Mortality risk factors in patients with zygomycosis: a retrospective and multicentre study of 25 cases

Objetivo Investigar los factores de riesgo de mortalidad en pacientes con zigomicosis. Pacientes & Métodos Revisión retrospectiva de pacientes diagnosticados de zigomicosis documentada en 17 centros en España, comparando los datos demográficos y los factores de riesgo entre los pacientes que sobrevivieron y aquellos que fallecieron. Resultados Se identificaron 25 pacientes con zigomicosis probada. El lugar primario de la infección fue rino-órbito-cerebral (28%) e infecciones diseminadas o cutáneas / de tejidos blandos en el 20% de los pacientes cada una. Once pacientes (44%) recibieron tratamiento antifúngico anticipado o empírico; de estos pacientes, cuatro de ellos recibieron anfotericina B liposomal, un paciente recibió anfotericina B complejo lipídico y 6 pacientes recibieron otros antifúngicos. La tasa de mortalidad global fue del 72%. En el análisis univariado, los factores asociados a un mayor riesgo de muerte fueron la presencia de enfermedad hematológica maligna (p=0,03), neutropenia (p=0,03) y monocitopenia (p=0,008).Conclusión Los datos de nuestro estudio concuerdan con los de trabajos previos que habían documentado una elevada tasa de mortalidad en pacientes con zigomicosis invasiva, especialmente en aquellos con enfermedad hematológica maligna subyacente, y la necesidad de instaurar rápidamente un tratamiento antifúngico eficaz (AU)

Aim: To investigate mortality risk factors in patients with zygomycosis. Patients and Methods: Retrospective case history review of patients diagnosed with proven zygomicosis in 17 centres in Spain. We compared demographics and risk factors in patients who survived, and in those who died. Results: We identified twenty-five patients with proven zygomycosis. The primary site of infection wasrhino-orbito-cerebral (28%) and disseminated (20%) or cutaneous/soft infections (20%) of the patients. Eleven patients (44%) received preemptive or empirical antifungal treatment; of these patients, 4 received liposomal amphotericin B, 1 received amphotericin B lipid complex, and 6 received other antifungals. The overall mortality rate was 72%. In the univariate analysis factors associated with an increased risk of death were the presence of a haematological malignancy (P = .03), neutropenia (P = .03) and monocytopenia (P = .008).Conclusion: Our study supports previous research that has documented a high mortality rate among patients with invasive zygomycosis, especially among those with an underlying haematological malignancy, and the need for a rapid initiation of an effective antifungal treatment (AU)

Mortality risk factors in patients with zygomycosis: a retrospective and multicentre study of 25 cases.

AIM: To investigate mortality risk factors in patients with zygomycosis. PATIENTS AND METHODS: Retrospective case history review of patients diagnosed with proven zygomicosis in 17 centres in Spain. We compared demographics and risk factors in patients who survived, and in those who died. RESULTS: We identified twenty-five patients with proven zygomycosis. The primary site of infection was rhino-orbito-cerebral (28%) and disseminated (20%) or cutaneous/soft infections (20%) of the patients. Eleven patients (44%) received preemptive or empirical antifungal treatment; of these patients, 4 received liposomal amphotericin B, 1 received amphotericin B lipid complex, and 6 received other antifungals. The overall mortality rate was 72%. In the univariate analysis factors associated with an increased risk of death were the presence of a haematological malignancy (P=.03), neutropenia (P=.03) and monocytopenia (P=.008). CONCLUSION: Our study supports previous research that has documented a high mortality rate among patients with invasive zygomycosis, especially among those with an underlying haematological malignancy, and the need for a rapid initiation of an effective antifungal treatment.

[Variability in the sensitivity to tigecycline against Acinetobacter baumannii in different culture media]. / Variabilidad en la sensibilidad de tigeciclina frente a Acinetobacter baumannii en diferentes medios de cultivo.

