[Early hospital mortality due to infectious diseases]. / Mortalidad precoz hospitalaria de etiología infecciosa.

BACKGROUND: Infectious diseases are an important health problem. Early hospital mortality (EHM) (first 48 hours after hospital admission) give us information about the etiology and the focus of infection. This study was designed because no articles have been found about this subject. MATERIAL AND METHODS: We reviewed the medical records coded by the ICD-9-CM of all patients that suffered from EHM due to infectious diseases during the period 1992 to 1999. RESULTS: Of all the patients analyzed, 0.7% died of EHM, and of theses, 6.9% were due to an infectious disease. Median age was 73.2 years; 56.1% were men. Index of comorbidity was higher than 1 in 59,9%, and 70,7% never has been admitted to the hospital before. At admission, fever was present in 43.9%. The illness severity was 60.9% sepsis, 24.4% severe sepsis, 13.4% septic shock and 1.2% multiorgan failure. Causes of death were respiratory (76.8%; pneumonia 58.5%). Pneumonia was more frequent among aged 65 years and older (p = 0.03). In 69.5% no microbiological techniques were performed with independence of the clinical severity or the presence or absence of fever. In 85.4% the casual agent was unidentified, but in the case of isolation, gram positive was the most frequent microorganism. CONCLUSIONS: Infections are an important cause of EHM, and community-acquired respiratory tract infection (mainly pneumonia) the most frequent cause of EHM. Patients were admitted to the hospital with sepsis in 60.9%, perhaps due to a diagnostic or therapeutic delay. Among aged 65 years and older, microbiological diagnostic procedures were rarely employed.

Mortalidad precoz hospitalaria de etiología infecciosa / Early hospital mortality due to infectious diseases

Introducción: Las enfermedades infecciosas suponen un grave problema de salud pública en nuestro medio debido a una mortalidad todavía nada desdeñable así como por el gran consumo de recursos sanitarios que originan. Dado que son escasas las publicaciones referentes a la mortalidad infecciosa en las primeras horas tras el ingreso hospitalario nos planteamos realizar este estudio. Material y métodos: Selección de la base de datos informatizada de nuestro Centro (1992-1999), de los pacientes fallecidos de causas infecciosas (ClE 9ª - Revisión, con su Modificación Clínica) en las primeras 48 horas después de su ingreso. Resultados: El 0,7 por ciento de los pacientes ingresados en nuestro Centro fallecieron en las primeras 48 horas del ingreso, en el 6,9 por ciento la causa de la muerte fue una infección. En este grupo la edad media fue de 73,2 años, y el 56.1 por ciento eran hombres. El 59,9 por ciento de los pacientes presentaba más de 1 un factor de riesgo extrínseco para el desarrollo de complicaciones infecciosas y el 70,7 por ciento nunca había ingresado previamente. Al ingreso, el 43,9 por ciento presentó fiebre, el 60,9 por ciento sepsis, el 24,4 por ciento sepsis severa, el 13,4 por ciento shock séptico y el 1,2 por ciento fracaso multiorgánico. El foco infeccioso más frecuente fue el respiratorio (76,8 por ciento), predominando la neumonía (58,5 por ciento), principalmente en 65 años (p = 0,03). En el 69,5 por ciento de los pacientes no se realizó ningún medio diagnóstico microbiológico, y su utilización disminuyó en los mayores de 65 años (p = 0,03), con independencia de la gravedad clínica o de la presencia de fiebre. En el 85,4 por ciento de los casos no se produjo identificación microbiológica Conclusiones: Entre las causas infecciosas de mortalidad intrahospitalaria en las 48 horas del ingreso las infecciones respiratorias, y más en concreto, las neumonías son las mas frecuentes. El 60,9 por ciento de los pacientes cumplia criterios de sepsis al ingreso. Las pruebas microbiológicas se realizaron en menos de un tercio de los pacientes y su utilización disminuye a medida que se incrementa la edad de los mismos (AU)

Background: Infectious diseases are an important health problem. Early hospital mortality (EHM) (first 48 hours after hospital admission) give us information about the etiology and the focus of infection. This study was designed because no articles have been found about this subject. Material and methods: We reviewed the medical records coded by the ICD-9-CM of all patients that suffered from EHM due to infectious diseases during the period 1992 to 1999. Results: Of all the patients analyzed, 0.7% died of EHM, and of theses, 6.9% were due to an infectious disease. Median age was 73.2 years; 56.1% were men. Index of comorbidity was higher than 1 in 59,9%, and 70,7% never has been admitted to the hospital before. At admission, fever was present in 43.9%. The illness severity was 60.9% sepsis, 24.4% severe sepsis, 13.4% septic shock and 1.2% multiorgan failure. Causes of death were respiratory (76.8%; pneumonia 58.5%). Pneumonia was more frequent among aged 65 years and older (p = 0.03). In 69.5% no microbiological techniques were performed with independence of the clinical severity or the presence or absence of fever. In 85.4% the casual agent was unidentified, but in the case of isolation, gram positive was the most frequent microorganism. Conclusions: Infections are an important cause of EHM, and community-acquired respiratory tract infection (mainly pneumonia) the most frequent cause of EHM. Patients were admitted to the hospital with sepsis in 60.9%, perhaps due to a diagnostic or therapeutic delay. Among aged 65 years and older, microbiological diagnostic procedures were rarely employed (AU)

[Endemic hepatitis B in 2 marginal ethnic minorities. Comparative study]. / Hepatitis B endémica en dos minorías étnicas marginales. Estudio comparativo.

BACKGROUND: To know and compare the prevalence of hepatitis B (HB) in two marginal populations (ciganes and gypsies) presumably pertaining to the same ethnic group and considered to have high risk for the disease. METHODS: Serologic markers were determined in 245 ciganes (65% of the total of the cigane population) and in 127 gypsies (45% of the total gypsy population). One hundred three individuals randomly chosen from the neighborhood were studied as a control group. RESULTS: HbsAg was negative in the gypsies and positive in 0.9% of the controls and in 27% of the ciganes (p < 0.001). HbeAg was positive in 15% of the ciganes and negative in the other two groups (p < 0.001). Antibodies were found in 10% of the controls, 12% of the gypsies and in 72% of the ciganes (p < 0.001). In gypsies it was found that 29% were infected from adolescence versus 13% of the control population (p < 0.001). High intrafamily horizontal transmission in infancy was found in the ciganes in addition to vertical transmission. CONCLUSIONS: The different habits and more precarious life style of the ciganes with respect to the gypsies may be the cause for the hyperendemia of hepatitis B in the former.