Role of age and comorbidities in mortality of patients with infective endocarditis.

PURPOSE: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. METHODS: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. RESULTS: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. CONCLUSION: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.

Safety and efficacy of daptomycin in outpatient parenteral antimicrobial therapy: a prospective and multicenter cohort study (DAPTODOM trial).

BACKGROUND: Daptomycin is an optimal choice for outpatient parenteral antibiotic therapy (OPAT) because of its safety, once-daily administration and its activity against Gram-positive bacteria. Although daptomycin is increasingly being used in OPAT, limited information about its safety in this scenario is available. METHODS: We performed a prospective multicentre pilot study to evaluate the safety of daptomycin in outpatients with proved or suspected Gram-positive infections (DAPTODOM). The primary objective was to evaluate the safety and the secondary objective to evaluate the efficacy in OPAT. We also looked at the development of daptomycin resistance in those cases with microbiological failure. RESULTS: We included 54 patients from 12 Spanish hospitals, 67% male with a mean age of 67.1 years. Most patients (87%) had chronic underlying diseases. The main reason for inclusion was skin and soft-tissue infections in 52%, followed by bacteremia or endocarditis in 34%. Staphylococcus aureus accounted for 44% of the isolates (24% were methicillin-resistant), coagulase-negative staphylococci 15% and enterococci 7%. Two patients (4%) had to be readmitted because of complications; only one patient had an adverse effect related to daptomycin (increase in serum creatine kinase levels), which disappeared after discontinuation (2%). At the end of follow-up, 96% of patients had good outcome and only 4% of patients did not have a clinical or microbiological cure. The use of a 2-minute bolus in 18 cases was not associated with adverse effects. CONCLUSIONS: Daptomycin was safe and efficacious in outpatients with Gram-positive bacterial infections and can be administered in 2-minute bolus infusion.

Tratamiento de la infección respiratoria por Pseudomonas aeruginosa en pacientes adultos en hospitalización a domicilio: características clínicas y evolutivas así como análisis de los factores pronósticos de recidiva / Treatment of respiratory infection by Pseudomonas aeruginosa in adult patients within a hospital at home service: clinical characteristics and analysis of prognostic factors for relapse

Introducción: Las infecciones respiratorias por Pseudomonas aeruginosa se asocian a mala función respiratoria, calidad de vida baja y frecuencia alta de hospitalización. Métodos: Estudio prospectivo de 6 años (2000¿2005) de pacientes ingresados en hospitalización a domicilio con infección respiratoria por P. aeruginosa para administración de tratamiento antibiótico parenteral. Se analizan variables clínicas, tratamiento, recidiva, tiempo libre de recidiva (TLR) y factores pronósticos. Resultados: Se registraron 111 episodios en 81 pacientes. Las bronquiectasias fue la afección más frecuente (57%). El tratamiento más administrado fue ceftazidima y tobramicina (61%). La estancia media fue de 14 días. El 80% tenía un grado de obstrucción respiratoria G-MG (grave-muy grave). El 35% finalizó el tratamiento con cultivo positivo. La mediana de seguimiento hasta la recidiva fue de 144 días. El 65% de los episodios recidivaron, y con más frecuencia los que tenían bronquiectasias, mayor grado de obstrucción respiratoria y llevaban aerosolterapia. El TLR en los pacientes con grado de obstrucción G-MG se redujo de 1.080 a 139 días, los que terminaban con cultivo positivo de 248 a 78 días y los que en el antibiograma tenían alguna resistencia frente a antibióticos antiseudomónicos, de 390 a 97 días. El análisis multivariante mostró la independencia de la gravedad en el grado de obstrucción respiratoria y la resistencia antibiótica en el incremento de la probabilidad de recidivar. Conclusión: Los pacientes infectados por P. aeruginosa en peor situación clínica, o con alguna resistencia antibiótica frente a antibióticos antiseudomónicos, recidivan más y probablemente en menos tiempo que los demás. Los servicios de hospitalización a domicilio son una buena alternativa para reducir el prolongado tiempo de ingreso de estos pacientes (AU)

Introduction: Pseudomonas aeruginosa respiratory infections are associated with poor respiratory function, low quality of life, and a high relapse rate. Methods: A 6-year prospective study (2000¿2005) was carried out. Patients with P. aeruginosa respiratory infection admitted to a Hospital at Home service for parenteral antibiotic treatment were enrolled in the study. Clinical response to treatment, relapse, and relapse-free time, were analyzed as primary endpoints. Results: A total of 111 episodes were recorded in 81 patients. Bronchiectasia was the most common associated disease (57%). Ceftazidime and tobramycin were the first-line therapies used (61%). The average length of stay was 14 days. Among the total, 80% of patients had severe/very severe respiratory obstruction, and 35% were culture-positive at the end of treatment. Median follow-up to relapse was 144 days; 65% of episodes relapsed. Relapse was associated with bronchiectasia, aerosol therapy, and more severe respiratory obstruction. In the patients with severe/very severe obstruction, there was a decrease in relapse-free time from 1080 to 139 days, in those with positive culture at the end of therapy from 248 to 78 days, and in those with resistance to any antipseudomonal antibiotic, from 390 to 97 days. On multivariate analysis, severity of respiratory obstruction and the antibiotic resistance were independent risk factors for relapse. Conclusion: Patients infected by P. aeruginosa in poor clinical condition or showing resistance to any antipseudomonal antibiotics have a higher probability of relapse, and a shorter time to relapse than other patients with this infection. The Hospital at Home Service is a good approach to reducing the long-term hospital stay in these patients (AU)

[Treatment of respiratory infection by Pseudomonas aeruginosa in adult patients within a hospital at home service: clinical characteristics and analysis of prognostic factors for relapse]. / Tratamiento de la infección respiratoria por Pseudomonas aeruginosa en pacientes adultos en hospitalización a domicilio: características clínicas y evolutivas así como análisis de los factores pronósticos de recidiva.

INTRODUCTION: Pseudomonas aeruginosa respiratory infections are associated with poor respiratory function, low quality of life, and a high relapse rate. METHODS: A 6-year prospective study (2000-2005) was carried out. Patients with P. aeruginosa respiratory infection admitted to a Hospital at Home service for parenteral antibiotic treatment were enrolled in the study. Clinical response to treatment, relapse, and relapse-free time, were analyzed as primary endpoints. RESULTS: A total of 111 episodes were recorded in 81 patients. Bronchiectasia was the most common associated disease (57%). Ceftazidime and tobramycin were the first-line therapies used (61%). The average length of stay was 14 days. Among the total, 80% of patients had severe/very severe respiratory obstruction, and 35% were culture-positive at the end of treatment. Median follow-up to relapse was 144 days; 65% of episodes relapsed. Relapse was associated with bronchiectasia, aerosol therapy, and more severe respiratory obstruction. In the patients with severe/very severe obstruction, there was a decrease in relapse-free time from 1080 to 139 days, in those with positive culture at the end of therapy from 248 to 78 days, and in those with resistance to any antipseudomonal antibiotic, from 390 to 97 days. On multivariate analysis, severity of respiratory obstruction and the antibiotic resistance were independent risk factors for relapse. CONCLUSION: Patients infected by P. aeruginosa in poor clinical condition or showing resistance to any antipseudomonal antibiotics have a higher probability of relapse, and a shorter time to relapse than other patients with this infection. The Hospital at Home Service is a good approach to reducing the long-term hospital stay in these patients.

Hospitalización a domicilio y uso inadecuado de la hospitalización en cirugía general / Domiciliary hospitalization and inadequate use of hospital admission in general surgery

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