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Evaluación de la utilización de colistín dentro de un hospital de alta complejidad
(Universidad de Chile, 2018)
predominantemente empíricas (64,8%), mientras que las nebulizadas fueron en su mayor parte microbiológicas (78,3%). La dosis y frecuencia más utilizada fue de 3 millones de Unidades Internacionales (MUI) cada 8 horas, ocupada en 88 ocasiones. Solamente en 5 terapias...
The increase of microbial resistance to antibiotics and the lack of new drugs has promoted the reintroduction into the clinical context of old antibiotics previously in disuse, such as colistin, put aside before due to its toxicity. Many efforts have been done to optimize the use of colistin in the recent years, including the administration of loading doses, increase of its dosing, and the use of combined therapy, so that its administration has been constantly updated. The objective of the current work was to characterize the use of colistin during 2017 in the Hospital Clínico de la Universidad de Chile, characterizing the treated patients, the treatments administered, the associated microbiology, the response to treatment, and associated adverse effects. Under an observational retrospective study, every patient over 18 years that had used intravenous or nebulized colistin for at least 48 hours during January to October 2017 was studied, and their therapies until December 2017 were characterized, by reading their clinical records. Fifty-five patients were included in the study, equivalent to 114 treatments, with the most of infection sites being respiratory (57.9%). Sixty four percent of the treatments started on the Intensive Care Unit (ICU), and only 7% started on a general ward. Most of the patients had been recently hospitalized (86.8%), and most of them also had a previous antibiotic use (90.4%), including previous colistin therapies in 21.1% of the cases. Within the 114 therapies, 79.8% were intravenous and 20.2% were nebulized. The intravenous therapies were mostly empiric (64.8%), while the nebulized ones where in the most part microbiological (78.3%). The most frequently used dose and frequency was 3 million International Units (MIU) every 8 hours, used in 88 therapies. In only 5 treatments (5,5%) a loading dose was used. The two most identified pathogens were Pseudomonas aeruginosa in 41 therapies and Klebsiella spp. in 16 therapies. The P. aeruginosa isolates had a very high susceptibility to colistin (94.9%) and a susceptibility to amikacin of 56.1%, while the susceptibility to beta lactams was very low, close to 20%. According to the identified microbiology, 31 isolates required a colistin treatment, with a favorable response in 87.1% of the cases. In five therapies colistin was deliberately used against non-colistin susceptible pathogens, presenting three favorable responses to treatment and two unfavorable. Regarding the therapies that didn’t required colistin, an empiric therapy was completed in 13.3% of the cases, while in the rest of the treatments the antibiotic therapy was de-escalated or suspended. Thirteen cases of nephrotoxicity concomitant to colistin were recorded (14.3%), being the only type of adverse effect found. Globally, the colistin consumption on this hospital was 2.4 DDD/100 beds/day, and it was higher during January and February. The department with the most consumption was, by far, the ICU, with 45.5 DDD/100 beds/day. From this data, it can be concluded that, in this center, colistin is mainly used for the treatment of respiratory infections caused by Gram-negative bacilli resistant to other antibiotics, especially Pseudomonas aeruginosa, with a favorable response in 87.1% of the cases. Colistin is administered intravenously or nebulized, generally as 3 MIU each 8 hours, and rarely applying loading doses. Based on this evaluation, colistin use must be limited to when it is necessary. To that end, an appropriate sampling is required, duplicity with meropenem should be avoided and, if it is possible, amikacin should be given a bigger role on therapies, either alone or in combination therapy. In the other side, when colistin therapy is needed, it must be optimized, with appropriate doses and combined therapy, and the addition of loading doses...
