Factors associated with development of nephrotoxicity in patients treated with vancomycin versus daptomycin for severe Gram-positive infections: A practice-based study.

OBJECTIVE: To evaluate nephrotoxicity development in patients treated with vancomycin (VAN) and daptomycin (DAP) for proven severe Gram-positive infections in daily practice. METHODS: A practice-based, observational, retrospective study (eight Spanish hospitals) was performed including patients ≥18 years with a baseline glomerular filtration rate (GFR)>30 mL/min and/or serum creatinine level<2 mg/dL treated with DAP or VAN for >48h. Nephrotoxicity was considered as a decrease in baseline GRF to <50 mL/min or decrease of >10 mL/min from a baseline GRF<50 mL/min. Multivariate analyses were performed to determine factors associated with 1) treatment selection, 2) nephrotoxicity development, and 3) nephrotoxicity development within each antibiotic group. RESULTS: A total of 133 patients (62 treated with DAP, 71 with VAN) were included. Twenty-one (15.8%) developed nephrotoxicity: 4/62 (6.3%) patients with DAP and 17/71 (23.3%) with VAN (p=0.006). No differences in concomitant administration of aminoglycosides or other potential nephrotoxic drugs were found between groups. Factors associated with DAP treatment were diabetes mellitus with organ lesion (OR=7.81, 95%CI:1.39-4.35) and basal creatinine ≥0.9 mg/dL (OR=2.53, 95%CI:1.15-4.35). Factors associated with VAN treatment were stroke (OR=7.22, 95%CI:1.50-34.67), acute myocardial infarction (OR=6.59, 95%CI:1.51-28.69) and primary bacteremia (OR=5.18, 95%CI:1.03-25.99). Factors associated with nephrotoxicity (R2=0.142; p=0.001) were creatinine clearance<80 mL/min (OR=9.22, 95%CI:1.98-30.93) and VAN treatment (OR=6.07, 95%CI:1.86-19.93). Factors associated with nephrotoxicity within patients treated with VAN (R2=0.232; p=0.018) were congestive heart failure (OR=4.35, 95%CI:1.23-15.37), endocarditis (OR=7.63, 95%CI:1.02-57.31) and basal creatinine clearance<80 mL/min (OR=7.73, 95%CI:1.20-49.71). CONCLUSIONS: Nephrotoxicity with VAN was significantly higher than with DAP despite poorer basal renal status in the DAP group.

Bradicardia sinusal sintomática tras inicio de octreotide subcutánea / Symptomatic sinus bradycardia induced by subcutaneous octreotide

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[Analysis of early tracheostomy and its impact on development of pneumonia, use of resources and mortality in neurocritically ill patients]. / Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos.

OBJECTIVE: We analyze the most suitable time to perform tracheostomy in neurocritically ill patients. We compare morbimortality and use of resources between those patients in which tracheostomy was done early (9 days), in a selected group of patients. MATERIAL AND METHODS: We made an observational prospective study involving a group of patients diagnosed as traumatic brain injury (TBI) or stroke, whose tracheostomy was performed during their stay at the Intensive Care Unit. We compared two groups: a) early tracheostomy (during first 9 days of ICU stay); b) late tracheostomy (made on 10th day or later). As variables, we studied: demographic data, severity of illness at admission, admittance department, diagnosis, length of intubation, length of mechanical ventilation (LMV), sedation and antibiotic treatment needs, ventilator-associated pneumonia (VAP) events, ICU length of stay and mortality. We calculated relative risk of suffering from pneumonia and made a multivariate logistic regression to establish which factors were associated with an increased risk of developing pneumonia. Statistical signification p

Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos / Analysis of early tracheostomy and its impact on development of pneumonia, use of resources and mortality in neurocritically ill patients

Objetivos. Analizar el momento más adecuado parala realización de la traqueotomía en enfermos neurocríticos,comparando en una población seleccionadade pacientes las diferencias de morbimortalidad yconsumo de recursos entre el grupo en que se realizó latraqueotomía precozmente (≤9 días) y aquéllos en losque fue más tardía (>9 días).Material y métodos. Estudio prospectivo y observacionalen una población de pacientes con diagnósticode traumatismo craneoencefálico (TCE) o accidentecerebrovascular (ACVA) que precisaron traqueotomíadurante su ingreso en UCI. Se compararon los datosen dos grupos de pacientes: a) traqueotomía precoz(TP) en los primeros 9 días; b) traqueotomía tardía(TT) a partir del 10º día. Variables estudiadas: datosdemográficos, gravedad al ingreso, procedencia, diagnóstico,duración de la intubación orotraqueal (IOT)y de la ventilación mecánica (VM), necesidades desedación y de antibioterapia, frecuencia de neumoníaasociada a ventilación mecánica (NAV), duración de laestancia y mortalidad. Se calculó el riesgo relativo depadecer neumonía y un modelo de regresión logísticamultivariante para determinar los factores asociadosal desarrollo de neumonía. Significación estadísticapara una p≤0.05.Resultados. Se estudiaron 118 pacientes, 60% conTCE. La media de IOT previa a la traqueotomía (TRQ)fue de 12 días y la duración de la VM de 20 días. Sediagnosticaron 94 episodios de NAV en 81 pacientes(68.6%). El grupo de TP muestra menor duración de laVM, de la sedación, de la antibioterapia y de la estanciaen UCI, con menor incidencia de neumonía (p<0.001).La precocidad de la TRQ no influyó en la duración de laestancia hospitalaria (p=0.844), ni en la mortalidad enUCI (p=0.924), ni en la hospitalaria (p=0.754). La mediade edad fue menor en el grupo con TCE (p<0.001),además la TRQ se realiza más tarde (p=0.026) y requieren (..) (AU)

Objective. We analyze the most suitable time to performtracheostomy in neurocritically ill patients. Wecompare morbimortality and use of resources betweenthose patients in which tracheostomy was done early(≤ 9 days) and those in which it was perform later (>9days), in a selected group of patients.Material and methods. We made an observationalprospective study involving a group of patients diagnosedas traumatic brain injury (TBI) or stroke, whosetracheostomy was performed during their stay at theIntensive Care Unit. We compared two groups: a) earlytracheostomy (during first 9 days of ICU stay); b) latetracheostomy (made on 10th day or later). As variables,we studied: demographic data, severity of illness atadmission, admittance department, diagnosis, lengthof intubation, length of mechanical ventilation (LMV),sedation and antibiotic treatment needs, ventilatorassociatedpneumonia (VAP) events, ICU length of stayand mortality. We calculated relative risk of sufferingfrom pneumonia and made a multivariate logisticregression to establish which factors were associatedwith an increased risk of developing pneumonia. Statisticalsignification p < 0.05.Results. We analyzed 118 patients, 60% with TBI.Mean length of intubation before tracheostomy was 12days and mean LMV was 20 days. 94 VAP events werediagnosed in 81 patients (68.6%). Early tracheostomygroup showed lower length of mechanical ventilationand ICU stay, lower length of sedation and antibiotictreatment, and less pneumonia events (p<0,001). Theprecocity of tracheostomy didn’t have any influenceeither on hospital length of stay (p=0.844), ICU mortality(p=0.924) or in-hospital mortality (p=0.754). At theTBI group mean age was lower (p<0.001), tracheostomywas made later (p=0.026), and patients needed a longersedation (p=0.001) and a longer antibiotic treatment(..) (AU)