ABSTRACT
Objetivo. La presencia de microorganismos resistentes es una causa importante de fallo en el tratamiento antimicrobiano inicial. Los objetivos de este estudio son conocer el perfil de resistencia de los microorganismos causantes de bacteriemia de origen abdominal e identificar si el uso previo de antibióticos y el lugar de adquisición de la bacteriemia son factores de riesgo para determinar la presencia de microorganismos resistentes. Material y método. Se diseñó un estudio de cohorte retrospectiva de todos los pacientes adultos que presentaron bacteriemia y/o fungemia cuyo foco infeccioso primario fue de origen abdominal ingresados en un hospital universitario durante los años 2011-2013. Se describieron los perfiles de resistencia a los antimicrobianos y se utilizó una comparación de proporciones con un test chi cuadrado al 95% de confianza para determinar si las variables estudiadas fueron factores de riesgo en el aislamiento de microorganismos resistentes. Resultados. De un total de 1.245 pacientes con bacteriemia, 212 (17%) presentaron bacteriemia de origen abdominal. Respecto al perfil de resistencias destacó Staphylococcus aureus resistente a meticilina (50%), estafilococos coagulasa negativos resistentes a linezolid (20,58%), enterococos resistentes a vancomicina (3,12%), Escherichia coli resistente a cefalosporinas de 3.a generación (9,9%) y fluorquinolonas (35,64%), Klebsiella pneumoniae resistente a fluorquinolonas (8,33%), Pseudomonas aeruginosa resistente a quinolonas y carbapenem (25 y 25% respectivamente), Acinetobacter baumanii resistente a quinolonas y carbapenem (100% y 100% respectivamente), Candida albicans resistente a fluconazol (11,11%), la única Candida krusei aislada resistente a fluconazol y Candida parapsilosis resistente a equinocandinas (12,5%). En nuestro estudio, el uso previo de antibiótico tuvo asociación estadísticamente significativa con el aislamiento de microorganismos resistentes (p=0,013) pero no el lugar de adquisición de la bacteriemia (p=0,239). Conclusiones. Conocer la incidencia de microorganismos resistentes en cada hospital puede mejorar el tratamiento antimicrobiano empírico inicial en pacientes con bacteriemia de origen abdominal. El uso previo de antibióticos se relacionó de forma estadísticamente significativa con el aislamiento de microorganismos resistentes (AU)
Objective. The presence of resistant microorganisms is a major cause of failure in initial empirical antimicrobial therapy. The objectives of this study are to determine the resistance profile of microorganisms that cause bacteraemia of abdominal origin and to identify whether the previous use of antibiotics and the place of acquisition of bacteraemia are risk factors associated with the presence of resistant organisms. Material and methods. A clinical, observational, epidemiological, retrospective cohort study was conducted with all the adult patients admitted to a university hospital from 2011-2013. Antimicrobial resistance profiles were described and a 95% confidence interval chi-square test was used to determine whether the variables studied were risk factors in the isolation of resistant microorganisms. Results. Of the 1245 patients with bacteraemia, 212 (17%) presented bacteraemia of abdominal origin. The resistance profile highlights the incidence of methicillin resistant Staphylococcus aureus (50%), coagulase-negative staphylococci resistant to linezolid (20.58%), enterococci resistant to vancomycin (3.12%), Escherichia coli resistant to third-generation cephalosporins (9.9%) and fluoroquinolones (35.64%), Klebsiella pneumoniae resistant to third-generation cephalosporins (8.33%), Pseudomonas aeruginosa resistant to fluoroquinolones and carbapenem (25% and 25% respectively) and Acinetobacter baumanii resistant to fluoroquinolones and carbapenem (100% and 100% respectively), Candida albicans resistant to fluconazole (11.11%), single Candida krusei isolate resistant to fluconazole and Candida parapsilosis resistant to echinocandins (12.5%). In our study, previous use of antibiotics had a statistically significant association with the isolation of resistant microorganisms (P=.013) but not the place of acquisition of bacteraemia (P=.239). Conclusion. Establishing the incidence of resistant organisms can improve empirical antimicrobial therapy in patients with bacteraemia of abdominal origin. Previous use of antibiotics was statistically significantly related to the isolation of resistant microorganisms (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Bacteremia/drug therapy , Bacteremia/epidemiology , Fungemia/drug therapy , Fungemia/epidemiology , Risk Factors , Drug Resistance, Microbial , Anti-Bacterial Agents/therapeutic use , Retrospective Studies , Cohort Studies , Methicillin-Resistant Staphylococcus aureus , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Streptococcus pneumoniae , Vancomycin ResistanceABSTRACT
OBJECTIVE: The presence of resistant microorganisms is a major cause of failure in initial empirical antimicrobial therapy. The objectives of this study are to determine the resistance profile of microorganisms that cause bacteraemia of abdominal origin and to identify whether the previous use of antibiotics and the place of acquisition of bacteraemia are risk factors associated with the presence of resistant organisms. MATERIAL AND METHODS: A clinical, observational, epidemiological, retrospective cohort study was conducted with all the adult patients admitted to a university hospital from 2011-2013. Antimicrobial resistance profiles were described and a 95% confidence interval chi-square test was used to determine whether the variables studied were risk factors in the isolation of resistant microorganisms. RESULTS: Of the 1245 patients with bacteraemia, 212 (17%) presented bacteraemia of abdominal origin. The resistance profile highlights the incidence of methicillin resistant Staphylococcus aureus (50%), coagulase-negative