CDC Releases Data on Deaths from Poisoning

Poisoning from prescription or illicit drugs is one of the leading causes of death from unintentional injury in the United States. The Centers for Disease Control and Prevention (CDC) analyzed data from 1999 to 2004 and found that the annual deaths from poisoning had increased 62.5 percent (age-adjusted rate), from 12,186 deaths in 1999 to 20,950 deaths in 2004.

The number of women who died from poisoning increased by 103 percent; this increase was twice that seen in men. Poisoning deaths increased 75.8 percent among white persons, 113.6 percent in those living in the South, and 13.3 percent in persons 15 to 24 years of age. Persons 35 to 54 years of age accounted for 59.6 percent of poisoning deaths in 2004.

These data suggest that additional educational measures are needed and that regulatory measures should be more aggressive. The CDC notes that the trends in this report are related primarily to overdoses of prescription opioid analgesics and secondarily to cocaine and prescription sedative overdoses; they do not appear, however, to be related to heroin, methamphetamine, or other illicit drug use.

CDC Reports on MRSA Infections Among Patients on Dialysis

Staphylococcus aureus, a leading cause of bloodstream infections in the United States, has become increasingly resistant to first-line antimicrobial agents. Patients on dialysis are particularly susceptible to methicillin-resistant S. aureus (MRSA) infection.

Compared with the general population, in which MRSA infections occur in only 0.2 to 0.4 per 1,000 persons, patients on dialysis are at high risk of MRSA infection. The Centers for Disease Control and Prevention (CDC) estimates that invasive MRSA infections occurred in 45 out of 1,000 patients on dialysis in 2005; these results indicate a 100-fold higher risk of MRSA infection in these patients.

Patients on dialysis who are older than 50 years are at especially increased risk of infection. The CDC also found that men and blacks on dialysis are at increased risk; of the total number of patients on dialysis who had been infected with MRSA, 57 percent were men, and 56 percent were black.

Those patients on dialysis who have invasive devices or a catheter also are at increased risk; according to the CDC, in the event of infection, 90 percent of those patients required hospitalization, and the in-hospital mortality rate for MRSA was 17 percent. Although the risk of infection in patients with a catheter is high, the risk is intermediate for grafts and low for arteriovenous fistulas.

Physicians should use antimicrobials judiciously to reduce pathogens only after following published guidelines. This is particularly true of vancomycin, because cases of S. aureus resistance to this drug have been reported.

AHA Releases Statement on the Use of COX-2 Inhibitors and NSAIDs

Physicians should consider the increased risks associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), including cerebrovascular and cardiovascular events, according to new guidelines issued by the American Heart Association (AHA). Warning labels have been ordered and advisories on the increased risks of these events in patients who take NSAIDs have been issued to patients and physicians by several regulatory agencies.

Evidence further suggests that myocardial infarction, heart failure, hypertension, and stroke can occur at increased rates in patients who take cyclooxygenase-2 (COX-2) inhibitors. Persons with a history of cardiovascular disease and those at increased risk are more likely to experience these adverse effects.

For patients at increased risk of cardiovascular and cerebrovascular events, COX-2 inhibitors should be prescribed only if no alternative pain relief medications exist. If prescribed to patients at increased risk, COX-2 inhibitors should be given only at the lowest dosage and for the shortest duration necessary. The use of any COX inhibitor, including NSAIDs, for long periods should be considered only in consultation with a physician.