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- 저자 : Andrea Vila (검색결과 3 건)
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Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline
Andrea Vila,Hugo Pagella,Claudio Amadio,Alejandro Leiva 대한감염학회 2016 Infection and Chemotherapy Vol.48 No.4
Prosthesis retention is not recommended for multidrug-resistant Acinetobacter prosthetic joint infection due to its high failure rate. Nevertheless, replacing the prosthesis implies high morbidity and prolonged hospitalization. Although tigecycline is not approved for the treatment of prosthetic joint infection due to multidrug resistant Acinetobacter baumannii, its appropriate use may preclude prosthesis exchange. Since the area under the curve divided by the minimum inhibitory concentration is the best pharmacodynamic predictor of its efficacy, we used tigecycline at high dose, in order to optimize its efficacy and achieve implant retention in 3 patients who refused prosthesis exchange. All patients with prosthetic joint infections treated at our Institution are prospectively registered in a database. Three patients with early prosthetic joint infection of total hip arthroplasty due to multidrug resistant A. baumannii were treated with debridement, antibiotics and implant retention, using a high maintenance dose of tigecycline (100 mg every 12 hours). The cases were retrospectively reviewed. All patients signed informed consent for receiving off-label use of tigecycline. Tigecycline was well tolerated, allowing its administration at high maintenance dose for a median of 40 days (range 30–60). Two patients were then switched to minocycline at standard doses for a median of 3.3 months in order to complete treatment. Currently, none of the patients showed relapse. Increasing the dose of tigecycline could be considered as a means to better attain pharmacodynamic targets in patients with severe or difficult-to-treat infections. Tigecycline at high maintenance dose might be useful when retention of the implant is attempted for treatment for prosthetic joint infections due to multidrug resistant Acinetobacter. Although this approach might be promising, off-label use of tigecycline should be interpreted cautiously until prospective data are available. Tigecycline is probably under-dosed for the treatment of implant and biofilm associated infections.
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New optimum distribution of lateral strength of shear-type buildings for uniform damage
Jesús Donaire-Á vila,Andrea Lucchini,Amadeo Benavent-Climent,Fabrizio Mollaioli 국제구조공학회 2020 Structural Engineering and Mechanics, An Int'l Jou Vol.76 No.3
The seismic design of conventional frame structures is meant to enhance plastic deformations at beam ends and prevent yielding in columns. To this end, columns are made stronger than beams. Yet yielding in columns cannot be avoided with the column-to-beam strength ratios (about 1.3) prescribed by seismic codes. Preventing plastic deformations in columns calls for ratios close to 4, which is not feasible for economic reasons. Furthermore, material properties and the rearrangement of geometric shapes inevitably make the distribution of damage among stories uneven. Damage in the i-th story can be characterized as the accumulated plastic strain energy (Wpi) normalized by the product of the story shear force (Qyi) and drift (yi) at yielding. Past studies showed that the distribution of the plastic strain energy dissipation demand, Wpi /Wpj, can be evaluated from the deviation of Qyi with respect to an “optimum value” that would make the ratio Wpi/(Qyiyi) —i.e. the damage— equal in all stories. This paper investigates how the soil type and ductility demand affect the optimum lateral strength distribution. New optimum lateral strength distributions are put forth and compared with others proposed in the literature.
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