Každý operačný výkon predstavuje u pacienta určité riziko a možnosť vzniku pooperačných komplikácii, hoci ide o bežne vykonávanú operáciu. Najčastejšie sa komplikácie vyskytujú u obéznych pacientov, kedy aj z banálnej operácie môže pacient skončiť na oddelení poskytujúcom intenzívnu starostlivosť a bojovať tak o svoj život. U obéznych pacientov je poskytovanie intenzívnej starostlivosti náročnejšie, nakoľko je potrebné u nich saturovať všetky základné potreby od prijímania potravy cez hygienu až po vyprázdňovanie. Cieľom príspevku je predstaviť a opísať priebeh liečby a ošetrovateľskej starostlivosti u extrémne obéznej pacientky po cholecystektómii, ktorej stav si vyžadoval intenzívnu starostlivosť z dôvodu rozvíjajúcej sa sepsy v oblasti operačnej rany, kde bolo potrebné využitie inovatívnych liečebných postupov a metód pri jej hojení. Metodika: Pomocou kvalitatívneho výskumu formou kazuistiky, opisujeme zaujímavý prípad pacientky, ktorá si vyžadovala 95 dňovú hospitalizáciu na intenzívnom oddelení s ťažkou sepsou, kardiovaskulárnym zlyhávaním, nutnosťou umelej pľúcnej ventilácie (UVP), s využitím VAC systému (vacuum assisted closure) na hojenie rany, dekubitmi rôznych stupňov, infekčnou hnačkou a syndrómom závislosti od UVP. Výsledky: Pacientka preložená z chirurgickej jednotky intenzívnej starostlivosti (JIS) v poruche vedomia, s potrebou zabezpečenia dýchacích ciest, napojenia na UVP, potrebou vazopresorickej podpory, septickým stavom, rozpadom operačnej rany a potrebou korekcie glykémie inzulínom v lineárnom dávkovači. Po cirkulačnej stabilizácii pacientky na 13. deň hospitalizácie bol naložený chirurgom do operačnej rany VAC systém, ktorý sa v pravidelných intervaloch menil. Počas hospitalizácie stav pacientky komplikovaný vznikom dekubitov a Clostridioides difficile infection (CDI). U pacientky postupne vznikol syndróm závislosti na UVP, preto extubovaná až na 91. deň. Na 95. deň pacientka v stabilizovanom stave so zhojenými dekubitmi, preliečenou CDI infekciou a s VAC systémom preložená na oddelenie dlhodobo chorých. Aj banálna operácia môže skončiť bojom o život. U extrémne obéznych pacientov je riziko komplikácii vyššie, nakoľko trpia viacerými ochoreniami, ktoré spomaľujú proces hojenia rán a zároveň zvyšujú nároky na poskytovanú ošetrovateľskú starostlivosť vo všetkých oblastiach. Zachránený život však prevyšuje všetky nároky a je najväčšou odmenou pre celý personál oddelenia.
Every surgical procedure represents a certain risk and possibility of developing a patient. postoperative complications, although it is a commonly performed operation. Most often, complications occur in obese patients, when even a banal operation can cause a end up in an intensive care unit and fight for their lives. In obese patients, the provision of intensive care is more difficult, as it is necessary to restoreall basic needs from foodintake to hygiene to defecation. The aim of the paper is to present and describe the course of treatment and nursing care in an extremely obese cholecystectomy patient who secondition required intensive care for developing sepsis in the area of the surgical wound, as a result of which the wound It fell apart and it was necessary to use innovative treatments and methods to heal it. Methodology: Using qualitative research in the form of a case report, we describe an interesting the case of a patient who required 95 days of hospitalization in an intensive care unit with severe sepsis, cardiovascular failure, the need for artificial pulmonary ventilation (APV), using the VAC system (vacuum assisted closure) wound healing, pressure ulcers of varying degrees, infectious diarrhea and addictionsyndrome UVP. Results: Patient transferred from the surgical intensive care unit (ICU) in a disorder of consciousness, with a need securing the respiratory tract, connection to UVP, the need for vasopressor support, septic condition, disintegration of the surgical wound and the need for glucose correction with insulin in lineardispenser. After circulatory stabilization of the patient on the 13th day of hospitalization, loaded by the surgeoninto the surgical wound of the VAC system, which at regular intervals Changed. During hospitalization, the patient’s condition is complicated by the development of pressure ulcers and Clostridioides difficile infection (CDI). The patient gradually developed UVP dependence syndrome, so shewasextubated on day 91. At the 95. day a patient in a stablecondition with healed pressure ulcers, retreated CDI infection and with the VAC system transferred to the long-term care unit. Even a banal operation can end in a fight for life. In extremely obese patients, it is the risk of complications is higher, as they suffer from several diseases that slowdown the process of wound healing and at the sametimeincrease the demands on the nursing care provided in the allareas. However, a life saved exceed sall claims and is the grea test reward for the entire staff of the department.
