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BACKGROUND: The global burden associated with antimicrobial resistance is of increasing concern. AIM: To evaluate risk factors associated with multidrug-resistant (MDR) infection and its clinical impact in a cohort of patients with healthcare-associated bacteraemic urinary tract infections (BUTIs). METHODS: This was a prospective, multicentre, post-hoc analysis of patients with healthcare-associated-BUTI (ITUBRAS-2). The primary outcome was MDR profile. Secondary outcomes were clinical response (at 48-72 h and at hospital discharge) and length of hospital stay from onset of BUTI. Logistic regression was used to evaluate variables associated with MDR profile and clinical response. Length of hospital stay was evaluated using multivariate median regression. FINDINGS: In all, 443 episodes were included, of which 271 (61.17%) were classified as expressing an MDR profile. In univariate analysis, MDR profile was associated with E. coli episodes (odds ratio (OR): 3.13; 95% confidence interval (CI): 2.11-4.69, P < 0.001) and the extensively drug-resistant (XDR) pattern with P. aeruginosa aetiology (7.84; 2.37-25.95; P = 0.001). MDR was independently associated with prior use of fluoroquinolones (adjusted OR: 2.43; 95% CI: 1.25-4.69), cephalosporins (2.14; 1.35-3.41), and imipenem or meropenem (2.08; 1.03-4.20) but not with prior ertapenem. In terms of outcomes, MDR profile was not associated with lower frequency of clinical cure, but was associated with longer hospital stay. CONCLUSION: MDR profile was independently associated with prior use of fluoroquinolones, cephalosporins, imipenem, and meropenem, but not with prior ertapenem. MDR-BUTI episodes were not associated with worse clinical cure, although they were independently associated with longer duration of hospital stay.
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To report a unique case of a patient who developed simultaneous bilateral maculopathy presumed from intake of fluoxetine. The optic coherence tomography (OCT) macular showed a subfoveal disruption in the outer retinal layer in both eyes (OU), higher in the left one (OS). Although reported cases of serotonin recapture inhibitors (SSRIs) Maculopathy so far have been caused by sertraline, fluoxetine shares the biological mechanism, and OCT findings and ocular symptoms are the same as published. We should be aware with ocular symptoms in patients that take fluoxetine.
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Fluoxetina , Enfermedades de la Retina , Inhibidores Selectivos de la Recaptación de Serotonina , Tomografía de Coherencia Óptica , Humanos , Fluoxetina/efectos adversos , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Enfermedades de la Retina/inducido químicamente , Enfermedades de la Retina/diagnóstico por imagen , Femenino , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The aim of this study was to estimate the incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infections (SA-PJI) after primary hip and knee arthroplasty in European centres. METHODS: This study was conducted in patients who underwent primary hip and knee arthroplasty in 19 European hospitals between 2014 and 2016. The global incidence of PJI and SA-PJI was calculated. The associated disease burden was measured indirectly as infection-related mortality plus loss of function. For healthcare utilization, number and duration of hospitalizations, number and type of surgical procedures, duration of antibiotic treatments, and number of outpatient visits were collected. Subgroup and regression analyses were used to evaluate the impact of SA-PJI on healthcare utilization, controlling for confounding variables. RESULTS: The incidence of PJI caused by any micro-organism was 1.41%, and 0.40% for SA-PJI. Among SA-PJI, 20.7% were due to MRSA with substantial regional differences, and were more frequent in partial hip arthroplasty (PHA). Related deaths and loss of function occurred in 7.0% and 10.2% of SA-PJI cases, respectively, and were higher in patients with PHA. Compared with patients without PJI, patients with SA-PJI had a mean of 1.4 more readmissions, 25.1 more days of hospitalization, underwent 1.8 more surgical procedures, and had 5.4 more outpatient visits, controlling for confounding variables. Healthcare utilization was higher in patients who failed surgical treatment of SA-PJI. CONCLUSIONS: This study confirmed that the SA-PJI burden is high, especially in PHA, and provided a solid basis for planning interventions to prevent SA-PJI.
