RESUMO
ABSTRACT A retrospective cohort study, were evaluated: polymyxin B plus aminoglycosides or polymyxin B plus other antibiotics. Any degree of acute kidney injury occurred in 26 (86.6%) patients. The median time to acute kidney injury was 6.0 (95% CI 3-14) days in the polymyxin-aminoglycoside containing regimen group, against 27.0 (95% CI 6-42) days in the polymyxin with other antimicrobial combinations group (p = 0.03). Polymyxin B with aminoglycosides group progressed faster to any degree of renal dysfunction.
Assuntos
Humanos , Masculino , Feminino , Polimixina B/uso terapêutico , Infecções por Enterobacteriaceae/tratamento farmacológico , Rim/efeitos dos fármacos , Mediastinite/microbiologia , Mediastinite/tratamento farmacológico , Antibacterianos/uso terapêutico , Testes de Sensibilidade Microbiana , Carbapenêmicos/farmacologia , Estudos Retrospectivos , Resultado do Tratamento , Estatísticas não Paramétricas , Medição de Risco , Resistência beta-Lactâmica/efeitos dos fármacos , Infecções por Enterobacteriaceae/mortalidade , Estimativa de Kaplan-Meier , Injúria Renal Aguda/induzido quimicamente , Aminoglicosídeos/uso terapêutico , Mediastinite/mortalidadeRESUMO
A retrospective cohort study, were evaluated: polymyxin B plus aminoglycosides or polymyxin B plus other antibiotics. Any degree of acute kidney injury occurred in 26 (86.6%) patients. The median time to acute kidney injury was 6.0 (95% CI 3-14) days in the polymyxin-aminoglycoside containing regimen group, against 27.0 (95% CI 6-42) days in the polymyxin with other antimicrobial combinations group (p=0.03). Polymyxin B with aminoglycosides group progressed faster to any degree of renal dysfunction.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Enterobacteriaceae/tratamento farmacológico , Rim/efeitos dos fármacos , Mediastinite/tratamento farmacológico , Mediastinite/microbiologia , Polimixina B/uso terapêutico , Injúria Renal Aguda/induzido quimicamente , Aminoglicosídeos/uso terapêutico , Carbapenêmicos/farmacologia , Infecções por Enterobacteriaceae/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Mediastinite/mortalidade , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Resultado do Tratamento , Resistência beta-Lactâmica/efeitos dos fármacosRESUMO
This study aimed to evaluate our 30-year experience in the treatment of deep sternal wound infection after cardiac surgery. Between 1979 and 2009, deep sternal wound infections occurred in 200 of 22,366 (0.89%) patients who underwent sternotomy. The study population was divided into 3 groups. In group A (62 patients; 1979-1994), an initial attempt at conservative antibiotic therapy was the rule, followed by surgery in case of failure. In group B (83 patients; 1995-2002), the treatment was in 3 steps: wound debridement and closed irrigation for 10 days; in case of failure, open dressing with sugar and hyperbaric treatment; delayed healing and negative wound cultures mandated plastic reconstruction. In group C (2002-2009), the treatment was based on early surgical debridement, vacuum application, and reconstruction using pectoralis muscle flap. Hospital mortality in group A was significantly higher than that in groups B and C. Hospital stay, time for normalization of white blood cell count and C reactive protein, and time for defervescence were significantly shorter in group C. In our experience, early surgical debridement and vacuum application followed by plastic reconstruction provided a satisfactory rate of healing and a good survival rate.