The increase of microbial resistance to antibiotics and the lack of new drugs has promoted the reintroduction into the clinical context of old antibiotics previously in disuse, such as colistin, put aside before due to its toxicity. Many efforts have been done to optimize the use of colistin in the recent years, including the administration of loading doses, increase of its dosing, and the use of combined therapy, so that its administration has been constantly updated. The objective of the current work was to characterize the use of colistin during 2017 in the Hospital Clínico de la Universidad de Chile, characterizing the treated patients, the treatments administered, the associated microbiology, the response to treatment, and associated adverse effects. Under an observational retrospective study, every patient over 18 years that had used intravenous or nebulized colistin for at least 48 hours during January to October 2017 was studied, and their therapies until December 2017 were characterized, by reading their clinical records. Fifty-five patients were included in the study, equivalent to 114 treatments, with the most of infection sites being respiratory (57.9%). Sixty four percent of the treatments started on the Intensive Care Unit (ICU), and only 7% started on a general ward. Most of the patients had been recently hospitalized (86.8%), and most of them also had a previous antibiotic use (90.4%), including previous colistin therapies in 21.1% of the cases. Within the 114 therapies, 79.8% were intravenous and 20.2% were nebulized. The intravenous therapies were mostly empiric (64.8%), while the nebulized ones where in the most part microbiological (78.3%). The most frequently used dose and frequency was 3 million International Units (MIU) every 8 hours, used in 88 therapies. In only 5 treatments (5,5%) a loading dose was used. The two most identified pathogens were Pseudomonas aeruginosa in 41 therapies and Klebsiella spp. in 16 therapies. The P. aeruginosa isolates had a very high susceptibility to colistin (94.9%) and a susceptibility to amikacin of 56.1%, while the susceptibility to beta lactams was very low, close to 20%. According to the identified microbiology, 31 isolates required a colistin treatment, with a favorable response in 87.1% of the cases. In five therapies colistin was deliberately used against non-colistin susceptible pathogens, presenting three favorable responses to treatment and two unfavorable. Regarding the therapies that didn’t required colistin, an empiric therapy was completed in 13.3% of the cases, while in the rest of the treatments the antibiotic therapy was de-escalated or suspended. Thirteen cases of nephrotoxicity concomitant to colistin were recorded (14.3%), being the only type of adverse effect found. Globally, the colistin consumption on this hospital was 2.4 DDD/100 beds/day, and it was higher during January and February. The department with the most consumption was, by far, the ICU, with 45.5 DDD/100 beds/day. From this data, it can be concluded that, in this center, colistin is mainly used for the treatment of respiratory infections caused by Gram-negative bacilli resistant to other antibiotics, especially Pseudomonas aeruginosa, with a favorable response in 87.1% of the cases. Colistin is administered intravenously or nebulized, generally as 3 MIU each 8 hours, and rarely applying loading doses. Based on this evaluation, colistin use must be limited to when it is necessary. To that end, an appropriate sampling is required, duplicity with meropenem should be avoided and, if it is possible, amikacin should be given a bigger role on therapies, either alone or in combination therapy. In the other side, when colistin therapy is needed, it must be optimized, with appropriate doses and combined therapy, and the addition of loading doses...
Centro integral para el adulto mayor y la comunidad, centro diurno, Cerro Monjas, Valparaíso
(Universidad de Chile, 2017)
título.
1.1 Introducción.
1.2 Motivaciones.
1.3 Problema.
1.4 Objetivos.
Capítulo 02: Marco teórico.
2.1 Caracterización del envejecimiento.
2.1.1 Situación demográfica: Cifras del adulto mayor en Chile.
2.1.2 El adulto mayor.
2.1.3 El fenómeno del...
adulto mayor: enfoques del envejecimiento. 2.1.4 Limitaciones funcionales de la tercera edad. 2.1.5 Discapacidad en el adulto mayor. 2.2 Conceptos básicos de accesibilidad y diseño universal. Capítulo 03: Propuesta de localización. 3.1 Ubicación del...
adulto mayor: enfoques del envejecimiento. 2.1.4 Limitaciones funcionales de la tercera edad. 2.1.5 Discapacidad en el adulto mayor. 2.2 Conceptos básicos de accesibilidad y diseño universal. Capítulo 03: Propuesta de localización. 3.1 Ubicación del...
Evaluación de integración sensorial en adultos con esquizofrenia
(Universidad de Chile, 2006)
influyen en el desempeño ocupacional....
Percepción usuaria de beneficios en salud del Programa Más Adultos Mayores Autovalentes en el Servicio de Salud Metropolitano Norte
(Sociedad Médica Santiago, 2020)
304
ARTÍCULO DE INVESTIGACIÓN
Rev Med Chile 2020; 148: 304-310
Percepción usuaria de beneficios
en salud del Programa Más Adultos
Mayores Autovalentes en el Servicio
de Salud Metropolitano Norte
JEAN GAJARDO1,2,a, x...
- cia en Chile2. El deterioro de la capacidad funcional en adultos mayores es un proceso que articula vul- nerabilidades relacionadas con el envejecimiento fisiológico y su interacción con otras variables en el curso de vida, tales como nivel...