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Artroplastia de Reemplazo de Cadera , Infecciones Relacionadas con Prótesis , Infecciones Estafilocócicas , Humanos , Staphylococcus aureus , Incidencia , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/etiología , Estudios Retrospectivos , Artroplastia de Reemplazo de Cadera/efectos adversos , Infecciones Estafilocócicas/epidemiología , Hospitales , Aceptación de la Atención de Salud , Costo de EnfermedadRESUMEN
OBJECTIVES: The aim was to describe the effectiveness of suppressive antibiotic treatment (SAT) in routine clinical practice when used in situations in which removal of a prosthetic implant is considered essential for the eradication of an infection, and it cannot be performed. METHODS: This was a descriptive retrospective and multicentre cohort study of prosthetic joint infection (PJI) cases managed with SAT. SAT was considered to have failed if a fistula appeared or persisted, if debridement was necessary, if the prosthesis was removed due to persistence of the infection or if uncontrolled symptoms were present. RESULTS: In total, 302 patients were analysed. Two hundred and three of these patients (67.2%) received monotherapy. The most commonly used drugs were tetracyclines (39.7% of patients) (120/302) and cotrimoxazole (35.4% of patients) (107/302). SAT was considered successful in 58.6% (177/302) of the patients (median time administered, 36.5 months; IQR 20.75-59.25). Infection was controlled in 50% of patients at 5 years according to Kaplan-Meier analysis. Resistance development was documented in 15 of 65 (23.1%) of the microbiologically documented cases. SAT failure was associated with age <70 years (sub-hazard ratio (SHR) 1.61, 95% CI 1.1-2.33), aetiology other than Gram-positive cocci (SHR 1.56, 95% CI 1.09-2.27) and location of the prosthesis in the upper limb (SHR 2.4, 95% CI 1.5-3.84). SAT suspension was necessary due to adverse effects in 17 of 302 patients (5.6%). CONCLUSIONS: SAT offers acceptable results for patients with PJI when surgical treatment is not performed or when it fails to eradicate the infection.
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Antibacterianos/uso terapéutico , Bacterias/efectos de los fármacos , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Desbridamiento , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/microbiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
En los últimos años, se está utilizando la fibrolaringoscopía con imagen de banda estrecha (NBI) como técnica novedosa para observar el patrón específico de microvas-cularización de una lesión concreta a evaluar. Es conocida por su utilidad en el diagnóstico de otras lesiones de vías aerodigestivas superiores, fundamentalmente laríngea y digestiva. Los melanomas mucosos son tumores infrecuentes, que suelen localizarse a nivel del área rinosinusaly que comportan un manejo y pronóstico distinto con respecto a los melanomas cutáneos. Se presenta el caso clínico de una paciente mujer con anamnesis, exploración y fibrolaringoscopía con imagen de banda estrecha, compatible con melanoma mucoso de fosa nasal izquierda. El tratamiento realizado fue quirúrgico, sin necesidad de tratamiento coadyuvante, y no presenta evidencia de enfermedad al año postseguimiento.
In recent years, it is being used fibrolaryngoscopy with narrowband image (NBI) as a novel technique to observe the specific pattern of microvasculature of a particular lesion. NBI is known for its usefulness in the diagnosis of other lesions of the upper aerodigestive tract, (primarily laryngeal and digestive lesions). Mucosal melanomas are rare tumors, which are usually located at the level of rhino-sinusal area and involving a different prognosis and management regarding cutaneous melanomas. We report a female patient case with anamnesis, clinical examination and NBI compatible with mucosal melanoma of left nostril. Surgical treatmentwas performed without adjuvant therapy, and there is no evidence of disease at one year post-monitoring.
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Humanos , Femenino , Anciano , Neoplasias de los Senos Paranasales/diagnóstico , Endoscopía/métodos , Imagen de Banda Estrecha/métodos , Melanoma/diagnóstico , Mucosa Nasal/patología , Neoplasias de los Senos Paranasales/cirugía , Melanoma/cirugía , Mucosa Nasal/cirugíaRESUMEN
It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements.
