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How Many Personnel Are Required for Antimicrobial Stewardship? More Than You Have at Your Hospital

A work group in the Veterans Administration determined that the necessary staffing of antimicrobial stewardship programs dealing with inpatients (including long-term care) is 1.0 clinical pharmacy specialist with infectious disease knowledge and 0.25 physician (preferably trained in infectious disease) per 100 occupied beds. Needs for outpatient stewardship, which is now mandated, were not included in the assessment.

Treatment of Pulmonary Mycobacterium avium Infection: Failure Is Common

Current treatment regimens for pulmonary Mycobacterium avium infection leave a great deal to be desired.

Immunohistochemistry and Diagnosis of Viral Diseases

Researchers reviewed five years of cases at an academic medical center’s pathology department for the use of immunohistochemistry to detect CMV, HSV-1, HSV-2, varicella zoster virus, adenovirus, or polyomavirus. Of 957 cases, 134 were positive. Viral cytopathic effect (CPE) was present on hematoxylin and eosin staining in 75% of the IHC+ cases. No changes in clinical care occurred in any of the IHC+ cases in which viral CPE was absent.

Mice, Mutations, and Microcephaly: The Evolving Pathogenesis of Congenital Zika Syndrome

Approximately five years ago, a single gene mutation altered Zika virus, making it able to target neuronal progenitor cells and cause what we now know as congenital Zika syndrome with microcephaly and ocular abnormalities.

Angiotensin II Raises Blood Pressure in Patients with Vasodilatory Shock

The ATHOS-3 trial represents an important proof of concept trial regarding angiotensin II as a new vasopressor in the armamentarium to treat vasodilatory shock.

Antibiotics and Adverse Events: Doctors, Do No Harm

A retrospective study found that among 1,488 hospitalized patients who received an antibiotic, 298 (20%) experienced at least one antibiotic-associated adverse drug event. Furthermore, 287 (19%) of the antibiotic regimens were not clinically indicated, and 56 (20%) of these were associated with an adverse drug event.

Natriuretic Peptide-guided Therapy Does Not Improve Systolic Heart Failure Outcomes

A recent meta-analysis of 11 trials showed a significant reduction in all-cause mortality with natriuretic peptide-guided therapy, although the individual trial results varied substantially.

Is a Dabigatran Reversal Agent Effective?

Dabigatran is an attractive oral anticoagulant for patients who demonstrate indications for oral anticoagulation but are at high risk of bleeding.

In-hospital vs. Telephone Availability of an Intensivist at Night

When overnight shifts were staffed by nighttime intensivists rather than residents with attending intensivists on call remotely, most nurses perceived improvements in clinical care, procedures, efficiency, communication, and job place comfort.

Is There Still a Role for High-frequency Oscillatory Ventilation in ARDS?

In this patient-level meta-analysis of four well-known randomized, controlled trials of high-frequency oscillatory ventilation (HFOV) in acute respiratory distress syndrome (ARDS), the authors found that HFOV increases mortality for most patients with ARDS but may improve survival among patients specifically with severe ARDS.