In this large cohort of 40,744 patients hospitalized with pneumonia, 9% were diagnosed with a pulmonary cancer after a mean time of 297 days. Risk factors for subsequent cancer diagnosis included white race, prior cancer, and smoking. Close follow up after pneumonia in patients with these risk factors should be ensured (abstract)

In this large retrospective multi-institutional analysis of 5715 patients with septic shock, initial receipt of appropriate antibiotics (based on subsequent cultures) had an odds ratio of survival to hospital discharge of 9.5 (CI 7.7-11.5). This study reinforces the need for obtaining adequate specimen cultures and starting broad spectrum antibiotics in patients with sepsis (abstract)

Telavancin has been FDA approved for treatment of complicated skin/soft tissue infections due to multi-drug resistant gram positive organisms. It is an IV lipoglycopeptide with Qday dosing and no need for drug level monitoring. It was proven non-inferior to vancomycin in two phase 3 trials (abstract)

In this large retrospective cohort of patients admitted to the hospital with CAP, researchers evaluated the IDSA/ATS 2007 guideline prediction of “severe CAP” and need for ICU admission, compared to other prediction models (SMART-COP, CURXO-80, CURB-65). The 2007 guidelines had the best predictive ability of need for ICU care. Using 4 of the 9 minor criteria (as opposed to 3 as recommended by the guideline) increased the PPV from 54% to 81%, without much change to the NPV (94% to 92%). The IDSA/ATS 2007 guideline definition of severe CAP accurately predicts a patients need for ICU care, better than other existing risk scores (abstract)

The FDA has issued a warning on the use of vytorin (simvastatin/ezetimibe) given the results of a recent randomized trial which showed vytorin was associated with a higher risk of cancer/cancer-related deaths compared to placebo. The FDA is not advising prescribers to stop using the medication at all, but to consider the benefits and risks compared to other lipid-lowering medications (FDA site)

In this trial of 310 patients aged 55-70, they were randomized to bioprosthetic or mechanical aortic valve replacement. There were no significant differences between the groups in peri-operative or long-term mortality, thromboembolism, bleeding, endocarditis, or major adverse prosthetic related events. The bioprosthetic group had higher rates of valve failure/re-operations (2.3% vs 0.6% per patient year), but the mechanical group had non-significantly higher rates of bleeding. The type of aortic valve choice depends on which risk is more tolerable: re-operation or bleeding (abstract)

In this trial of 93 patients with nosocomial MRSA pneumonia, they were randomized to IV vancomyin +/- rifampin. The combined therapy group had higher rates of 14 day clinical cure (54% vs 31%) but no difference in mortality. Adding rifampin to vancomycin may improve clinical cure rates in patients with MRSA pneumonia (abstract)

In this prospective observational cohort from a large database (National Registry of CPR), researchers determined the etiology and outcome of 51,919 patients with in-hospital pulseless cardiac arrest from 41 hospitals. They found Vfib (17%) and Vtach (9%) each had a 37% survival to discharge, but the more common rhythms, asystole (39%) and PEA (37%) only had survival rates of 11% and 12%. These statistics can help counsel patients regarding resuscitation outcomes (abstract)

A new risk calculator helps predict a patient’s 90 day risk of recurrent ischemic stroke. The calculator (available on line) is based on a patients clinical and radiologic findings at the time of the stroke, and can help predict which patients needs close follow up and aggressive secondary prevention measures (abstract).

The CDC has identified 21 cases of levamisole-tainted cocaine, which have resulted in agranulocytosis. Levamisole is an anti-helminthic drug that is known to cause agranulocytosis. It in unknown how or why the cocaine was tainted with the drug. In patients with new unexplained agranulocytosis and cocaine use, state or local health department should be contacted for levamisole testing (MMWR report)