With Special Guests Dr. Catie Glatz & Dr. Joseph S. Thomas
In this special episode of Inpatient Update, Dr. Mason Turner is joined by Dr. Catie Glatz and Dr. Joseph S. Thomas of the Journal of Hospital Medicine Digital Media Team to dig into three practice-changing articles featured in #JHMWrapped 2025— JHM’s annual roundup of some of the year’s most impactful hospital medicine literature:
- Gram-negative bacteremia — if Cipro and Bactrim aren’t options, does your patient really need continued IV antibiotics?
- Hypercapnia — do you actually need an ABG?
- Steroid leukocytosis — how much of that rising white count can you really blame on steroids?
Three common hospitalist reflexes—and evidence that may change what you do on rounds tomorrow.
Articles
Transition to Oral Beta-Lactam Therapy in Uncomplicated Gram-Negative Bacteremia
Journal of Hospital Medicine, 2025
Systematic review and meta-analysis of 8 studies and 7,500 patients comparing oral beta-lactams with fluoroquinolones or TMP-SMX.
Key Findings
- No significant difference in 30-day mortality
- No significant difference in antibiotic failure
- Oral beta-lactams offer another option for appropriately selected patients
Takeaway
Cipro or Bactrim resistance does not automatically mean a PICC line.
For uncomplicated gram-negative bacteremia with source control and clinical improvement, an appropriately dosed oral beta-lactam such as amoxicillin or cephalexin may be a reasonable step-down option.
Things We Do for No Reason™: Arterial Blood Gas Testing to Screen for Hypercarbic Respiratory Failure
Journal of Hospital Medicine, 2025
Across multiple prospective studies, a venous PCO₂ <45 mmHg reliably ruled out arterial hypercarbia.
Using VBGs as the initial screening test can:
- Avoid painful arterial sticks
- Reduce delays in care
- Reduce unnecessary ABGs
Takeaway
Worried about hypercapnia?
Start with a VBG.
If the venous PCO₂ is <45, significant hypercarbia is effectively ruled out. If elevated and greater precision would change management, then consider the ABG.
Elevation in White Blood Cell Count After Corticosteroid Use in Noninfected Hospitalized Patients
Journal of Hospital Medicine, 2025
Large cohort study of more than 28,000 hospitalized patients examining the expected leukocytosis after steroids.
Key Findings
- WBC rise was dose-dependent
- The effect peaked around 48 hours
- Mean increases ranged from approximately:
- 0.3 with low-dose steroids
- 1.7 with medium-dose steroids
- 4.8 with high-dose steroids
Takeaway
Steroids raise the white count—but often less than we casually assume.
A substantial or unexpectedly early rise should not automatically be dismissed as “just the steroids.” Consider the dose, timing, magnitude, and the clinical picture.
Practice-Changing Takeaways
- Gram-negative bacteremia: Oral beta-lactams may help appropriate patients avoid prolonged IV therapy.
- Hypercapnia: Screen with a VBG before reaching for an ABG.
- Steroids: Don’t blame every rising white count on demargination.
Question the reflex. Check the evidence. Treat the patient.
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