Comparing efficacy of enteral nutrition plus ranitidine and enteral nutrition alone as stress ulcer prophylaxis.

AIM: Adequacy of enteral nutrition (EN) alone as stress ulcer prophylaxis (SUP) is controversial. The aim of this study was to compare efficacy of EN alone and ranitidine plus EN as SUP. METHOD: Critically ill adults with indications to receive SUP were randomized to ranitidine 50 mg IV every 8 h plus EN (SUP) or EN alone (non-SUP) group for 7 days. Besides, endoscopy was performed at the time of recruitment and on day 7. RESULTS: During the study period, only one patient in each group of SUP and non-SUP experienced gastrointestinal bleeding. At the time of recruitment, gastric erosion and erythema were the most endoscopic findings in the SUP and non-SUP groups. These findings did not significantly change at the end of the study (p = 0.21). CONCLUSION: EN was at least effective as ranitidine plus EN as SUP.

Clinical Response and Outcome in Patients with Multidrug Resistant Gram-negative Infections.

OBJECTIVE: In this study, frequency and antimicrobial sensitivity pattern of multidrug resistant (MDR) microorganisms were evaluated in a referral teaching hospital in Iran. METHODS: Patients with MDR Gram-negative pathogens were followed during the course of hospitalization. Demographic data, baseline diseases, type of biological sample, isolated microorganism, type of infection, antibiotic regimen before the availability of the culture result and change in the antibiotic regimen following receiving the antibiogram results, response to the treatment regimen, and duration of hospitalization and patient's outcome were considered variables for each recruited patient. FINDINGS: In 71% of the patients, antibiotic regimens were changed according to the antibiogram results. A carbapenem alone or plus amikacin or ciprofloxacin were selected regimens for patients with extended-spectrum beta-lactamase (ESBL) infections. For patients with probable carbapenem-resistant Enterobacteriaceae infections, a carbapenem plus colistin was the most common antibiotic regimen. Clinical response was detected in 54.5% of the patients who were treated based on the antibiogram results. Clinical response was higher in the ESBL producers (ESBL-P) than the non-ESBL-P infections (75% vs. 52%). However, this difference was not significant (P = 0.09). Most nonresponders (80%) had sepsis due to Klebsiella species. Finally, 41.9% of the patients were discharged from the hospital and 58.2% died. CONCLUSION: Same as other countries, infections due MDR microorganisms is increasing in the recent years. This type of resistance caused poor clinical response and high rate mortality in the patients.

Metoclopramide as intermittent and continuous infusions in critically ill patients: a pilot randomized clinical trial.

AIM: Metoclopramide is commonly used as a prokinetic agent in critically ill patients with enteral feeding intolerance. In this study, noninferiority of metoclopramide as intermittent versus continuous infusion was examined in critically ill patients with enteral feeding intolerance. METHODS: Forty critically ill adults patients were assigned to receive metoclopramide as either intermittent (10 mg every 6 h) or continuous (2 mg/h) infusion. Frequency of feeding intolerance and adverse effects of metoclopramide were assessed during 7 days of study. RESULTS: Number of patients with feeding intolerance during different times of the course was not different between the groups. Although not statistically significant, diarrhea and cardiac rhythm were more common in continuous than intermittent infusion group. CONCLUSION: Continuous and intermittent infusions of metoclopramide showed equivalent effectiveness in critically ill patients.