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Artritis Infecciosa/epidemiología , Artritis Infecciosa/etiología , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/etiología , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Artritis Infecciosa/historia , Artroplastia/efectos adversos , Bacterias/efectos de los fármacos , Estudios de Cohortes , Comorbilidad , Farmacorresistencia Bacteriana , Femenino , Hongos/efectos de los fármacos , Historia del Siglo XXI , Humanos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/historia , España/epidemiologíaRESUMEN
El melanoma mucoso se considera un subtipo distinto al cutáneo. El 40% a 50% de los melanomas mucosos están localizados en la cabeza y el cuello, siendo los más frecuentes los nasosinusales y los de cavidad oral; en la porción anterior del tabique nasal y los cornetes inferior y medio. Estas neoplasias se originan de los melanocitos de la mucosa y submucosa nasosinusal. Generalmente se diagnostican tardíamente, frecuentemente con metástasis a distancia. Ante clínica nasosinusal unilateral sospechosa es muy importante una exploración exhaustiva de las vías aerodigestivas superiores y posteriormente, un estudio anatomopatológico. Se presenta a una paciente de 56 años, con historia de epistaxis de repetición de meses de evolución. En la exploración presenta una tumoración polipoidea que ocupa toda la fosa nasal derecha, con desviación septal y deformidad de la pirámide nasal. El estudio anatomopatológico informa de melanoma maligno infiltrante. Durante la hospitalización, la paciente presenta dificultad para caminar y dolor en cadera derecha, siendo diagnosticada por traumatología de fractura basicervical. Durante la cirugía, se envía fragmento óseo de cadera para estudio anatomopatológico, compatible con lesión de sustrato tisular óseo metastatizado por una proliferación celular de morfología e inmunofenotipo de melanoma.
The mucosal melanoma is considered a distinct subtype of cutaneous melanoma. The 40%-50% of cases of mucosal melanomas is located in the head and neck, the most common are found in sinonasal level and in the oral cavity; In the anterior portion of the nasal septum and the inferior and middle turbinates. Those neoplasms originate from the malignant cells found in the mucosa and submucosa. Usually are lately diagnosed, with distant metastases. If suspicious unilateral sinonasal manifestations appears is extremely important to realize an exhaustive exploration of superior aerodigestive vias and a histopathological examination of the lesion. We present a 56 year old with repeated epistaxis of several months of duration. The examination revealed a polypoid tumor occupying the entire right nostril, septal deviation and deformity of the nasal pyramid. Pathological studies reports infiltrating malignant melanoma. During the hospitalization the patient has difficulty walking and pain in the right hip, being diagnosed by Traumatology of fracture basicervical. During the surgery, a bone fragment hip is sent for anathomopathology study which is reported as bone tissue injury support substrate metastasized malignant cell proliferation by immunophenotype and morphology of melanoma.
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Humanos , Femenino , Persona de Mediana Edad , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias de los Senos Paranasales/patología , Melanoma/diagnóstico , Melanoma/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Epistaxis/etiología , Fracturas de CaderaRESUMEN
There are no previous studies comparing tuberculosis in transplant recipients (TRs) with other hosts. We compared the characteristics and outcomes of tuberculosis in TRs and patients from the general population. Twenty-two TRs who developed tuberculosis from 1996 through 2010 at a tertiary hospital were included. Each TR was matched by age, gender and year of diagnosis with four controls selected from among non-TR non-human immunodeficiency virus patients with tuberculosis. TRs (21 patients, 96%) had more factors predisposing to tuberculosis than non-TRs (33, 38%) (p <0.001). Pulmonary tuberculosis was more common in non-TRs (77 (88%) vs. 12 TRs (55%); p 0.001); disseminated tuberculosis was more frequent in TRs (five (23%) vs. four non-TRs (5%); p 0.005). Time from clinical suspicion of tuberculosis to definitive diagnosis was longer in TRs (median of 14 days) than in non-TRs (median of 0 days) (p <0.001), and invasive procedures were more often required (12 (55%) TRs and 15 (17%) non-TRs, respectively; p 0.001). Tuberculosis was diagnosed post-mortem in three TRs (14%) and in no non-TRs (p <0.001). Rates of toxicity associated with antituberculous therapy were 38% in TRs (six patients) and 10% (seven patients) in non-TRs (p 0.014). Tuberculosis-related mortality rates in TRs and non-TRs were 18% and 6%, respectively (p 0.057). The adjusted Cox regression analysis showed that the only predictor of tuberculosis-related mortality was a higher number of organs with tuberculosis involvement (adjusted hazard ratio 8.6; 95% CI 1.2-63). In conclusion, manifestations of tuberculosis in TRs differ from those in normal hosts. Post-transplant tuberculosis resists timely diagnosis, and is associated with a higher risk of death before a diagnosis can be made.
