ABSTRACT
Reading an antibiogram, however simple it may appear at first glance, is full of sometimes implicit but valuable information in the daily practice of the physician. A more subtle reading requires knowledge in the microbiology and pharmacology fields, even more so in the presence of resistant bacteria. The aim of this article is to provide the clinician with some keys to read and understand an antibiogram in the current context.
La lecture d'un antibiogramme, aussi simple qu'elle puisse paraître au premier coup d'Åil, regorge d'informations parfois implicites qui peuvent être précieuses dans la pratique quotidienne du médecin clinicien. Une lecture plus approfondie nécessite quelques connaissances de microbiologie et de pharmacologie, ce d'autant plus lorsque la bactérie est multirésistante. Cet article a pour but d'apporter quelques clés de lecture de l'antibiogramme au médecin clinicien dans ce contexte.
Subject(s)
Anti-Bacterial Agents , Reading , Humans , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Bacteria , Microbial Sensitivity TestsABSTRACT
BACKGROUND: Neuraxial blockade is used as primary anesthetic technique in one third of surgical procedures. The authors tested whether bisoprolol would protect patients at risk for cardiovascular complications undergoing surgery with spinal block. METHODS: The authors performed a double-blinded, placebo-controlled, multicenter trial to compare the effect of bisoprolol with that of placebo on 1-yr composite outcome including cardiovascular mortality, nonfatal myocardial infarction, unstable angina, congestive heart failure, and cerebrovascular insult. Bisoprolol was given orally before and after surgery for a maximum of 10 days. Adrenergic receptor polymorphisms and safety outcome measures of bisoprolol therapy were also determined. RESULTS: A total of 224 patients were enrolled. Spinal block could not be established in 5 patients. One hundred ten patients were assigned to the bisoprolol group, and 109 patients were assigned to the placebo group. The mean duration of treatment was 4.9 days in the bisoprolol group and 5.1 days in the placebo group. Bisoprolol therapy reduced mean heart rate by 10 beats/min. The primary outcome was identical between treatment groups and occurred in 25 patients (22.7%) in the bisoprolol group and 24 patients (22.0%) in the placebo group during the 1-yr follow-up (hazard ratio, 0.97; 95% confidence interval, 0.55-1.69; P = 0.90). However, carriers of at least one Gly allele of the beta1-adrenergic receptor polymorphism Arg389Gly showed a higher number of adverse events than Arg homozygous (32.4% vs. 18.7%; hazard ratio, 1.87; 95% confidence interval, 1.04-3.35; P = 0.04). CONCLUSIONS: Perioperative bisoprolol therapy did not affect cardiovascular outcome in these elderly at-risk patients undergoing surgery with spinal block.
