Antiseptic urinary catheterization and maintenance of the bladder catheter. / Antisepsia en el sondaje urinario y en el mantenimiento de la sonda vesical.

Catheter-related urinary tract infections are very common both in the community and in the acute hospital care setting, particularly in the critical care environment. In order to minimize this problem, it is essential to adopt a correct approach from insertion to withdrawal of the urinary catheter, and always perform proper antisepsis. There is too much information on antisepsis measures with no consistent results. The present article reviews the existing scientific evidence on the subject and establishes recommendations based on the evidence, in order to optimize outcomes. The entire process is complemented with considerations on how to secure proper management of the indwelling urinary catheter. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.

[New therapeutic options for the treatment of multiresistant bacteria in the ICU]. / Nuevas opciones terapéuticas para el tratamiento de las bacterias multirresistentes en Unidades de Cuidados Intensivos.

The number of new antimicrobial drugs in the health care clinical practice has decreased gradually and significantly in the last 15 years. At the same time, there has been an increase in the appearance of microorganisms with resistance to conventional antibiotics, above all in intensive care units (ICU). Within this group, Methicillin-resistant Staphylococcus aureus (MSRA) and methicillin-resistant coagulase- negative staphylococci, vancomycin-resistant enterococci, Pseudomonas aeruginosa and Acinetobacter baumanii resistant to carbapenemics and extended-spectrum betalactamase-producing (ESBL) Enterobacteria are the most important. These pathogens are frequently also resistant to other groups of antibiotics such as aminoglycosides, fluoroquinolones and macrolides. New recently introduced antimicrobial agents are available to combat these resistances. These are active mainly against gram positive bacteria resistant strains and in a more timely way against gram negative ones or both. Among the first group, the following stand out: daptomycin (a lipopeptide bactericide for parenteral use) and linezolid (oxazolidinone with bacteriostatic activity for parenteral and oral use). On its part, ertapenem (a carbapenem parenteral bactericide) and tigecyclin (a parenteral bacteriostatic tetracycline) are active against ESBL enterobacteria, the latter also being active against non-fermented gram positives and gram negatives, except for P. aeruginosa. Possibly, the introduction of these new compounds and other futures ones pending introduction will not only improve antimicrobial diversification but also serve to limit the spreading of these microorganisms.