Most Read Articles
Pearl Toh, 03 Jan 2019
Chemotherapy was associated with an increased risk of amenorrhoea among women with lung cancer, which may place them at a higher risk for early menopause, a study suggests.
26 Dec 2018
Secondhand exposure to aerosols from electronic nicotine delivery systems (ENDS) may contribute to asthma exacerbations in young people with asthma, a study has found.
Tristan Manalac, 11 Sep 2018
The immediate reduction of cigarette nicotine content results in greater improvements in levels of smoke exposure biomarkers than gradual reduction, though withdrawal symptoms are stronger, according to a recent study.
Pearl Toh, 31 Jul 2017
Continuous positive airway pressure (CPAP), a noninvasive ventilation, may help improve respiratory rate and reduce mortality in children with respiratory distress, particularly in those younger than 1 year, a recent study showed. CPAP intervention was initiated by nurses with minimal physician supervision in the study, supporting the use of noninvasive ventilation in low-resource settings where laboratory diagnostic tests are not readily available.

Treatment de-escalation in nosocomial pneumonia shortens hospital stay, lowers AKI risk

08 Nov 2018

Among patients with culture-negative nosocomial pneumonia, de-escalation of antimethicillin-resistant Staphylococcus aureus (MRSA) therapy is associated with a shorter hospital stay and lower incidence of acute kidney injury (AKI), a study suggests. De-escalation does not alter 28-day mortality.

This single-centre cohort study included 279 adult patients with nosocomial pneumonia and a negative respiratory culture. Treatment dose was de-escalated in 187 patients (DE group) and maintained in 92 (control group). De-escalation was defined as discontinuation of an anti-MRSA medication within 4 days of initiation.

Compared with those in the DE group, controls received 5 more days of MRSA coverage. This difference, notwithstanding, the primary outcome of 28-day mortality was comparable (28 percent in the DE group vs 23 percent in the control group; difference, –5.5 percent; 95 percent CI, –16.1 to 6.5).

Patients who underwent treatment de-escalation had shorter hospital (15 vs 20 days; difference, 3.2 days; 0.1–6.4) and intensive care unit (10 vs 13 days; difference, 2.2 days; –0.3 to 4.9) length of stays relative to controls.

Furthermore, significantly more patients in the control vs DE group developed AKI (36 percent vs 50 percent; difference, –13.8 percent; –26.9 to –0.4).

Current guidelines recommend nosocomial pneumonia patients with risk factors for MDR pathogens to be given a triple regimen, with dual coverage of Gram-negative pathogens and MRSA. In an unrelated article, an expert commented that treatment de-escalation in nosocomial pneumonia matters, since it reduces selection pressure, organ toxic effects and costs. [Lancet Infect Dis 2011;11:155-157]

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Most Read Articles
Pearl Toh, 03 Jan 2019
Chemotherapy was associated with an increased risk of amenorrhoea among women with lung cancer, which may place them at a higher risk for early menopause, a study suggests.
26 Dec 2018
Secondhand exposure to aerosols from electronic nicotine delivery systems (ENDS) may contribute to asthma exacerbations in young people with asthma, a study has found.
Tristan Manalac, 11 Sep 2018
The immediate reduction of cigarette nicotine content results in greater improvements in levels of smoke exposure biomarkers than gradual reduction, though withdrawal symptoms are stronger, according to a recent study.
Pearl Toh, 31 Jul 2017
Continuous positive airway pressure (CPAP), a noninvasive ventilation, may help improve respiratory rate and reduce mortality in children with respiratory distress, particularly in those younger than 1 year, a recent study showed. CPAP intervention was initiated by nurses with minimal physician supervision in the study, supporting the use of noninvasive ventilation in low-resource settings where laboratory diagnostic tests are not readily available.