Significant variability in admission criteria for pneumonia

In this single center analysis of admission criteria for pneumonia, there was significant variability by ED physician. Rates varied from 38% to 79%, and was not dependent on illness severity, day of week, time of day. Although a single institution study, it highlights variability in admission criteria, likely prevalent in many medical centers (abstract)

Flu season coming

The CDC is recommending universal vaccination (for all >6 months of age); the vaccine is available now in most areas, and is the same trivalent strains as last year. CMS is mandating universal screening and vaccination for inpatients, the measurement of which will go into effect on Jan 1, 2012 (CDC abstract)

Cardiac device related infections increase mortality

In this large analysis of medicare beneficiaries with cardiac devices, those that suffered a device infection had significantly higher LOS, cost, and short and long term mortality. Referrrals for cardiac device implantation need to be clearly based on evidence of benefit, given the short and long term cost and risk (abstract)

Long-term azithromycin reduces COPD exacerbations

In this trial of COPD patients with recent exacerbation, and on oxygen or steroids in the last year, they were randomized to daily azithromycin (250mg) or placebo. Those on azithromycin had significantly fewer exacerbations (1.5 vs 1.8 per patient year) and longer time to first exacerbation (266 vs 174 days). Mortality was the same, but azithromycin-resistant strains were higher. For some severe COPD patients, daily azithromycin may be beneficial, but long term consequences are unknown (abstract)

Pro-calcitonin algorithms reduce antibiotics, but not mortality

In this large systematic review of 14 randomized clinical trials, the use of pro-calcitonin algorithms for guiding antibiotics in patients with upper respiratory infections or suspected sepsis (in primary care, the ED, or the ICU) reduced antibiotic use, and did not affect mortality (abstract)