Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 72
Filtrar
1.
Crit Care ; 16(6): R222, 2012 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-23158219

RESUMO

INTRODUCTION: Recognition of patterns of organ failure may be useful in characterizing the clinical course of critically ill patients. We investigated the patterns of early changes in organ dysfunction/failure in intensive care unit (ICU) patients and their relation to outcome. METHODS: Using the database from a large prospective European study, we studied 2,933 patients who had stayed more than 48 hours in the ICU and described patterns of organ failure and their relation to outcome. Patients were divided into three groups: patients without sepsis, patients in whom sepsis was diagnosed within the first 48 hours after ICU admission, and patients in whom sepsis developed more than 48 hours after admission. Organ dysfunction was assessed by using the sequential organ failure assessment (SOFA) score. RESULTS: A total of 2,110 patients (72% of the study population) had organ failure at some point during their ICU stay. Patients who exhibited an improvement in organ function in the first 24 hours after admission to the ICU had lower ICU and hospital mortality rates compared with those who had unchanged or increased SOFA scores (12.4 and 18.4% versus 19.6 and 24.5%, P < 0.05, pairwise). As expected, organ failure was more common in sepsis than in nonsepsis patients. In patients with single-organ failure, in-hospital mortality was greater in sepsis than in nonsepsis patients. However, in patients with multiorgan failure, mortality rates were similar regardless of the presence of sepsis. Irrespective of the presence of sepsis, delta SOFA scores over the first 4 days in the ICU were higher in nonsurvivors than in survivors and decreased significantly over time in survivors. CONCLUSIONS: Early changes in organ function are strongly related to outcome. In patients with single-organ failure, in-hospital mortality was higher in sepsis than in nonsepsis patients. However, in multiorgan failure, mortality rates were not influenced by the presence of sepsis.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Insuficiência de Múltiplos Órgãos/epidemiologia , Idoso , Europa (Continente)/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/mortalidade , Escores de Disfunção Orgânica , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Sepse/epidemiologia
3.
PLoS One ; 6(10): e26470, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22046290

RESUMO

BACKGROUND: Bacteremia by Pseudomonas aeruginosa represents one severe infection. It is not clear whether beta-lactam monotherapy leads to similar rates of treatment success compared to combinations of beta-lactams with aminoglycosides or quinolones. METHODS: Retrospective cohort study from 3 tertiary hospitals (2 in Greece and 1 in Italy). Pseudomonas aeruginosa isolates were susceptible to a beta-lactam and an aminoglycoside or a quinolone. Patients received appropriate therapy for at least 48 hours. Primary outcome of interest was treatment success in patients with definitive beta-lactam combination therapy compared to monotherapy. Secondary outcomes were treatment success keeping the same empirical and definitive regimen, mortality, and toxicity. RESULTS: Out of 92 bacteremias there were 54 evaluable episodes for the primary outcome (20 received monotherapy). Treatment success was higher with combination therapy (85%) compared to beta-lactam monotherapy (65%), however not statistically significantly [Odds ratio (OR) 3.1; 95% Confidence Interval (CI) 0.69-14.7, p = 0.1]. Very long (>2 months) hospitalisation before bacteremia was the only factor independently associated with treatment success (OR 0.73; 95% CI 0.01-0.95, p = 0.046), however this result entailed few episodes. All-cause mortality did not differ significantly between combination therapy [6/31 (19%)] and monotherapy [8/19 (42%)], p = 0.11. Only Charlson comorbidity index was associated with excess mortality (p = 0.03). CONCLUSION: Our study, in accordance with previous ones, indicates that the choice between monotherapy and combination therapy may not affect treatment success significantly. However, our study does not have statistical power to identify small or moderate differences. A large randomized controlled trial evaluating this issue is justified.


