Burden of severe infections due to carbapenem-resistant pathogens in intensive care unit

Intensive care units(ICU)for various reasons,including the increasing age of admitted patients,comorbidities,and increasingly complex surgical procedures(e.g.,transplants),have become"the epicenter"of nosocomial infections,these are characterized by the presence of multidrug-resistant organisms(MDROs)as the cause of infection.Therefore,the perfect match of fragile patients and MDROs,as the cause of infection,makes ICU mortality very high.Furthermore,carbapenems were considered for years as last-resort antibiotics for the treatment of infections caused by MDROs;unfortunately,nowadays carbapenem resistance,mainly among Gram-negative pathogens,is a matter of the highest concern for worldwide public health.This comprehensive review aims to outline the problem from the intensivist's perspective,focusing on the new definition and epidemiology of the most common carbapenem-resistant MDROs(Acinetobacter baumannii,Pseudomonas aeruginosa and Enterobacterales)to emphasize the importance of the problem that must be permeating clinicians dealing with these diseases.

Level of Treatment Adherence in Patients with Type 2 Diabetes in Primary Care

Introduction: The glycemic control of type 2 diabetes is a very important challenge that requires a multidisciplinary group of specialists, an adequate psychosocial environment and family support and searching for better measures for the control and prevention of complications, which encourages the patient to improve his lifestyle. Method: The analysis was made with two primary care medical units, the Mutual Aid Group (GAM) from the Los Pinos Medical center, and the Chronic disease Specialized Medical Unit (UNEME EC), which provided integral care in the municipality of San Cristóbal de Las Casas, Chiapas. A sample of 138 patients was obtained through a random sampling with 95% confidence and a margin of error of ±5. The recollection of data was made with the application of the questionnaire “Lifestyle and adherence to pharmacological treatment in patients with type 2 diabetes, which consists of four sections that evaluate 1) socio-demographic data;2) anthropometric and clinical;Pharmacological adherence with Morisky’s 8-item questionnaire (MMSA-8);3) Lifestyle: with the instrument to Measure Lifestyle in Diabetics (IMEVID). Results: 37.6% had an HbA1c lesser than 7%, A prevalence of 50.7% was obtained in patients adhering to the pharmacological treatment, and 39.8% patients with a favorable lifestyle. The association of the patients’ results with an adequate glycemic control demonstrated by an HbA1C lesser than 7% was obtained through Student’s T test in which these patients are related with a better score on questionnaires by IMEVID and MMAS-8. Conclusions: The units with integral care and multidisciplinary treatment are fundamental in the care of patients with type 2 diabetes;the use of questionnaires such as IMEVID or MMAS-8 is useful in the daily clinical practice.