Most Read Articles
Roshini Claire Anthony, 5 days ago

Patients with mild hypertension who are at low risk for cardiovascular disease (CVD) do not appear to derive mortality or CVD benefit from antihypertensive treatments, raising questions on the need for treatment in this population, according to a recent study from England.

Pearl Toh, 09 Nov 2018
A personalized computerized neurofeedback intervention for training attention and memory shows potential in cognitive training for healthy elderly men, who improved in cognitive performance after the training, although no significant improvements were seen in the overall study population.
3 days ago
Type 1 diabetes impairs cognitive functioning in children, and this effect is exacerbated by extreme glycaemic levels, according to a recent meta-analysis.
Pearl Toh, 08 Nov 2018
The pneumonia-causing bacteria, Streptococcus pneumoniae (pneumococcus), can be spread through nose picking and rubbing after exposure of the hands to the bacteria — in addition to the conventionally known route of inhalation of airborne droplets, a study reveals.

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
Roshini Claire Anthony, 5 days ago

Patients with mild hypertension who are at low risk for cardiovascular disease (CVD) do not appear to derive mortality or CVD benefit from antihypertensive treatments, raising questions on the need for treatment in this population, according to a recent study from England.

Pearl Toh, 09 Nov 2018
A personalized computerized neurofeedback intervention for training attention and memory shows potential in cognitive training for healthy elderly men, who improved in cognitive performance after the training, although no significant improvements were seen in the overall study population.
3 days ago
Type 1 diabetes impairs cognitive functioning in children, and this effect is exacerbated by extreme glycaemic levels, according to a recent meta-analysis.
Pearl Toh, 08 Nov 2018
The pneumonia-causing bacteria, Streptococcus pneumoniae (pneumococcus), can be spread through nose picking and rubbing after exposure of the hands to the bacteria — in addition to the conventionally known route of inhalation of airborne droplets, a study reveals.