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1.
Med Intensiva ; 39(8): 467-76, 2015 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-25798955

RESUMO

OBJECTIVES: To determine the reasons of prescription, the characteristics of patients and factors that affected the outcome of critically ill patients treated with micafungin (MCF) during their stay in Spanish ICUs. MATERIAL AND METHODS: Observational, retrospective and multicenter study. Patients admitted to the ICU between March 2011 and October 2012 (20-month period) treated with MCF for any reason were included in the study. Severity of patients at the beginning of treatment was measured with the APACHE II, SOFA, Child-Pugh and MELD scores. Reasons for the use of MCF were classified as prophylaxis, preemptive treatment, empirical treatment and directed treatment. Continuous variables are expressed as mean and standard deviation or median, and categorical variables as percentages. A multivariate analysis was performed to identify variables related to intra-ICU mortality. RESULTS: The study population included 139 patients admitted to 19 Spanish ICUs, with a mean age of 57.3 (17.1) years, 89 (64%) men, with surgical (53.2%) and/or medical (44.6%) conditions, APACHE II score of 20.6 (7.7) and SOFA score of 8.4 (4.3), with 84.2% of patients requiring mechanical ventilation, 59% parenteral nutrition, 37.4% extrarenal depuration procedures and 37.4% treatment with steroids. MCF was indicated as empirical treatment of a proven infection in 51 (36.7%) cases, pre-emptive treatment in 50 (36%) especially as a result of the application of the Candida score (32 cases), directed treatment of fungal infection in 23 (16.5%) and as prophylactic treatment in 15 (10.8%) cases. In 108 (77%) cases, a daily dose of 100mg was administered, with a loading dose in only 9 cases (6.5%). The mean duration of treatment was 13.1 (13) days. A total of 59 (42.4%) patients died during their stay in the ICU and 16 after ICU discharge (hospital mortality 53.9%). Independent risk factors for intra-ICU mortality were the Child-Pugh score (OR 1.45, 95% CI 1.162-1.813; P=.001) and the MELD score (OR 1.05, 95% CI 1.011-1.099; P=.014). CONCLUSIONS: MCF is usually administered at a dose of 100mg/day, without loading dose and in 72.7% of cases as pre-emptive or empirical treatment. Factors that better predicted mortality were indicators of liver insufficiency at the time of starting treatment.


Assuntos
Antifúngicos/uso terapêutico , Cuidados Críticos/métodos , Equinocandinas/uso terapêutico , Lipopeptídeos/uso terapêutico , Micoses/tratamento farmacológico , Adulto , Idoso , Terapia Combinada , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Falência Hepática/complicações , Masculino , Micafungina , Pessoa de Meia-Idade , Micoses/prevenção & controle , Complicações Pós-Operatórias/tratamento farmacológico , Estudos Retrospectivos , Índice de Gravidade de Doença , Espanha/epidemiologia
2.
Transplant Proc ; 44(7): 2120-3, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22974930

RESUMO

Solid organ transplantation is becoming increasingly more common in the treatment of end-stage organ failure. The advent of newer immunosuppressive protocols and refined surgical techniques has allowed therapy to become standard care. Infection is a major and frequently life-threatening complication after transplantation and the incidence of opportunistic fungal infections in organ transplant recipients ranges from 2%-50% depending on the type of organ transplanted. We present a case of rhinomaxillary form of mucormycosis infection after liver transplantation. The succession of multiple risk factors in a torpid postoperative period was a key factor in the development of this disease. Multidisciplinary management with an early diagnosis, aggressive surgery, and intravenous and topical antifungal therapy care were definitive for the eradication of infection. The goal of the present report was to show efficacious management including the association of topical treatment with amphotericin B complex lipid to standard therapy and the absence of side effects.


Assuntos
Anfotericina B/administração & dosagem , Doenças Maxilomandibulares/tratamento farmacológico , Mucormicose/tratamento farmacológico , Doenças Nasais/tratamento farmacológico , Administração Tópica , Anfotericina B/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade
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