ABSTRACT
ABSTRACT: Current data on the frequency and efficacy of linezolid (LNZ) in infective endocarditis (IE) are based on small retrospective series. We used a national database to evaluate the effectiveness of LNZ in IE.This is a retrospective study of IE patients in the Spanish GAMES database who received LNZ. We defined 3 levels of therapeutic impact: LNZâ<â7âdays, LNZ high-impact (≥ 7âdays, > 50% of the total treatment, and > 50% of the LNZ doses prescribed in the first weeks of treatment), and LNZ ≥ 7âdays not fulfilling the high-impact criteria (LNZ-NHI). Effectiveness of LNZ was assessed using propensity score matching and multivariate analysis of high-impact cases in comparison to patients not treated with LNZ from the GAMES database matched for age-adjusted comorbidity Charlson index, heart failure, renal failure, prosthetic and intracardiac IE device, left-sided IE, and Staphylococcus aureus. Primary outcomes were in-hospital mortality and one-year mortality. Secondary outcomes included IE complications and relapses.From 3467 patients included in the GAMES database, 295 (8.5%) received LNZ. After excluding 3 patients, 292 were grouped as follows for the analyses: 99 (33.9%) patients in LNZâ<â7âdays, 11 (3.7%) in LNZ high-impact, and 178 (61%) in LNZ-NHI. In-hospital mortality was 51.5%, 54.4%, and 19.1% respectively. In the propensity analysis, LNZ high-impact group presented with respect to matched controls not treated with LNZ higher in-hospital mortality (54.5% vs 18.2%, Pâ=â.04). The multivariate analysis showed an independent relationship of LNZ use with in-hospital mortality (odds ratio 9.06, 95% confidence interval 1.15--71.08, Pâ=â.03).Treatment with LNZ is relatively frequent, but most cases do not fulfill our high-impact criteria. Our data suggest that the use of LNZ as definitive treatment in IE may be associated with higher in-hospital mortality.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Endocarditis, Bacterial/drug therapy , Linezolid/therapeutic use , Staphylococcal Infections/drug therapy , Aged , Endocarditis/drug therapy , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/mortality , Female , Hospital Mortality , Humans , Male , Middle Aged , Retrospective Studies , Staphylococcal Infections/diagnosis , Staphylococcus aureus/isolation & purification , Treatment OutcomeABSTRACT
Un porcentaje muy alto de pacientes hospitalizados (se estima más de un 90 %) requiere un acceso vascular durante su ingreso para administración de medicación, extracción de analíticas, soporte hematológico, nutrición parenteral, etc. Como profesionales enfermeros se nos plantea un reto importante a la hora de implantar nuevos dispositivos (líneas medias, catéteres centrales de inserción periférica, reservorios braquiales...) con nuevas técnicas (inserción ecoguiada, tunelización...) y, si cabe y más importante aún, el mantenimiento de estos para conseguir un correcto funcionamiento y evitar las complicaciones derivadas de su uso
A very high percentage of hospitalized patients (estimated to be more than 90 %) re-quire vascular access during their admission for medication administration, analytical extraction, hematological support, parenteral nutrition, etc. As nursing professionals, we face an important challenge when implanting new de-vices (midlines, peripherally insertion central catheters, brachial reservoirs...) with new techniques (echoguided insertion, tunneling...) and if possible and more important the maintenance of these to get a correct operation and avoid complications arising from its use
