Purpose of the study: DRV/r mx is proposed as a therapeutic option for patients with NNRTI toxicity. We aimed to evaluate the impact of switching to DRV/r mx in kidney function and lipid profile. Methods: From March 2009 to June 2012 we conducted an observational, retrospective multicenter study evaluating patients switching to DRV/r mx. Kidney function and lipid levels were measured at baseline and at 48 weeks of DRV/r mx. Renal function was estimated by MDRD GFR. Comparative analyzes were performed using Student's t test for paired samples. Summary of results: We identified 147 patients: women 30.6%, age 49±7yr, 45% IDU, 27.9% heterosexuals, AIDS 41.5%, Caucasian 58.5%, HCV-coinfected 48%, baseline HIV-RNA <1.7 log 93.2%, nadir and baseline CD4 count 180±150 and 663±297 cells/mm3, length of antiretroviral therapy 12.83±4.6 years and of HIV-RNA <1.7 62±43 months. The rate of HIV-RNA <1.7 at week 48 were 78.9% ITT; 92.6% OTT. Improvement was observed in kidney function after 48 w of DRV/r mx, mean 0 w vs 48 w MDRD (84.43±22.32 vs. 87.88±23.24; p=0.001). Subgroup analysis demonstrated significantly higher increases in MDRD in patients with a prior tenofovir-based regimen (TDF), 83.14±21.86 and 48 w 88.97±21.23; p=0.000, and those with a protease inhibitor plus TDF-based regimen (mean 0 w vs 48 w MDRD 80.66±22.53 87.09±23.37; p=0.002). Lipid profile improved significantly in terms of reduction in total cholesterol (mean 0 w col: 192.47±42.44 vs mean 48 w col 170.48±70.79; p=0.013) with an improvement in the ratio total cholesterol/ HDL (0 w 4.46±1.62 vs 48 w ratio 3.97±2.12; p=0.000). There were no significant changes in lipid profile in subgroup analysis according to previous antiretroviral treatment change. Conclusions: Patients switching to DRV/r monotherapy showed significant improvement in kidney function and lipid profile at 48 w, both implied on cardiovascular risk
INTRODUCTION Acute calculous cholecystitis (ACC) is the second surgical cause of emergency consultation in the Western world. According to the Tokyo International Guidelines 2018 (TIG18), the treatment of choice is laparoscopic cholecystectomy in patients with mild or moderate cholecystitis. However, in severe cases there is a great variability of therapeutic options. We analyzed the adequacy of antibiotic therapy by studying intraoperative cultures (bile and peritoneal fluid) and preoperative blood cultures, to identify the effect of this antibiotic therapy on complication and mortality rates. MATERIAL AND METHODS A retrospective unicentric study on a prospective database of 725 ACCs between 2012 and 2016. More than 200 general, clinical, postoperative and microbiological variables are collected, including the antibiogram of the isolated germs in order to determine the adequacy of each administered antibiotic. RESULTS Cultures were performed in 76.1% of the cases, with a greater tendency to cultivate in older patients, men or with greater severity according to TIG18 (p < 0.001). Cultured patients had a higher rate of postoperative complications (p = 0.001). Patients who received adequate empirical antibiotic therapy had a lower rate of complications (50% vs 64%;p=0.037) and lower mortality (2.8% vs 11.8%;p=0.003) compared to patients with resistant germs to the antibiotic therapy given, especially important in severe ACC (3.7% vs 15.7%;p=0.022). CONCLUSIONS Adequate empirical antibiotic therapy is associated with fewer complications, as well as a lower mortality rate, especially in severe ACCs. Patients with severe ACC will probably require empirical broad-spectrum antibiotic coverage.
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