Medicina intensiva
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The judicious use of existing antibiotics is essential for preserving their activity against infections. In the era of multi-drug resistance, this is of particular importance in clinical areas characterized by high antibiotic use, such as the ICU. ⋯ The use of continuous renal replacement therapy and extracorporeal membrane oxygenation remain important interventions in these patients; however, both of these treatments can have a profound effect on antibiotic exposure. We suggest placing emphasis on the use of therapeutic drug monitoring and dose individualization when optimizing therapy in these settings.
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Pre-emptive isolation refers to the application of contact precaution measures in patients with strongly suspected colonization by multiresistant bacteria. ⋯ The implementation of CPPI resulted in a significant decrease in pre-emptive isolations which were not indicated correctly, a decrease in the time elapsed between isolation and collection of samples, and a decrease in the duration of isolation measures in cases in which isolation was unnecessary, without increasing the rate of "adequate pre-emptive isolation".
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Before deciding increases in the number or capacitance of Intensive Care Units (ICUs), or the regionalization of Units, it is essential to know their present effectiveness. ⋯ The mean occupancy rate of Catalonian ICUs may appear correct, but in some Units over-occupancy very often precludes early ICU treatment and even ICU admission for a significant number of critically ill patients.