ABSTRACT
BackgroundCOVID-19 infection has led to an overwhelming effort by health institutions to meet the high demand for hospital admissions. AimTo analyse the clinical variables associated with readmission of patients who had previously been discharged after admission for COVID-19. Design and methodsWe studied a retrospective cohort of patients with laboratory-confirmed SARS-CoV-2 infection who were admitted and subsequently discharged alive. We then conducted a nested case-control study paired (1:1 ratio) by age, sex and period of admission. ResultsOut of 1368 patients who were discharged during the study period, 61 patients (4.4%) were readmitted. Immunocompromised patients were at increased risk for readmission. There was also a trend towards a higher probability of readmission in hypertensive patients (p=0.07). Cases had had a shorter hospital stay and a higher prevalence of fever during the 48 hours prior to discharge. There were no significant differences in oxygen levels measured at admission and discharge by pulse oximetry intra-subject or between the groups. Neutrophil/lymphocyte ratio at hospital admission tended to be higher in cases than in controls (p=0.06). The motive for readmission in 10 patients (16.4%), was a thrombotic event in venous or arterial territory (p<0.001). Neither glucocorticoids nor anticoagulants prescribed at hospital discharge were associated with a lower readmission rate. ConclusionsThe rate of readmission after discharge from hospital for COVID-19 was low. Immunocompromised patients and those presenting with fever during the 48 hours prior to discharge are at greater risk of readmission to hospital.
ABSTRACT
BackgroundThe COVID pandemic has had a major impact on healthcare in hospitals, including the diagnosis and treatment of infections. Hospital-acquired infective endocarditis (HAIE) is a severe complication of medical procedures that has shown a progressive increase in recent years. Objectivesto determine whether the incidence of HAIE during the first two months of the epidemic (March-April 2020) was higher than previously observed and to describe the clinical characteristics of these cases. The probability of studied event (HAIE) during the studied period was calculate by Poisson distribution. ResultsFour cases of HAIE were diagnosed in our institution during the study period. The incidence of HAIE during the study period was 2/patient-month and 0.25/patient-month during the previous 5 years (p=0.024). Two cases appeared during admission for COVID-19 with pulmonary involvement treated with methylprednisolone and tocilizumab. The other two cases were admitted to the hospital during the epidemic. All cases underwent central venous and urinary catheterization during admission. The etiology of HAIE was Enterococcus faecalis (2 cases), Staphylococcus aureus and Candida albicans (one case each). A source of infection was identified in three cases (central venous catheter, peripheral venous catheter, sternal wound infection, respectively). One patient was operated on. There were no fatalities during the first 30 days of follow-up. ConclusionsThe incidence of HAIE during COVID-19 pandemic in our institution was higher than usual. In order to reduce the risk of this serious infection, optimal catheter care, appropriate use of corticosteroids and interleukin antagonists and early treatment of every local infection should be prioritized during coronavirus outbreaks.
ABSTRACT
The present article is an update of the literature onintra-abdominal infection, which represents a spectrumof diseases with a common pathogenesis. Establishinga prompt diagnosis and avoiding treatment delays arekey to achieving the best outcomes. Mortality dependson initiating early appropriate treatment to restore fluidand electrolyte imbalances, supporting the functionof vital organs, providing appropriate broad-spectrumantimicrobial therapy, and achieving adequate sourcecontrol.A multidisciplinary group of Spanish physicians with aninterest in these infections selected the most importantpapers produced in the field during 2005 and 2006.One of the members of the group discussed the contentof each of the selected papers, with a critical reviewby other members of the panel.After a review of the state of the art, papers from the fieldsof epidemiology, pathophysiology, basic science, causativemicroorganisms and microbiological diagnosis, mainclinical syndromes, principles of therapy, new antibioticsand surgical procedures, preventive measures,recommended antimicrobial regimens and guidelineswere discussed by the group. Faculty from this panel havemade an interesting contribution to our understandingand management of intra-abdominal infections at present.Their contribution is particularly relevant for clinicalpractice(AU)
El presente artículo es una puesta al día de la literaturasobre infecciones intraabdominales, que constituyen unagama de procesos con una patogenia común. Para lograrlos mejores resultados tiene una importancia decisivaestablecer un diagnóstico precoz y evitar los retrasos en eltratamiento. La reducción de la mortalidad se basaen iniciar precozmente un tratamiento apropiado pararestaurar los desequilibrios hidroelectrolíticos, en apoyarla función de los órganos vitales, en proporcionar untratamiento adecuado con antibióticos de amplio espectroy en controlar correctamente las fuentes de la infección.Un grupo multidisciplinario de médicos españolesinteresados en este campo seleccionó los trabajos másdestacados que se han publicado sobre el tema en 2005y 2006. Cada artículo seleccionado fue analizado por unmiembro del panel, y el resto de miembros efectuóuna revisión crítica.Después de revisar el estado del arte, el grupo discutiólos trabajos sobre epidemiología, fisiopatología,ciencias básicas, microorganismos causalesy diagnóstico bacteriológico, principales síndromesclínicos, fundamentos del tratamiento, nuevos antibióticosy procedimientos quirúrgicos, medidas preventivas,y pautas y normas antimicrobianas recomendadas.Los miembros de este panel han aportado unainteresante contribución a nuestros conocimientosy a la conducta a seguir actualmente antelas infecciones intraabdominales. Su contribuciónes especialmente relevante para la práctica clínica(AU