INTRODUCTION: The tigecycline may represent a therapeutic alternative for the control of multiresistant A. baumannii, although there is no consensus regarding the cutoff points for sensitivity or variability of MIC as a function of culture medium used for the antibiogram against this microorganism. Therefore, our objective was to verify this variability, and propose the culture medium that comes closest to the standard method. METHODS: We selected 41 strains of carbapenem-resistant A. baumannii. We analyzed the sensitivity to tigecycline in different culture media: Mueller Hinton agar Oxoid commercial (C-MH), Mueller Hinton fresh agar BD and Co., USA (F-MH) and ISO-sensitest fresh agar Oxoid, using the E-test and disk. The MICs were compared against those obtained using the technique standard of macrodilution. RESULTS: The mean MIC and inhibition diameters obtained in the different culture media corresponded to 9.26 mg/L and 15.1 mm in diameter for MH-C, 1.71 mg/L and 22.7 mm for MH-F; 2.68 mg/L and 20.8 mm for ISO-sensitest. Half the MIC obtained by the standard method of dilution was 0.47 mg/L (SD =0.21), with values between 0.25 and 1 mg/L. CONCLUSION: In the three growth media studied, MICs superior to the standard are observed, which is false to interpret resistance in many cases. However, the medium that comes closer more that of reference is the MH-F.

[Mortality and hospital stay adjusted for severity as indicators of effectiveness and efficiency of attention to intensive care unit patients]. / Mortalidad y estancia hospitalaria ajustada por gravedad como indicadores de efectividad y eficiencia de la atención de pacientes en Unidades de Cuidados Intensivos.

OBJECTIVE: To evaluate effectiveness and efficiency of ICU care using the APACHE III model customized for Spain. DESIGN: Prospective, observational, multi-centre cohort study. SETTING: Nine Spanish ICUs. PATIENTS: One thousand two hundred and eleven patients admitted consecutively. Patients under 16 years of age, patients admitted for less than 24 hours, patients admitted for definitive pacemaker implant and ICU readmissions within the same hospital stay were excluded. PRIMARY ENDPOINTS: All the necessary endpoints to calculate the APACHE III score and predicted mortality risk were collected. The Standardized Mortality Ratio (SMR) was calculated. The Actual Weighted Hospital Days (AWHD) was calculated according to the patient's status and patient's location (ward or ICU). The Weighted Hospital Days Predicted (WHDP) was calculated according to the multiple regression model that provided the best explanation of the hospital stay. Later, the Standardized Resource Use Performance Index (SRUPI), computed as AWHD/WHDP, was calculated for each hospital. RESULTS: The SMR was 0.9 (95% CI: 0.82-0.99), SRUPI was greater than 1 in 3 of 9 hospitals, According the SMR and SRUPI only one hospital was qualified as an outlier. CONCLUSIONS; In this study, no relationship was found between quality of care and use of resources. Moreover, this methodology may be a useful tool in order to detect deviations from the standard of care and use of resources, and in this way to lead to the analysis of different causes, the differences among hospitals being taken into account.

Mortalidad y estancia hospitalaria ajustada por gravedad como indicadores de efectividad y eficiencia de la atención de pacientes en Unidades de Cuidados Intensivos / Mortality and hospital stay adjusted for severity as indicators of effectiveness and efficiency of attention to Intensive Care Unit patients

Objetivo. Evaluar la efectividad y la eficiencia de la atención en Unidadesa de Cuidados Intensivos (UCI) mediante el índice APACHE III adaptado a España. Diseño. Estudio multicéntrico prospectivo observacional de cohortes. Ámbito. Nueve UCI en España. Pacientes. Mil doscientos once pacientes ingresados consecutivamente. Se excluyeron menores de 16 años, con estancia inferior a 24 horas, ingresados para implante definitivo de marcapasos y reingresados en UCI dentro del mismo ingreso hospitalario. Variables de interés principales. Se recogieron para cada paciente los datos de filiación y todas aquellas variables necesarias para calcular el índice APACHE III y su riesgo de mortalidad. Se calculó la razón estandarizada de mortalidad (REM). Se calculó la estancia hospitalaria ponderada observada (EHPO) adjudicando diferentes pesos a cada día de estancia, en función del tipo de paciente y del lugar de cada día de estancia. Se calculó la estancia hospitalaria ponderada predicha (EHPP) según el modelo de regresión múltiple que mejor explicaba la estancia hospitalaria. Posteriormente se calculó el índice de utilización de recursos (IUR) ­ EHPO/EHPP ­ para cada hospital. Resultados. La REM global fue de 0,9 (IC 95%: 0,82-0,99). El IUR fue mayor de 1 en tres de los 9 hospitales. Valorando el REM y el IUR conjuntamente sólo un hospital se salió del estándar marcado por los 9 hospitales del estudio. Conclusiones. En este estudio no se encontró relación entre la calidad de la asistencia a los pacientes y la utilización de recursos; sin embargo esta metodología puede ser una herramienta para detectar desviaciones del estándar por exceso de la mortalidad o de la utilización de recursos, y esto, conducir al análisis de posibles causas, teniendo en cuenta las diferencias entre los distintos hospitales y UCI

