ObjectiveTo describe a single center experience involving the administration of colistin to treat nosocomial infections caused by multidrug-resistant Gram-negative bacteria and identify factors associated with acute kidney injury and mortality.MethodsThis retrospective longitudinal study evaluates critically ill patients with infections caused by multidrug-resistant Gram-negative bacteria. All adult patients who required treatment with intravenous colistin (colistimethate sodium) from January to December 2008 were considered eligible for the study. Data include demographics, diagnosis, duration of treatment, presence of acute kidney injury and 30-day mortality.ResultsColistin was used to treat an infection in 109 (13.8%) of the 789 patients admitted to the intensive care unit. The 30-day mortality observed in these patients was 71.6%. Twenty-nine patients (26.6%) presented kidney injury prior to colistin treatment, and six of these patients were able to recover kidney function even during colistin treatment. Twenty-one patients (19.2%) developed acute kidney injury while taking colistin, and 11 of these patients required dialysis. The variable independently associated with the presence of acute kidney injury was the Sequential Organ Failure Assessment at the beginning of colistin treatment (OR 1.46; 95%CI 1.20-1.79; p<0.001). The factors age (OR 1.03; 95%CI 1.00-1.05; p=0.02) and vasopressor use (OR 12.48; 95%CI 4.49-34.70; p<0.001) were associated with death in the logistic-regression model.ConclusionsOrgan dysfunction at the beginning of colistin treatment was associated with acute kidney injury. In a small group of patients, we were able to observe an improvement of kidney function during colistin treatment. Age and vasopressor use were associated with death.
Cystic fibrosis (CF) is an autosomal recessive inherited disease secondary to a defect in the CF transmembrane conductance regulator gene (CFTR). Mortality in CF is associated with impairment of lung function in which bacterial infection plays a fundamental role. The microorganism Pseudomonas aeruginosa (P. aeruginosa) is a marker of poor prognosis. Tobramycin was the first parenteral antibiotic to be used as inhaled medication in CF. Owing to its beneficial effects; it was subsequently used in designed inhaled formulations. The first formulation was the inhalation solution, which improved lung function, lowered hospitalization rates, and reduced the courses of intravenous antibiotic. However, the high associated costs and time necessary to administer the medication negatively affected quality of life. The recent development of tobramycin inhalation powder has optimized treatment. The dry powder inhaler is a simple device that reduces administration time and improves adherence. As there is no risk of bacterial contamination, disinfection is unnecessary.
RESUMOO presente estudo objetivou relatar o isolamento de Pseudonomas aeruginosa resistente à Colistina após tentativas de tratar uma pneumonia hospitalar. As informações foram obtidas por meio da revisão do prontuário médico após identificação de Pseudomonas aeruginosa resistente à Colistina pelo Laboratório de Microbiologia da própria instituição. Considerações finais: o caso relatado retoma a discussão das dificuldades atuais na terapêutica antimicrobiana destinada à infecção hospitalar, principalmente quando acomete pacientes idosos e internados em Unidade de Terapia Intensiva. Palavras-chave:Pseudomonas aeruginosa, resistência à Colistina, relato de caso. INTRODUÇÃOSegundo o Ministério da Saúde, a infecção hospitalar é qualquer infecção adquirida após a internação do paciente que manifesta durante a internação ou mesmo após a alta, quando puder ser relacionada com a internação ou procedimentos hospitalares. As Unidades de Terapia Intensiva (UTIs) são consideradas o alvo de resistência microbiana, já que os pacientes muitas vezes são portadores de doenças graves, são submetidos à prescrição de antimicrobianos e a vários procedimentos invasivos, o que os expõem a infecções 1 . O paciente idoso, os prematuros e recém nascidos são os mais susceptíveis a adquirir uma infecção hospitalar. A pneumonia, por fatores que a favorecem como presença de outras doenças, de bactérias na cavidade oral, aspirações freqüentes do conteúdo da cavidade oral, de onde as bactérias são levadas para os pulmões, defeitos dos mecanismos de defesa do organismo, desnutrição e necessidade de hospitalizações freqüentes, é a infecção mais prevalente em idosos 2 . A pneumonia é uma das principais causas de mortalidade em idosos internados, sendo a maioria de origem bacteriana como Streptococcus pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Haemophilus influenzae, Moraxella catarrhalis e Staphylococcus aureus. Geralmente o tratamento inicial para estas infecções é empírico, com antibioticoterapia baseada na idade, unidade onde a infecção foi adquirida, na possibilidade de aspiração de secreção da orofaringe, presença de comorbidades e condições imunológicas do paciente 3 . Para a Sociedade Brasileira de Pneumologia e Tisiologia, a escolha adequada dos antibióticos é de fundamental importância. É imprescindível o conhecimento da prevalência dos agentes
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