ABSTRACT
OBJECTIVE: This study intends to determine the prevalence of multidrug resistant (MDR) infections by A. baumannii, K. pneumoniae and P. aeruginosa in a tertiary care teaching hospital intensive care unit (ICU) in San Juan, PR, estimate the mortality rate and compare the morbidity and mortality differences among those treated with and without polymyxin B. METHODS: We selected adults patients admitted to the ICU who had positive cultures from January 2012 to June 2013. Sample consisted of 25 patients with age ranges from 27-78 years, 13 women and 12 men. RESULTS: The median age at death was 60 years. Polymyxin B nephrotoxicity was identified on 15% of the patients. Variables related to higher survival were younger age, female sex, use of polymyxin B, and the use of daptomycin. The use of vancomycin and vasopressors were associated with worse outcome. Mortality associated to single MDR bacteria was 88% for A. baumannii, 84% for K. pneumoniae and 67% for P. aeruginosa. All patients with more than one MDR infection died in the ICU. CONCLUSION: The use of polymyxin B was associated with an ICU mortality reduction. Unexpectedly we found a significantly improved survival in patients who received polymyxin B in combination with daptomycin, which awaits prospective confirmation.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Gram-Negative Bacteria/drug effects , Gram-Negative Bacterial Infections/drug therapy , Polymyxin B/administration & dosage , Adult , Aged , Anti-Bacterial Agents/adverse effects , Drug Resistance, Multiple, Bacterial , Female , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/epidemiology , Gram-Negative Bacterial Infections/mortality , Hispanic or Latino , Humans , Intensive Care Units , Male , Middle Aged , Polymyxin B/adverse effects , Prevalence , Prospective Studies , Puerto Rico , Survival RateABSTRACT
The probability of recording infectious diseases and injuries to the musculoskeletal system during sports events with a large number of participants is very high. From an historical perspective the distribution and trends of diseases that have an impact on public health have been evaluated by means of epidemiological surveillance systems. However, the application of these epidemiological methods to sports medicine is relatively recent. The utilization of an epidemiological surveillance system during sports events with a large number of participating athletes and countries has been reported in a limited number of competitions. In this article we describe the design of a system for epidemiological surveillance utilized during the XVII Central American and Caribbean Sports Games held in Puerto Rico in 1993, as an example of a surveillance system that could be regularly established in this type of event
Subject(s)
Humans , Athletic Injuries/epidemiology , Communicable Diseases/epidemiology , Program Development , Population Surveillance/methods , Central America/ethnology , Puerto Rico/epidemiology , Caribbean Region/ethnologyABSTRACT
The objective of the epidemiological surveillance system for the XVII Central American and Caribbean Sports Games in 1993 in Puerto Rico was to estimate the morbidity related to infectious diseases and sports injuries during the competitions. In the village hospital a total of 794 medical consultations were reported; 57.7 per cent of the patients were athletes. Among athletes, the rate of consultation was 10.4 for every 100 participants. The consultations were more frequent in males (535, 67.4 per cent ). The analysis by country of origin revealed that the athletes from Guatemala (42, 9.2 per cent ) and Jamaica (35, 7.6 per cent ) used the services more frequently. The incidence of consultations by sport was higher in field hockey (47, 10.3 per cent ), followed by athletics (46, 10 per cent ), and softball (36, 7.9 per cent ). The most frequent diagnoses were injuries--302, 38.04 per cent ; of these 229 (75.8 per cent ) were athletes--,conditions of the respiratory system (180, 22.67 per cent ), problems of the skin and mucous membranes (85, 10.71 per cent ), and problems of the gastrointestinal tract (56, 7.05 per cent ). The severity of the majority of the conditions was mild and required primary care health professionals