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Antituberculosos/administración & dosificación , Receptores de Trasplantes , Tuberculosis/tratamiento farmacológico , Tuberculosis/patología , Adulto , Antituberculosos/efectos adversos , Estudios de Casos y Controles , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Centros de Atención Terciaria , Resultado del Tratamiento , Tuberculosis/diagnóstico , Tuberculosis/mortalidadRESUMEN
The objective of this study was to review the characteristics and outcome of prosthetic joint infections (PJI) due to Enterococcus sp. collected in 18 hospitals from six European countries. Patients with a PJI due to Enterococcus sp. diagnosed between January 1999 and July 2012 were retrospectively reviewed. Relevant information about demographics, comorbidity, clinical characteristics, microbiological data, surgical treatment and outcome was registered. Univariable and multivariable analyses were performed. A total of 203 patients met the inclusion criteria. The mean (SD) was 70.4 (13.6) years. In 59 patients the infection was diagnosed within the first 30 days (29.1%) from arthroplasty, in 44 (21.7%) between 31 and 90 days, in 54 (26.6%) between 91 days and 2 years and in 43 (21%) after 2 years. Enterococcus faecalis was isolated in 176 cases (89%). In 107 (54%) patients the infection was polymicrobial. Any comorbidity (OR 2.53, 95% CI 1.18-5.40, p 0.01), and fever (OR 2.65, 95% CI 1.23-5.69, p 0.01) were independently associated with failure. The only factor associated with remission was infections diagnosed later than 2 years (OR 0.25, 95% CI 0.09-0.71, p 0.009). In conclusion, prosthetic joint infections due to Enterococcus sp. were diagnosed within the first 2 years from arthroplasty in >70% of the patients, almost 50% had at least one comorbidity and infections were frequently polymicrobial (54%). The global failure rate was 44% and patients with comorbidities, fever, and diagnosed within the first 2 years from arthroplasty had a poor prognosis.
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Artritis/epidemiología , Enterococcus/aislamiento & purificación , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones Relacionadas con Prótesis/epidemiología , Anciano , Anciano de 80 o más Años , Artritis/microbiología , Coinfección/epidemiología , Coinfección/microbiología , Comorbilidad , Europa (Continente)/epidemiología , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Cooperación Internacional , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/microbiología , Estudios RetrospectivosRESUMEN
We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement>30 days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76 years, interquartile range (IQR) 68-81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25 months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13-0.40; p<0.001), whereas chronic renal impairment predicted failure (aHR, 2.56; 95% CI, 1.14-5.77; p 0.0232). Our results confirm a 79% success rate in ciprofloxacin-susceptible GN-PJI treated with debridement, ciprofloxacin and implant retention. New therapeutic strategies are needed for ciprofloxacin-resistant PJI.