Assuntos
Antibacterianos/administração & dosagem , Bacteriemia/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Aminoglicosídeos/uso terapêutico , Antibacterianos/uso terapêutico , Estudos de Coortes , Quimioterapia Combinada , Humanos , Quinolonas/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , beta-Lactamas/uso terapêutico
4.
Crit Care ; 15(5): R247, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22018206

RESUMO

INTRODUCTION: This prospective study investigated whether plasma ionized calcium concentration abnormalities and other electrolyte disturbances represent risk factors for the development of critical illness polyneuromyopathy (CIPNM) in ICU patients. METHODS: One hundred and ninety consecutive adult critically ill patients with prolonged ICU stay (longer than 7 days) were prospectively evaluated. Patients with acute weakness and/or weaning difficulties were subjected to extensive electrophysiological measurements in order to establish the diagnosis of CIPNM. All recognized and/or possible risk factors for development of CIPNM were recorded. RESULTS: The diagnosis of CIPNM was confirmed in 40 patients (21.05%). By applying a logistic regression model, hypocalcemia (P = 0.02), hypercalcemia (P = 0.01) and septic shock (P = 0.04) were independently associated with the development of CIPNM in critically ill patients. CONCLUSIONS: We found that septic shock and abnormal fluctuations of plasma Ca²âº concentration represent significant risk factors for the development of CIPNM in critically ill patients.


Assuntos
Distúrbios do Metabolismo do Cálcio/complicações , Cálcio/sangue , Doenças Musculares/etiologia , Polineuropatias/etiologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Doenças Musculares/sangue , Polineuropatias/sangue , Estudos Prospectivos , Fatores de Risco , Equilíbrio Hidroeletrolítico
5.
Ann Intensive Care ; 1(1): 30, 2011 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-21906382

RESUMO

Recent clinical studies performed in a large number of patients showed that colistin "forgotten" for several decades revived for the management of infections due to multidrug-resistant (MDR) Gram-negative bacteria (GNB) and had acceptable effectiveness and considerably less toxicity than that reported in older publications. Colistin is a rapidly bactericidal antimicrobial agent that possesses a significant postantibiotic effect against MDR Gram-negative pathogens, such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. The optimal colistin dosing regimen against MDR GNB is still unknown in the intensive care unit (ICU) setting. A better understanding of the pharmacokinetic-pharmacodynamic relationship of colistin is urgently needed to determine the optimal dosing regimen. Although pharmacokinetic and pharmacodynamic data in ICU patients are scarce, recent evidence shows that the pharmacokinetics/pharmacodynamics of colistimethate sodium and colistin in critically ill patients differ from those previously found in other groups, such as cystic fibrosis patients. The AUC:MIC ratio has been found to be the parameter best associated with colistin efficacy. To maximize the AUC:MIC ratio, higher doses of colistimethate sodium and alterations in the dosing intervals may be warranted in the ICU setting. In addition, the development of colistin resistance has been linked to inadequate colistin dosing. This enforces the importance of colistin dose optimization in critically ill patients. Although higher colistin doses seem to be beneficial, the lack of colistin pharmacokinetic-pharmacodynamic data results in difficulty for the optimization of daily colistin dose. In conclusion, although colistin seems to be a very reliable alternative for the management of life-threatening nosocomial infections due to MDR GNB, it should be emphasized that there is a lack of guidelines regarding the ideal management of these infections and the appropriate colistin doses in critically ill patients with and without multiple organ failure.

