ABSTRACT
INTRODUCTION: Percutaneous nephrostomy tubes (PNT), which are used in some cancer hospitals, are associated with an increase in urinary tract infections (UTI). OBJECTIVE: To determine the impact of a standardized care program on the incidence of UTIs requiring hospitalization (UTI-RH). MATERIAL AND METHODS: Retrospective study that included patients with a first PNT inserted. The incidence, relative risk (RR), costs and outcomes of patients with UTI-RH were compared during the period before (P0) vs. after the intervention (P1). RESULTS: 113 PNTs were inserted during P0, and 74 at P1. During P0, 61 patients (53.9%) experienced 64 UTI-RH events in 22,557 PNT days. At P1, four patients (5.4%) had a UTI-RH in 6,548 PNT days (IRR: 0.21, 95% CI: 0.05-0.57). The RR was 0.09 (95% CI: 0.03-0.25). Monthly cost per day/bed was USD 3,823 at P0 and USD 1,076 at P1, and for antibiotics, it was USD 790 at P0 and USD 123.5 at P1. CONCLUSIONS: This study highlights the importance of a standardized care program for permanent percutaneous devices, since this reduces antibiotic use, hospitalization, and the cost of care.
ANTECEDENTES: Los catéteres de nefrostomía percutánea (CNP) que se utilizan en algunos hospitales oncológicos condicionan un incremento en las infecciones del tracto urinario (ITU). OBJETIVO: Determinar el impacto de un programa estandarizado de atención en la incidencia de ITU que requiere hospitalización (ITU-RH). MATERIAL Y MÉTODOS: Estudio retrospectivo que incluyó pacientes con un primer CNP. Se comparó la incidencia, riesgo relativo (RR), costos y evolución de los pacientes con ITU-RH durante el período previo a la intervención (P0) versus posterior a ella (P1). RESULTADOS: Se instalaron 113 CNP durante P0 y 74 durante P1. Durante P0, 61 pacientes (53.9 %) presentaron 64 episodios de ITU-RH, en 22 557 días de uso de CNP. Durante P1, cuatro pacientes (5.4%) cursaron con ITU-RH en el transcurso de 6548 días de uso del CNP (razón de tasa de incidencia de 0.21, IC 95 % = 0.05-0.57). El RR fue de 0.09 (IC 95 % = 0.03-0.25). El costo mensual por día-cama fue de 3823 USD en P0 y de 1076 USD en P1; el de los antibióticos, de 790 USD en P0 y 123.5 USD en P1. CONCLUSIONES: Este estudio resalta la importancia de un programa estandarizado del cuidado de los dispositivos permanentes, el cual disminuye el uso de antibióticos, la hospitalización y el costo de la atención.
Subject(s)
Hospitalization , Nephrostomy, Percutaneous , Urinary Tract Infections , Humans , Urinary Tract Infections/epidemiology , Retrospective Studies , Male , Female , Incidence , Middle Aged , Aged , Anti-Bacterial Agents/therapeutic use , Aged, 80 and over , AdultABSTRACT
Resumen Antecedentes: Los catéteres de nefrostomía percutánea (CNP) que se utilizan en algunos hospitales oncológicos condicionan un incremento en las infecciones del tracto urinario (ITU). Objetivo: Determinar el impacto de un programa estandarizado de atención en la incidencia de ITU que requiere hospitalización (ITU-RH). Material y métodos: Estudio retrospectivo que incluyó pacientes con un primer CNP. Se comparó la incidencia, riesgo relativo (RR), costos y evolución de los pacientes con ITU-RH durante el período previo a la intervención (P0) versus posterior a ella (P1). Resultados: Se instalaron 113 CNP durante P0 y 74 durante P1. Durante P0, 61 pacientes (53.9 %) presentaron 64 episodios de ITU-RH, en 22 557 días de uso de CNP. Durante P1, cuatro pacientes (5.4%) cursaron con ITU-RH en el transcurso de 6548 días de uso del CNP (razón de tasa de incidencia de 0.21, IC 95 % = 0.05-0.57). El RR fue de 0.09 (IC 95 % = 0.03-0.25). El costo mensual por día-cama fue de 3823 USD en P0 y de 1076 USD en P1; el de los antibióticos, de 790 USD en P0 y 123.5 USD en P1. Conclusiones: Este estudio resalta la importancia de un programa estandarizado del cuidado de los dispositivos permanentes, el cual disminuye el uso de antibióticos, la hospitalización y el costo de la atención.
Abstract Background: Percutaneous nephrostomy tubes (PNT), which are used in some cancer hospitals, are associated with an increase in the incidence of urinary tract infections (UTI). Objective: To determine the impact of a standardized care program on the incidence of UTI requiring hospitalization (UTI-RH). Material and methods: Retrospective study that included patients with a first PNT inserted. The incidence, relative risk (RR), costs and outcomes of patients with UTI-RH were compared during the period before (P0) vs. after the intervention (P1). Results: 113 PNCs were inserted during P0, and 74 at P1. During P0, 61 patients (53.9%) experienced 64 UTI-RH events in 22,557 PNT days. At P1, four patients (5.4%) had a UTI-RH in 6,548 PNT days (IRR: 0.21, 95% CI: 0.05-0.57). The RR was 0.09 (95% CI: 0.03-0.25). Monthly cost per day/bed was USD 3,823 at P0 and USD 1,076 at P1, and for antibiotics, it was USD 790 at P0 and USD 123.5 at P1. Conclusions: This study highlights the importance of a standardized care program for permanent percutaneous devices, since this reduces antibiotic use, hospitalization, and the cost of care.
ABSTRACT
OBJECTIVES: We aimed to describe the clinical and imaging characteristics; associated risk factors and neurological outcome of posterior reversible encephalopathy syndrome (PRES) in patients with systemic lupus erythematosus (SLE). METHODS: From October 2001 to January 2007, we identified patients with SLE and the criteria for PRES in our institution, which is a tertiary-care referral center for patients with SLE; the patients were evaluated at baseline and followed to determine the clinical outcome. RESULTS: We identified 22 episodes of PRES in 21 patients; 20 (95.2%) were women, mean age of onset was 24.9+/-8.6 years, all patients had high systemic activity (SLEDAI scores from 12 to 39). Acute hypertension was observed in 18 episodes (81.8%), and renal failure in 16 (72.7%); only 3 patients were on cyclophosphamide at the time of the onset of PRES. Persistent neurological deficit was observed in 2 cases; one patient died during the acute episode. CONCLUSIONS: PRES is a central nervous system syndrome that is observed in SLE patients. It was associated mainly to high systemic activity, acute hypertension, and renal failure. Although reversibility is common, residual neurological damage may be observed.
