HCAP accounts for one-fifth of cases of severe pneumonia in patients admitted to Spanish ICUs. The empirical antibiotic therapy recommended for CAP would be appropriate for 90 % of patients with HCAP in our population, and consequently the decision to include coverage of multidrug-resistant pathogens for HCAP should be cautiously judged in order to prevent the overuse of antimicrobials.

Background The European Union (EU) has introduced a new process to identify medicines that are being monitored particularly closely by regulatory authorities. The black triangle will be used in all EU Member States to identify medicines subject to additional monitoring, such as belimumab. Purpose To check the effectiveness and safety of belimumab. Materials and methods A retrospective study from July 2012 to March 2013 of patients who were treated with belimumab. To begin the treatment, the patients were required to meet the criteria set by the European Medicines Agency. Their test results (immunoglobulins, antinuclear antibodies (ANA), anti-DNA, C3 and C4 levels) and medical records (subjective opinion of the patient, prednisone doses, adverse effects) were used to monitor the patients. The results were collected at the beginning of the treatment, three and six months later and the subjective opinion of the patient at the end of the study. Results Five women were treated (median age 36[25–50]), but only four were included because one abandoned the treatment due to thrombosis. At the beginning of the treatment the patients had the following values: ANA+, anti-DNA+, low C3 and C4. The treatment resulted in a reversal of the ANA and anti-DNA values, from positive to negative. Regarding the C3 levels, a median of 90 mg/dl[71–103] was obtained in the first month. Within 3 months this value rose to 106 mg/dl[86–121], which meant an increase of 16 mg/dl. Another 3 months later, a median of 112 mg/dl[101–123] was achieved (increase of 6 mg/dl). The prednisone dose was halved around week 36[32–40] of the treatment. Most frequent adverse effects were: fatigue, nausea, diffuse aching, arthralgia. Conclusions Analytical parameters improved in every case. Three patients referred subjectively to an improvement in symptoms. One of the patients abandoned the treatment due to thrombosis, which cannot be related only to the treatment (until that point, the test values had been improving) No conflict of interest.

PurposeTo describe data on epidemiology, microbiology, clinical characteristics and outcome of adult ICU patients 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 hours), 'urgent' (2-6 hours), and 'delayed' (>6 hours). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and [95% confidence interval]. ResultsThe 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=0.102). A stepwise increase in mortality was observed with increasing SOFA scores (19.6% for a value £4 to 55.4% for a value >12, p<0.001). The highest odds of death were associated with septic shock .00]), late-onset hospital-acquired peritonitis ) and failed source control evidenced by persistent inflammation at Day 7 ). Compared with 'emergency' source control intervention (<2 hours of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality ). Conclusions 'Urgent' and successful source control were 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.

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reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. carbon dioxide 30 [27][28][29][30][31][32][33][34][35] mmHg and median temperature 37.1 [36.8-37.3]°C. After removal of artefacts, the mean monitoring time was 22 h08 (8 h54). All patients had impaired cerebral autoregulation during their monitoring time. The mean IAR index was 17 (9.5) %. During H 0 H 6 and H 18 H 24 , the majority of our patients; respectively 53 and 71 % had an IAR index > 10 %. Conclusion According to our data, patients with septic shock had impaired cerebral autoregulation within the first 24 hours of their admission in the ICU. In our patients, we described a variability of distribution of impaired autoregulation according to time. ReferencesSchramm P, Klein KU, Falkenberg L, et al. Impaired cerebrovascular autoregulation in patients with severe sepsis and sepsis-associated delirium. Crit Care 2012; 16: R181. Aries MJH, Czosnyka M, Budohoski KP, et al. Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit. Care Med. 2012.