6.
Int J Infect Dis ; 15(11): e732-9, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21945848

RESUMO

Fosfomycin, originally named phosphonomycin, was discovered in Spain in 1969. There are three forms of fosfomycin: fosfomycin tromethamine (a soluble salt) and fosfomycin calcium for oral use, and fosfomycin disodium for intravenous use. Fosfomycin is a bactericidal antibiotic that interferes with cell wall synthesis in both Gram-positive and Gram-negative bacteria by inhibiting the initial step involving phosphoenolpyruvate synthetase. It has a broad spectrum of activity against a wide range of Gram-positive and Gram-negative bacteria. It is highly active against Gram-positive pathogens such as Staphylococcus aureus and Enterococcus, and against Gram-negative bacteria such as Pseudomonas aeruginosa and Klebsiella pneumoniae. Its unique mechanism of action may provide a synergistic effect to other classes of antibiotics including beta-lactams, aminoglycosides, and fluoroquinolones. Oral fosfomycin is mainly used in the treatment of urinary tract infections, particularly those caused by Escherichia coli and Enterococcus faecalis. Intravenous fosfomycin has been administered in combination with other antibiotics for the treatment of nosocomial infections due to multidrug-resistant (MDR) Gram-positive and Gram-negative bacteria. Fosfomycin has good distribution into tissues, achieving clinically relevant concentrations in serum, kidneys, bladder wall, prostate, lungs, inflamed tissues, bone, cerebrospinal fluid, abscess fluid, and heart valves. Fosfomycin is well tolerated, with a low incidence of adverse events. Further randomized controlled trials are needed in order to evaluate the efficacy of intravenous fosfomycin for the management of nosocomial infections due to MDR pathogens.


Assuntos
Antibacterianos/uso terapêutico , Fosfomicina/uso terapêutico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Enterococcus faecalis/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Fosfomicina/farmacocinética , Fosfomicina/farmacologia , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Pseudomonas aeruginosa/efeitos dos fármacos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
7.
Int J Antimicrob Agents ; 38(3): 197-216, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21741802

RESUMO

Emergence of resistance to widely used trimethoprim/sulfamethoxazole (TMP/SMX) as well as common adverse events in human immunodeficiency virus (HIV)-infected patients casts interest on combinations of TMP with other sulfonamides. Sulfametrole (SMT) combined with TMP could provide a choice for difficult-to-treat infections, particularly when administered intravenously. The objective of this review was to evaluate the available clinical and pharmacokinetic/pharmacodynamic (PK/PD) evidence regarding TMP/SMT, particularly in comparison with TMP/SMX. We reviewed the available evidence retrieved from searches in PubMed/Scopus/Google Scholar and by bibliography hand-searching. In total, 46 eligible studies (most published before 1997) were identified, 7 regarding intravenous (i.v.) TMP/SMT, 24 regarding oral TMP/SMT and 15 providing comparative data for TMP/SMT versus TMP/SMX. The antimicrobial activity of TMP/SMT was similar to TMP/SMX for Gram-positive isolates. A greater percentage of Escherichia coli and Proteus spp. isolates were susceptible to TMP/SMT compared with TMP/SMX. PK/PD data suggest a dosage adjustment of i.v. TMP/SMT in patients with seriously impaired renal function. Four randomised controlled trials and 16 non-comparative studies reported good effectiveness/safety outcomes for oral TMP/SMT in genital ulcers (mainly chancroid), respiratory tract infections and urinary tract infections (UTIs). Moreover, i.v. TMP/SMT was effective against Pneumocystis jiroveci infection in HIV-infected patients, severe pneumonia and UTIs. In one study, hypersensitivity reactions occurred in 18/52 (34.6%) of HIV-infected patients; 2/52 (3.8%) developed psychosis. Gastrointestinal adverse events were mild and rare. Excipients in i.v. TMP/SMT formulations might be less toxic compared with i.v. TMP/SMX formulations, particularly for children. In conclusion, despite the scarcity of contemporary evidence, available data suggest that TMP/SMT could be an alternative treatment option to TMP/SMX, even in serious infections, when administered intravenously.