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Antibacterianos/uso terapéutico , Artritis/terapia , Desbridamiento , Infecciones por Bacterias Gramnegativas/terapia , Retención de la Prótesis , Infecciones Relacionadas con Prótesis/terapia , Anciano , Anciano de 80 o más Años , Ciprofloxacina/uso terapéutico , Femenino , Humanos , Masculino , Estudios Retrospectivos , España , Resultado del TratamientoRESUMEN
Ongoing network activity often manifests as irregular fluctuations in local field potentials (LFPs), a complex mixture of multicellular synaptic currents of varying locations and extensions. Among other conditions, for synchronously firing presynaptic units to generate sizable postsynaptic LFPs, their axonal territories should overlap. We have taken advantage of anatomical regularity of the rat hippocampus and combined multiple linear recordings and spatial discrimination techniques to separate pathway-specific LFPs with enough spatial resolution to discriminate postsynaptic regions of varying activation, and to investigate their presynaptic origin, chemical nature, and spatial extension. We identified 6 main excitatory and inhibitory LFP generators with different synaptic territories in principal cells and hippocampal subfields matching anatomical pathways. Some recognized pathways did not contribute notably to LFPs. Each showed different septo-temporal spatial modules over which the field potential fluctuations were synchronous. These modules were explained by either the strong overlap of synaptic territories of coactivated afferent neurons (e.g., CA3 clusters for CA1 Schaffer LFPs), or widespread coalescence of postsynaptic territories (granule cell somatic inhibition). We also show evidence that distinct modes of afferent synchronization generate stereotyped spatial patterns of synchronous LFPs in one pathway. Thus, studying spatial coherence of pathway-specific LFPs provides remote access to the dynamics of afferent populations.
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Potenciales Evocados/fisiología , Hipocampo/citología , Modelos Neurológicos , Red Nerviosa/fisiología , Neuronas/citología , Terminales Presinápticos/fisiología , Animales , Bicuculina/farmacología , Estimulación Eléctrica , Potenciales Evocados/efectos de los fármacos , Antagonistas de Aminoácidos Excitadores/farmacología , Femenino , Lateralidad Funcional , Antagonistas de Receptores de GABA-A/farmacología , Hipocampo/fisiología , Red Nerviosa/efectos de los fármacos , Neuronas/efectos de los fármacos , Neuronas/fisiología , Vía Perforante/fisiología , Terminales Presinápticos/efectos de los fármacos , Quinoxalinas/farmacología , Ratas , Ratas Sprague-DawleyRESUMEN
We report the case of a 6 year old patient who started with abdominal pain and left sciatica, which did not improve after applying symptomatic treatment. A complete analytical and imaging study was performed, which showed a lesion in left S1 corresponding to Garrè's chronic diffuse sclerosing osteomyelitis. The diagnosis was confirmed by biopsy of the lesion. Treatment was established with corticosteroids and anti-inflammatory drugs, obtaining a clinical improvement, although in the follow-up imaging tests 2 years after the onset of the symptoms, the lesion persists but with a significant reduction in its size.
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Osteomielitis/diagnóstico , Sacro/patología , Enfermedades de la Columna Vertebral/diagnóstico , Niño , Enfermedad Crónica , Humanos , Masculino , EsclerosisRESUMEN
Presentamos el caso de un paciente de 6 años, que comenzó con dolor abdominal y ciatalgia izquierda sin mejoría después de aplicar un tratamiento sintomático. El estudio analítico completo y de imagen realizado mostró una lesión en S1 izquierda correspondiente a osteomielitis esclerosante crónica de Garrè, confirmando el diagnóstico mediante biopsia de la lesión. Se instauró tratamiento con corticoides y antiinflamatorio, que consiguen una remisión parcial de los síntomas, y en las pruebas de imagen realizadas 2 años después del inicio de los síntomas persiste la lesión, aunque con una disminución significativa de su tamaño (AU)