- cia en Chile2. El deterioro de la capacidad funcional en adultos mayores es un proceso que articula vul- nerabilidades relacionadas con el envejecimiento fisiológico y su interacción con otras variables en el curso de vida, tales como nivel...
“Garden Dreams"
(Universidad de Chile, 2021-06)
.................................................................................................. 76
5
RESUMEN EJECUTIVO
Garden Dreams, es un lugar de recreación y esparcimiento para adultos mayores en la
comuna de Concepción, región del Biobío. En una innovadora modalidad diurna en
donde encontrarán cuidados y atención personalizada...
importancia de contar con un lugar donde puedan ocuparse de las necesidades de los adultos mayores. Evidenciamos, en la encuesta, que el 87% de los encuestados (N=373) considera que necesario que los adultos mayores participen y asistan a un centro de...
importancia de contar con un lugar donde puedan ocuparse de las necesidades de los adultos mayores. Evidenciamos, en la encuesta, que el 87% de los encuestados (N=373) considera que necesario que los adultos mayores participen y asistan a un centro de...
Cambio psicoterapéutico desde diferentes perspectivas en adolescentes con síntomas depresivos
(Universidad de Chile, 2016)
El presente estudio se inserta en el proyecto Fondecyt número 1141179 “Experiencias de Éxito y Fracaso en Psicoterapia – Construcción de un Modelo Comprehensivo Multidimensional”, liderado por Mariane Krause Jacob. Particularmente este estudio tuvo...
Arteterapia en el limbo : intervenciones para la transición entre la vida y la muerte
(Universidad de Chile, 2015)
Este documento presenta la descripción del proceso de arteterapia con una mujer de cuarenta años en cuidados paliativos por cáncer cerebral avanzado, y las reflexiones que surgen de su viaje creativo por diferentes estados de conexión y consciencia...
Prevalencia y determinantes de adherencia a terapia antihipertensiva en pacientes de la Región Metropolitana
(Sociedad Médica de Santiago, 2015)
569
ARTíCULOS DE INVESTIGACIóN
Rev Med Chile 2015; 143: 569-576
Prevalencia y determinantes
de adherencia a terapia
antihipertensiva en pacientes de la
Región Metropolitana
Paola VarleTa1,2, CarloS akel1,3, móniCa a...
score 1 de 77 ± 13 mmHg. Adherencia a fármacos antihipertensivos La adherencia al TrHTA por MGL fue de 54%. Analizada la variable adherencia en modelo de regresión logística con: edad, sexo, estado civil, ocupación, nivel educacional, nº de...
score 1 de 77 ± 13 mmHg. Adherencia a fármacos antihipertensivos La adherencia al TrHTA por MGL fue de 54%. Analizada la variable adherencia en modelo de regresión logística con: edad, sexo, estado civil, ocupación, nivel educacional, nº de...
Centro de día para el adulto mayor plenitud
(Universidad de Chile, 2011-01)
entregue valor a los usuarios mejorando y manteniendo la calidad de vida a los adultos mayores. Es así como se han identificado los siguientes pilares donde se desarrollará una ventaja competitiva sustentable en el tiempo: Programa y personal calificado: El...
Análisis de la discapacidad severa en Chile en pacientes atendidos en la atención primaria, Año 2011-2012
(Universidad de Chile, 2014)
TRASTORNO DE ESPECTRO AUTISTA
REVISTA CHILENA DE TERAPIA OCUPACIONAL
Las tasas de discapacidad severa en población bajo
control por mil habitantes en nuestro país aumentan
conforme aumenta la edad, siendo muy notorio en las
personas mayores de 65 años...
21 REVISTA CHILENA DE TERAPIA OCUPACIONAL ISSN 0717-6767 VOL. 14, Nº. 1, Julio 2014, PÁG. 21 - 31 ANÁLISIS DE LA DISCAPACIDAD SEVERA EN CHILE EN PACIENTES ATENDIDOS EN LA ATENCIÓN PRIMARIA, AÑO 2011-2012 ANALYSIS...
21 REVISTA CHILENA DE TERAPIA OCUPACIONAL ISSN 0717-6767 VOL. 14, Nº. 1, Julio 2014, PÁG. 21 - 31 ANÁLISIS DE LA DISCAPACIDAD SEVERA EN CHILE EN PACIENTES ATENDIDOS EN LA ATENCIÓN PRIMARIA, AÑO 2011-2012 ANALYSIS...