Search

Sepsis is the main cause of acute kidney injury (AKI) among individuals hospitalized in intensive care units. Acute kidney injury is an independent risk factor for mortality, and its occurrence increases the complexity and cost of treatment. However, the pathophysiological mechanisms of AKI remain unclear. Hemodynamic, vascular, tubular, cellular, inflammatory, and oxidative processes are involved. Individuals with AKI generally have various comorbidities and are elderly and hypercatabolic and on vasopressors and mechanical ventilation. Dialysis is the main treatment for AKI. Although there is no clear benefit of any specific dialysis modality, these patients are initially instructed to use continuous dialysis methods, especially for the most severe cases with multiple organ system dysfunctions and for those who display signs of hemodynamic instability. Recent studies demonstrate that patients should receive a dialysis dose of at least 25 mL.kg(-1).h(-1). Universidade Federal de São Paulo UNIFESP, Div Nephrol, São Paulo, Brazil Hosp Israelita Albert Einstein, Renal Transplant Unit, São Paulo, Brazil Universidade Federal de São Paulo UNIFESP, Div Nephrol, São Paulo, Brazil Web of Science

Staphylococcus aureus is a frequent agent of serious intensive care unit infections with high associated mortality rates. Resistance to methicillin is frequent, exceeding 50% in many countries, and for these strains, vancomycin is the agent of choice. Resistance to this drug is now frequent for Enterococcus, but low rates are reported for S. aureus. Nonetheless, treatment failures with vancomycin for infections caused by strains considered susceptible have been reported during recent years. This article aims to review the possible explanations for this phenomenon, which is challenging the old paradigm of S. aureus infections and vancomycin use. Universidade Federal de São Paulo, Dept Infect Dis, BR-05685090 São Paulo, Brazil Hosp Israelita Albert Einstein, São Paulo, Brazil Universidade Federal de São Paulo, Dept Infect Dis, BR-05685090 São Paulo, Brazil Web of Science