PDF (10 MB) - Jurnalul de Chirurgie
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Articole Multimedia <strong>Jurnalul</strong> <strong>de</strong> <strong>Chirurgie</strong>, Iaşi, 2011, Vol. 7, Nr. 3 [ISSN 1584 – 9341<br />
Clinical cure<br />
<strong>10</strong>0%<br />
80%<br />
60%<br />
40%<br />
20%<br />
0%<br />
92.2%<br />
87.6%<br />
190<br />
199<br />
177<br />
202<br />
Rata vin<strong>de</strong>cării clinice<br />
Linezolid<br />
Teicoplanin<br />
All infections Pneumonia SSTI Bacteraemia<br />
p=0.005<br />
96.2%<br />
92.9%<br />
51<br />
53<br />
52<br />
56<br />
96.6%<br />
113<br />
117<br />
92.8%<br />
<strong>10</strong>1<br />
111<br />
88.5%<br />
23<br />
26<br />
56.7%<br />
17<br />
30<br />
p=0.009<br />
Wilcox et al. J Antimicrob Chemother 2004;53:335–344<br />
344<br />
Linezolid vs Vancomicin:<br />
cin:<br />
Vin<strong>de</strong>care clinică a pacienţilor ilor cu VAP<br />
Retrospective analysis of 2 randomized, double-blind studies<br />
Clinical cure (% Patients)<br />
70 Linezolid<br />
Vancomycin<br />
62.2<br />
60 53.7<br />
50<br />
48.9<br />
40<br />
30<br />
37.7<br />
35.2<br />
21.2<br />
20<br />
P = 0.07 P = 0.02<br />
P = 0.01<br />
<strong>10</strong><br />
0<br />
Gram+ VAP S aureus VAP MRSA VAP<br />
(n = 434) (n = 214) (n = 70)<br />
Adapted Adapted from Kollef from MH, Kollef et al. MH, Intensive et al. Intensive Care Med. Care 2004;30:388-94.<br />
Med. 2004;30:388-94.<br />
Mortalitatea in pneumoniile cu germeni Gram +<br />
Linezolid vs Vancomicin:<br />
cin:<br />
Pneumonia nosocomială cu MRSA<br />
Terapia orală ă cu linezolid –<br />
când este posibil<br />
Retrospective analysis of 2 randomized, double-blind studies<br />
<strong>10</strong>0<br />
90<br />
80<br />
70<br />
60 Linezolid Vancomycin<br />
50<br />
4 9 14 19 24 29<br />
Time After Diagnosis (days)<br />
Adapted from Kollef MH, et al. Intensive Care Med. 2004;30:388-94.<br />
Adapted from Wun<strong>de</strong>rink R, et al. Chest. 2003;124:1789-97.<br />
Survival (% Patients)<br />
Linezolid concentraţie plasmatică<br />
(mg/L)<br />
<strong>10</strong><br />
Tablete<br />
9<br />
8<br />
7<br />
IV<br />
6<br />
5<br />
4<br />
3<br />
2<br />
1<br />
0<br />
0 2 4 6 8 <strong>10</strong> 12 14 16 18 20 22 24<br />
Timpul după administrarea dozei (ore)<br />
Norrby R. Exp Opin Pharmacother. 2001;2:298.<br />
De-escalation escalation in clinical practice<br />
Changes in antibiotic therapy based on microbiological results<br />
UNKNOWN<br />
n=<strong>10</strong><br />
Change n=3<br />
Poor clinical<br />
resolution<br />
Poor clinical<br />
resolution<br />
n=12<br />
De-escalation<br />
escalation<br />
n=38<br />
121 episo<strong>de</strong>s<br />
Aetiology<br />
Appropriate<br />
treatment<br />
KNOWN<br />
n=111<br />
Change<br />
n=65<br />
Inappropriate<br />
treatment<br />
Resistant<br />
Adverse events<br />
pathogens<br />
n=4<br />
n=11<br />
Rello et al. Crit Care Med 2004;32:2183–190<br />
190<br />
Concluzii<br />
• Mortalitatea şi frecvenţa pneumoniilor nosocomiale impun ghiduri specifice<br />
• Terapia antibiotică nu trebuie amânată (în special, când există factori <strong>de</strong> risc)<br />
• Terapia initială a<strong>de</strong>cvată reduce mortalitatea<br />
• Terapia empirică recomandată:<br />
– Cefalosporine antipseudomonas/carbapenemi/β-lactamina/inhibitor β-<br />
lactamaze<br />
– PLUS Fluoroquinolone antipseudomonas /aminiglicozi<strong>de</strong><br />
– PLUS Linezolid / vancomicina<br />
• Linezolid este consi<strong>de</strong>rat prima optiune <strong>de</strong> tratament in infectiile<br />
pulmonare cu germeni gram pozitivi DATORITA REZULTATELOR<br />
CLINICE SI A PENETRABILITATII PULMONARE SUPERIOARE<br />
GLICOPEPTIDELOR<br />
480
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