Assuntos
Anti-Infecciosos/administração & dosagem , Sulfanilamidas/administração & dosagem , Trimetoprima/administração & dosagem , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/farmacocinética , Anti-Infecciosos/farmacologia , Infecções Bacterianas/tratamento farmacológico , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Humanos , Pneumonia por Pneumocystis/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Sulfanilamidas/efeitos adversos , Sulfanilamidas/farmacocinética , Sulfanilamidas/farmacologia , Resultado do Tratamento , Trimetoprima/efeitos adversos , Trimetoprima/farmacocinética , Trimetoprima/farmacologia
9.
Am J Infect Control ; 39(7): 542-7, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21496955

RESUMO

BACKGROUND: Infections associated with central venous catheters (CVCs) are associated with considerable morbidity and mortality. METHODS: We conducted a survey to evaluate the theoretical knowledge and practices of intensive care unit doctors and nursing staff regarding CVC-related infections. RESULTS: A questionnaire was distributed to 345 doctors and nurses. The response rate was 71.6%. Of the responders, 84.9% worked in public hospitals, 40% had been trained in CVC-related infection issues, and 27% were familiar with the relevant Centers of Disease Control and Prevention guidelines. The mean percentage of correct answers (± standard deviation) on the 3 parts of the questionnaire were 42.9% ± 16.2%, 86.9% ± 9.5%, and 85.4% ± 7.2%. In the subset of questions referring to procedures that were doctors' exclusive responsibility, 13.6% of the doctors answered all questions correctly. Age >37 years, awareness of relevant official guidelines, working in a private hospital, and being a doctor were identified as independent variables associated with high scores in knowledge regarding the prevention of CVC-related infections. Female sex and training in infection prevention were associated with higher scores on the part evaluating adherence to specific practices regarding CVC insertion, whereas being a nurse was associated with higher scores on the part evaluating CVC maintenance. CONCLUSION: Our findings suggest that there is a need for increased theoretical knowledge and improvement in practices regarding CVC care. Educational programs directed at doctors and nurses working in intensive care units may aid this effort.


Assuntos
Cateterismo Venoso Central/enfermagem , Cateterismo Venoso Central/normas , Infecção Hospitalar/prevenção & controle , Unidades de Terapia Intensiva/normas , Adulto , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/etiologia , Feminino , Grécia , Fidelidade a Diretrizes , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Modelos Lineares , Masculino , Análise Multivariada , Recursos Humanos de Enfermagem no Hospital , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Inquéritos e Questionários
10.
Clin Infect Dis ; 52(6): 750-70, 2011 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-21367728

RESUMO

We aimed to assess the accuracy of measuring serum or plasma (1→3)-ß-D-glucan (BDG) for the diagnosis of invasive fungal infections (IFIs) by means of a meta-analysis of relevant studies. We searched in bibliographic databases for relevant cohort or case-control studies. We primarily compared BDG between patients with proven or probable IFIs (excluding Pneumocystis jirovecii infections), according to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group or similar criteria, and patients without IFIs (excluding healthy individuals as controls). A total of 2979 patients (594 with proven or probable IFIs), included in 16 studies, were analyzed. The pooled sensitivity of BDG was 76.8% (95% confidence interval [CI], 67.1%-84.3%), and the specificity was 85.3% (95% CI, 79.6%-89.7%). The area under the summary receiver operating characteristic curve was 0.89. Marked statistical heterogeneity was noted. BDG has good diagnostic accuracy for distinguishing proven or probable IFIs from no IFIs. It can be useful in clinical practice, if implemented in the proper setting and interpreted after consideration of its limitations.


Assuntos
Biomarcadores/sangue , Técnicas de Laboratório Clínico/métodos , Micoses/diagnóstico , beta-Glucanas/sangue , Humanos , Plasma/química , Proteoglicanas , Curva ROC , Sensibilidade e Especificidade , Soro/química
11.
Curr Drug Deliv ; 8(2): 208-12, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21235473

RESUMO

Critically ill patients, who develop ventilator-associated pneumonia during prolonged mechanical ventilation, often require antimicrobial agents administered through the endotracheal or the tracheotomy tube. The delivery of antibiotics via the respiratory tract has been established over the past years as an alternative route in order to deliver high concentrations of antimicrobial agents directly to the lungs and avoid systemic toxicity. Since the only formal indications for inhaled/aerosolized antimicrobial agents is for patients suffering from cystic fibrosis, consequently the majority of research and published studies concerns this group of patients. Newer devices and new antibiotic formulations are currently off-label used in ambulatory cystic fibrosis patients whereas similar data for the mechanically ventilated patients do not yet exist.