Objective. To evaluate effectiveness and efficiency of ICU care using the APACHE III model customized for Spain. Desing. Prospective, observational, multi-centre cohort study. Setting. Nine Spanish ICUs. Patients. One thousand two hundred and eleven patients admitted consecutively. Patients under 16 years of age, patients admitted for less than 24 hours, patients admitted for definitive pacemaker implant and ICU readmissions within the same hospital stay were excluded. Primary endpoints. All the necessary endpoints to calculate the APACHE III score and predicted mortality risk were collected. The Standardized Mortality Ratio (SMR) was calculated. The Actual Weighted Hospital Days (AWHD) was calculated according to the patient's status and patient's location (ward or ICU). The Weighted Hospital Days Predicted (WHDP) was calculated according to the multiple regression model that provided the best explanation of the hospital stay. Later, the Standardized Resource Use Performance Index (SRUPI), computed as AWHD/WHDP, was calculated for each hospital. Results. The SMR was 0.9 (95% CI: 0.82-0.99), SRUPI was greater than 1 in 3 of 9 hospitals, According the SMR and SRUPI only one hospital was qualified as an outlier. Conclusions. In this study, no relationship was found between quality of care and use of resources. Moreover, this methodology may be a useful tool in order to detect deviations from the standard of care and use of resources, and in this way to lead to the analysis of different causes, the differences among hospitals being taken into account

Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America guidelines on survival.

BACKGROUND: The purpose of our study was to analyze prognostic factors associated with mortality for patients with severe community-acquired pneumonia (CAP). METHODS: We conducted a prospective multicenter study including all patients with CAP admitted to the intensive care unit during a 15-month period in 33 Spanish hospitals. Admission data and data on the evolution of the disease were recorded. Multivariate analysis was performed using the SPSS statistical package (SPSS). RESULTS: A total of 529 patients with severe CAP were enrolled; the mean age (+/-SD) was 59.9+/-16.1 years, and the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score (+/-SD) was 18.9+/-7.4. Overall mortality among patients in the intensive case unit was 27.9% (148 patients). The rate of adherence to Infectious Diseases Society of America (IDSA) guidelines was 57.8%. Significantly higher mortality was documented among patients with nonadherence to treatment (33.2% vs. 24.2%). Multivariate analysis identified age (odds ratio [OR], 1.7), APACHE II score (OR, 4.1), nonadherence to IDSA guidelines (OR, 1.6), and immunocompromise (OR, 1.9) as the variables present at admission to the intensive care unit that were independently associated with death in the intensive care unit. In 15 (75%) of 20 cases of Pseudomonas aeruginosa infection, the antimicrobial treatment at admission was inadequate (including 8 of 15 cases involving patients with adherence to IDSA guidelines). Chronic obstructive pulmonary disease (OR, 17.9), malignancy (OR, 11.0), previous antibiotic exposure (OR, 6.2), and radiographic findings demonstrating rapid spread of disease (OR, 3.9) were associated with P. aeruginosa pneumonia. CONCLUSIONS: Better adherence to IDSA guidelines would help to improve survival among patients with severe CAP. Pseudomonas coverage should be considered for patients with chronic obstructive pulmonary disease, malignancy, or recent antibiotic exposure.