RESUMEN
OBJECTIVE: To evaluate nephrotoxicity development in patients treated with vancomycin (VAN) and daptomycin (DAP) for proven severe Gram-positive infections in daily practice. METHODS: A practice-based, observational, retrospective study (eight Spanish hospitals) was performed including patients ≥18 years with a baseline glomerular filtration rate (GFR)>30 mL/min and/or serum creatinine level<2 mg/dL treated with DAP or VAN for >48h. Nephrotoxicity was considered as a decrease in baseline GRF to <50 mL/min or decrease of >10 mL/min from a baseline GRF<50 mL/min. Multivariate analyses were performed to determine factors associated with 1) treatment selection, 2) nephrotoxicity development, and 3) nephrotoxicity development within each antibiotic group. RESULTS: A total of 133 patients (62 treated with DAP, 71 with VAN) were included. Twenty-one (15.8%) developed nephrotoxicity: 4/62 (6.3%) patients with DAP and 17/71 (23.3%) with VAN (p=0.006). No differences in concomitant administration of aminoglycosides or other potential nephrotoxic drugs were found between groups. Factors associated with DAP treatment were diabetes mellitus with organ lesion (OR=7.81, 95%CI:1.39-4.35) and basal creatinine ≥0.9 mg/dL (OR=2.53, 95%CI:1.15-4.35). Factors associated with VAN treatment were stroke (OR=7.22, 95%CI:1.50-34.67), acute myocardial infarction (OR=6.59, 95%CI:1.51-28.69) and primary bacteremia (OR=5.18, 95%CI:1.03-25.99). Factors associated with nephrotoxicity (R2=0.142; p=0.001) were creatinine clearance<80 mL/min (OR=9.22, 95%CI:1.98-30.93) and VAN treatment (OR=6.07, 95%CI:1.86-19.93). Factors associated with nephrotoxicity within patients treated with VAN (R2=0.232; p=0.018) were congestive heart failure (OR=4.35, 95%CI:1.23-15.37), endocarditis (OR=7.63, 95%CI:1.02-57.31) and basal creatinine clearance<80 mL/min (OR=7.73, 95%CI:1.20-49.71). CONCLUSIONS: Nephrotoxicity with VAN was significantly higher than with DAP despite poorer basal renal status in the DAP group.
Asunto(s)
Antibacterianos/efectos adversos , Daptomicina/efectos adversos , Infecciones por Bacterias Grampositivas/complicaciones , Enfermedades Renales/inducido químicamente , Enfermedades Renales/epidemiología , Vancomicina/efectos adversos , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Creatinina/sangre , Daptomicina/uso terapéutico , Femenino , Tasa de Filtración Glomerular , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Vancomicina/uso terapéuticoAsunto(s)
Bradicardia/inducido químicamente , Octreótido/efectos adversos , Anciano , Atropina/uso terapéutico , Bradicardia/tratamiento farmacológico , Bloqueo de Rama/complicaciones , Fármacos Cardiovasculares/uso terapéutico , Comorbilidad , Electrocardiografía , Epinefrina/uso terapéutico , Humanos , Inyecciones Subcutáneas , Masculino , Octreótido/administración & dosificación , Octreótido/farmacología , Neoplasias Pancreáticas/diagnóstico por imagen , CintigrafíaRESUMEN
OBJECTIVE: We analyze the most suitable time to perform tracheostomy in neurocritically ill patients. We compare morbimortality and use of resources between those patients in which tracheostomy was done early (Asunto(s)
Enfermedad Crítica
, Recursos en Salud/estadística & datos numéricos
, Enfermedades del Sistema Nervioso
, Neumonía Asociada al Ventilador/etiología
, Neumonía Asociada al Ventilador/mortalidad
, Traqueostomía/efectos adversos
, Traqueostomía/estadística & datos numéricos
, Adulto
, Anciano
, Lesiones Encefálicas/patología
, Lesiones Encefálicas/fisiopatología
, Lesiones Encefálicas/cirugía
, Femenino
, Mortalidad Hospitalaria
, Humanos
, Unidades de Cuidados Intensivos
, Tiempo de Internación
, Masculino
, Persona de Mediana Edad
, Análisis Multivariante
, Enfermedades del Sistema Nervioso/complicaciones
, Enfermedades del Sistema Nervioso/fisiopatología
, Enfermedades del Sistema Nervioso/cirugía
, Estudios Prospectivos
, Factores de Tiempo
, Resultado del Tratamiento