ABSTRACT
BACKGROUND: Ceftobiprole is a fifth-generation cephalosporin that has been approved in Europe solely for the treatment of community-acquired and nosocomial pneumonia. The objective was to analyze the use of ceftobiprole medocaril (Cefto-M) in Spanish clinical practice in patients with infections in hospital or outpatient parenteral antimicrobial therapy (OPAT). METHODS: This retrospective, observational, multicenter study included patients treated from 1 September 2021 to 31 December 2022. RESULTS: A total of 249 individuals were enrolled, aged 66.6 ± 15.4 years, of whom 59.4% were male with a Charlson index of four (IQR 2-6), 13.7% had COVID-19, and 4.8% were in an intensive care unit (ICU). The most frequent type of infection was respiratory (55.8%), followed by skin and soft tissue infection (21.7%). Cefto-M was administered to 67.9% of the patients as an empirical treatment, in which was administered as monotherapy for 7 days (5-10) in 53.8% of cases. The infection-related mortality was 11.2%. The highest mortality rates were identified for ventilator-associated pneumonia (40%) and infections due to methicillin-resistant Staphylococus aureus (20.8%) and Pseudomonas aeruginosa (16.1%). The mortality-related factors were age (OR: 1.1, 95%CI (1.04-1.16)), ICU admission (OR: 42.02, 95%CI (4.49-393.4)), and sepsis/septic shock (OR: 2.94, 95%CI (1.01-8.54)). CONCLUSIONS: In real life, Cefto-M is a safe antibiotic, comprising only half of prescriptions for respiratory infections, that is mainly administered as rescue therapy in pluripathological patients with severe infectious diseases.
Subject(s)
Aortic Valve/microbiology , Bioprosthesis/microbiology , Candidiasis/microbiology , Endocarditis/microbiology , Heart Valve Prosthesis/microbiology , Mitral Valve/microbiology , Aged , Aortic Valve/diagnostic imaging , Candida albicans/isolation & purification , Candidiasis/diagnostic imaging , Device Removal , Endocarditis/diagnostic imaging , Female , Heart Valve Prosthesis Implantation/adverse effects , Humans , Mitral Valve/diagnostic imaging , Postoperative Complications/diagnostic imaging , Postoperative Complications/microbiology , ReoperationABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Urinary Tract Infections/therapy , Klebsiella pneumoniae/isolation & purification , Administration, Intravesical , Colistin/administration & dosage , Klebsiella Infections/drug therapy , Urinary Tract Infections/microbiology , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/administration & dosageSubject(s)
Colistin , Klebsiella Infections , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins , Colistin/pharmacology , Colistin/therapeutic use , Drug Resistance, Multiple, Bacterial , Humans , Klebsiella Infections/complications , Klebsiella Infections/drug therapy , Klebsiella pneumoniae , beta-LactamasesABSTRACT
A 52-year-old male patient, who underwent mitral replacement with a mechanical prosthesis as a child, sustained a cardiac arrest which was successfully resuscitated. Further investigation showed prosthesis malfunction with significant regurgitation in the context of multi-organ failure. In such a life-threatening condition, veno-arterial extracorporeal membrane oxygenation was considered as a rescue procedure to achieve optimisation of clinical status to allow definitive surgical treatment. An unusual complete fracture of the prosthesis was subsequently identified as the cause of acute dysfunction.
ABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Salmonella enteritidis/pathogenicity , Abdominal Abscess/diagnostic imaging , Abdominal Abscess/drug therapy , Abdominal Abscess/etiology , Salmonella Infections/complicationsABSTRACT
Postoperative bleeding with its important socioeconomic cost is associated with an increased morbidity and mortality. It causes hemodynamic instability, increases blood loss, and multiplies the number of transfusions required. Especially in vascular or aortic surgery, postoperative bleeding can become a life-threatening complication due to anticoagulant or antiaggregation preoperative status or postoperative coagulation dysfunction after a high level of heparinization. Presently described is the case of a patient who underwent an aortic valve and ascending aorta replacement. A simple but effective method to achieve hemostasis, designed particularly for aortic surgery and the use of Dacron grafts, is presented. No residual adherence or contraindications exist, and it can potentially be applied to any kind of surgical process. This method offers a cheap, biocompatible, and highly effective means to achieve complete hemostasis without the use of extra sutures, or expensive synthetic or allogeneic hemostatic agents or sealants.
