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Ruiz de Azúa-López, L. Martín-Villén, J.J. Egea-Guerrero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Z." "apellidos" => "Ruiz de Azúa-López" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Martín-Villén" ] 2 => array:2 [ "nombre" => "J.J." 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Roldán-Reina, R. Martín-Bermúdez, Y. Corcia-Palomo, L. Martín-Villén" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A.J." "apellidos" => "Roldán-Reina" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Martín-Bermúdez" ] 2 => array:2 [ "nombre" => "Y." "apellidos" => "Corcia-Palomo" ] 3 => array:2 [ "nombre" => "L." 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Sirvent, J. González" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J.-M." "apellidos" => "Sirvent" "email" => array:2 [ 0 => "jsirvent.girona.ics@gencat.cat" 1 => "jmsirvent4@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "González" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Intensive Care (ICU), Study Group of Infections in Critically Ill Patients, Institut d’Investigació Biomèdica de Girona (IDIBGI), Hospital Universitari de Girona Doctor Josep trueta, Girona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta a «Resistencia a antibióticos: pensando fuera del hospital»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the letter by Roldán-Reina et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> in relationship with our point of view published in this journal<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> referring to the original article published 20 years ago.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> We fully agree with the authors on their concern for progressive resistance of micro-organisms that cause respiratory infection to cefuroxime and amoxicillin-clavulanic and consequently that they have become obsolete, these antibiotics should not be used for the prevention of ventilator-associated pneumonia in intubated coma patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The authors described the results of their recent retrospective and observational study<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> to evaluate the resistance patterns of the common microorganisms isolated from bronchial aspirates in patients admitted to the ICU after resuscitated cardiac arrest. In the study the most frequent were <span class="elsevierStyleItalic">Staphylococcus aureus</span> (22.2%), <span class="elsevierStyleItalic">Escherichia coli</span> (14.8%), <span class="elsevierStyleItalic">Enterobacter cloacae</span> (14.8%), <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> (11.1%), <span class="elsevierStyleItalic">Serratia marcescens</span> (11.1%) <span class="elsevierStyleItalic">and Haemophilus influenzae</span> (7.4%). They observed that 48.1% of the isolated microorganisms were resistant to amoxicillin-clavulanic, 18.5% to piperacillin-tazobactam and 14.8% to third-generation cephalosporin. They described no microorganism was resistant to quinolones or carbapenems.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thus, the authors give us an approximate idea as to what might be an alternative to cefuroxime for prevention of ventilator-associated pneumonia in coma patients, and we believe is time to develop new RCT to study other antibiotics for prophylaxis with no effect on normal anaerobic microbiota and with a broad-spectrum to Gram-positive and enteric Gram-negative bacilli. A good alternative to cefuroxime might be levofloxacin, because the pharmacological properties are suitable and it is active against the causative micro-organisms.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However, we should pay special attention to the development of local antibiotic resistance, and maintaining the antibiotic prophylaxis only 24<span class="elsevierStyleHsp" style=""></span>h (one dose in case of levofloxacin).</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "http://dx.doi.org/10.1016/j.medin.2017.05.008" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibiotic resistance: thinking outside the hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.J. Roldán-Reina" 1 => "R. Martín-Bermúdez" 2 => "Y. Corcia-Palomo" 3 => "L. Martín-Villèc)n" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Med Intens" "fecha" => "2017" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibiotic prophylaxis against ventilator-associated pneumonia in patients with coma: where are we now" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. 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Bonet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.155.5.9154884" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1997" "volumen" => "155" "paginaInicial" => "1729" "paginaFinal" => "1734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9154884" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Empiric antibiotic therapy after cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.J. Roldán-Reina" 1 => "Y. Corcia-Palomo" 2 => "R. Martín-Bermúdez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2017" "volumen" => "148" "paginaInicial" => "92" "paginaFinal" => "93" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspiration pneumonitis and aspiration pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.E. Marik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200103013440908" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2001" "volumen" => "344" "paginaInicial" => "665" "paginaFinal" => "671" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11228282" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004100000008/v1_201710301314/S2173572717301832/v1_201710301314/en/main.assets" "Apartado" => array:4 [ "identificador" => "64604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004100000008/v1_201710301314/S2173572717301832/v1_201710301314/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717301832?idApp=WMIE" ]
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