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OBJECTIVES: This study aimed to determine the association of Escherichia coli microbiological factors with 30-day mortality in patients with bloodstream infection (BSI) presenting with a dysregulated response to infection (i.e. sepsis or septic shock). METHODS: Whole-genome sequencing was performed on 224 E coli isolates of patients with sepsis/septic shock, from 22 Spanish hospitals. Phylogroup, sequence type, virulence, antibiotic resistance, and pathogenicity islands were assessed. A multivariable model for 30-day mortality including clinical and epidemiological variables was built, to which microbiological variables were hierarchically added. The predictive capacity of the models was estimated by the area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI). RESULTS: Mortality at day 30 was 31% (69 patients). The clinical model for mortality included (adjusted OR; 95% CI) age (1.04; 1.02-1.07), Charlson index ≥3 (1.78; 0.95-3.32), urinary BSI source (0.30; 0.16-0.57), and active empirical treatment (0.36; 0.11-1.14) with an AUROC of 0.73 (95% CI, 0.67-0.80). Addition of microbiological factors selected clone ST95 (3.64; 0.94-14.04), eilA gene (2.62; 1.14-6.02), and astA gene (2.39; 0.87-6.59) as associated with mortality, with an AUROC of 0.76 (0.69-0.82). DISCUSSION: Despite having a modest overall contribution, some microbiological factors were associated with increased odds of death and deserve to be studied as potential therapeutic or preventive targets.
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Introducción: Las enfermedades de transmisión sexual, como la cervicitis, la proctitis y la uretritis, se asocian a altas tasas de infección por VIH. Ante la sospecha de estas patologías, se debería solicitar una serología del VIH. Material y métodos: Estudio retrospectivo realizado durante 2018 en el Hospital Costa del Sol (Marbella, Málaga). Se revisaron las serologías para el VIH solicitadas en pacientes a los que se les pidió una PCR para Chlamydia trachomatis y Neisseria gonorrhoeae. Resultados: Se valoraron 1.818 pacientes, en los que se realizó serología para el VIH al 44,7%, de las cuales 14 (1,7%) resultaron positivas. El 55,3% restante fueron oportunidades perdidas de diagnóstico. Conclusiones: Las infecciones por C.trachomatis y N.gonorrhoeae están asociadas a una elevada tasa de infección oculta por el VIH. El grado de sospecha de VIH en esta población sigue siendo bajo, y resulta esencial que se refuerce ante la posibilidad de infección por estas patologías.(AU)
Introduction: Sexually transmitted diseases such as cervicitis, proctitis and urethritis are associated with high rates of HIV infection. When these pathologies are suspected, HIV serology should be requested. Material and methods: A Retrospective study was performed during 2018 at the Hospital Costa del Sol (Marbella, Málaga, Spain). HIV serologies requested in patients who were asked for PCR for Chlamydia trachomatis and Neisseria gonorrhoeae were reviewed. Results: A total of 1818 patients were evaluated, in which HIV serology was performed in 44.7%, of which 14 (1.7%) were positive. The remaining 55.3% were missed diagnostic opportunities. Conclusions: C.trachomatis and N.gonorrhoeae infections are associated with a high rate of occult HIV infection. The degree of suspicion of HIV in this population remains low and it is essential that it be reinforced in the presence of the possibility of infection by these pathologies.(AU)
Subject(s)
Humans , Male , Female , HIV Infections/diagnosis , Early Diagnosis , Sexually Transmitted Diseases , Chlamydia , Gonorrhea , Epidemiology, Descriptive , Retrospective Studies , Cross-Sectional Studies , Microbiology , Microbiological Techniques , Communicable Diseases , Urethritis , Uterine Cervicitis , ProctitisSubject(s)
Humans , Female , Middle Aged , Thrombosis/etiology , Cytomegalovirus , Immunocompetence , Portal Vein , Inpatients , Physical ExaminationABSTRACT
Introducción: describir un cuadro poco habitual como es la leishmaniasis visceral con afectación colónica. Caso clínico: presentamos el caso de un paciente VIH positivo con leishmaniasis visceral. Se describe el caso clínico, con los procedimientos realizados, el tratamiento y su evolución. Se adjunta tabla comparativa de los casos publicados de leishmaniasis con afectación de colon. Discusión: la afectación intestinal en la leishmaniasis visceral es un proceso infrecuente, que debe incluirse en el diagnóstico diferencial en todo paciente inmunodeprimido con clínica de diarrea y que requiere un diagnóstico precoz y tratamiento adecuado, del que depende el pronóstico del paciente (AU)
