Eficacia del método alternativo en la introducción de la alimentación complementaria: revisión sistemática

[Resumen] Introducción: Baby-Led weaning parte de la nueva recomendación de la OMS que fomenta que los niños comiencen la introducción de la AC en el sexto mes de vida. Este método propone ofrecer alimentos sólidos en piezas preparadas previamente para que el lactante se alimente por sí mismo llevándose los trozos de comida a la boca y eliminando así la alimentación triturada con cuchara. De esta manera, el niño es capaz de regular el cuánto y con qué rápidez quiere comer, desarrollando, su autonomía y sensación de saciedad. Si bien en los últimos años ha habido un aumento considerable de familas que utilizan este método, existe todavía cierta variabilidad por parte de profesionales sanitarios a la hora de recomendarlo. Objetivo: Conocer la eficacia de la introducción de la alimentación complementaria mediente el BLW. Metodología: Se realizó una búsqueda sistemática de RS y ECAs en diferentes bases de datos (Medline, Cinahl y SCOPUS). La selección de artículos se hizo mediante la lectura del título, resumen y texto completo, escogiendo aquellos que cumplían los criterios de selección. Para evaluar la calidad metodológica se uso la Declaración PRISMA para las RS y la Declaración CONSORT para los ECAs. Resultados: Se encontraron un total de tres RS, dos fueron excluídas por no cumplir con los criterios de calidad y una por no ajustarse a los criterios de selección. El total de ECAs localizados fueron de 8, de los cuales uno fue excluído por ser el protocolo de un estudio y otro por no cumplir con la calidad metológica. El total de estudios que cumpliesen con los criterios de exclusion fue de 6 ECAs. Conclusiones: El BLW no está ligado a un mayor riesgo de atragantamientos ni al deficit de hierro, pero mejora la calidad de la dieta a edades tempranas, siendo a los 24 meses mayor el aporte de frutas y vegetales que mediante el MT. En relación a la mejoría de la ingesta de nutrientes no hay resultados que indiquen que es más adecuada con un método u otro, pero si es adecuada. La asociación entre el BLW y un peso e IMC más adecuados necesita de mayor realización de estudios.[Abstract] Introduction: Baby-led weaning part of the WHO recommendation that encourages children to begin the introduction of AC not sixth month of life. This method has as obxectivo to provide solid food in previously prepared bred so that or neno pruned to nourish itself by lifting the anacos of food to mouth and, polo therefore, eliminating food crushed with culler. Deste xeito, or neno can regulate singing and with what velocidade quere comer, desenvolvendo súa autonomy and sentimento saciedade. Although there has been a considerable increase in the number of families who use this method in recent years, there is still some variation in health professionals at the time of recommending it. Obxective: Cognating effectiveness of introducing complementary feeding through BLW. Methodology: A systematic search of SR and RCTs was performed in different databases (Medline, Cinahl and SCOPUS). The selection of articles was done by reading the title, summary and full text, choosing those that met the selection criteria. To evaluate the methodological quality, the PRISMA Declaration was used for the SR and the CONSORT Declaration for the ECAs. Results: A total of three SRs were found, two were excluded because they did not meet the quality criteria and one because they did not meet the selection criteria. The total number of localized RCTs was 8, of which one was excluded because it was the protocol of one study and another because it did not meet the metological quality. The total number of studies that met the exclusion criteria was 6 RCTs. Conclusions: The BLW is not linked to an increased risk of choking or iron deficiency, but improves the quality of the diet at early ages, being at 24 months greater the contribution of fruits and vegetables than by MT. In relation to the improvement of nutrient intake, there are no results that indicate that it is more appropriate with one method or another, but if it is adequate. The association between the BLW and a more suitable weight and BMI requires more studies.[Resumo] Introdución: Baby-led weaning parte da nova recomendación da OMS na que incentiva ós nenos a comezar a introdución da AC no sexto mes de vida. Este método ten como obxectivo proporcionar comida sólida en pezas preparadas previamente para que o neno poida alimentarse por si mesmo levándose os anacos de comida á boca e, polo tanto, eliminando a alimentación triturada con culler. Deste xeito, o neno pode regular cánto e con qué velocidade quere comer, desenvolvendo a súa autonomía e sentimento de saciedade. Aínda que houbo un aumento considerable de familas que usan este método nos últimos anos, aínda hai algunha variabilidade por profesionais sanitarios á hora de recomendalo. Obxectivo: Coñecer a eficacia da introdución da alimentación complementaria a través da BLW. Metodoloxía: Realizouse unha busca sistemática de RS e ECAs en diferentes bases de datos (Medline, Cinahl e SCOPUS). A selección de artigos fíxose lendo o título, resumo e texto completo, escollendo aqueles que cumprían os criterios de selección. Para avaliar a calidade metodolóxica, utilizouse a Declaración PRISMA para a RS ea Declaración de CONSORT para as ECA. Resultados: Atopáronse un total de tres RS, dous foron excluídos porque non cumpriron os criterios de calidade e outro porque non cumpriu os criterios de selección. O número total de ECAs localizados foi de 8, dos cales un excluiuse porque era o protocolo dun estudo e outro porque non cumpriu a calidade metolóxica. O número total de estudos que cumpriron os criterios de exclusión foi de 6 ECAs. Conclusións: O BLW non está vinculado a un maior risco de atragantamento nin coa deficiencia de ferro, pero mellora a calidade da dieta nos primeiros meses, sendo ós 24 meses maior a inxesta de froitas e verduras que no MT. En relación á mellora da inxesta de nutrientes, non hai resultados que indiquen que é máis apropiado cun método ou outro, pero sí é adecuado. A asociación entre o BLW e un peso máis axeitado e IMC require máis estudos.Traballo fin de grao (UDC.FEP). Enfermaría. Curso 2018/201

Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

evere intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed

Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

Purpose: To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods: Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI). Results: The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value ≤ 4-55.4% for a value > 12, p < 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (< 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion: 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome