PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock.
Objective: To describe the pharmacokinetic (PK) profile of anidulafungin and to evaluate its concentration in the peritoneal fluid (PF) of patients suspected of suffering from peritoneal infection undergoing abdominal surgery, in order to ensure that therapeutic levels are achieved within the peritoneal cavity. Methods:A descriptive, open, prospective, observational, multicentre and non-interventional study was performed. Anidulafungin was used at conventional doses. Blood and PF samples were obtained on day 2 of treatment or on any of the following days. Results: A total of 31 patients in a serious clinical condition, as demonstrated by high mean clinical severity scale scores (APACHE II and SOFA scores), were included in the study. The mean area under the curve (AUC) in PF was 30% (31 AE 19%) of that determined in the plasma and the maximum concentration (Cmax) reached in PF (mg/l) was close to 1 (0.9 AE 0.5). No adverse effects were observed in any of the 31 patients.Conclusions: Anidulafungin at conventional doses reaches PF concentrations that exceed the minimum inhibitory concentration of the usual Candida spp, which explains the proven efficacy of this echinocandin in the treatment of Candida peritonitis in critically ill patients.
Existe una acuciante escasez de órganos y tejidos para cubrir las necesidades de un gran número de enfermos crónicos, por tanto, revisar las situaciones que viven las familias de los donantes durante el proceso de la donación en relación con la actuación de los profesionales implicados, puede servirnos en el futuro para desarrollar y mejorar pautas que consigan cambiar ciertas actitudes y conductas, con el objetivo de lograr una respuesta más favorable a la donación de órganos. Nos surgió la necesidad de estudiar de forma pormenorizada cada uno de los eslabones del proceso de la donación, que conduce hasta el momento crucial de la entrevista familiar y posterior a ésta, ya que es importante conseguir que el recuerdo de la donación para cada familia concreta, sea lo más positivo posible. Con interés de mejorar los diversos aspectos relacionados con el proceso de donación, nos disponemos desde la Coordinación de Trasplantes a analizar el grado de satisfacción de las familias de donantes con dicho proceso así como a conocer más de cerca los motivos de sus decisiones y sus percepciones con respecto a nuestro trabajo.
Background The polymicrobial nature of complicated intra-abdominal infections makes these infections particularly challenging to treat. The initial selection of antimicrobial therapy is therefore extremely important. Purpose The authors assessed the use of tigecycline in treatment of complicated intra-abdominal infections. Materials and methods A retrospective observational study was made about patients with complicated intra-abdominal infection treated with tigecycline in a Intensive Care Unit from November'07 to December'10. The authors checked: age, sex, APACHE II at admission, aetiology of infection, posology, antibiograms, duration of the treatment in days, clinical recovery and death. Results During the study, 97 patients were included: 64 men and 33 women. The mean age was 58,5±17,7 years. With regard to the aetiology of infections, 64 patients were diagnosed of secondary peritonitis, 27 of abscesses and 6 presented tertiary peritonitis. The microorganisms more frequently identified were gram-negative bacilli (Escherichia Coli found predominantly) and gram-positive cocci (Enterococcus spp.)The average in the scale APACHE II was 16,5 ±7 points. The percentage of patients at admission with sepsis and septic shock was 43,3% and 56,7%, respectively. All the patients received the first dose of 100 mg followed of 50 mg every 12 h for intravenous route. The average duration of the treatment was of 9,5±3.75 days. Clinical recovery occurred in most patients (80,7%). The death rate was 27,8%, which was lower than expected, according to the scale APACHE II (36,7% expected). With regard to the safety, serious adverse effects associated to tigecycline were not registered. Conclusions Our finding shows that tigecycline was effective and safe in complicated intra-abdominal infections when it was used according to authorised conditions (dosage and indications)
Liver transplantation (LT) is a common current technique for end-stage liver disease. Complications after the surgical procedure, though uncommon, can be of very different origin and can also be severe enough to lead to liver and multiorgan failure and finally graft loss and/or recipient's death. Intensivists and the surgical team must be familiarized with these early complications to detect them as soon as possible in order to use the best diagnostic tools and take the best therapeutic measures to restore anatomical integrity and organ function to optimize the liver graft. In this chapter, we present an updated state of the art for efficiently tackling with all different, most usual complications that an LT patient can present during early postoperative period.
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