Importancia de la hemodiafiltración precoz en el tratamiento de la acidosis láctica asociada a la administración de metformina / The importance of early haemodiafiltration in the treatment of lactic acidosis associated with the administration of metformin

La metformina es un fármaco muy utilizado en pacientes con diabetes tipo 2. La acidosis láctica asociada a metformina (ALAM) en pacientes diabéticos es poco frecuente, pero puede llegar a ser grave. De todas formas, la relación entre metformina y acidosis láctica ha sido muy controvertida. Presentamos siete casos de pacientes con ALAM que llegaron a nuestro centro en un período de un año y que fueron tratados de forma precoz con hemofiltración. Existen algunos factores de riesgo que parecen predisponer a esa patología, como fracaso renal agudo, situaciones de hipoxemia y sepsis, insuficiencia cardíaca o respiratoria, historia previa de acidosis láctica, hepatopatía y en cuadros de deshidratación. Es por ello por lo que se desaconseja su utilización en pacientes con filtrado glomerular inferior a 30 ml/min/1,73 m2. Todos los pacientes que presentamos fueron tratados de forma precoz con hemofiltración. La mortalidad de nuestra serie fue del 16,6%. Consideramos que la ALAM es una enfermedad grave que requiere un diagnóstico y un tratamiento precoces. El tratamiento renal sustitutivo no es la solución para todos los pacientes, pero puede mejorar el pronóstico en aquellos que están más graves si se inicia de forma precoz. Creemos importante limitar el uso de la metformina en los pacientes diabéticos con función renal alterada, a pesar de que todavía existe controversia en los distintos estudios publicados (AU)

Metformin is a drug widely used in type 2 diabetic patients. The metformin-associated lactic acidosis (MALA) in diabetic patients is rare but can be serious. However, the relationship between metformin and lactic acidosis has been controversial. We present seven cases of patients with ALAM who came to our centre over a period of one year and who were treated early with haemodiafiltration. There are some risk factors that appear to predispose to this pathology, such as: acute renal failure, hypoxemia and sepsis situations, cardiac or respiratory failure, previous history of lactic acidosis, liver disease and dehydration boxes. That is why their use is discouraged in patients with GFR below 30ml/min/1.73m2. All patients described were treated early with haemodiafiltration. The mortality in our series was 16.6%. We believe that ALAM is a serious condition that requires prompt diagnosis and early treatment. Renal replacement therapy is not the solution for all patients, but can improve prognosis in more severe if started early. We should limit the use of metformin in diabetic patients with impaired renal function, although there is still controversy in the various published studies (AU)

The importance of early haemodiafiltration in the treatment of lactic acidosis associated with the administration of metformin.

Metformin is a drug widely used in type 2 diabetic patients. Metformin-associated lactic acidosis (MALA) in diabetic patients is rare but can be serious. However, the relationship between metformin and lactic acidosis is under debate. We present seven cases of patients with MALA who came to our centre over a period of one year and who were treated early with haemodiafiltration. There are some risk factors that appear to predispose patients to this pathology, such as: acute renal failure, situations of hypoxemia and sepsis, cardiac or respiratory failure, previous history of lactic acidosis, liver disease and dehydration. As such, the use of metformin is discouraged in patients with GFR below 30 ml/min/1.73 m(2). All patients in our study were treated early with haemodiafiltration. The mortality in our study was 16.6%. We believe that MALA is a serious condition that requires prompt diagnosis and early treatment. Renal replacement therapy is not the solution for all patients, but can improve prognosis in more severe cases if started early. We should limit the use of metformin in diabetic patients with impaired renal function, although there is still controversy in the medical literature.

Comparative cost of selective screening to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA), compared with the attributable costs of MRSA infection.

The annual cost of a screening program to detect methicillin-resistant Staphylococcus aureus (MRSA) in a teaching hospital in Spain was 10,261 Euro. The average cost per MRSA infection was 2,730 Euro; therefore, the cost of the program would be covered if it only prevented 4 infections per year (11% of the total number of MRSA infections at our hospital).

Prevention of catheter-related bloodstream infection in critically ill patients using a disinfectable, needle-free connector: a randomized controlled trial.

OBJECTIVE: The aim of this study was to assess the efficacy of a disinfectable, needle-free connector in the prophylaxis of catheter-related bloodstream infection. METHODS: A randomized controlled trial was performed in a polyvalent intensive care unit. Patients who needed multilumen central venous catheters were randomly assigned to a study or a control group. All catheters were inserted and manipulated according to the Centers for Disease Control and Prevention (CDC) recommendations. Study group patients were equipped with catheters with disinfectable, needle-free connectors whereas control group patients were equipped with catheters with 3-way stopcocks. Two peripheral blood cultures and a semiquantitative culture of the catheter tip were performed on removal of the catheter. RESULTS: The study included 243 patients, with a total of 278 central venous catheters. The catheters' mean insertion duration was 9.9 days. Both groups were comparable regarding patient and catheter characteristics. Incidence rate of catheter-related bloodstream infection was 0.7 per 1000 days of catheter use in the study group, compared with 5.0 per 1000 days of catheter use in the control group (P=.03). CONCLUSIONS: To add a disinfectable, needle-free connector to the CDC recommendations reduces the incidence of catheter-related bloodstream infection in critically ill patients with central venous catheters.