Update in Hospital Medicine
Facing a packed house in the main auditorium, Kevin O’Leary, MD, of Northwestern University’s Feinberg School of Medicine in Chicago and Efren Manjarrez, MD, from the University of Miami’s Miller School of Medicine synthesized dozens of research articles that are clinically relevant to hospitalists everywhere. “We looked for articles that would change or modify your current practice,” Dr. O’Leary said.
Complicated Pneumonia and Acute Hematogenous Osteomyelitis: New Insights into Diagnosis and Management
The etiologic agents for complicated pneumonias and osteomyelitis have changed recently, according to Vanderbilt University School of Medicine’s Derek Williams, MD, MPH, and C. Buddy Creech, MD, MPH, who assisted pediatric hospitalists in updated diagnosis and intervention strategies.
The increase in complicated pneumonias and empyemas is mostly due to the increase in Streptococcus pneumoniae serotype 19a. After introduction of the PCV-7 vaccine, incidence of serotype 19a infections increased to 98% of infections. Serotype 19a is now included in the PCV-13 vaccine, approved by the FDA in 2011. There are multiple interventions available for empyemas, including chest tube alone, chest tube with fibrinolysis, and VATS. Current research is being done to assess efficacy for these measures.
Osteomyelitis might be caused by direct inoculation, spread from local infection, or hematogenous spread. S. aureus is a causative agent in 80% to 90% of patients. MRSA infection has a more complicated course. Based on patient response and inflammatory markers, a short course of intravenous antibiotics followed by oral antibiotics might be appropriate.