We report the case of a 6 year old patient who started with abdominal pain and left sciatica, which did not improve after applying symptomatic treatment. A complete analytical and imaging study was performed, which showed a lesion in left S1 corresponding to Garrès chronic diffuse sclerosing osteomyelitis. The diagnosis was confirmed by biopsy of the lesion. Treatment was established with corticosteroids and anti-inflammatory drugs, obtaining a clinical improvement, although in the follow-up imaging tests 2 years after the onset of the symptoms, the lesion persists but with a significant reduction in its size (AU)
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Humanos , Masculino , Niño , Osteomielitis/complicaciones , Osteomielitis/diagnóstico , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Biopsia , Corticoesteroides/uso terapéutico , Antiinflamatorios/uso terapéutico , Osteomielitis/fisiopatología , Osteomielitis , Acetaminofén/uso terapéutico , Región Lumbosacra/patología , Región Lumbosacra , Diagnóstico DiferencialRESUMEN
OBJECTIVES: A high proportion of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia die within a few days of the onset of infection. However, predictive factors for early mortality (EM) have barely been examined. The aim of this study was to determine the predictive factors for EM in patients with MRSA bacteraemia. METHODS: All episodes of MRSA bacteraemia were prospectively followed in 21 Spanish hospitals from June 2008 to December 2009. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed in a central laboratory. Mortality was defined as death from any cause occurring in the 30 days after the onset of MRSA bacteraemia. EM was defined as patients who died within the first 2 days, and late mortality (LM) for patients who died after this period. Multivariate analyses were performed by using logistic regression models. RESULTS: A total of 579 episodes were recorded. Mortality was observed in 179 patients (31%): it was early in 49 (8.5%) patients and late in 130 (22.5%). Independent risk factors for EM were [OR (95% CI)] initial Pitt score >3 [3.99 (1.72-3.24)], previous rapid fatal disease [3.67 (1.32-10.24)], source of infection lower respiratory tract or unknown [3.76 (1.31-10.83) and 2.83 (1.11-7.21)], non-nosocomial acquisition [2.59 (1.16-5.77)] and inappropriate initial antibiotic therapy [3.59 (1.63-7.89)]. When predictive factors for EM and LM were compared, inappropriate initial antibiotic therapy was the only distinctive predictor of EM, while endocarditis and lower respiratory tract sources both predicted LM. CONCLUSIONS: In our large cohort of patients several factors were related to EM, but the only distinctive predictor of EM was inappropriate initial antibiotic therapy.
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Bacteriemia/mortalidad , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/mortalidad , Factores de Edad , Anciano , Bacteriemia/microbiología , Estudios de Cohortes , Farmacorresistencia Bacteriana , Femenino , Humanos , Modelos Logísticos , Masculino , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de Riesgo , Factores Sexuales , Infecciones Estafilocócicas/microbiología , Resultado del TratamientoRESUMEN
Mortality related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) remains high, despite changes in the epidemiology. To analyze the current predictive factors for mortality we conducted a prospective study in a large cohort of patients with MRSA-BSI from 21 Spanish hospitals. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed, including susceptibility to antibiotics and molecular characterization. Vancomycin MICs (V-MIC) were tested by the E-test and microdilution methods. Time until death was the dependent variable in a Cox regression analysis. Overall, 579 episodes were included. Acquisition was nosocomial in 59% and vascular catheter was the most frequent source (38%). A dominant PFGE genotype was found in 368 (67%) isolates, which belonged to Clonal Complex (CC)5 and carried SCCmecIV and agr2. Microdilution V-MIC50 and V-MIC90 were 0.7 and 1.0 mg/L, respectively. Initial therapy was appropriate in 66% of episodes. Overall mortality was observed in 179 (32%) episodes. The Cox-regression analysis identified age >70 years (HR 1.88), previous fatal disease (HR 2.16), Pitt score >1 (HR 3.45), high-risk source (HR 1.85) and inappropriate initial treatment (HR 1.39) as independent predictive factors for mortality. CC5 and CC22 (HR 0.52 and 0.45) were associated with significantly lower mortality rates than CC8. V-MIC ≥1.5 did not have a significant impact on mortality, regardless of the method used to assess it.
