Procalcitonin can help guide antibiotic therapy in ICU patients

Procalcitonin can help guide antibiotic management, including when to discontinue therapy, in ICU patients, a new meta-analysis found.

Researchers searched MEDLINE, EMBASE, the Cochrane Controlled Trials register, and others for comparative studies and systematic reviews on using procalcitonin-guided antibiotic therapy in patients with infections. Specifically, they sought data from randomized, controlled trials that compared using procalcitonin versus clinical criteria to guide initiation, intensification or discontinuation of antibiotic therapy. Outcomes were antibiotic usage, morbidity and mortality. The results were published online August 17 by the Journal of Hospital Medicine.

Data from the 18 qualified studies were pooled into five clinically similar groups. In adult ICU patients, using procalcitonin to guide antibiotic discontinuation lowered the duration of antibiotic use by 2.05 days (95% CI, −2.59 to −1.52) without increasing morbidity or mortality. However, using procalcitonin as an indicator of need for antibiotic intensification led to greater antibiotic usage and morbidity, including longer length of stay and more days on mechanical ventilation. In adults with respiratory tract infections, guidance with procalcitonin significantly reduced antibiotic duration by 2.35 days (95% CI, −4.38 to −0.33) and antibiotic prescription rate by 22% (95% CI, −41% to −4%); it also decreased total antibiotic exposure and didn't affect morbidity or mortality.

The authors noted that, despite some differences between this and previous reviews, the conclusion is the same: Procalcitonin-guided decision making reduces use of antibiotics without changing morbidity and mortality, as compared to clinical criteria-guided decision making. However, procalcitonin shouldn't be used to guide intensification of antibiotics in adult ICU patients, they added, and there's not enough evidence to recommend procalcitonin-guided therapy in postoperative patients at risk for infection.

Megachurch epicenter of Texas measles outbreak.

USA Today (8/23, Szabo, 5.82M) reported the measles outbreak in Texas which has sickened 25 so far, has been tied to the members of Eagle Mountain International Church in Newark, Texas, after exposure to the virus from a church visitor “who had recently traveled to a country where measles remains common.” The infected “include nine children and six adults, ranging in age from 4 months old to 44 years old,” many of whom were not fully immunized, and some with no vaccination record. In a statement, Eagle Mountain pastor Terri Pearsons, “said she still has some reservations about vaccines,” and recommended “that her congregants take vitamin D to fortify their immune systems,” in addition to obtaining the measles vaccine.

        Forbes (8/24, Willingham, 5.76M) reported that the church’s leader, Kenneth Copeland, has “reportedly...warned followers away from vaccines, advocating for faith healing and pushing the debunked notion that vaccines cause autism.” Public health officials in neighboring counties and states are on alert due to the highly infectious nature of measles.

Study: Flu Shots May Help Prevent Heart Attacks

Bloomberg News (8/22, Gale) reported that research published online in Heart suggests that flu vaccines may help to prevent heart attacks, a finding that “suggests flu vaccination programs targeting the elderly should be extended to include younger adults, especially those with coronary artery disease.” Investigators found that “immunization against the respiratory illness lowered the probability of heart attack by 45 percent.”

QT Prolongation Common in Patients Taken to Hospital with Severe Hypoglycemia

MedPage Today (8/17, Fiore) reported that research published online in Diabetes Care suggests that individuals with diabetes who are “taken to the hospital for severe hypoglycemia have a high prevalence of QT prolongation.” Researchers found, “in a retrospective study at a single center in Tokyo, 50% of patients with type 1 diabetes and 59.9% of those with type 2 disease had a prolonged QT interval during hospitalization for severe hypoglycemia.”

Protein-Based Urine Test May Predict Kidney Transplant Outcomes

Low urinary levels of the protein CXCL9 could identify kidney transplant recipients with a low risk of developing kidney injury and a high probability of having stable long-term kidney function in a recent American Journal of Transplantation study. Researchers periodically collected urine samples from 280 adult and child kidney transplant recipients for 2 years after transplantation. Urinary CXCL9 levels began to increase up to 30 days before clinical signs of kidney injury, which could help doctors intervene early to potentially prevent rejection-associated kidney damage. The protein levels began to drop after treatment for rejection.

Exercise Can Safely Help Patients with Moderate CKD Become Fitter and Lose Weight

In a study of 83 patients with moderate CKD, those who participated in a structured exercise and lifestyle program for 12 months became significantly fitter—with an 11% increase in their maximal aerobic capacity compared with a 1% decrease in patients receiving usual care. Patients in the program also achieved a small but significant amount of weight loss and heart function improved. The CJASN findingssuggest that exercise can be safe in patients with kidney disease even if they have various other medical problems.

Small changes in your diet like limiting salt and fat can make a big impact on your health

http://www.kidneyfund.org/kidney-health/live-healthy/tips-for-healthy-living.html?utm_source=twitter&utm_medium=post&utm_campaign=SocialMedia&utm_term=Healthy_tips

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Tips for Healthy Living

Eat a diet low in salt and fat
Be physically active
Keep a healthy weight
Control your cholesterol
Take medicines as directed
Limit alcohol
Avoid tobacco

Eat a diet low in salt and fat

Eating healthy can help prevent or control diabetes, high blood pressure and kidney disease.  A healthy diet has a balance of fruits, vegetables, whole grains, dairy products, lean meats and beans.  Even small changes like limiting salt (sodium) and fat, can make a big difference in your health.

Limit salt

• Do not add salt to your food when cooking or eating.  Try cooking with fresh herbs, lemon juice or other spices.
• Choose fresh or frozen vegetables instead of canned vegetables.  If you do use canned vegetables, rinse them before eating or cooking with them to remove extra salt.
• Shop for items that say “reduced-sodium” or “low-sodium.”
• Avoid processed foods like frozen dinners and lunch meats.
• Limit fast food and salty snacks, like chips, pretzels and salted nuts.

Limit fat

• Choose lean meats or fish.  Remove the skin and trim the fat off your meats before you cook them.
• Bake, grill or broil your foods instead of frying them.
• Shop for fat-free and low-fat dairy products, salad dressing and mayonnaise.
• Try olive oil or canola oil instead of vegetable oil.
• Choose egg whites or egg substitute rather than whole eggs.

Choosing healthy foods is a great start, but eating too much of healthy foods can also be a problem.  The other part of a healthy diet is portion control (watching how much you eat).  To help control your portions, you might:

• Eat slowly and stop eating when you are not hungry anymore.  It takes about 20 minutes for your stomach to tell your brain that you are full.
• Check nutrition facts to learn the true serving size of a food.  For example, a 20-ounce bottle of soda is really two and a half servings.
• Do not eat directly from the bag or box.  Take out one serving and put the box or bag away.
• Avoid eating when watching TV or driving.
• Be mindful of your portions even when you do not have a measuring cup, spoon or scale.

Get more information about kidney friendly diets here.

Be physically active

Exercise can help you stay healthy.  To get the most benefit, exercise for at least 30 minutes, 5 days of the week.  If that seems like too much, start out slow and work your way up.  Look for fun activities that you enjoy.  Try walking with a friend, dancing, swimming or playing a sport.  Adding just a little more activity to your routine can help.  Exercise can also help relieve stress, another common cause of high blood pressure.

Keep a healthy weight

Keeping a healthy weight can help you manage your blood sugar, control your blood pressure, and lower your risk for kidney disease.  Being overweight puts you more at risk for diabetes and high blood pressure.  Talk to your doctor about how much you should weigh.  If you are overweight, losing just a few pounds can make a big difference.

Control your cholesterol

Having high cholesterol, especially if you have diabetes, puts you more at risk for kidney disease, heart disease and stroke.  It can also cause diabetic kidney disease to get worse faster.

For most people, normal cholesterol levels are:

• Total Cholesterol: Less than 200
• HDL (“good” cholesterol): More than 40
• LDL (“bad” cholesterol): Less than 100

Your triglycerides are also important.  People with high triglycerides are more at risk for kidney disease, heart disease and stroke.  For most people, a healthy triglyceride level is less than 150.

If your total cholesterol, LDL or triglycerides are high, or if your HDL is low, talk to your doctor.  Your doctor may suggest exercise, diet changes or medicines to help you get to a healthy cholesterol level.

Take medicines as directed

To help protect your kidneys, take medicines as directed. 

Some medicines may help you manage conditions that can damage your kidneys, like diabetes or high blood pressure. Ask your doctor how to take any medicines he or she prescribes.  Make sure to take the medicines just how your doctor tells you.  This may mean taking some medicines, like blood pressure medicines, even when you feel fine.
  
Other medicines can harm your kidneys if you take them too much.  For example, even over-the-counter pain medicines can damage your kidneys over time.  Follow the label directions for any medicines you take.  Share with your doctor a list of all of your medicines (even over-the-counter medicines and vitamins) to help make sure that you are not taking anything that may harm your kidneys.

Limit alcohol

Drinking alcohol in large amounts can cause your blood pressure to rise.  Limiting how much alcohol you drink can help you keep a healthy blood pressure.  Have no more than two drinks per day if you’re a man and no more than one drink per day if you’re a woman.

Avoid tobacco

Using tobacco (smoking or chewing) puts you more at risk for high blood pressure, kidney disease and many other health problems.  If you already have kidney disease, using tobacco can make it get worse faster.

If you use tobacco, quitting can help lower your chances of getting kidney disease or help slow the disease down if you already have it.