Assuntos
Anti-Infecciosos/administração & dosagem , Cuidados Críticos/tendências , Sistemas de Liberação de Medicamentos , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Respiração Artificial/efeitos adversos , Administração por Inalação , Aerossóis , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/uso terapêutico , Composição de Medicamentos/tendências , Sistemas de Liberação de Medicamentos/tendências , Humanos , Inaladores Dosimetrados/tendências , Nebulizadores e Vaporizadores/tendências
12.
Am J Infect Control ; 39(5): 396-400, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21035919

RESUMO

BACKGROUND: Characteristics and burden of primary bacteremia because of multidrug-resistant (MDR) gram-negative bacteria (GNB) in intensive care unit (ICU) patients remain understudied. METHODS: A cohort study of patients with primary MDR GNB-related bacteremia from the ICU of a tertiary Greek hospital during a 3-year period was conducted for recognition of clinical characteristics and risk factors for adverse outcome. A case-control study was further performed to evaluate risk factors for development of MDR GNB-related primary bacteremia. RESULTS: Fifty monomicrobial episodes of primary bacteremia because of Klebsiella pneumoniae (n = 20), Acinetobacter baumannii (n = 18), and Pseudomonas aeruginosa (n = 12) were recorded. The presence of diabetes mellitus was the only significant risk factor for development of MDR GNB-related primary bacteremia. Most episodes (78%) were ICU acquired in patients with prolonged mechanical ventilation and previous hospitalization in the ward. Mortality was 47.6% vs 19% of controls, P = .01. Mortality was higher in recurrent bacteremia (62.5%). Mortality was statistically associated with age (P = .002) and degree of multiorgan dysfunction expressed by sequential organ failure assessment score on day of bacteremia documentation (P = .001). CONCLUSION: Critically ill patients with MDR GNB-related primary bacteremia present significant mortality mainly associated with age and multiorgan failure. A baumanii bacteremia confers significant mortality compared with the benign course of K pneumoniae in such settings. Diabetes mellitus is a risk factor for development of such episodes, which may, in part, be general ward acquired, underlining the need for expanded vigilance.


Assuntos
Bacteriemia/mortalidade , Estado Terminal/mortalidade , Infecção Hospitalar/mortalidade , Farmacorresistência Bacteriana Múltipla , Unidades de Terapia Intensiva/estatística & dados numéricos , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/patogenicidade , Idoso , Anti-Infecciosos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Estudos de Casos e Controles , Estudos de Coortes , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Diabetes Mellitus/microbiologia , Feminino , Grécia/epidemiologia , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/patogenicidade , Masculino , Pessoa de Meia-Idade , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/patogenicidade , Estudos Retrospectivos , Fatores de Risco
13.
Expert Opin Drug Metab Toxicol ; 7(2): 245-55, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21128824

RESUMO

IMPORTANCE OF THE FIELD: Although colistin has recently played a key role in the treatment of nosocomial infections due to multidrug resistant Gram-negative pathogens, there is a lack of clinical studies examining colistin pharmacokinetics (PKs) in humans. This refers to all routes of colistin administration in clinical practice. Colistin PK data are also limited in critically ill patients. AREAS COVERED IN THIS REVIEW: Literature search took into account data dealing with colistin PK obtained from animal studies performed during previous decades (1970s, 1980s and 1990s) and from recent human studies performed during the last decade. WHAT THE READER WILL GAIN: Valuable information on pharmacodynamics (PD)/PK of colistin used in the treatments of nosocomial infections due to multidrug resistant Gram-negative pathogens, mostly Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae. A better understanding of PKs could offer significant improvement of colistin use in humans, especially optimization of colistin doses in different routes of administration in order to maximize clinical efficacy and minimize adverse effects and rate of resistance. TAKE HOME MESSAGE: There is a lack of human studies on colistin PK and PD. Significant PD parameters best predicting colistin efficacy and their optimal values such as C(max):MIC ratio, AUC/MIC and T > MIC have not yet been clearly defined. It should be noted that further investigation on colistin PK/PD in vitro and in vivo models is required.


