RESUMO
A multicenter survey, carried out in 2010 in Argentina, showed an increased prevalence of extended-spectrum ß-lactamase (ESBL)-producing enterobacteria, with some changes in the molecular epidemiology of circulating ESBLs. While enzymes of the CTX-M-2 group remain endemic, the emergence of CTX-M-15 and of enzymes of the CTX-M-8 and CTX-M-9 groups was observed. The CTX-M-15-positive isolates represented 40% of CTX-M producers and included representatives of Escherichia coli ST131 and Klebsiella pneumoniae ST11.
Assuntos
Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/efeitos dos fármacos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Resistência beta-Lactâmica/genética , beta-Lactamases/genética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Argentina/epidemiologia , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Heterogeneidade Genética , Humanos , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/genética , Resistência beta-Lactâmica/efeitos dos fármacos , beta-Lactamases/metabolismo , beta-Lactamas/farmacologia , beta-Lactamas/uso terapêuticoRESUMO
113 consecutive elective liver resections were performed in 107 patients over a period of 8 and half years. The indication was a malignant tumor in 75.2% of cases and a benign lesion in 24.8%. The remnant liver was pathologic in 22.1% of cases (16 steatosis, 8 cirrhosis and 1 fibrosis). The extent of liver resection was major (> or = 3 segments according to Couinaud classification) in 60 cases and minor in 45 cases. No intraoperative mortality occurred. Hospital mortality was 4.4%. Major complications, including death, occurred in 36.3% of cases (41/113). Statistical analysis of various risk factors was performed, regarding age, type of liver disease, cholestasis, surgical approach, extent of resection, type of hepatic vascular clamping, liver ischemia, quality of the remnant liver, intraoperative hemorrhage and length of the procedure. Multivariate analysis demonstrated three major statistically significant risk factors: pre operative cholestasis (r = 0.373; p = 0.0012), extent of liver resection (r = 0.377; p = 0.0011), and intra operative blood transfusion (r = 0.364; p < 0.008) with a global correlation coefficient of 0.582 (p < 0.0001). These results should lead to better surgical selection for liver resection and reduced morbidity and mortality.