staphylococci resistant to linezolid (20.58%), enterococci resistant to vancomycin (3.12%), Escherichia coli resistant to third-generation cephalosporins (9.9%) and fluoroquinolones (35.64%), Klebsiella pneumoniae resistant to third-generation cephalosporins (8.33%), Pseudomonas aeruginosa resistant to fluoroquinolones and carbapenem (25% and 25% respectively) and Acinetobacter baumanii resistant to fluoroquinolones and carbapenem (100% and 100% respectively), Candida albicans resistant to fluconazole (11.11%), single Candida krusei isolate resistant to fluconazole and Candida parapsilosis resistant to echinocandins (12.5%). In our study, previous use of antibiotics had a statistically significant association with the isolation of resistant microorganisms (P=.013) but not the place of acquisition of bacteraemia (P=.239). CONCLUSION: Establishing the incidence of resistant organisms can improve empirical antimicrobial therapy in patients with bacteraemia of abdominal origin. Previous use of antibiotics was statistically significantly related to the isolation of resistant microorganisms.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteria/drug effects , Digestive System Diseases/microbiology , Drug Resistance, Microbial , Adult , Aged , Anti-Bacterial Agents/adverse effects , Bacteremia/epidemiology , Bacteremia/microbiology , Bacteria/isolation & purification , Candidemia/drug therapy , Candidemia/epidemiology , Candidemia/microbiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Comorbidity , Cross Infection/drug therapy , Cross Infection/microbiology , Digestive System Diseases/complications , Drug Resistance, Fungal , Drug Resistance, Multiple, Bacterial , Female , Hospitals, University/statistics & numerical data , Humans , Male , Middle Aged , Postoperative Complications/drug therapy , Postoperative Complications/microbiology , Retrospective Studies , Risk Factors , Sepsis/epidemiology , Sepsis/microbiology , Spain/epidemiology , Young AdultABSTRACT
La lesión del nervio laríngeo recurrente es una de las principales complicaciones de la cirugía de tiroides y paratiroides. Cuando esta lesión es bilateral, se produce una obstrucción aguda de la vía aérea con compromiso vital para el paciente. Con la identificación visual intraoperatoria se consigue preservar la integridad nerviosa más frecuentemente que si no se identifica el nervio. Para ayudar a identificarlo, se puede monitorizar el nervio laríngeo recurrente utilizando un tubo endotraqueal electromiográfico. En estos casos resulta fundamental el papel del anestesiólogo, colocando correctamente el tubo endotraqueal electromiográfico, de manera que los electrodos hagan contacto con las cuerdas vocales durante toda la intervención. Además, los resultados de la electromiografía se ven afectados por los bloqueantes neuromusculares, por lo que debemos adecuar la elección y dosis garantizando una profundidad anestésica adecuada. La realización de un protocolo conjunto con el resto de especialistas resulta muy útil (AU)
Recurrent laryngeal nerve injury remains one of the main complications in thyroid and parathyroid surgery. When this injury is bilateral, an acute upper airway obstruction may occur, leading to a potentially life-threatening situation for the patient. The visual identification of the nerve during surgery is the best way to preserve its integrity. However identification of the nerves by means of electromyographic stimuli through electrodes attached to endotracheal tubes could help in decreasing nerve injury. In these cases the experience and role of the anesthetist is essential to correctly place the electromyographic endotracheal tube and ensure that the electrodes are in touch with the vocal cords during the surgery. Moreover, the results of the electromyography can be affected by the neuromuscular blocking agents. Therefore, the choice and dose must be adapted, in order to ensure a suitable anesthetic depth, and adequate response (AU)
Subject(s)
Humans , Male , Female , Neuromuscular Monitoring/methods , Electromyography/instrumentation , Electromyography/methods , Electromyography , Anesthesia , Anesthesia, General/methods , Anesthesia, General , Neuromuscular Blockade/instrumentation , Neuromuscular Blockade/methods , Neuromuscular Blockade , Electromyography/standards , Thyroid Diseases/drug therapy , Thyroid Diseases , Thyroid Function Tests/methods , Thyroid Gland/pathology , Neuromuscular Monitoring , Thyroid Gland , Laryngeal Nerves , Laryngeal Nerves/physiopathology , Laryngeal Nerves/surgeryABSTRACT
Recurrent laryngeal nerve injury remains one of the main complications in thyroid and parathyroid surgery. When this injury is bilateral, an acute upper airway obstruction may occur, leading to a potentially life-threatening situation for the patient. The visual identification of the nerve during surgery is the best way to preserve its integrity. However identification of the nerves by means of electromyographic stimuli through electrodes attached to endotracheal tubes could help in decreasing nerve injury. In these cases the experience and role of the anesthetist is essential to correctly place the electromyographic endotracheal tube and ensure that the electrodes are in touch with the vocal cords during the surgery. Moreover, the results of the electromyography can be affected by the neuromuscular blocking agents. Therefore, the choice and dose must be adapted, in order to ensure a suitable anesthetic depth, and adequate response.
Subject(s)
Anesthesia , Electromyography , Intraoperative Neurophysiological Monitoring/methods , Parathyroidectomy , Recurrent Laryngeal Nerve Injuries/diagnosis , Recurrent Laryngeal Nerve Injuries/prevention & control , Thyroidectomy , Electromyography/instrumentation , Equipment Design , Humans , Intraoperative Neurophysiological Monitoring/instrumentation , Intubation, Intratracheal/instrumentationABSTRACT
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