Background: To describe an unusual clinical presentation of visceral leishmaniasis affecting the colon. Case report: We report the case of an HIV-positive patient with visceral leishmaniasis. We describe the clinical case, the procedures performed, the treatment provided and the patients evolution. A comparative table of previously reported similar cases is shown. Discussion: Visceral leishmaniasis with intestinal involvement is an uncommon process. Nevertheless, this possibility should be taken into consideration in the differential diagnosis of immunosuppressed patients with symptoms of diarrhea, as a favorable prognosis depends on early diagnosis and appropriate treatment (AU)
Subject(s)
Humans , Male , Middle Aged , HIV/pathogenicity , Leishmaniasis, Visceral/complications , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/pathology , Early Diagnosis , Clostridioides difficile , Clostridioides difficile/isolation & purification , Amphotericin B/therapeutic use , Immunocompromised Host , Prognosis , Splenomegaly/complications , Splenomegaly/pathology , Anti-Retroviral Agents/therapeutic use , Renal Insufficiency/complicationsABSTRACT
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Subject(s)
Humans , Male , Female , Hypertension, Pulmonary/complications , HIV Infections/complications , Reverse Transcriptase Inhibitors/adverse effects , Anti-HIV Agents/therapeutic useABSTRACT
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Humans , Bacteremia/epidemiology , Early Diagnosis , Emergency Medical Services/statistics & numerical data , Risk Factors , Risk Adjustment/methods , Forecasting , Evaluation of the Efficacy-Effectiveness of Interventions , Patient DischargeABSTRACT
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Humans , Male , Middle Aged , HIV Infections/complications , Oropharyngeal Neoplasms/complications , Leishmaniasis/complications , Hepatitis C/complications , BiopsyABSTRACT
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Male , Female , Adult , Humans , HIV Infections/drug therapy , Wasting Syndrome/etiology , Antiretroviral Therapy, Highly Active/adverse effects , HIV Infections/complicationsABSTRACT
Antecedentes y objetivo. La efectividad de los antirretrovirales está asociada de forma muy estrecha al grado de adhesión. Este trabajo pretende determinar la asociación de las variables demográficas y psicosociales con la adherencia al tratamiento antirretroviral. Pacientes y métodos. Se realizó un estudio transversal con 320 pacientes en tratamiento antirretroviral, atendidos en cuatro hospitales de la Comunidad Autónoma Andaluza. Se utilizó un cuestionario semiestructurado, administrado por personal sanitario. Resultados. La edad media de la muestra fue 39,7 años. El 11,9% de la muestra estudiada fue considerada no adherida al tratamiento antirretroviral. Se detectó una interacción entre la presencia de morbilidad psíquica y la puntuación del índice de salud mental (ISM). Así, entre aquellos que padecían morbilidad psíquica a una mejor calidad de vida mental se les asoció un menor riesgo de no adherirse al tratamiento (p = 0,04), no describiéndose esta asociación entre aquéllos sin morbilidad psíquica. Una mayor edad, ser homosexual y haber estado menos años como consumidor de drogas por vía parenteral mostraron una tendencia a asociarse a la no adherencia. Conclusiones. Los factores demográficos y psicosociales influyen en la adherencia al tratamiento antirretroviral (AU)
Background and objective. Antiretroviral efficacy is closely related to the degree of adherence. The aim of this study is to assess the association between psychosocial and demographic variables and adherence to antiretroviral treatment. Patients and methods. A cross-sectional survey of 320 patients under antiretroviral treatment was conducted in four Andalusian hospitals, using a semi-structured questionnaire given by health care professionals. Results. Median age was 39.7 years. Nearly 12% of the sample was considered non-compliant to antiretroviral treatment. An interaction was observed between psychological morbidity and mental health quality of life scores. Among patients who presented psychological morbidity, a higher mental quality of life score was associated with a lower risk of non-compliance (P = 0.04). This association was not found among patients without psychological morbidity. Older age, homosexual or bisexual status and the use of injecting drugs for a shorter period of time was associated with non-compliance. Conclusions. Demographic and psychological factors have an influence on adherence to antiretroviral treatment (AU)
Subject(s)
Male , Female , Humans , Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/psychology , Patient Compliance/psychology , Patient Compliance/statistics & numerical data , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
