RESUMO
OBJECTIVE: To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. METHODS: Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. RESULTS: A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. CONCLUSIONS: Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
Assuntos
Endocardite Bacteriana/complicações , Endocardite Bacteriana/epidemiologia , Cirrose Hepática/complicações , Idoso , Procedimentos Cirúrgicos Cardíacos , Estudos de Coortes , Endocardite Bacteriana/mortalidade , Feminino , Humanos , Cirrose Hepática/microbiologia , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologiaRESUMO
No disponible
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Humanos , Masculino , Pessoa de Meia-Idade , Aneurisma Infectado/complicações , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/tratamento farmacológico , Listeria monocytogenes/isolamento & purificação , Listeria monocytogenes/patogenicidade , Aneurisma Infectado/fisiopatologia , Aneurisma Infectado , Tomografia Computadorizada de Emissão/instrumentação , Tomografia Computadorizada de Emissão/métodos , Tomografia Computadorizada de Emissão , Listeria monocytogenes , Hipertensão/complicaçõesRESUMO
No disponible
Assuntos
Masculino , Humanos , Antibacterianos/efeitos adversos , Ceftriaxona/efeitos adversos , Pseudotumor Cerebral/induzido quimicamenteRESUMO
No disponible
Assuntos
Humanos , Sialorreia , Antagonistas Colinérgicos , Derivados da EscopolaminaRESUMO
INTRODUCTION. To report the five-year experience in ambulatory parenteral antimicrobial treatments of a Hospital at Home (HH). METHODS. Prospective, descriptive study in which demographic data, infection types, antibiotics, dosages, treatment duration, administration methods, and complications were recorded. RESULTS. A total of 325 ambulatory parenteral antibiotic treatments were instituted. The mean age of patients was 56 years (range: 4-96). Patients included 225 men and 100 women. The mean duration of treatment was 16 days (range: 1-176 days). The total number of stays was 4,313 days. The sources of the treated infections included: respiratory tract, 40.3%; osteoarticular, 13.2%; digestive tract, 7%; cytomegalovirus, 6.4%; soft tissue, 5.5%; bacteremias, 5,2%; central nervous system, 4.9%; urinary tract, 4.6%; febrile syndromes, 3.7%; postsurgical, 3%; and endocarditis, 2.5%. Ceftriaxone was the antibiotic most widely used. Seventy-nine percent of treatments were throught the intravenous route. In the last two years infusion pumps were used. Treatment was completed in 93.3% of cases, three patients died and 19 patients required readmission. The most common complication was phlebitis, in 12.6% of cases. CONCLUSIONS. Currently, there is the possibility of safely treating a large number of infections at patient's home with parenteral antibiotics.
RESUMO
Objetivo. Describir la experiencia en tratamientos antimicrobianos parenterales en domicilio de una Unidad de Hospitalización a Domicilio (UHD) en un período de 5 años. Metodología. Se realiza un estudio prospectivo, descriptivo, en el que se recogen datos demográficos, tipos de infección, antibióticos y posología utilizada, duración del tratamiento, método de infusión y complicaciones aparecidas. Resultados. Se han instaurado 325 tratamientos antibióticos parenterales a domicilio. La edad media fue 5 6 años (rango: 4 -9 6 años); por sexos, 2 2 5 varones y 1 0 0 mujeres. La duración media de los tratamientos fue de 1 6 días (rango: 1 -1 7 6 días). El número total de estancias fue 4 .3 1 3 días. Las infecciones tratadas han sido muy variadas: respiratorias, 4 0 ,3 %; osteoarticulares, 1 3 ,2 %; del aparato digestivo, 7 %; por citomegalovirus, 6 ,4 %; de tejidos blandos, 5 ,5 %; bacteriemias, 5 ,2 %; del sistema nervioso central, 4 ,9 %; urinarias, 4 ,6 %; síndromes febriles, 3 ,7 %; posquirúrgicas, 3 %, y endocarditis, 2,5%. El antibiótico más utilizado ha sido la ceftriaxona. El 7 9 % de los tratamientos fue endovenoso. En los 2 últimos años se han utilizado bombas de infusión. Se completó el tratamiento en un 9 3 ,3 % de los casos, falleciendo 3 pacientes y requiriendo reingreso 1 9 . La complicación más frecuente ha sido la flebitis en un 12,6% de los casos. Conclusiones. En la actualidad existe la posibilidad de tratar una gran número de infecciones en el domicilio del paciente con antibióticos parenterales de una manera segura (AU)
Objective. To report the five-year experience in ambulatory parenteral antimicrobial treatments of a Hospital at Home (HH). Methods. Prospective, descriptive study in which demographic data, infection types, antibiotics, dosages, treatment duration, administration methods, and complications were recorded. Results. A total of 325 ambulatory parenteral antibiotic treatments were instituted. The mean age of patients was 5 6 years (range: 4 -9 6 ). Patients included 2 2 5 men and 1 0 0 women. The mean duration of treatment was 1 6 days (range: 1 -1 7 6 days). The total number of stays was 4 ,3 1 3 days. The sources of the treated infections included: respiratory tract, 4 0 .3 %; osteoarticular, 1 3 .2 %; digestive tract, 7 %; cytomegalovirus, 6 .4 %; soft tissue, 5 .5 %; bacteremias, 5 ,2 %; central nervous system, 4 .9 %; urinary tract, 4 .6 %; febrile syndromes, 3 .7 %; postsurgical, 3 %; and endocarditis, 2 .5 %. Ceftriaxone was the antibiotic most widely used. Seventy-nine percent of treatments were throught the intravenous route. In the last two years infusion pumps were used. Treatment was completed in 9 3 .3 % of cases, three patients died and 19 patients required readmission. The most common complication was phlebitis, in 12.6% of cases. Conclusions. Currently, there is the possibility of safely treating a large number of infections at patients home with parenteral antibiotics (AU)
