ID

Universal MRSA decolonization in ICUs

The large multi-center ICU trial randomized ICUs to 1 of 3 strategies: MRSA screening/isolation, MRSA screening/isolation/decolonization, or global decolonization (5 days BID nasal mupiricin and daily chlorhexidine bathing). The hazard ratios for MRSA isolates in the 3 groups were 0.92, 0.75, 0.63 respectively. The hazard ratios for any bloodstream infection in the 3 groups were 0.99, 0.78, and 0.56 respectively. Global decolonization of ICU patients results in lower MRSA acquisition and bloodstream infections compared to targeted decolonization based on screening (abstract).

Penicillin for cellulitis prophylaxis

The large trial recruited patients with 2 or more recurrent bouts of leg cellulitis and randomized them to 12 months of penicillin (250mg BID) or placebo. Recurrence was lower in the penicillin group (22% vs 37%), with no difference in adverse effects (abstract).

Statins for sepsis

This randomized trial of 250 patients with sepsis, who were randomized to 14 days of statin or placebo, found no difference in serum markers of inflammation, organ dysfunction scores or morality between the groups. However, they did find that among prior statin users, those randomized to placebo had significantly higher 28 day mortality than those randomized to a statin (28% vs 5). Although more studies are needed, this study suggests that those already on statins who develop sepsis should be continued on their statin (abstract).

Pneumococcal pneumonia still bad news

This cohort from the VA found those confirmed with pneumococcal pneumonia had a 12% 1 month mortality, and a 10 year mortality rate of~30%, which is higher than age-matched expectations. The prognosis was worse with bacteremic disease, and with higher PORT scores (abstract).