- MeSH
- Clostridioides difficile MeSH
- Surgical Wound Dehiscence nursing therapy MeSH
- Pressure Ulcer nursing therapy MeSH
- Wound Healing MeSH
- Obesity complications MeSH
- Critical Care Nursing MeSH
- Critical Care MeSH
- Pulmonary Ventilation MeSH
- Postoperative Complications nursing therapy MeSH
- Sepsis MeSH
- Negative-Pressure Wound Therapy MeSH
- Treatment Outcome MeSH
- Publication type
- Case Reports MeSH
BACKGROUND: Faecal microbiota transplantation (FMT) is the standard treatment for patients with multiple recurrent Clostridioides difficile infection (rCDI). Recently, new commercially developed human microbiota-derived medicinal products have been evaluated and Food and Drug Administration-approved with considerable differences in terms of composition, administration, and targeted populations. OBJECTIVES: To review available data on the different microbiota-derived treatments at the stage of advanced clinical evaluation and research in rCDI in comparison with FMT. SOURCES: Phase II or III trials evaluating a microbiota-derived medicinal product to prevent rCDI. CONTENT: Two commercial microbiota-derived medicinal products are approved by the Food and Drug Administration: Rebyota (RBX2660 Ferring Pharmaceuticals, marketed in the United States) and VOWST (SER-109 -Seres Therapeutics, marketed in the United States), whereas VE303 (Vedanta Biosciences Inc) will be studied in phase III trial. RBX2660 and SER-109 are based on the processing of stools from healthy donors, whereas VE303 consists of a defined bacterial consortium originating from human stools and produced from clonal cell banks. All have proven efficacy to prevent rCDI compared with placebo in patients considered at high risk of recurrence. However, the heterogeneity of the inclusion criteria, and the time between each episode and CDI diagnostics makes direct comparison between trials difficult. The differences regarding the risk of recurrence between the treatment and placebo arms were lower than previously described for FMT (FMT: Δ = 50.5%; RBX2660-phase III: Δ = 13.1%; SER-109-phase III: Δ = 28%; high-dose VE303-phase-II: Δ = 31.7%). All treatments presented a good overall safety profile with mainly mild gastrointestinal symptoms. IMPLICATIONS: Stool-derived products and bacterial consortia need to be clearly distinguished in terms of product characterization and their associated risks with specific long-term post-marketing evaluation similar to registries used for FMT. Their place in the therapeutic strategy for patients with rCDI requires further studies to determine the most appropriate patient population and administration route to prevent rCDI.