Assuntos
Antibacterianos/farmacocinética , Colistina/farmacocinética , Infecção Hospitalar/tratamento farmacológico , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Área Sob a Curva , Ensaios Clínicos como Assunto , Colistina/farmacologia , Colistina/uso terapêutico , Estado Terminal , Avaliação Pré-Clínica de Medicamentos , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Testes de Sensibilidade Microbiana
14.
J Clin Lab Anal ; 24(6): 389-98, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21089169

RESUMO

BACKGROUND: Cardiopulmonary bypass (CPB) has been associated with activation and injury of endothelial cells, probably responsible for the systemic inflammatory response syndrome (SIRS) taking place in these patients. METHODS: We measured plasma concentrations of soluble P-selectin (sP-s), E-selectin (sE-s), tetranectin (TN), vonWillebrand factor (vWF) levels, and angiotensin-converting enzyme (ACE) activity in 31 adult patients undergoing elective coronary artery bypass grafting, just before and up to three days after surgery, and in 25 healthy volunteers. RESULTS: Patients showed higher plasma sP-s and sE-s and ACE concentrations, just before surgery, but significantly lower TN levels, compared with controls. During the first three postoperative days (PD), the concentration of each of the molecules followed a different and independent pattern, although in the third PD, the levels of sP-s, sE-s and ACE were higher and those of vWF and TN lower, compared with the preoperative ones. However, patients had higher sP-s (P=0.06), sE-s (P=0.07), and vWF (P=0.005), but lower TN concentrations (P=0.02) on the third PD compared with controls. CONCLUSIONS: CPB is characterised by pronounced changes in plasma sP-s, sE-s, TN, vWF levels, and ACE activity, which are associated with significant alteration in the intra- and early postoperative endothelial function observed in open heart surgery.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária , Endotélio Vascular/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/sangue , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Lectinas Tipo C/sangue , Masculino , Pessoa de Meia-Idade , Peptidil Dipeptidase A/sangue , Selectinas/sangue , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Fatores de Tempo , Fator de von Willebrand/análise
15.
Expert Rev Anti Infect Ther ; 8(9): 1009-17, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20818945

RESUMO

The emergence of nosocomial infections due to multidrug-resistant Gram-negative bacteria led to the revival of 'forgotten' antibiotics, such as polymyxins. Colistin, mainly colistimethate sodium (polymyxin E), has been predominantly used. Recent studies suggest that colistin administered as monotherapy or combination therapy is an effective and safe antimicrobial agent for multidrug-resistant Gram-negative bacteria infections. The reported colistin nephrotoxicity is 20% or lower. Although colistin is commonly administered intravenously, it can also be administered via inhalation for pneumonia/ventilator-associated pneumonia treatment or by the intraventricular/intrathecal route for meningitis/ventriculitis treatment. Randomized controlled trials are needed to answer clinical questions such as the appropriate colistin dose, to compare colistin monotherapy with combination therapy, and to determine the exact therapeutic role of aerosolized or intrathecal/intraventricular administration of colistin.


