RESUMEN
Dosing cefepime for renal function does not completely prevent neurotoxicity in a kidney transplant patient. Cefepime neurotoxicity has been reported primarily among patients with renal insufficiency who received standard doses of the antibiotic. We report a case of nonconvulsive status epilepticus from dose-adjusted cefepime in a kidney transplant patient. The timing of symptoms along with clinical and electroencephalographic improvement after discontinuation of cefepime was critical to the diagnosis. Whether we should adjust the dose of cefepime differently in a patient with transplanted kidney to prevent neurotoxicity is unknown.
Asunto(s)
Antibacterianos/efectos adversos , Cefepima/efectos adversos , Trasplante de Riñón , Síndromes de Neurotoxicidad/etiología , Estado Epiléptico/inducido químicamente , Antibacterianos/administración & dosificación , Cefepima/administración & dosificación , Electroencefalografía , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/tratamiento farmacológico , Pielonefritis/tratamiento farmacológicoRESUMEN
BACKGROUND: The optimal incubation period for synovial fluid cultures is unknown. OBJECTIVES: Our study was designed to determine the positivity rate and time to positivity of synovial fluid cultures from adults with suspected acute bacterial arthritis. METHODS: We reviewed the charts of 94 adults who had acute monoarthritis. Patients were classified as low risk or high risk for acute bacterial arthritis. The positivity rate and time to positivity of synovial fluid in combined agar plate and broth culture were calculated. RESULTS: The overall positivity rate was 22.3% (21 of 94). None of the 21 low-risk patients had a positive culture. Twenty-one (28.7%) of 73 high-risk subjects showed growth, with a mean time to positivity of 36.7 ± 27.1 hours. While half of these turned positive within a day of incubation, growth was detected at up to 90 hours. CONCLUSIONS: In patients with acute monoarthritis, especially those at high risk for infection, it is reasonable to incubate cultures for 4 days before considering them to be negative.
Asunto(s)
Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Líquido Sinovial/microbiología , Enfermedad Aguda , Adulto , Enterococcus faecalis/aislamiento & purificación , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Staphylococcus aureus/aislamiento & purificación , Factores de TiempoRESUMEN
Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency are not represented in clinical trials for heart failure. Moreover, many of the recommended medications can cause haemolysis in this group of patients. We present the case of a 71-year-old woman with G6PD deficiency admitted for acute non-ischemic heart failure with reduced ejection fraction. Our experience showed that a combination of ethacrynic acid and spironolactone is safe and effective for relief of volume overload in this group of patients. Studies are needed to determine whether the morbidity and mortality benefits of established heart failure regimens extend to patients with G6PD deficiency.
