RESUMO
Acinetobacter spp. and Pseudomonas aeruginosa are common pathogens of ventilator-associated pneumonia (VAP). The presentation and outcome of VAP due to Acinetobacter spp. and P. aeruginosa susceptible to carbapenems (Carb-S; imipenem and/or meropenem) and to colistin only (Col-S) were compared in the present retrospective study in three intensive care units. A total of 61 episodes of VAP caused by Acinetobacter spp. or P. aeruginosa were studied, of which 30 isolates were Carb-S and 31 were Col-S. Demographics, worsening of renal function and mortality were not different. The univariate analysis showed that a later onset and a previous episode of VAP, prior antimicrobial therapy for >10 days and previous therapy with carbapenems during the present admission were more frequent in patients with Col-S strains. On multivariate analysis, prior antimicrobial therapy for >10 days and a previous episode of VAP remained significantly associated with Col-S VAP. Approximately 41% of the infections caused by Col-S isolates, but none of those due to Carb-S isolates, had received prior carbapenem therapy. Colistin-susceptible ventilator-associated pneumonia episodes can be effectively treated using colistin without significant renal dysfunction. This susceptibility pattern could be suspected in patients with a previous ventilator-associated pneumonia episode or prior antibiotic therapy for >10 days preceding the present ventilator-associated pneumonia episode.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Antibacterianos/uso terapêutico , Colistina/uso terapêutico , Pneumonia/tratamento farmacológico , Pneumonia/microbiologia , Infecções por Pseudomonas/tratamento farmacológico , Respiração Artificial/efeitos adversos , Infecções por Acinetobacter/complicações , Infecções por Acinetobacter/microbiologia , Análise de Variância , Distribuição de Qui-Quadrado , Resistência Microbiana a Medicamentos , Feminino , Humanos , Imipenem/uso terapêutico , Masculino , Meropeném , Pessoa de Meia-Idade , Pneumonia/etiologia , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Fatores de Risco , Tienamicinas/uso terapêutico , Ventiladores MecânicosRESUMO
1. Total skinfold thicknesses (sum of seven sites) were measured in fifty-seven pregnant women with low energy and protein intake, at weeks 24, 30 and 35 of gestation. 2. Women were classified in two groups (overweight and low weight), according to their weight-for-height at week 24 of gestation. 3. Half of the women did not increase, or even reduced the amount of subcutaneous fat during the observation period. The lowest mean value of total skinfold thickness was found in the low-weight women who showed a reduction of the subcutaneous fat. 4. This finding shows that a significant proportion of malnourished women do not follow the average pattern of subcutaneous fat accumulation seen in healthy pregnant women without food intake restriction, during the second half of pregnancy.