ABSTRACT
OBJECTIVES: This study aimed to evaluate the effectiveness of dalbavancin as sequential therapy in patients with infective endocarditis (IE) due to gram positive bacteria (GPB) in a real-life heterogenous cohort with comorbid patients. METHODS: A single center retrospective cohort study including all patients with definite IE treated with dalbavancin between January 2017 and February 2022 was developed. A 6-month follow-up was performed. The main outcomes were clinical cure rate, clinical and microbiological relapse, 6-month mortality, and adverse effects (AEs) rate. RESULTS: The study included 61 IE episodes. The median age was 78.5 years (interquartile range [IQR] 63.2-85.2), 78.7% were male, with a median Charlson comorbidity index of 7 (IQR 4-9) points. Overall, 49.2% suffered native valve IE. The most common microorganism was Staphylococcus aureus (26.3%) followed by Enterococcus faecalis (21.3%). The median duration of initial antimicrobial therapy and dalbavancin therapy were 27 (IQR 20-34) and 14 days (IQR 14-28) respectively. The total reduction of hospitalization was 1090 days. The most frequent dosage was 1500mg of dalbavancin every 14 days (96.7%). An AE was detected in 8.2% of patients, only one (1.6%) was attributed to dalbavancin (infusion reaction). Clinical cure was achieved in 86.9% of patients. One patient (1.6%) with Enterococcus faecalis IE suffered relapse. The 6-month mortality was 11.5%, with only one IE-related death (1.6%). CONCLUSION: This study shows a high efficacy of dalbavancin in a heterogeneous real-world cohort of IE patients, with an excellent safety profile. Dalbavancin allowed a substantial reduction of in-hospital length of stay.
ABSTRACT
Objetivo. Conocer el porcentaje de mujeres que han realizado consulta preconcepcional (CPC), los motivos de dicha consulta y las intervenciones realizadas. Diseño. Estudio observacional descriptivo, basado en entrevistas personales. Emplazamiento. Atención Primaria. Participantes. 465 mujeres con embarazo a término en los últimos doce meses. Mediciones principales. Realización de CPC, motivos, profesionales consultados, consulta privada o pública y actividades realizadas (exploración física, ginecológica, pruebas de laboratorio, citología, estudio genético, vacunaciones, consejo sanitario, quimioprofilaxis). Resultados. El 69,2% de los embarazos fue planificado. El 23,9% de las entrevistadas realizó CPC (IC95% 20,0-27,7). La CPC fue más frecuente en primíparas, mayores de 30 años, españolas y universitarias (p<0,05). El motivo más habitual de CPC fue la prevención de problemas (40,8%). El 63,1% utilizó el sistema público, el 31,1% la privada y el 5,8% ambos. El profesional más consultado fue el médico de familia (60,2%). Las actividades más frecuentemente realizadas fueron: quimioprofilaxis (94,2%), consejo sanitario (82,5%), analítica (68,9%), citología (66,0%), exploración física (55,3%) y ginecológica (44,7%). Sólo hubo un 9,7% de vacunaciones. Existen diferencias entre las actividades realizadas en el sistema público y la medicina privada. Conclusiones. El porcentaje de embarazos planificados es mayor de lo esperado, al igual que el de mujeres que realizaron CPC, probablemente por una mayor concienciación de la mujer. Los motivos son básicamente preventivos, por encima de la existencia de factores de riesgo o enfermedades crónicas. Hay un uso importante de la medicina privada. No existe una actuación homogénea en las actividades realizadas. Tanto la quimioprofilaxis como las vacunaciones son en general bajas (AU)
Objective: Ascertain the percentage of women who have made a pre-conception consultation, the reasons for the consultation and interventions carried out. Design: Observational descriptive-type study based on personal interviews. Location: Primary healthcare. Participants: 465 women with term pregnancies in the last twelve months. Main Surveyed Data: Having pre-conception consultation (PCC), reasons, professionals consulted, private or public practice, activities carried out (physical or gynaecological examination, laboratory tests, pap smear, genetic study, vaccinations, healthcare advice, chemoprophylaxis) Results: 69.2% of pregnancies were planned. 23.9% of those interviewed made a pre-conception consultation (IC95% 20.0-27.7). PCC was most frequent in first-time mothers over 30 years old, of Spanish nationality and with a university degree (p<0.05). The most common reason for a PCC was the prevention of problems (40.8%). 63.1% used public health services, 31.1% private health and 5.8%, both. The most consulted professional was the family doctor (60.2%). The most frequent activities were: chemoprophylaxis (94.2%), healthcare advice (82.5%), analysis (68.9%), pap smear (66.0%), physical examination (55.3%) and gynaecological examination (44.7%). Vaccinations represented only 9.7%. There are differences between activities carried out in public and private health practices. Conclusions: The percentage of planned pregnancies is higher than expected, as was the number of women having PCC, probably due to a greater awareness. The reasons are basically preventive, above the existence of risk factors or chronic illness. There is considerable use of private medicine. There is no unified procedure in activities carried out. Both chemoprophylaxis and vaccination are low (AU)
