Mediastinitis post revascularización miocárdica: impacto del cambio de profilaxis antibiótica en la fundación Cardioinfantil 2012 - 2013

INTRODUCCIÓN. La mediastinitis posterior a cirugía de revascularización miocárdica es una infección infrecuente, pero potencialmente fatal. En la Fundación Cardioinfantil se ha observado una tendencia al incremento de la misma en los últimos años, obligando a un cambio en las medidas de profilaxis antimicrobiana, pasando de cefalosporinas a vancomicina – gentamicina, sin embargo no se conoce aún el impacto de estas medidas. OBJETIVO: Determinar si el cambio de la profilaxis antibiótica en pacientes sometidos a revascularización miocárdica influye en una disminución de la incidencia de mediastinitis durante los años 2012 – 2013. METODOLOGÍA: Estudio de cohortes retrospectivo, evaluando la incidencia de mediastinitis post revascularización miocárdica, en pacientes expuestos a 2 diferentes tipos de profilaxis antimicrobiana (cefalosporinas vs vancomicina-gentamicina). Se describieron los patrones de susceptibilidad y resistencia de los patógenos encontrados en mediastinitis y la mortalidad de esta patología. RESULTADOS: Los patógenos más frecuentemente aislados en la mediastinitis fueron Staphylococcus aureus y Klebsiella pneumoniae, en la mayoría monomicrobiano. Se encontraron patógenos con perfiles de resistencia como betalactamasas de espectro extendido en Gram negativos y resistencia a la meticilina en cocos Gram positivos. El RR de mediastinitis del grupo expuesto a vancomicina-gentamicina respecto al grupo de cefalosporinas fue de 0,9 con IC 95% 0,28 – 3,28. CONCLUSIÓN: la epidemiologia microbiana de la mediastinitis no difiere de la reportada en otras series. La profilaxis antimicrobiana con vancomicina - gentamicina en pacientes sometidos a revascularización miocárdica, no redujo la incidencia de mediastinitis. Se propone regresar a la terapia de profilaxis con cefalosporinas.

Catalogue of manuscripts and other objects in the museum of the Public record office, with brief descriptive and historical notes.

Mode of access: Internet.

The search room catalogues and other finding aids to the records preserved in the Public Record Office, London.

Prepared by a British expert for the use of Dr. Reese and for the guidance of the Virginia Committee: William J. Van Schreeven, Virginia State Library and Francis L. Berkeley, Jr., University of Virginia Library.

Calendar of the state papers relating to Scotland and Mary, Queen of Scots, 1547-1603, preserved in the Public Record Office, the British Museum, and elsewhere in England.

Editors: v. 1-2, J. Bain.--v. 3-9, W. K. Boyd.--V. 10, W. K. Boyd and H. W. Meikle.--v. 11, A. I. Cameron.--v. 12, M. S. Guiseppi.--v. 13, J. D. Mackie.

The Employers' liability act, 1880, and the Workmen's compensation act, 1906. With the statutes relating to and cases decided on the previous Workmen's compensation acts in England, Scotland, and Ireland; the County court rules of procedure under the act of 1906; the Home office regulations and forms. /

Includes index.

Manwood's Treatise of the forest laws : shewing not only the laws now in force, but the original of forests, what they are, and how they differ from chases, parks, and warrens; with all such things as are incident to either: together with the proper terms of art, collected out of the common and statute laws of this realm; as also from the assises and iters of Pickering and Lancaster, and several other ancient and learned authors. Treating also of the office of agistors, beadles, foresters, keepers, rangers, verderors and woodwards, and of the Courts of attachment, & c. With all the variety of cases relating to forests, chases, parks, and warrens; and all the laws concerning the game made, adjudged or repealed, since the year 1665. The whole digested under proper titles in an alphabetical order.

"Appendix. Charta de foresta, of Canvtvs, a Dane, and king of this realm; granted at a Parliament holden at Winchester, anno Dom. 1016 [and other statutes relating to forests]": p. 393-435.

Shakespearean extracts from "Edward Pudsey's booke", temp. Q. Elizabeth & K. James I. which include some from an unknown play by William Shakespeare [or rather from Chapman's "Blind beggar of Alexander"] Also a few unpublished records of the Shakespeare of Snitterfield and Wroxall preserved in the Public Record Office.

Mode of access: Internet.

Calendar of the patent rolls : preserved in the Public Record Office /

Some volumes are published by Kraus Reprint, Nendeln/Liechtenstein.

Calendar of treasury books, 1660/67- preserved in the Public Record Office.

Publisher varies.

Observations on the motion of Sir Robert Heron, M.P.in the late parliament : respecting the vacating of seats in Parliament on the acceptance of office /

C. Roworth and Sons, printers.

Curia Regis rolls ... : preserved in the Public Record Office.

Published: London : Boydell Press/Public Record Office, 1999-

List of Chancery rolls, preserved in the Public record office.

Mode of access: Internet.

Royal naval biography : or, Memoirs of the services of all the flag-officers, superannuated rear-admirals, retired-captains, post-captains, and commanders, whose names appeared on the Admiralty list of sea officers at the commencement of the present year, or who have since been promoted, illustrated by a series of historical and explanatory notes ... with copious addenda /

"Naval operations in Ava, during the Burmese war": v. 3, pt. 1, appendix (120 p.).

Calendar of state papers, domestic series, of the reign of Charles I ... Preserved in the State paper department of Her Majesty's Public record office ...

Editors: v. 1-13, John Bruce (with William Douglas Hamilton, v. 13).--v. 14-23, William Douglas Hamilton (with Sophia Crawford Lomas, v. 23)

Calendar of state papers, domestic series, of the reigns of Edward VI., Mary, Elizabeth [and James I] ... preserved in the State paper department of Her Majesty's Public record office.

Editors: v. 1-2, Robert Lemon.--v. 3-12, Mary Anne Everett Green.