Kidney Injury After Minimal Radiographic Contrast Administration in Patients With Acute Coronary Syndromes
Briguori C et al. JACC (March 2024)
Bottom line: This randomized, single-blind, investigator-driven clinical trial evaluated the effectiveness of the DyeVert CM diversion system in reducing contrast media (CM) volume and preventing acute kidney injury (AKI) in patients with acute coronary syndromes (ACS) undergoing invasive procedures. The study included 550 participants and compared the intervention group, which used the CM diversion system, to the control group, which used conventional contrast injection methods. The primary endpoint was the rate of AKI (serum creatinine increase ≥ 0.3 mg/dL within 48 hours after CM exposure). Results showed a lower CM volume (95 ± 30 mL vs 160 ± 23 mL; P < 0.001) and significant reduction in AKI in the intervention group (16%) compared to the control group (24.3%). The study concluded that the use of the CM diversion system was effective in reducing CM volume and preventing AKI in this patient population.
Stewardship Prompts to Improve Antibiotic Selection for Pneumonia (INSPIRE)
Gohil S et al. JAMA (April 2024)
Bottom Line: This cluster-randomized trial evaluated the effectiveness of a computerized provider order entry (CPOE) stewardship bundle compared to routine stewardship in reducing empiric extended-spectrum antibiotic use in non-critically ill adults hospitalized with pneumonia. The study included 96,451 patients admitted with pneumonia at 59 hospitals. The intervention group (n = 29 hospitals) received education, feedback, and real-time MDRO risk-based CPOE prompts, while the control group (n = 30 hospitals) received routine stewardship practices. The primary outcome was empiric (first 3 days of hospitalization) extended-spectrum antibiotic days of therapy and secondary outcomes included empiric vancomycin and antipseudomonal days of therapy. The study found a 28.4% reduction in empiric extended-spectrum antibiotic days of therapy in the intervention group (rate ratio, 0.72 [95% CI, 0.66-0.78]; P < .001). Safety outcomes, including days to ICU transfer and hospital length of stay, did not differ significantly between the two groups. The study concluded that CPOE prompts can effectively reduce empiric extended-spectrum antibiotic use in this patient population.
Discontinuation vs. continuation of renin-angiotensin system inhibition before non-cardiac surgery (SPACE)
Ackland G et al. European Heart Journal (April 2024)
Bottom Line: This randomized controlled trial conducted in six UK centres included 262 patients aged ≥ 60 years undergoing elective non-cardiac surgery and compared the effects of continuing or stopping renin-angiotensin system (RAS) inhibitors on peri-operative myocardial injury. The primary outcome was myocardial injury within 48 hours after surgery (plasma high-sensitivity troponin-T [hs-TnT] ≥ 15 ng/L within 48 h after surgery, or ≥ 5 ng/L increase when pre-operative hs-TnT ≥ 15 ng/L). The results showed no significant difference between the continuation and discontinuation groups (41.3% and 48.3% respectively; odds ratio [for continuing]: 0.77; 95% CI 0.45–1.31). However, there were higher rates of acute hypertension in the group that stopped RAS inhibitors (12.4% versus 5.3%; odds ratio [for continuing]: 0.4; 95% CI 0.16–1.00). The study suggests that discontinuing RAS inhibitors before surgery may not be beneficial and could potentially increase the risk of acute hypertension. Further studies are needed to confirm these findings.
