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Peritonitis is one of the main complications of peritoneal dialysis and accounts for considerable mortality and hospitalization. It is usually treated with intraperitoneal antibiotherapy, as it is the best way to achieve high concentrations at the site of infection. We report a case of an 86-year-old female patient with end-stage renal disease under continuous ambulatory peritoneal dialysis, who was admitted to our hospital with complaints of intense diffused abdominal pain. The effluent culture yielded Staphylococcus hominis only sensible to vancomycin and linezolid. She was diagnosed with peritonitis secondary to Staphylococcus hominis infection and treated with oral linezolid without cateter removal. Adequate linezolid peritoneal fluid concentration (between 3 and 20 μg/mL) was achieved and the antibiotic therapy was maintained for 21 days with clinical and analytical improvement. According to our knowledge, this was the first Staphylococcus peritonitis in a peritoneal dialysis patient, successfully treated with oral linezolid and has had linezolid levels monitored in the peritoneal dialysis effluent.

Introduction: Kidney transplant (KT) recipients are highly susceptible to urinary tract infections (UTIs). Few data are available regarding the effects of cranberry products in KT recipients. Subjects and methods: This was a randomized double-blind study comparing daily treatment with a cranberry capsule versus a placebo capsule for 6 months. The study protocol was conducted in accordance with the Helsinki Declaration and was approved by the local ethics committee. The study group comprised women undergoing KT for over 1 year, and the exclusion criteria included simultaneous antibiotic UTI prophylaxis. The primary endpoint was UTI occurrence, and the secondary endpoints were the time to first UTI, hospitalization, antibiotic resistance, graft function, immunosuppressive dose changes, and side effects. Results: 55 KT women at a single centre were included as follows: 25 were randomized to the cranberry group, and 30 were assigned to the placebo group. During the study period, 16.4% of the participants presented with a UTI. A diagnosis of UTI within the previous year and KT duration, but not cranberry use (p=0.95) were independent predictors of UTI. Discussion: Cranberry capsules appear to be safe in KT women; however, no clinical efficacy of UTI prophylaxis was demonstrated in this well-designed but underpowered study. Further multicentric and longer trial should be performed to determine cranberry clinical efficacy

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Os novos anticoagulantes orais são opções emergentes para a prevenção e tratamento das doenças tromboembólicas. São cada vez mais usados na prática clínica pela facilidade do seu uso e pelos seus benefícios clínicos mas a sua utilização mais generalizada carece de demonstração de custo efetividade. O objectivo consistiu na realização de uma revisão sistemática dos estudos de custo-efetividade dos novos anticoagulantes orais, dabigatrano, rivaroxabano e apixabano, em todas as suas indicações clínicas e descrever os resultados principais. Foi realizada uma revisão sistemática da literatura nas bases de dados Pubmed, Embase, Scopus, Cochrane e Web of Knowledge, para identificar todos os estudos de custo-efetividade dos novos anticoagulantes orais em todas as suas indicações clínicas. A pesquisa selecionou 42 estudos, 15 relacionados com a tromboprofilaxia na artroplastia total da anca ou na artroplastia total do joelho e 27 na prevenção do acidente vascular cerebral na fibrilhação auricular. Não foram identificados estudos para as indicações de tratamento e prevenção secundária do tromboembolismo venoso ou para a prevenção secundária após síndromes coronários agudos. Os resultados principais incluíram os rácios custo-efetividade incremental por anos de vida ajustados pela qualidade, comparações com o limite pré-fixado à disponibilidade a pagar e análises de sensibilidade que revelaram custo-efetividade ou dominância dos novos anticoagulantes orais. A presente revisão sistemática demonstra que os novos anticoagulantes orais são custo-efetivos para a tromboprofilaxia em cirurgia ortopédica major e para a prevenção do acidente vascular cerebral na fibrilhação auricular., Novel oral anticoagulants are emerging options for the prevention and treatment of thromboembolic diseases. They are increasingly used in clinical practice due to simplicity of use and clinical benefits but an important step is to evaluate their cost-effectiveness. We aimed to perform a systematic review of cost-effectiveness studies of novel oral anticoagulants, dabigatran, rivaroxaban and apixaban, in all their clinical indications and describe key findings. A systematic review of the literature was conducted searching Pubmed, Embase, Scopus, Cochrane and Web of Knowledge databases to identify all cost-effectiveness studies of novel oral anticoagulants in all their clinical indications. The research selected 42 studies, 15 related to thromboprophylaxis in total hip arthroplasty or total knee arthroplasty and 27 to stroke prevention in non-valvular atrial fibrillation. No studies were identified for the indications of treatment and secondary prevention of venous thromboembolism or for the secondary prevention after acute coronary syndromes. Key findings included incremental cost-effectiveness ratios per quality-adjusted life-years, comparisons with appropriate willingness-to-pay thresholds and sensitivity analysis that revealed cost-effectiveness or dominance for the novel oral anticoagulants. This present systematic review demonstrates that novel oral anticoagulants are cost-effective for the thromboprophylaxis in major orthopedic surgery and for stroke prevention in atrial fibrillation., Orientação: Ana Mirco