- MeSH
- Clostridioides difficile * MeSH
- Fecal Microbiota Transplantation MeSH
- Clostridium Infections * microbiology MeSH
- Humans MeSH
- Microbiota * MeSH
- Recurrence MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- MeSH
- Anti-Bacterial Agents * therapeutic use MeSH
- Clostridium Infections * drug therapy MeSH
- Humans MeSH
- Recurrence MeSH
- Check Tag
- Humans MeSH
- Publication type
- Letter MeSH
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
Mikrobiom pacienta ovlivňuje úspěšnost léčby maligních nádorů immunoterapií. Fekální bakterioterapie je metoda, která se v klinické praxi úspěšně používá k obnovení mikrobní rovnováhy při infekci Clostridium difficile a experimentálně i u některých chronických onemocnění. Cílem projektu je studovat možnost přenosu pozitivní terapeutické odpovědi na anti-PD-1 z pacientů, co na terapii odpovídají, na pacienty, kteří na léčbu neodpovídají, pomocí fekální bakterioterapie. V rámci projektu budeme analyzovat složení střevního mikrobiomu, bariérovou funkci střeva a adaptivní (T i B buněčnou) odpověď proti mikrobním antigenům za cílem hledat vhodné časné biomarkery a mechanismy tohoto důležitého fenoménu. Vzniklé hypotézy ověříme na experimentálním modelu maligních nádorů s využitím unikátních gnotobiotických myší kolonizovaných mikrobiomem z pacientů citlivých a necitlivých k léčbě anti-PD-1.; Patient's microbiota influences the effectivity of cancer treatment with immunotherapy. Fecal microbiota transplantation (FMT) is a well established method, which is currently successfully used to restore the gut microbial ecology in the treatment of Clostridium difficile infection. Utility of this therapeutic approach is currently tested in several chronic inflammatory or metabolic diseases. The aim of this project is to sudy if the response to anti-PD-1 treatment in the cancer patients could by transferred from responders to non-responders by FMT. Moreover, we will analyze the gut microbiota (both bacteria and fungi) by 16S gene or ITS2 sequencing, gut barrier function and adaptive immune response (both T and B) to microbial antigens to find suitable biomarkers and mechanisms. We will test the new hypotheses in animal models of cancer in unique gnotobiotic mice artificially colonized with the microbiota from responders or non-responders.
- Keywords
- fecal microbiota transplantation, checkpoint inhibitory, checkpoint inhibitors, imunita, immunity, cancer, rakovina, mikrobiota, microbiota, fekální bakterioterapie,
- NML Publication type
- závěrečné zprávy o řešení grantu AZV MZ ČR
... Zadák) 6 -- 1.4.1 Akutní ischemie střeva 6 -- 1.4.2 Ischemická kolitida 6 -- 1.5 Kolitida způsobená Clostridium ... ... difficile (Zdeněk Zadák) 7 -- 1.6 Abdominální katastrofa pod obrazem akalkulózní cholecystitidy (Zdeněk ...
1. elektronické vydání 1 online zdroj (208 stran)
Abdominální katastrofa je závažný klinický stav, který obvykle vzniká jako komplikace při léčbě nitrobřišních netraumatických onemocnění anebo při poranění břicha. Kniha je odborným pojednáním, které vychází z dlouholetých zkušeností autorského kolektivu. Provází čtenáře všemi etapami léčby pacientů a pozornost věnuje jednotlivým úskalím léčby.
OBJECTIVES: To assess the effectiveness of shortened regimens of vancomycin or fidaxomicin in the treatment of Clostridioides difficile infection (CDI). METHODS: Adult patients with CDI hospitalized from January 2022 to May 2023 were included in this observational study. In patients with CDI treated with vancomycin or fidaxomicin, antibiotic treatment was discontinued after either 5 or 7 days of vancomycin or 5 days of fidaxomicin if there was a clinical response and improvement in laboratory parameters. The control cohort was treated with the standard 10 day regimen of either vancomycin or fidaxomicin. The follow-up was 60 days. Causative C. difficile strains were characterized by ribotyping and toxin gene detection when available. RESULTS: Twenty-five patients (median age 76 years) received shortened treatment with vancomycin (n = 21), or fidaxomicin (n = 4). Five cases fulfilled the criteria for severe CDI. Twenty-three patients completed follow-up; two died from causes other than CDI, and two developed recurrent CDI (8.0%). Ribotypes (RTs) 001 and 014 were the most prevalent with 20% each. In two C. difficile isolates, binary toxin genes were detected (RTs 078 and 023). In the control group of 22 patients recurrent CDI developed in 5 patients (22.7%). No statistically significant differences were found between the groups. CONCLUSIONS: Shortened treatment regimens for CDI with vancomycin and fidaxomicin were shown to be effective in our cohort of patients compared with 10 days of treatment. The recurrence rate was lower in the study group. A larger, prospective, double-blind, randomized, multicentre study is needed to support our findings.