Assuntos
Antibacterianos/uso terapêutico , Colistina/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Administração por Inalação , Antibacterianos/administração & dosagem , Colistina/administração & dosagem , Quimioterapia Combinada , Humanos , Injeções Intravenosas , Injeções Intraventriculares , Injeções Espinhais
16.
Interact Cardiovasc Thorac Surg ; 11(3): 234-7, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20542981

RESUMO

We prospectively examined 1359 adult patients undergoing isolated coronary revascularization with the Pi-circuit technique, consisting of beating heart, aorta no-touch, use of composite grafts, and off-pump arterial revascularization. Patients were divided into two groups based on body weight; Group A consisting of 295 (21.7%) obese patients [body mass index (BMI) > or =30 kg/m(2)] and Group B of 1064 (79.3%) non-obese patients (BMI <30 kg/m(2)). Advanced age and emergency surgery favored the non-obese group [63.0+/-10.4 vs. 65.3+/-9.6 years (P<0.0005) and 10.2% vs. 17.1% (P=0.004), with an increase in the number of octogenarians among them (1.7% Group A vs. 5.4% in Group B, P=0.11)]. The use of double internal mammary arteries (90.5% in Group A vs. 86.9% in Group B, P=0.109), the mean number of distal anastomoses (2.8+/-0.9 in Group A vs. 2.7+/-0.9 in Group B, P=0.5) and the number of sequential anastomoses performed (28.1% in Group A vs. 31% in Group B, P=0.3) were similar. No difference in morbidity rates was detected. All cause in-hospital mortality was comparable. Survival was similar in both groups also. Obesity is not a risk factor for morbidity and mortality in this group of patients.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Obesidade/complicações , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Feminino , Grécia , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Obesidade/mortalidade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
17.
Crit Care ; 14(2): R32, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20230620

RESUMO

INTRODUCTION: There are few data related to the effects of different sources of infection on outcome. We used the Sepsis Occurrence in Acutely ill Patients (SOAP) database to investigate differences in the impact of respiratory tract and abdominal sites of infection on organ failure and survival. METHODS: The SOAP study was a cohort, multicenter, observational study which included data from all adult patients admitted to one of 198 participating intensive care units (ICUs) from 24 European countries during the study period. In this substudy, patients were divided into two groups depending on whether, on admission, they had abdominal infection but no respiratory infection or respiratory infection but no abdominal infection. The two groups were compared with respect to patient and infection-related characteristics, organ failure patterns, and outcomes. RESULTS: Of the 3,147 patients in the SOAP database, 777 (25%) patients had sepsis on ICU admission; 162 (21%) had abdominal infection without concurrent respiratory infection and 380 (49%) had respiratory infection without concurrent abdominal infection. Age, sex, and severity scores were similar in the two groups. On admission, septic shock was more common in patients with abdominal infection (40.1% vs. 29.5%, P = 0.016) who were also more likely to have early coagulation failure (17.3% vs. 9.5%, P = 0.01) and acute renal failure (38.3% vs. 29.5%, P = 0.045). In contrast, patients with respiratory infection were more likely to have early neurological failure (30.5% vs. 9.9%, P < 0.001). The median length of ICU stay was the same in the two groups, but the median length of hospital stay was longer in patients with abdominal than in those with respiratory infection (27 vs. 20 days, P = 0.02). ICU (29%) and hospital (38%) mortality rates were identical in the two groups. CONCLUSIONS: There are important differences in patient profiles related to the site of infection; however, mortality rates in these two groups of patients are identical.


Assuntos
Abdome/microbiologia , Unidades de Terapia Intensiva , Infecções Respiratórias/etiologia , Idoso , Estudos de Coortes , Infecção Hospitalar/mortalidade , Bases de Dados Factuais , Europa (Continente)/epidemiologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Observação , Razão de Chances , Infecções Respiratórias/mortalidade
18.
Expert Opin Pharmacother ; 11(5): 779-88, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20210684

