Ventilator-associated pneumonia by methicillin-susceptible Staphylococcus aureus: do minimum inhibitory concentrations to vancomycin and daptomycin matter?

The use of vancomycin minimum inhibitory concentration (MIC) as an outcome predictor in patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia has become an important topic for debate in the last few years. Given these previous results, we decided to investigate whether MICs to vancomycin or daptomycin had any effect on the evolution of patients with ventilator-associated pneumonia (VAP) due to MSSA. An observational, retrospective, multicenter study was conducted among patients with MSSA VAP. We analyzed the relationship between vancomycin and daptomycin MICs and early clinical response (72 h), 30-day mortality, intensive care unit (ICU) length of stay (LOS), and duration on mechanical ventilation. Univariate and multivariate analyses were performed. Sixty-six patients from 12 centers were included. Twenty-six patients (39%) had an infection due to MSSA strains with a vancomycin MIC ≥1.5 µg/mL. Daptomycin MIC was determined in 58 patients, of whom 17 (29%) had an MIC ≥1.0 µg/mL. Ten patients (15%) did not respond to first-line treatment. Only daptomycin MIC ≥1.0 µg/mL had a significant association [odds ratio (OR): 30.00; 95% confidence interval (CI): 2.91-60.41] with early treatment failure. The 30-day mortality was 12% (n = 8). Any variable was associated with mortality in the multivariate analysis. None of the variables studied were associated with ICU LOS or duration on mechanical ventilation. In patients with MSSA VAP, vancomycin MIC does not influence the response to antibiotic treatment or the 30-day mortality. Daptomycin MIC was directly related to early treatment failure.

Síndrome de tako-tsubo. Discinesia transitoria del ventrículo izquierdo. Presentación de nuestra casuística / Tako-tsubo syndrome. Transient left ventricular dyskinesia. Presentation of our casuistics

Este síndrome fue descrito en 1990, y se caracteriza por dolor torácico que simula un síndrome coronario agudo (SCA), alteraciones en el ECG y coronarias sin lesiones. Presentamos 16 pacientes ingresados en nuestra UCI, con criterios de síndrome de discinesia transitoria del ventrículo izquierdo (SDTVI). Todos nuestros pacientes menos uno eran mujeres con edad, en general, mayor de 55 años. Se detectó dolor torácico en el 75% de los pacientes. Un 43% tuvo como desencadenante una situación estresante emocional. Un 56% tuvo elevación del ST. La elevación de biomarcadores fue ligera-moderada, salvo en un paciente que fue especialmente elevado. A todos se les realizó coronariografía y ventriculografía, detectándose una discinesia septal o anterolateral, con fracción de eyección normal en el 75% de los casos. La discinesia desapareció entre los 4 días y las 6 semanas (AU)

This syndrome was described in 1990. It is characterized by chest pain that simulatesan acute coronary syndrome (ACS), with alterations in the ECG, but with normal coronaryarteries. We present 16 patients admitted in our ICU, who met the criteria of transient leftventricular dysfunction syndrome (TLVDS). All but 1 patient were women, with age in generalhigher than 55 years. Chest pain was detected in the 75% of them. A total of 43% had emotionalstress as 56% had an elevation of the ST segment, essentially anterolateral. The increase of thebiomarkers was slight-to-moderate, with the exception of one patient in whom it was especiallyhigh. All of them had undergone a coronary arteriogram and ventriculography, and either septalor anterolateral dyskinesia had been detected, with normal ejection fraction. In 75% of the casesthe dyskinesia had disappeared between 4 days to 6 weeks (AU)

[Tako-tsubo syndrome. Transient left ventricular dyskinesia. Presentation of our casuistics]. / Síndrome de tako-tsubo. Discinesia transitoria del ventrículo izquierdo. Presentación de nuestra casuística.

This syndrome was described in 1990. It is characterized by chest pain that simulates an acute coronary syndrome (ACS), with alterations in the ECG, but with normal coronary arteries. We present 16 patients admitted in our ICU, who met the criteria of transient left ventricular dysfunction syndrome (TLVDS). All but 1 patient were women, with age in general higher than 55 years. Chest pain was detected in the 75% of them. A total of 43% had emotional stress as 56% had an elevation of the ST segment, essentially anterolateral. The increase of the biomarkers was slight-to-moderate, with the exception of one patient in whom it was especially high. All of them had undergone a coronary arteriogram and ventriculography, and either septal or anterolateral dyskinesia had been detected, with normal ejection fraction. In 75% of the cases the dyskinesia had disappeared between 4 days to 6 weeks.

Edema pulmonar no cardiogénico postextubación / Postextubation non-cardiogenic pulmonary edema

El edema pulmonar no cardiogénico por obstrucción de la vía aérea superior, aunque descrito inicialmente en niños, se presenta en adultos excepcionalmente y se han descrito casos esporádicos. Aunque el cuadro clínico generalmente es benigno y se resuelve normalmente en menos de 36 h desde su instauración, algunos casos desarrollan insuficiencia respiratoria grave de más larga evolución. Presentamos el caso de un paciente que desarrolló edema pulmonar no cardiogénico tras laringoespasmo postextubación, de características graves, y analizamos los posibles mecanismos patogénicos (AU)

Tromboembolismo pulmonar y tomografía computarizada helicoidal / Pulmonary thrmboembolism and spiral computed tomography

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[Massive hemothorax: an exceptional complication of Rendu-Osler-Weber disease]. / Hemotórax masivo: complicación excepcional de la enfermedad de Rendu-Osler-Weber.

Hereditary familial telangiectasis is a vascular dysplasia characterized by a triple syndrome: hereditary character, telangiectasias and hemorrhages. Its association with systemic and/or pulmonary arterio-venous fistulae is frequent and can condition several complications: cerebral abscess, digestive hemorrhages, epistaxis, hemoptysis, hypoxemia, polyglobulia, and rarely the appearance of hemothorax. We describe a patient who was admitted in hospital with a hypovolemic shock secondary to a massive hemothorax; during emergency surgery, which was necessary to perform, a pulmonary A-V fistula was observed in the middle lobe. The studies afterwards performed demonstrated that it was a Rendu-Osler-Weber disease with duodenal, hepatic, and cerebral involvement.