Asunto(s)
Bacteriemia/microbiología , Bacteriemia/mortalidad , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Electroforesis en Gel de Campo Pulsado , Femenino , Genotipo , Hospitales , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Tipificación Molecular , Estudios Prospectivos , Factores de Riesgo , España , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Análisis de Supervivencia , Resultado del Tratamiento , Vancomicina/farmacologíaRESUMEN
The clinical and microbiological characteristics of community-onset healthcare-associated (HCA) bacteraemia of urinary source are not well defined. We conducted a prospective cohort study at eight tertiary-care hospitals in Spain, from October 2010 to June 2011. All consecutive adult patients hospitalized with bacteraemic urinary tract infection (BUTI) were included. HCA-BUTI episodes were compared with community-acquired (CA) and hospital-acquired (HA) BUTI. A logistic regression analysis was performed to identify 30-day mortality risk factors. We included 667 episodes of BUTI (246 HCA, 279 CA and 142 HA). Differences between HCA-BUTI and CA-BUTI were female gender (40% vs 69%, p <0.001), McCabe score II-III (48% vs 14%, p <0.001), Pitt score ≥2 (40% vs 31%, p 0.03), isolation of extended spectrum ß-lactamase-producing Enterobacteriaciae (13% vs 5%, p <0.001), median hospital stay (9 vs 7 days, p 0.03), inappropriate empirical antimicrobial therapy (21% vs 13%, p 0.02) and mortality (11.4% vs 3.9%, p 0.001). Pseudomonas aeruginosa was more frequently isolated in HA-BUTI (16%) than in HCA-BUTI (4%, p <0.001). Independent factors for mortality were age (OR 1.04; 95% CI 1.01-1.07), McCabe score II-III (OR 3.2; 95% CI 1.8-5.5), Pitt score ≥2 (OR 3.2 (1.8-5.5) and HA-BUTI OR 3.4 (1.2-9.0)). Patients with HCA-BUTI are a specific group with significant clinical and microbiological differences from patients with CA-BUTI, and some similarities with patients with HA-BUTI. Mortality was associated with patient condition, the severity of infection and hospital acquisition.
Asunto(s)
Bacteriemia/epidemiología , Infecciones Comunitarias Adquiridas/epidemiología , Infección Hospitalaria/epidemiología , Infecciones Urinarias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Bacteriemia/complicaciones , Bacteriemia/microbiología , Bacteriemia/mortalidad , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/mortalidad , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , España/epidemiología , Centros de Atención Terciaria , Resultado del Tratamiento , Infecciones Urinarias/complicaciones , Infecciones Urinarias/microbiología , Infecciones Urinarias/mortalidad , Adulto JovenRESUMEN
An outbreak of Pseudomonas fluorescens infection in six patients in a coronary care unit was associated with a source not previously reported, namely the ice bath used for cardiac output determinations. Outbreaks of pseudobacteraemia caused by P. fluorescens and occasional blood transfusion-associated bloodstream infection (BSI) have been described. However, during the last two decades, two outbreaks of P. fluorescens BSI have been described and this article reports a third. Isolation of P. fluorescens in blood cultures must alert clinicians to the possibility of contamination of infusate, lock solutions or catheter flush.
Asunto(s)
Unidades de Cuidados Coronarios , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Infecciones por Pseudomonas/epidemiología , Adolescente , Adulto , Anciano , Bacteriemia/epidemiología , Bacteriemia/microbiología , Infección Hospitalaria/microbiología , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/microbiología , Pseudomonas fluorescens/aislamiento & purificación , Adulto JovenRESUMEN
The purpose of this investigation was to assess the prevalence of upper urinary tract involvement in patients with candiduria by means of (111)indium-oxine-labeled leukocyte scintigraphy. An observational cohort study of patients with confirmed candiduria was conducted in an acute-care teaching hospital in Spain from March 2006 through February 2009. An (111)In-labeled leukocyte scan was performed in order to assess the upper urinary tract involvement. A series of non-matched patients without candiduria nor bacteriuria undergoing scintigraphy to exclude infections in other sites than the urinary tract was also studied. Demographics, baseline illness, and clinical data were recorded. Candiduria was detected in 428 patients, and scintigraphy was performed in 35 of these patients. Twenty-nine patients without candiduria nor bacteriuria were also studied. Positive renal scintigraphy was documented in 24 (68%) patients with confirmed candiduria and in 3 (10%) patients without candiduria (p < 0.005). Renal uptake was not associated with a higher mortality nor with re-admissions. Subclinical pyelonephritis could be more frequent in patients with candiduria than it has been previously considered.
