Manejo terapéutico de aspergilosis invasiva en paciente trasplantado e isavuconazol como nueva alternativa antifúngica / Therapeutic management of invasive aspergillosis in a transplant patient and isavuconazole as a new antifungal alternative

Las infecciones oportunistas en pacientes sometidos a trasplante de órgano sólido (TOS) son una causa de morbimortalidad muy importante. Entre ellas las infecciones fúngicas, aunque menos frecuentes, destacan por su alta mortalidad. Una de las infecciones por hongos más usual es la ocasionada por Aspergillus. El tratamiento de elección de aspergilosis invasiva en un paciente con TOS es voriconazol.Presentamos el caso de un paciente inmunodeprimido tras trasplante renal con cuadro de sepsis grave de origen respiratorio en probable contexto de una aspergilosis invasiva. El interés del caso radica en la intervención farmacéutica en el complejo manejo farmacológico del paciente a lo largo de su estancia en la Unidad de Críticos y en la terapia antimicrobiana satisfactoria con isavuconazol, un nuevo antifúngico. (AU)

Opportunistic infections in patients undergoing solid organ transplantation (TOS) are a very important cause of morbidity and mortality. Among them, fungal infections, stand out for their higher mortality. One of the most frequent fungal infections is caused by Aspergillus. There are more than 150 species of Aspergillus, being Aspergillus fumigatus the most common agent of invasive fungal infections in human. Gold standard treatment for invasive aspergillosis in a patient with TOS is voriconazole.We present the case of a kidney transplanted and immunocompromised patient with severe sepsis of respiratory origin in context of invasive aspergillosis. Interest of this case lies on the multiple pharmaceutical interventions in the patient’s complex pharmacological management throughout his stay in the critics unit and satisfactory treat-ment with isavuconazole, a new antifungal. (AU)

Extubación electiva durante el contacto piel con piel en el prematuro extremo / Elective extubation during skin-to-skin contact in the extremely premature newborn

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Antenatal corticosteroids and perinatal outcomes in infants born at 23-25 weeks of gestation.

OBJECTIVES: To evaluate the perinatal results of infants born between 23 and 25.6 weeks of gestation. METHODS: Medical charts of all women giving birth prematurely (23-25.6 w) from January 2005 to December 2011 were retrospectively reviewed. Cases of malformed infants or deliveries elsewhere were excluded. RESULTS: 198 infants were included. Chorioamnionitis occurred in 86 (43.4%) of the whole group: 26 (86.7%) in the 23-week; 35 (53.8%) in the 24-week and 25 (24.3%) in the 25-week groups. Foetal maturation with antenatal corticosteroids was complete in 119 cases (60.1%): 4 (13.3%) in the 23-week; 35 (53.8%) in the 24-week and 80 (77.7%) in the 25-week groups. Foetal death at birth occurred in 22 cases (11%) and 61 newborns (30.8%) died in the neonatal period. Of the 106 survivors with 2 years complete follow-up, 45 infants (42.4%) did not present sequelae; 16 infants (15.1%) had severe sequelae. A 66.6% (4) of infants born at 23 weeks of gestation did not present sequelae compared with a 32.3% (11) at 24 weeks and 45.4% (30) at 25 weeks. CONCLUSIONS: The chorioamnionitis rate was higher when gestational age was lower. The foetal maturation rate was higher when gestational age was higher. A low severe sequelae rate was observed in the whole series, particularly in the 23-week group where the rate was lower than expected; however, these results could have been influenced by the small size of the 23-week group.