Enfermedades infecciosas y microbiología clínica
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Enferm. Infecc. Microbiol. Clin. · Oct 2010
Review Biography Historical Article[100 years of Dr. Ehrlich's magic bullet (1909-2009)].
The aim of this article is to pay tribute to Paul Ehrlich and his contributions to science, in particular those related to antimicrobial therapy, at the end of a prodigious decade of celebrations to fête his person and work. The year 2009 marks the centenary of the discovery of the experimental anti-syphilitic activity of Salvarsan and the first clinical studies showing its efficacy against syphilis. This homage is conveyed through the presentation of bibliographic data, mention of his most important scientific achievements based on his original publications, and by analyzing the film Dr. Ehrlich's Magic Bullet (1940) by William Dieterle.
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Enferm. Infecc. Microbiol. Clin. · Sep 2010
Review[Duration of antibiotic therapy in intraabdominal infections].
The duration of antibiotic treatment in patients with an infectious process is based on empirical considerations and those with intraabdominal infections are no exception. Therefore, the recommended duration of antibiotic therapy in intraabdominal infection is controversial and no consensus has been reached due to the lack of controlled studies that would provide sufficient scientific evidence. ⋯ These considerations have led to the exploration of "short-term treatment" strategies, lasting 3-5 days, with encouraging results. However, the development of biomarkers such as procalcitonin opens the door to individualized treatment that might allow the duration of antibiotic treatment in intraabdominal and other infections to be individually tailed to patient response.
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Enferm. Infecc. Microbiol. Clin. · Sep 2010
Review[Role of new carbapenems in nosocomial intraabdominal infection].
Complicated intraabdominal infections require surgical intervention and the earliest possible empiric broad-spectrum antibacterial therapy. Doripenem, a broad-spectrum carbapenem, provides coverage of key Gram-negative and positive aerobes and anaerobes encountered in complicated intraabdominal infections. In two trials in patients with complicated intraabdominal infections, doripenem was not inferior to meropenem. ⋯ Microbiological cure rates were 84.3% with doripenem and 84.5% with meropenem. Doripenem was more effective in the treatment of patients with Pseudomonas aeruginosa. In conclusion, doripenem is a valuable addition to the options available for the empirical treatment of hospitalized patients with serious intraabdominal infections.
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Enferm. Infecc. Microbiol. Clin. · Sep 2010
Review[Intraabdominal hypertension and abdominal compartment syndrome].
Although intraabdominal pressure (IAP) has been studied for more than 100 years, the concepts of intraabdominal hypertension (IAH) and abdominal compartmental syndrome (ACS) have only been developed as clinical entities of interest in intensive care in the last 5 years. At the first Congress on Abdominal Compartment Syndrome in December 2004, a series of definitions were established, which were published in 2006. IAH is defined as IAP ≥ 12 mmHg and is classified in four severity grades, the maximum grade being ACS, with the development of multiorgan failure. ⋯ The only treatment for ACS is surgical decompression. In patients with moderate IAH, medical treatment should be optimized, based on the following measures: a) serial IAP monitoring; b) optimization of systemic perfusion and the function of the distinct systems in patients with high IAP; c) instauration of specific measures to decrease IAP; and d) early surgical decompression for refractory IAH. The application of the medical measures that can reduce IAP and early abdominal decompression in ACS improve survival in critically ill patients with IAH.
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Enferm. Infecc. Microbiol. Clin. · Sep 2010
Review[What should and should not be covered in intraabdominal infection].
Despite improvements in our knowledge of the physiopathology of severe infection, diagnostic methods, antibiotic therapy, postoperative care and surgical techniques, a substantial number of patients with intraabdominal infection (IAI) will develop advanced stages of septic insult requiring admission to the intensive care unit. The success of treatment of IAI is multifactorial and the best antibiotic protocol may be insufficient unless adequate control of the focus of infection has been achieved. ⋯ We also analyze the patients at risk of infection with microorganisms requiring broad-spectrum antimicrobial coverage. However, excessive antibiotic treatment, in terms of either spectrum or duration, could jeopardize future patients in an environment already threatened by the scarcity of research and development into new molecules required for the emergence of pathogens resistant to current antibiotics.