor outcome were the same three factors, plus "unstable co-morbidity on admission." Authors said that only 1.1% of patients who had no risk factors experienced the first poor outcome, while only 6.2% experienced the second.
The study was published in the June 25 Archives of Internal Medicine.
Vancomycin bests metronidazole for severe C. difficile
In what authors say is the first randomized, double-blinded trial comparing oral metronidazole to oral vancomycin in patients with C. difficile, vancomycin was found to be superior in patients with severe disease.
Patients’ disease severity was stratified by age, temperature, and albumin levels or white blood cell count, as well as by the presence of endoscopic pseudomembranous colitis or ICU admission.
Results showed no significant difference in clinical cure rate for patients with mild disease. However, for those with severe disease, cure rates ran 76% in the metronidazole group and 97% in the vancomycin arm.
Study results were published in the Aug. 1 Clinical Infectious Diseases.