RESUMO

IMPORTANCE OF THE FIELD: Acinetobacter baumannii has emerged as a major cause of healthcare-associated infections. It commonly presents resistance to multiple antimicrobial agents, occasionally including carbapenems and polymyxins, and hence, it is considered the paradigm of multidrug-resistant (MDR) or pandrug-resistant (PDR) bacterium. MDR A. baumannii is a rapidly emerging pathogen, especially in the intensive care setting, causing infections including bacteremia, pneumonia/ventilator-associated pneumonia (VAP), meningitis, urinary tract infection, central venous catheter-related infection, and wound infection. AREAS COVERED IN THIS REVIEW: All potential antimicrobial agents that are available for the treatment of Acinetobacter infections are presented. Emphasis was given to the management of nosocomial infections due to MDR A. baumannii and its close relatives, spp. 3 and 13TU. Areas covered include bloodstream infections, pneumonia or VAP, meningitis, urinary tract infection, skin and soft-tissue or wound infections due to Acinetobacter. WHAT THE READER WILL GAIN: The antibiotics that are usually effective against A. baumannii infections include carbapenems, polymyxins E and B, sulbactam, piperacillin/tazobactam, tigecycline and aminoglycosides. Carbapenems (imipenem, meropenem, doripenem) are the mainstay of treatment for A. baumannii, though carbapenem-resistant Acinetobacter strains have increasingly been reported worldwide in recent years. However, although well-designed trials of new therapeutic approaches are certainly required, the most important factor necessary to guide clinicians in their choice of empirical or targeted therapy should be knowledge of the susceptibility patterns of strains present in their own geographical area. TAKE HOME MESSAGE: Pooled data suggest that infections caused by A. baumannii, especially those with inappropriate treatment, are associated with considerable attributable mortality. The optimal treatment for A. baumannii nosocomial infections has not been established, especially for MDR strains. Therefore, well-designed clinical studies are necessary to guide clinicians on decisions regarding the best therapeutic approach for patients with MDR A. baumannii infections. In addition, new experimental studies are warranted to evaluate the activity and safety of peptides and other novel antibacterial agents for A. baumannii infections.


Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/uso terapêutico , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/isolamento & purificação , Antibacterianos/efeitos adversos , Antibacterianos/farmacologia , Ensaios Clínicos como Assunto , Infecção Hospitalar/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Humanos
19.
Clin Infect Dis ; 50(4): 468-72, 2010 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-20085466

RESUMO

BACKGROUND: Comparative cohort studies are often conducted to identify novel therapeutic strategies or prognostic factors for ventilator-associated pneumonia (VAP). We aimed to evaluate the power of such studies to provide clinically and statistically significant conclusions with regard to mortality differences. METHODS: We searched in PubMed and Scopus for comparative cohort studies that evaluated mortality in patients with VAP. We calculated the central estimates and corresponding 95% confidence intervals (CIs) for mortality differences between compared patient groups. We also calculated the statistical power of the included studies to detect a difference in mortality that corresponds to a risk ratio of 0.80. RESULTS: We identified 39 (20 prospective) comparative cohort studies on VAP as eligible for inclusion in this analysis. The median absolute risk difference in mortality between compared groups was 10% (interquartile range [IQR], 5%-18%), and the median width of the 95% CI of the absolute risk difference in mortality was 34% (IQR, 28%-42.5%). The median power of the included studies to detect a risk ratio for mortality of 0.80 was 14.7% (IQR, 10.6%-21.8%). CONCLUSIONS: There is considerable uncertainty around the central estimate of comparative cohort studies on VAP with regard to mortality differences. For a wiser use of resources allocated to research, we emphasize the need to conduct cohort studies with larger sample size so that potential differences between the compared groups are more likely to be shown.


Assuntos
Estudos de Coortes , Interpretação Estatística de Dados , Pneumonia Associada à Ventilação Mecânica/mortalidade , Humanos
20.
Scand J Infect Dis ; 42(1): 69-71, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-19883151

RESUMO

We report the first series of indigenous European patients with severe leptospirosis in need of intensive care because of acute respiratory distress syndrome, coma and shock. The all-cause hospital mortality was 16.7%, and may have been influenced by relatively early diagnosis, indicating the need for heightened clinical suspicion in Europe.


Assuntos
Leptospirose/epidemiologia , Leptospirose/patologia , Adulto , Idoso , Europa (Continente) , Humanos , Unidades de Terapia Intensiva , Leptospirose/mortalidade , Masculino , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...