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Update in Hospital Medicine
1999-2000 Series: Update Sessions from ACP-ASIM's 1999 Annual Session
Margaret Ring Gillock, Editor, and David Cramer, MD, Co-Editor
The boundaries of hospital medicine are not defined by specific organs and their associated diseases but rather by the severity of the patient's condition, the subsequent risk for morbidity and death, and the intensity and monitoring of treatment necessary to provide care. Four content areas relevant to the care of hospitalized patients are the focus of this Update: nosocomial illness, community-acquired pneumonia, venous thromboembolic disease, and prognostic variables.
Nosocomial Illness
Physicians take an oath to do no harm, but the hospital environment itself carries its own risk. This disparity is addressed in the following section through a discussion of antibiotic resistance, stress ulceration and upper gastrointestinal bleeding, hospital-acquired pressure ulcers, and adverse drug reactions.
Vancomycin Resistance Has a Negative Effect on Survival and Leads to Higher Health Care Costs
Stosor V, Peterson LR, Postelnick M, et al. Enterococcus faecium bacteremia: does vancomycin resistance make a difference? Arch Intern Med. 1998; 158:522-7.
Stosor and colleagues retrospectively analyzed the clinical features and outcomes of 53 patients with Enterococcus faecium bacteremia to better understand the epidemiologic characteristics of vancomycin-resistant enterococcus (VRE) bacteremia and to determine the clinical effect of vancomycin resistance on the outcome of patients with this infection. In the records reviewed, there were 32 episodes of vancomycin-susceptible enterococcus (VSE) bacteremia and 21 episodes of VRE bacteremia. All cases of VRE bacteremia were nosocomially acquired. Previous administration of vancomycin was associated with VRE bacteremia (16 [80%] cases of VRE compared with 10 [34%] cases of VSE; P < 0.002), as were indwelling bladder catheters (13 [62%] cases of VRE compared with 9 [28%] cases of VSE; P = 0.01). Survival rates for patients with VSE and VRE bacteremia were 59% and 24%, respectively (P = 0.009), despite similar severity-of-illness scores. Patients infected with VRE had longer hospitalizations and were more likely to be on …