Subject(s)
Adipose Tissue , Cardiac Surgical Procedures/methods , Hemostatic Techniques , Adipose Tissue/surgery , Adipose Tissue/transplantation , Aorta/surgery , Aortic Valve/surgery , Humans , Male , Middle Aged , Postoperative Hemorrhage/prevention & controlSubject(s)
Cardiac Conduction System Disease/etiology , Coronary Thrombosis/etiology , Postoperative Complications/diagnosis , Aged, 80 and over , Aortic Valve Stenosis/surgery , Cardiac Conduction System Disease/diagnosis , Cardiac Conduction System Disease/pathology , Coronary Thrombosis/diagnosis , Coronary Thrombosis/pathology , Female , Heart Valve Prosthesis Implantation/methods , Humans , Postoperative Complications/pathologyABSTRACT
BACKGROUND: Daptomycin is a bactericidal antibiotic approved for the treatment of skin and soft tissue infections and right-side endocarditis. However, there is a lack of published data outlining its usefulness in vascular graft infections (VGI). The aim of this study was to describe the clinical experience of daptomycin use in the treatment of VGI caused by Gram-positive bacteria. METHODS: This was a retrospective cohort study of patients diagnosed with VGI receiving daptomycin at a tertiary care hospital during the period January 2010 to December 2012. RESULTS: Of a total 1066 consecutive patients who had undergone vascular grafts (VG), 25 were diagnosed with VGI. Fifteen of these patients (11 prosthetic VG, three autologous VG, one both types) received daptomycin (median dose 6.7mg/kg/day, range 4.1-7.1mg/kg/day; median age 69 years, range 45-83 years; 80% male). The infected bypass was removed in 13 cases. The most common reason for selecting daptomycin was kidney failure (53%). The Gram-positive organisms isolated were coagulase-negative Staphylococcus (n=10), Staphylococcus aureus (n=3) (two methicillin-resistant S. aureus), Enterococcus faecium (n=2), and Enterococcus faecalis (n=1). The mean follow-up was 69 months (interquartile range 48-72 months). Ten patients (66.7%) achieved complete healing of the VGI. A recurrence of the infection was observed in 100% of patients in whom the bypass was not removed. Among patients who did not achieve complete healing, one needed a supracondylar amputation and one died as a consequence of infection. Five patients received treatment with rifampicin in addition to daptomycin and they were all cured. CONCLUSIONS: The use of daptomycin and surgery for Gram-positive VGI was effective and well tolerated, and this may be a good alternative for the treatment of VGI in patients with peripheral arterial disease in whom renal insufficiency is common.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Daptomycin/therapeutic use , Gram-Positive Bacterial Infections/drug therapy , Vascular Grafting , Aged , Aged, 80 and over , Endocarditis/drug therapy , Endocarditis/microbiology , Endocarditis/surgery , Enterococcus faecalis/drug effects , Enterococcus faecium/drug effects , Female , Follow-Up Studies , Humans , Male , Methicillin-Resistant Staphylococcus aureus/drug effects , Middle Aged , Recurrence , Retrospective Studies , Rifampin/therapeutic use , Skin Diseases, Infectious/drug therapy , Skin Diseases, Infectious/microbiology , Soft Tissue Infections/drug therapy , Soft Tissue Infections/microbiology , Staphylococcus aureus/drug effects , Treatment Outcome , Wound Healing/drug effectsSubject(s)
Abdominal Abscess/etiology , Salmonella Infections/complications , Salmonella enteritidis/isolation & purification , Splenic Diseases/etiology , Stomach Diseases/etiology , Abdominal Abscess/microbiology , Diabetes Complications/microbiology , Disease Susceptibility , Feces/microbiology , Humans , Male , Middle Aged , Splenic Diseases/microbiology , Stomach Diseases/microbiologySubject(s)
Humans , Female , Aged, 80 and over , Postoperative Complications/diagnosis , Coronary Thrombosis/etiology , Cardiac Conduction System Disease/etiology , Aortic Valve Stenosis/surgery , Postoperative Complications/pathology , Coronary Thrombosis/pathology , Heart Valve Prosthesis Implantation/methods , Cardiac Conduction System Disease/diagnosis , Cardiac Conduction System Disease/pathologySubject(s)
Aortic Dissection/etiology , Spinal Puncture/adverse effects , Aged, 80 and over , Female , Humans , Sternum/surgeryABSTRACT
We report a dramatic case of meningococcal sepsis manifesting as purpura fulminans in an elderly diabetic woman. Hemodynamic instability and severe bilateral cutaneous lesions involving her hands and feet developed rapidly. Specific antibiotic therapy and the administration of inotropic and vasopressor drugs were initiated. The severity and extension of the cutaneous lesions (attributed to purpura fulminans) worsened because of the need for vasoconstrictors for the treatment of septic shock. Bilateral transmetatarsal and metacarpal amputations were required to stabilize the patient.