Estudio aleatorio de dos emulsiones grasas diferentes en la nutrición parenteral total del enfermo quirúrgico desnutrido: efecto sobre la morbilidad infecciosa y la mortalidad Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients: effect on infectious morbidity and mortality

Objetivo: Las infusiones lipídicas de una mezcla física de triglicéridos de cadena media/triglicéridos de cadena larga (MCT/LCT), utilizadas en la nutrición parenteral total (NPT) peroperatoria, tienen menos efecto inmunosupresor en estudios de laboratorio que las emulsiones que contienen únicamente triglicéridos de cadena larga (LCT). El objetivo de este estudio fue comparar la incidencia de infecciones nosocomiales y la mortalidad hospitalaria de los pacientes quirúrgicos severamente desnutridos, tratados con NPT con una emulsión lipídica de MCT/LCT, o con una mezcla LCT, administradas de forma aleatoria y a doble ciego. Pacientes y métodos: Se reclutaron de forma prospectiva 72 pacientes severamente desnutridos sometidos a una laparotomía programada o urgente, estratificados por la presencia o ausencia de cáncer, e ingresados en los Servicios de Cirugía General y Medicina Intensiva de un hospital universitario. El desenlace principal fue la incidencia de infección nosocomial intrahospitalaria y el desenlace secundario fue la mortalidad. Resultados: Los pacientes del grupo de estudio (MCT/LCT) y el grupo control (LCT) tenían características similares. Los pacientes del grupo de MCT/LCT tuvieron una menor incidencia de abscesos intraabdominales (2/26) que el grupo LCT (10/31) de forma significativa (p Goal: Lipid infusions of a physical mixture of medium- chain triglycerides and long-chain triglycerides (MCT/LCT) used in peri-operative total parenteral nutrition (TPN) have a lower immunosuppressive effect in laboratory studies than emulsions containing only longchain triglycerides (LCT). The purpose of the present study was to compare the incidence of nosocomial infections and the in-hospital mortality of severely undernourished surgical patients treated with TPN using an MCT/LCT lipid emulsion or with an LCT mixture, administered under a randomized, double blind protocol. Patients and methods: A total of 72 severely undernourished patients subjected to planned or emergency laparotomy were prospectively recruited and stratified by the presence or absence of cancer, on admission to the departments of General Surgery and Intensive Care Medicine at a teaching hospital. The main outcome was the incidence of intra-hospital nosocomial infection and the secondary outcome was mortality. Results: The patients in the study group (MCT/LCT) and the control group (LCT) shared similar characteristics. The patients in the MCT/LCT group had a significantly lower incidence of intra- abdominal abscesses (2/26) than those in the LCT group (10/31) (p < 0.05; RR 0.18; CI 95%; 0.03-0.89). There were no significant differences in the incidence of other infections. Nor was there a difference between the two groups in terms of the intrahospital mortality (4/26 versus 11/31). In the stratified analysis, patients without cancer treated with MCT/LCT presented significantly fewer intra-abdominal abscesses (2/14) than those with LCT (5/8) (p < 0.05; RR 0.1; CI 95%; 0.01-0.79) and a significantly lower mortality (2/14 versus 5/8; p < 0.05; RR 0.1; CI 95%; 0.01-0.79). Conclusions: Lipid infusions of MCT/LCT used in perioperative TPN protect severely undernourished sur- gical patients against the onset of intra-abdominal abscesses when compared with LCT infusions. Patients without cancer may obtain more benefit from the use of these mixtures

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective