RESUMEN
In the present study, the incidence and antimicrobial resistance patterns of the microorganisms that caused bloodstream infections (BSIs) in a medical-surgical intensive care unit during the years 2005-2007 were determined. The mean BSI incidence density was 6.56 per 1000 patient-days. The incidence density increased linearly during the study period (from 3.57 to 9.60 per 1000 patient-days). Staphylococcus aureus was most frequently isolated (47.3%), followed by Enterococcus spp. (10.8%) and Candida spp. (10.1%). There was a high rate of resistance to several of the prescribed antimicrobials among the bacteria isolated from patients with BSIs.
Asunto(s)
Bacteriemia/microbiología , Infecciones Bacterianas/microbiología , Fungemia/microbiología , Hongos/clasificación , Bacterias Gramnegativas/clasificación , Bacterias Grampositivas/clasificación , Micosis/microbiología , Bacteriemia/epidemiología , Infecciones Bacterianas/epidemiología , Farmacorresistencia Bacteriana , Fungemia/epidemiología , Hongos/efectos de los fármacos , Hongos/aislamiento & purificación , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/aislamiento & purificación , Humanos , Incidencia , Unidades de Cuidados Intensivos , Pruebas de Sensibilidad Microbiana , Micosis/epidemiologíaRESUMEN
BACKGROUND AND OBJECTIVE: The anaesthetic method for intracranial neurosurgery must provide haemodynamic stability on emergence and allow early evaluation of the neurological status. In this study, we examined the effects of the alpha-2 agonist dexmedetomidine given at the end of the procedure to prevent hyperdynamic responses during extubation and to allow a comfortable and high-quality recovery. METHODS: Forty ASA I-III patients, aged between 18 and 75 yr, having elective intracranial surgery, were divided into two random groups. Standard procedures and drugs were used for monitoring, induction and maintenance. Isoflurane was reduced by 50% 5 min before the end of the surgery, and in Group I dexmedetomidine 0.5 microg kg(-1) and in Group II 20 mL of 0.9% NaCl were administrated intravenously over 60 s. Systolic, diastolic and mean arterial pressures, and heart rate were recorded before intravenous administration and also at 1, 3 and 5 min after administration, 1 min before extubation, during extubation, 1, 3, 5, 10, 15, 20 and 30 min after extubation. Duration of extubation and recovery were noted, and the quality of extubation was evaluated on a 5-point scale. RESULTS: Mean arterial pressure and heart rate were significantly higher in Group II than in Group I (P < 0.01). There were no statistically significant differences between groups regarding the duration of extubation and recovery (P > 0.05). Extubation quality score of all the patients were 1 in Group I and in Group II, the quality scores were 1 for 35%, 2 for 45% and 3 for 20% of the patients (P < 0.001). None of the patients in Group I and Group II showed respiratory depression, nausea or vomiting. CONCLUSION: Without interfering in recovery time, dexmedetomidine 0.5 microg kg(-1) administered 5 min before the end of surgery stabilizes haemodynamics, allows easy extubation, provides a more comfortable recovery and early neurological examination following intracranial operations.
Asunto(s)
Periodo de Recuperación de la Anestesia , Encefalopatías/cirugía , Dexmedetomidina/farmacología , Frecuencia Cardíaca/efectos de los fármacos , Recuperación de la Función/efectos de los fármacos , Adolescente , Adulto , Anciano , Presión Sanguínea/efectos de los fármacos , Femenino , Humanos , Intubación , Masculino , Persona de Mediana Edad , NeurocirugiaRESUMEN
We conducted a prospective study of targeted surveillance of healthcare-associated infections (HAIs) in 13 intensive care units (ICUs) from 12 Turkish hospitals, all members of the International Nosocomial Infection Control Consortium (INICC). The definitions of the US Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (NNISS) were applied. During the three-year study, 3288 patients for accumulated duration of 37 631 days acquired 1277 device-associated infections (DAI), an overall rate of 38.3% or 33.9 DAIs per 1000 ICU-days. Ventilator-associated pneumonia (VAP) (47.4% of all DAI, 26.5 cases per 1000 ventilator-days) gave the highest risk, followed by central venous catheter (CVC)-related bloodstream infections (30.4% of all DAI, 17.6 cases per 1000 catheter-days) and catheter-associated urinary tract infections (22.1% of all DAI, 8.3 cases per 1000 catheter-days). Overall 89.2% of all Staphylococcus aureus infections were caused by methicillin-resistant strains, 48.2% of the Enterobacteriaceae isolates were resistant to ceftriaxone, 52.0% to ceftazidime, and 33.2% to piperacilin-tazobactam; 51.1% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.7% to ceftazidime, 38.7% to imipenem, and 30.0% to piperacilin-tazobactam; 1.9% of Enterococcus sp. isolates were resistant to vancomycin. This is the first multi-centre study showing DAI in Turkish ICUs. DAI rates in the ICUs of Turkey are higher than reports from industrialized countries.