Medicina
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Observational Study
[Kinetics of procalcitonin in infections caused by multidrug-resistant bacteria].
Procalcitonin guidance stimulates a reduction in the duration of antibiotic treatment in critically ill patients with a presumed bacterial infection, but its role in infections caused by multidrug-resistant bacteria has not been sufficiently explored. In this retrospective observational study, we analyzed procalcitonin curves of 32 patients with culture-confirmed ventilation-associated pneumonia (VAP) and catheter-related bloodstream infections (CRBSI) occurred during the period 11/1/2016 to 7/1/2019. Sixteen infections were caused by multidrug-resistant bacteria (10 CRBSI and 6 VAP) and other 16 by sensitive bacteria (10 CRBSI and 6 VAP). ⋯ In multidrug-resistant bacteria, the inflammatory response measured by procalcitonin is stronger and longer, even with an effective antibiotic treatment. However, the decline occurs before the conventional antibiotic scheme is completed. The potential application of antibiotic protocols guided by procalcitonin to these groups of patients grants further studies aimed to reduce exposure to antibiotics in critical multidrug-resistant infections.
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Prognostic models have been developed to help make decisions in the treatment of pulmonary embolism (PE). Among them, the Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI), however they have not been validated in our setting. The objective was to evaluate PESI and sPESI scores ability to predict in-hospital mortality in patients with PE in Argentina. ⋯ Both models presented good calibration. The PESI and sPESI risk scores demonstrated similar performance and good accuracy in predicting hospital and 30-day mortality. Both scores can be established as simple prediction tools for PE patients in Argentina.
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Cardiovascular diseases are the leading cause of death in most regions of the world, usually followed by infectious diseases. For decades, infections in general, and particularly those involving the respiratory system, have been known to be associated with an increased risk of cardiovascular and cerebrovascular events, and their consequent morbidity and mortality. Although vaccines are an excellent strategy in the prevention of infectious diseases, the proportion of immunized adults in our country is frankly deficient. ⋯ The spectrum of pathologies that can trigger respiratory infections is wide: development or worsening of heart failure, arrhythmias, acute coronary syndromes and cerebrovascular diseases, among the main ones. The role of immunoprophylaxis with influenza, pneumococcal and tetanus vaccine in patients with different heart diseases is addressed here, evaluating the evidence supporting its use, and placing special emphasis on practical aspects of its use, such as adverse effects, contraindications and special care situations, such as congenital heart disease in adults, heart transplantation, anticoagulation or egg allergy. Thus, this document aims to assist in decision-making for any doctor involved in the care of patients with cardiovascular disease.
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The six-minute walk test has been generally applied in people with pathologies and some studies have proposed models to predict maximum oxygen consumption. Our objective was to elaborate on an equation to predict the maximum oxygen consumption in the six-minute walking test for university students. A hundred and forty people participated in this study. ⋯ The Bland-Altman diagram indicated that there were no significant differences between the equation and the measurement of the maximum oxygen consumption (p = 0.89), with a confidence interval of 0.054 ml·kg·min-1 (95% CI [-0.72; 0.83]). The equation predicts the maximum oxygen consumption. It is suggested to evaluate university students considering biological and environmental differences between countries.
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Clostridiodes difficile infection (CDi) is the most common cause of nosocomial diarrhea. Vancomycin, associated or not to metronidazol, is the treatment of choice. However, the rate of treatment failure has increased over the last years and fecal microbiota transplantation (FMT) has emerged as a therapeutic option. ⋯ Seven patients (31%) presented mild and self-limited adverse effects. FMT has shown a high efficacy as rescue treatment in cases with refractory or recurrent CDi regardless of severity, with mild side effects. Availability of a stool banks provide reliable, timely and equitable access to FMT for CDi.