The efficacy of fidaxomicin in the treatment of Clostridium difficile infection in a real-world clinical setting: a Spanish multi-centre retrospective cohort.

The objective of this study was to evaluate the efficacy and safety of fidaxomicin in the real-life clinical setting. This was a retrospective cohort of patients with Clostridium difficile infection (CDI) treated with fidaxomicin in 20 Spanish hospitals between July 2013 and July 2014. Clinical cure, 30-day recurrence, 30-day mortality, sustained cure, and factors associated with the failure to achieve sustained cure were analyzed. Of the 72 patients in the cohort 41 (56.9 %) had a fatal underlying disease. There were 44 (61.1 %) recurrent episodes and 26 cases (36.1 %) with a history of multiple recurrences. Most episodes were severe (26, 36 %) or severe-complicated (14, 19.4 %). Clinical cure rate was 90.3 %, recurrence rate was 16.7 % and three patients (4.2 %) died during the follow-up period. Sustained cure was achieved in 52 cases (72.2 %). Adverse events were reported in five cases (6.9 %). Factors associated with the lack of sustained cure were cardiovascular comorbidity (OR 11.4; 95 %CI 1.9-67.8), acute kidney failure (OR 7.4; 95 %CI 1.3-43.1), concomitant systemic antibiotic treatment (OR 6.2; 95 %CI 1.1-36.8), and C-reactive protein value at diagnosis (OR 1.2 for each 1 mg/dl increase; 95 %CI 1.03-1.3). Fidaxomicin is an effective and well tolerable treatment for severe CDI and for cases with elevated recurrence risk.

[Noninvasive ventilation]. / Ventilación mecánica no invasiva.

Endotracheal intubation and mechanical ventilation have traditionally been employed in patients with acute respiratory insufficiency. However, this form of management can have serious adverse effects, mainly infections and barotrauma. Noninvasive ventilation (NIV) has been shown to be an effective alternative, as it reduces both the frequency of complications and cost of care. In fact, NIV is currently the first choice treatment for acute respiratory insufficiency in patients who have chronic obstructive pulmonary disease or who are immunocompromised. It is also commonly applied in patients with asthma, pneumonia, and acute cardiogenic pulmonary edema. Correct indication and training in use of NIV equipment is necessary to ensure success and facilitate patient tolerance.

[AIDS and anesthesia]. / SIDA y anestesia.

AIDS concerns anaesthetic practice for various reasons. First, this syndrome can affect different organs that have anaesthetic implications. Second, drugs usually taken by the patient can interact with anaesthetic agents. And last, the risk of infection for health workers must be taken into account, as well as the procedure to follow after accidental injures.