[To go in-depth in the knowledge of the device to control fecal elimination in the critical patient]. / Profundizando en el conocimiento sobre el manejo del dispositivo para control de la eliminación fecal en el paciente crítico.

OBJECTIVE: To describe the general characteristics of the patient and device use. To know retention balloon pressure (RBP) and related factors. To identify rate of leakage incidence, relocation and perineal damage due to the device (PSD) and related risk factors. MATERIAL AND METHODS: An analytical observational, cross-sectional study conducted in a polyvalent ICU from June-December 2010 was performed. The sample included Flexi-Seal(®) carriers. Variables evaluated were patient and device use characteristics, RBP, leakage and quantity, relocation and reason, PSD, sedoanalgesia infusion, neuromuscular block, patient position, Flexi-Seal type catheter, ventilatory mode (VM), intra-abdominal pressure (IAP), mean intrathoracic pressure (MITP), PEEP, Glasgow, color-aspect, fecal consistency and volume. Significance P<.05. RESULTS: Twenty-one patients were included, 52% male, aged 54±17 with 30 insertion episodes, Flexi-Seal-Signal(®) 33%, 10±8 days permanency, main indication 33% «diarrhea and injured skin¼," 30% device removal «intolerance and/or spontaneous expulsion¼. Median (Me) PGR =40; RI (61-19) cmH2O. Factors associated to higher PGR: SCI absence, prone-decubitus position, leakage, relocation, conventional Flexi-Seal(®), MV, lower PEEP and IMP, Color-aspect, higher MITP. Leakage, relocation and PSD incidence density 43, 30 and 2 cases/100 days of catheter, respectively. Leakage and relocation risk factors: higher PGR, Glasgow and fecal volume, lower MITP, MV, assisted-spontaneous mode OR 2.5 CI (1.6-3.8) and OR 1.7(1.1-2.7), absence SCI OR 3.3 (2.2-5.1) and OR 2.4(1.5-3.8), absence neuromuscular block OR 2.4 (1.4-3.9) and OR 1.8 (1.1-3.1), Flexi-Seal(®) conventional OR 2.7(1.7-4.1) and OR 2 (1.2-3.3), respectively. Leakage risk factors: color-aspect, supine position, lower IMP and PEEP. CONCLUSIONS: Monitoring RBP may alert us about leakage presence and relocation need. Knowing associated risk factors to RBP, leakage and relocation would help to develop strategies to reduce their high incidence rate such as decreasing RBP by reducing inflated volume.

[Appropriateness of empiric antibiotic therapy in urinary tract infection in emergency room]. / Adecuación del tratamiento empírico de la infección urinaria en urgencias.

INTRODUCTION: To describe characteristics of urinary tract infections attended in an Emergency Department. To assess antibiotic prescription and inappropriate treatment implications. METHODS: Adults patients attended in an Emergency Department during 2 months with UTI confirmed with urocultive were included. Appropriate antibiotic treatment was considered if the first antibiotic used was sensitive. We compared patients with appropriate and inappropriate antibiotic treatment. A logistic regression was performed to evaluate variables associated to inappropriate antibiotic treatment. RESULTS: A total of 151 patients were included (61% women, 67.1[22.3] years). Comorbidity was present in 63% of patients. Urinary sepsis was the most frequent diagnosis (32.5%). E coli was isolated in 65.6% of cases, and 10% presented bacteremia. Percentage of inappropriate antibiotic treatment was 20.5. It was associated (uncontrolled analysis) with male gender, elder patients, recent urinary simptoms, urologic manipulation more than 1 month ago, previous antibiotic use (especially ciprofloxacin or amoxicillin-clavulanate) and presentation with urinary sepsis. Logistic regression analysis showed association only with age (HR 0.978 per year, CI95% 0.957-1, p=0.029) and previous antibiotic use (HR 0.298, CI95% 0.098-0.901, p=0.05). Patients with inappropriate antibiotic treatment did not have higher mortality. CONCLUSIONS: Inappropriate antibiotic treatment for UTI in Emergency Department is relatively frequent and it is associated to older age and previous antibiotic use.

Adecuación del tratamiento empírico de la infección urinaria en urgencias / Appropriateness of empiric antibiotic therapy in urinary tract infection in emergency room

IntroducciónSe diseñó este trabajo para describir las infecciones urinarias atendidas en un servicio de urgencias y valorar el grado de adecuación del antibiótico empírico.MétodosSe incluyeron todos los pacientes adultos atendidos en urgencias durante 2 meses con sospecha de infección urinaria con posterior urocultivo positivo. Se consideró tratamiento adecuado si el microorganismo fue sensible al primer antibiótico empleado. Se compararon los pacientes con y sin adecuación y se realizó un análisis de regresión logística para valorar variables asociadas con la inadecuación.ResultadosSe incluyeron 151 pacientes, el 61% eran mujeres y la edad media fue de 67,1 años (22,3). El 63% de los pacientes tenía comorbilidades. El diagnóstico más frecuente fue infección urinaria febril sin foco claro (32,5%). Se aisló Escherichia coli en el 65,6% de los pacientes y el 10% tuvo bacteriemia. La inadecuación del tratamiento empírico fue del 20,5%, y se asoció en el análisis univariado a ser varón, de más edad, con menor duración de los síntomas urinarios, con más tiempo transcurrido desde la manipulación urológica, con uso de antibiótico previo (especialmente ciprofloxacino o amoxicilina-clavulánico), y que se presentaban con infección urinaria febril sin foco claro. En el análisis controlado, la edad más avanzada (hazard ratio [HR]: 0,978 por año, IC95%: 0,957–0,999; p=0,029) y el uso de antibiótico previo (HR: 0,298, IC95%: 0,098–0,901; p=0,05) fueron las únicas variables asociadas a inadecuación. Los pacientes que recibieron tratamiento inadecuado no tuvieron mayor mortalidad.ConclusionesLa inadecuación del tratamiento empírico de la infección de la vía urinaria en urgencias es relativamente frecuente y se asocia a la edad avanzada y al uso de antibiótico previo(AU)

IntroductionTo describe characteristics of urinary tract infections attended in an Emergency Department. To assess antibiotic prescription and inappropriate treatment implications.MethodsAdults patients attended in an Emergency Department during 2 months with UTI confirmed with urocultive were included. Appropriate antibiotic treatment was considered if the first antibiotic used was sensitive. We compared patients with appropriate and inappropriate antibiotic treatment. A logistic regression was performed to evaluate variables associated to inappropriate antibiotic treatment.ResultsA total of 151 patients were included (61% women, 67.1[22.3] years). Comorbidity was present in 63% of patients. Urinary sepsis was the most frequent diagnosis (32.5%). E coli was isolated in 65.6% of cases, and 10% presented bacteremia. Percentage of inappropriate antibiotic treatment was 20.5. It was associated (uncontrolled analysis) with male gender, elder patients, recent urinary simptoms, urologic manipulation more than 1 month ago, previous antibiotic use (especially ciprofloxacin or amoxicillin-clavulanate) and presentation with urinary sepsis. Logistic regression analysis showed association only with age (HR 0.978 per year, CI95% 0.957–1, p=0.029) and previous antibiotic use (HR 0.298, CI95% 0.098–0.901, p=0.05). Patients with inappropriate antibiotic treatment did not have higher mortality.ConclusionsInappropriate antibiotic treatment for UTI in Emergency Department is relatively frequent and it is associated to older age and previous antibiotic use(AU)