Introducción. La calidad de vida es uno de los métodos de evaluación subjetiva más utilizados en enfermedades de carácter crónico. El objetivo de este estudio es analizar la asociación entre parámetros clínicos y terapéuticos y las 11 dimensiones de calidad de vida en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Métodos. Se realizó un estudio transversal con 320 pacientes en tratamiento antirretroviral de 4 hospitales andaluces. Se utilizó un cuestionario semiestructurado administrado por personal sanitario. La calidad de vida relacionada con la salud se midió a través del cuestionario MOS-HIV (Medical Outcomes Study HIV Health Survey), que es un instrumento específico para pacientes con VIH. Resultados. El 73,4% de los entrevistados eran varones, el 35,6% tenían sida y el 88,1% fue considerado adherente al tratamiento. Los pacientes con una mayor carga viral presentaron puntuaciones más bajas en todas las dimensiones de la calidad de vida, a excepción de la función cognitiva. Los pacientes con sida mostraron una peor calidad de vida en 10 de las 11 dimensiones. Aquéllos con una adherencia adecuada al tratamiento antirretroviral mostraron una mejor calidad de vida en 10 dimensiones. No se detectaron diferencias estadísticamente significativas en las medias de las dimensiones del cuestionario MOS-HIV entre pacientes cuya combinación farmacológica incluía inhibidores de la proteasa y aquellos que no, a excepción de la dimensión de calidad de vida. Conclusión. El estado clínico y la adherencia del paciente no sólo afectan a su supervivencia, sino también a diferentes dimensiones de su calidad de vida (AU)
Introduction. Quality of life is one of the most frequently used subjective measures in chronic health problems. The aim of this study is to analyze the association between clinical and therapeutic parameters, and 11 quality of life domains in HIV-infected patients. Methods. A cross-sectional survey of 320 patients on antiretroviral treatment was conducted in four Andalusian hospitals (Spain). A semi-structured questionnaire was administered by health care professionals. Health-related quality of life was assessed with the MOS-HIV questionnaire, an instrument designed specifically for HIV-infected patients. Results. Almost three-quarters of the population were men (73.4%); 35.6% had developed aids, and 88.1% were considered adherent to treatment. Patients with greater viral load presented lower quality of life scores for all the domains, except cognitive functioning. Patients who had developed aids showed poorer quality of life for 10 of the 11 domains. Patients with adequate adherence to antiretroviral treatment showed better quality of life for 10 domains. No statistically significant differences in the domain scores except for quality of life were found between patients with a treatment regimen including protease inhibitors and those without. Conclusion. The patient's clinical status and adherence affect not only survival, but also quality of life (AU)
Subject(s)
Adult , Aged , Middle Aged , Humans , Antiretroviral Therapy, Highly Active , HIV Infections/psychology , Patient Compliance/statistics & numerical data , Quality of Life , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/psychology , CD4 Lymphocyte Count , Cross-Sectional Studies , HIV Infections/drug therapy , Treatment Outcome , Spain , Viral LoadABSTRACT
El objeto de este estudio es analizar la relación existente entre la morbilidad psíquica y el apoyo social con la calidad de vida. Por otro, el papel que realiza el apoyo social como amortiguador de la morbilidad psíquica en estos pacientes. Se estudiaron a 320 pacientes VIH positivos en tratamiento con antirretrovirales, que acudieron a las consultas externas del servicio de infecciosos de cuatro hospitales de la comunidad autónoma andaluza. Así, una mejor calidad de vida se asoció a una ausencia de morbilidad psíquica y a la presencia de apoyo social, a la vez que se observa el papel fundamental que juega el apoyo social como amortiguador de la morbilidad psíquica en este tipo de pacientes. Estos resultados ponen de relieve la importancia que los factores psicosociales tienen durante el transcurso de enfermedades de carácter crónico
The aim of this study is to analyse the existing relation between the psychic morbidity and social support and the quality of life. Besides this, the paper analyses the buffer roll that social support plays on the psychic morbidity in these patients. We studied 320 HIV+ patients in treatment with antiretrovirals, who attended the infectious disease services of four hospitals of the Autonomous Andalusian Community. Being associated a better quality of life to an absence of psychic morbidity and to the presence of social support, it is observed the relevant buffer role that the social support like shock absorber of the psychic morbidity in this one type of patients. These results show the importance that the psycho-social factors have during the course of chronic diseases
Subject(s)
Humans , Sickness Impact Profile , HIV Infections/complications , Anti-Retroviral Agents/adverse effects , Mental Disorders/epidemiology , HIV Infections/drug therapy , Social Support , Quality of Life , ComorbidityABSTRACT
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