- MeSH
- Anti-Bacterial Agents * therapeutic use administration & dosage MeSH
- Clostridioides difficile * genetics drug effects classification MeSH
- Fidaxomicin * therapeutic use administration & dosage MeSH
- Clostridium Infections * drug therapy microbiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Ribotyping * MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Vancomycin * therapeutic use administration & dosage MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
... Zadák) 6 -- 1.4.1 Akutní ischemie střeva 6 -- 1.4.2 Ischemická kolitida 6 -- 1.5 Kolitida způsobená Clostridium ... ... difficile (Zdeněk Zadák) 7 -- 1.6 Abdominální katastrofa pod obrazem akalkulózní cholecystitidy (Zdeněk ...
xv, 192 stran : ilustrace ; 26 cm
Publikace se zaměřuje na různé typy abdominálních katastrof a na jejich komplexní léčbu. Určeno odborné veřejnosti.; Abdominální katastrofa je závažný klinický stav, který obvykle vzniká jako komplikace při léčbě nitrobřišních netraumatických onemocnění anebo při poranění břicha. Kniha je odborným pojednáním, které vychází z dlouholetých zkušeností autorského kolektivu. Provází čtenáře všemi etapami léčby pacientů a pozornost věnuje jednotlivým úskalím léčby.
- Keywords
- abdominální katastrofa, břišní katastrofa,
- MeSH
- Abdomen pathology MeSH
- Comprehensive Health Care MeSH
- Digestive System Diseases therapy MeSH
- Nutrition Therapy MeSH
- Critical Care MeSH
- Emergency Treatment MeSH
- Catastrophic Illness therapy MeSH
- Conspectus
- Patologie. Klinická medicína
- NML Fields
- gastroenterologie
- anesteziologie a intenzivní lékařství
- urgentní lékařství
- NML Publication type
- kolektivní monografie
Clostridioides difficile is a leading cause of healthcare-associated infections. The main objective was to assess the current landscape of CDI infection prevention and control (IPC) practices. An anonymous survey of IPC practices for CDI was conducted between July 25 and October 31, 2022. Precautions for symptomatic patients were applicable for 75.9% and were discontinued 48 h minimum after the resolution of diarrhea for 40.7% of respondents. Daily cleaning of CDI patients' rooms was reported by 23 (42.6%). There was unexpected heterogeneity in IPC practices regarding the hospital management of CDI.
The ribotyping of Clostridioides difficile is one of the basic methods of molecular epidemiology for monitoring the spread of C. difficile infections. In the Czech Republic, this procedure is mainly available in university hospitals. The introduction of ribotyping in a tertiary health care facility such as Liberec Regional Hospital not only increases safety in the facility but also supports regional professional development. In our study, 556 stool samples collected between June 2017 and June 2018 were used for C. difficile infection screening, followed by cultivation, toxinotyping, and ribotyping of positive samples. The toxinotyping of 96 samples revealed that 44.8% of typed strains could produce toxins A and B encoded by tcdA and tcdB, respectively. The ribotyping of the same samples revealed two epidemic peaks, caused by the regionally most prevalent ribotype 176 (n = 30, 31.3). C. difficile infection incidence ranged between 5.5 and 4.2 cases per 10,000 patient-bed days. Molecular diagnostics and molecular epidemiology are the two most developing parts of clinical laboratories. The correct applications of molecular methods help ensure greater safety in hospitals.
