PDF (10 MB) - Jurnalul de Chirurgie

More documents

Recommendations

Info

Articole Multimedia Jurnalul de Chirurgie, Iaşi, 2011, Vol. 7, Nr. 3 [ISSN 1584 – 9341 Frecven cvenţa a rezistenţei ei germenilor gram pozitivi în n Europa Country MRSA MR-CoNSa VR E. faecalis VR E. faecium France 31.5 71 0 0 Germany 17.2 67.4 0 19.7 Greece 36.6 83.3 0 16.7 Ireland 54.7 66.7 0 71.4 Israel 46 80 0 40 Italy 38.3 82.4 1.6 19.4 Poland 27.2 81.3 0 4.3 Spain 25.3 61.9 0 14.3 Sweden 2.1 54.8 0 0 Switzerland 15.7 65.6 0 0 Turkey 30.9 74.4 0 8.6 United Kingdom 42.5 53.3 17.9 66.7 Overall 29.1 71.5 0.9 17.9 Sader et al. BMC Infect Dis 2007;7:29 Europe 2005 Linezolid în tratamentul HAP • este recomandat ca terapie empirică pentru HAP cu debut tardiv sau pentru pacienţii cu factori de risc de GMR • Situaţii clinice obligatorii pentru iniţierea terapiei cu Zyvoxid: – Pacienţi la risc sau cu insuficienţă renală instalată • La acesti pacienţi există tendinţa subdozării vancomicinei – Pacienţi cu risc de nefrotoxicitate sau cu administrare concomitentă de medicamente nefrotoxice http://www.rivm.nl/earss/ ATS/IDSA. Am J Respir Crit Care Med. 2005;171:388-416. Craven DE et al. Infect Dis Clin N Am. 2004;18:939-962. Penetranţa a pulmonară a vancomicinei la pacienţii ii critici Concentration (mg/L) 25 20 15 10 5 0 Serum Interstitium 1 2 3 4 5 6 7 8 9 10 Patient Concentraţiile de Linezolid vs CMI 90 patogeni Gram-pozitivi Concentraţia medie (μg/mL) 70 60 50 40 30 20 Concentration (g/mL) 10 0 –-10 0 Penetrabilitatea linezolid la nivel pulmonar LI Plasmă CMI 90 , Staphylococcus aureus CMI 90 , Enterococcus spp. CMI 90 , Streptococcus pneumoniae 4 8 12 24 ore Georges et al. Eur J Clin Microbiol Infect Dis 1997;16:385–388 388 Adaptat după Conte JE et al. Antimicrob Agents Chemother. 2002; 46:1477,1478. 479
Articole Multimedia Jurnalul de Chirurgie, Iaşi, 2011, Vol. 7, Nr. 3 [ISSN 1584 – 9341 Clinical cure 100% 80% 60% 40% 20% 0% 92.2% 87.6% 190 199 177 202 Rata vindecării clinice Linezolid Teicoplanin All infections Pneumonia SSTI Bacteraemia p=0.005 96.2% 92.9% 51 53 52 56 96.6% 113 117 92.8% 101 111 88.5% 23 26 56.7% 17 30 p=0.009 Wilcox et al. J Antimicrob Chemother 2004;53:335–344 344 Linezolid vs Vancomicin: cin: Vindecare clinică a pacienţilor ilor cu VAP Retrospective analysis of 2 randomized, double-blind studies Clinical cure (% Patients) 70 Linezolid Vancomycin 62.2 60 53.7 50 48.9 40 30 37.7 35.2 21.2 20 P = 0.07 P = 0.02 P = 0.01 10 0 Gram+ VAP S aureus VAP MRSA VAP (n = 434) (n = 214) (n = 70) Adapted Adapted from Kollef from MH, Kollef et al. MH, Intensive et al. Intensive Care Med. Care 2004;30:388-94. Med. 2004;30:388-94. Mortalitatea in pneumoniile cu germeni Gram + Linezolid vs Vancomicin: cin: Pneumonia nosocomială cu MRSA Terapia orală ă cu linezolid – când este posibil Retrospective analysis of 2 randomized, double-blind studies 100 90 80 70 60 Linezolid Vancomycin 50 4 9 14 19 24 29 Time After Diagnosis (days) Adapted from Kollef MH, et al. Intensive Care Med. 2004;30:388-94. Adapted from Wunderink R, et al. Chest. 2003;124:1789-97. Survival (% Patients) Linezolid concentraţie plasmatică (mg/L) 10 Tablete 9 8 7 IV 6 5 4 3 2 1 0 0 2 4 6 8 10 12 14 16 18 20 22 24 Timpul după administrarea dozei (ore) Norrby R. Exp Opin Pharmacother. 2001;2:298. De-escalation escalation in clinical practice Changes in antibiotic therapy based on microbiological results UNKNOWN n=10 Change n=3 Poor clinical resolution Poor clinical resolution n=12 De-escalation escalation n=38 121 episodes Aetiology Appropriate treatment KNOWN n=111 Change n=65 Inappropriate treatment Resistant Adverse events pathogens n=4 n=11 Rello et al. Crit Care Med 2004;32:2183–190 190 Concluzii • Mortalitatea şi frecvenţa pneumoniilor nosocomiale impun ghiduri specifice • Terapia antibiotică nu trebuie amânată (în special, când există factori de risc) • Terapia initială adecvată reduce mortalitatea • Terapia empirică recomandată: – Cefalosporine antipseudomonas/carbapenemi/β-lactamina/inhibitor β- lactamaze – PLUS Fluoroquinolone antipseudomonas /aminiglicozide – PLUS Linezolid / vancomicina • Linezolid este considerat prima optiune de tratament in infectiile pulmonare cu germeni gram pozitivi DATORITA REZULTATELOR CLINICE SI A PENETRABILITATII PULMONARE SUPERIOARE GLICOPEPTIDELOR 480
Page 2 and 3:
Jurnalul de Chirurgie, Iaşi, 2011,
Page 4 and 5:
Cuprins Jurnalul de Chirurgie, Iaş
Page 6 and 7:
Cuprins Jurnalul de Chirurgie, Iaş
Page 8 and 9:
Editorial Jurnalul de Chirurgie, Ia
Page 10 and 11:
Page 12 and 13:
Page 14 and 15:
Page 16 and 17:
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Articole de sinteză Jurnalul de Ch
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Articole originale Jurnalul de Chir
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Cazuri clinice Jurnalul de Chirurgi
Page 134 and 135:
Cazuri clinice Jurnalul de Chirurgi
Page 136 and 137: Cazuri clinice Jurnalul de Chirurgi
Page 168 and 169: Anatomie şi tehnici chirurgicale J
Page 184 and 185: Articole Multimedia Jurnalul de Chi
Page 188 and 189: Istorie Jurnalul de Chirurgie, Iaş
Page 196 and 197: Recenzii Jurnalul de Chirurgie, Ia
show all

PDF (10 MB) - Jurnalul de Chirurgie

Create successful ePaper yourself

Delete template?

Save as template?