RESUMEN
OBJECTIVE: To describe the incidence of cardiovascular adverse events in patients with sepsis in its various stages. DESIGN: A longitudinal, descriptive, observational study was carried out. SETTING: Intensive care units of two university hospitals in Bogotá (Colombia). PATIENTS: A number of patients consecutively admitted to the adult ICU with a diagnosis of sepsis, and no evidence of previous ischemic myocardial injury. INTERVENTIONS: Forty-eight hours of electrocardiographic record using Holter technology. MAIN VARIABLES: Ischemia, cardiac arrhythmia, heart rate variability. RESULTS: A total of 100 patients were analyzed, 62% being staged as presenting septic shock. Three percent suffered ischemic events detected by Holter and unnoticed through conventional monitoring. Forty-six percent suffered an arrhythmic event detected by Holter, compared with only 6% as detected by conventional monitoring. Mortality was 40%. All patients showed loss of heart rate variability. CONCLUSION: In this study patients with sepsis showed a low incidence of cardiovascular ischemic events. In contrast, arrhythmic events showed a high incidence. Conventional monitoring failed to detect any of the ischemic events and most arrhythmic events. In this study, cardiovascular events generated by adrenergic discharge had no impact upon mortality.
Asunto(s)
Arritmias Cardíacas/epidemiología , Isquemia Miocárdica/epidemiología , Sepsis/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/tratamiento farmacológico , Arritmias Cardíacas/etiología , Fármacos Cardiovasculares/uso terapéutico , Colombia/epidemiología , Diabetes Mellitus/epidemiología , Electrocardiografía Ambulatoria , Femenino , Estudios de Seguimiento , Frecuencia Cardíaca , Hospitales Universitarios/estadística & datos numéricos , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Incidencia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/tratamiento farmacológico , Isquemia Miocárdica/etiología , Obesidad/epidemiología , Factores de Riesgo , Adulto JovenRESUMEN
A one-day point prevalence study to investigate the patterns of antibiotic use was undertaken in 43 latin American (LA) intensive care units. Of 510 patients admitted, 231 received antibiotic treatment on the day of the study (45%); in 125 cases (54%) due to nosocomial-acquired infections. The most frequent infection reported was nosocomial pneumonia (43%). Only in 122 patients (53%) were cultures performed before starting antibiotic treatment. 33% of the isolated microorganisms were enterobacteriaceae (40% extended-spectrum beta-lactamase-producing), 23% methicillin-resistant Staphylococcus aureus and 17% carbapenems-resistant non-fermentative Gram-negatives. The antibiotics most frequently prescribed were carbapenems (99/231, 43%); alone (60/99, 60%) or in combination with vancomycin (39/99, 40%). "Restricted" antibiotics (carbapenems, vancomycin, piperacillin-tazobactam, broad-spectrum cephalosporins, tigecycline, polymixins and linezolid) were most frequently indicated in severely ill patients (APACHE II score at admission >15, p=0.0007 and, SOFA score at the beginning of the antibiotic treatment >3, p=0.0000). Only 36% of antibiotic treatments were cultured-directed.Our findings help explain the high rates of multidrug-resistant pathogens in LA settings (i.e. ESBL-producing Gram-negatives) and the severity of the registered patients illnesses.