Asunto(s)
Candidiasis/diagnóstico , Candidiasis/epidemiología , Infecciones Urinarias/diagnóstico , Anciano , Anciano de 80 o más Años , Anfotericina B/uso terapéutico , Candida/aislamiento & purificación , Candida/patogenicidad , Candidiasis/diagnóstico por imagen , Estudios de Cohortes , Femenino , Humanos , Indio/química , Indio/metabolismo , Masculino , Persona de Mediana Edad , Prevalencia , Pielonefritis/complicaciones , Cintigrafía , España/epidemiología , Sistema Urinario/diagnóstico por imagen , Sistema Urinario/microbiología , Sistema Urinario/patología , Infecciones Urinarias/diagnóstico por imagen , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiologíaRESUMEN
From the first descriptions of HIV/AIDS, the lung has been the site most frequently affected by the disease. Most patients develop a pulmonary complication during the history of HIV infection, mainly of infectious aetiology. Important changes in the epidemiology of HIV-related pulmonary infections have occurred. Overall, prescription of Pneumocystis jirovecii prophylaxis and the introduction of highly active antiretroviral therapy (HAART) are the main causes. Currently, the most frequent diagnosis in developed countries is bacterial pneumonia, especially pneumococcal pneumonia, the second most frequent cause is Pneumocystis pneumonia and the third is tuberculosis. However, in Africa, tuberculosis could be the most common pulmonary complication of HIV. Pulmonary infections remain one of the most important causes of morbidity and mortality in these patients, and the first cause of hospital admission in the HAART era. Achieving an aetiological diagnosis of pulmonary infection in these patients is important due to its prognostic consequences.
Asunto(s)
Infecciones por VIH/microbiología , Enfermedades Pulmonares/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Antibacterianos/uso terapéutico , Terapia Antirretroviral Altamente Activa , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/epidemiología , MasculinoRESUMEN
Objetivo. Dado que la radiación recibida en una cistografía convencional, es del orden de 20 veces superior a la de una cistografía isotópica y que la sensibilidad de ésta última, es más alta en el diagnóstico del reflujo vésicoureteral, nos planteamos su utilización en el despistaje de este, en pacientes con hidronefrosis congénita. Material y métodos. En el periodo 2003-2009, se ha aplicado el siguiente protocolo a los neonatos con antecedentes de hidronefrosis prenatal con la finalidad de descartar reflujo. Profilaxis antibiótica si se confirma en ecografía a la semana de vida la dilatación de la vía excretora, a las 6 semanas de vida, se realiza nuevo control ecográfico, en el cual si la ectasia es superior a 8 mm, se practica cistogammagrafía directa. Si se trata de un niño de sexo masculino con dilatación o afectación parenquimatosa severa, o en casos en que se sospeche duplicidad, se practica cistografía convencional. Resultados. De los 65 casos estudiados, se ha detectado reflujo en 13 pacientes (20%) en 18 unidades renales (3 leve, 8 moderado y7 severo). El seguimiento se ha realizado en la mayoría de casos concistografía isotópica. Ninguno de los 13 pacientes con refl ujo a los que (..) (AU)
Objective. As the radiation received in conventional cystographyis about 20 times higher than radionuclide cystography and the sensitivity of the last is higher in order to diagnose vesicoureteral refl ux, we consider the use of radionuclide cystography in early detection of refluxin patients with prenatally detected hydronephrosis. Materials and methods. Between 2003 and 2009, a study of neonates with prenatal history of hydronephrosis was performed in order to rule out reflux. Our protocol was as follows: The diagnosis was confirmed by postnatal ultrasound at 1 week (in this case patient initiate antibiotic prophylaxis). A new ultrasound was repeated at 6 weeks, if the dilatation was larger than 8 mm at this time, direct radionuclide escintigraphy was performed. The patients were placed on prophylactic antibiotics until the screenining results were known. Conventional cystography was performed if a male infant showed (..) (AU)