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1.
Artigo em Inglês | MEDLINE | ID: mdl-38001020

RESUMO

INTRODUCTION: The frailty present at hospital admission and the stressors to which patients are subjected during their stay may increase dependency at hospital discharge. OBJECTIVES: To assess the predictive validity of the Clinical Frailty Scale-España (CFS-Es) on increased dependency at 3 and 12 months (m) after hospital discharge. METHODOLOGY: Multicentre cohort study in 2020-2022. Including patients with >48 h stay in intensive care units (ICU) and non-COVID-19. VARIABLES: pre-admission frailty (CFS-Es). Sex, age, days of stay (ICU and hospital), dependency on admission and at 3 m and 12 m after discharge (Barthel index), muscle weakness (Medical Research Council Scale sum score <48), hospital readmissions. STATISTICS: descriptive and multivariate analysis. RESULTS: 254 cases were included. Thirty-nine per cent were women and the median [Q1-Q3] age was 67 [56-77] years. SAPS 3 on admission (median [Q1-Q3]): 62 [51-71] points. Frail patients on admission (CFS-Es 5-9): 58 (23%). Dependency on admission (n = 254) vs. 3 m after hospital discharge (n = 171) vs. 12 m after hospital discharge (n = 118): 1) Barthel 90-100: 82% vs. 68% vs. 65%. 2) Barthel 60-85: 15% vs. 15% vs. 20%. 3) Barthel 0-55: 3% vs. 17% vs. 15%. In the multivariate analysis, adjusted for the variables recorded, we observed that frail patients on admission (CFS-Es 5-9) are 2.8 times (95%CI: 1.03-7.58; p = 0.043) more likely to increase dependency (Barthel 90-100 to <90 or Barthel 85-60 to <60) at 3 m post-discharge (with respect to admission) and 3.5 times (95%CI: 1.18-10.30; p = 0.024) more likely to increase dependency at 12 m post-discharge. Furthermore, for each additional CFS-Es point there is a 1.6-fold (95%CI: 1.01-2.23; p = 0.016) greater chance of increased dependency in the 12 m following discharge. CONCLUSIONS: CFS-Es at admission can predict increased dependency at 3 m and 12 m after hospital discharge.

4.
Rev Esp Quimioter ; 33(6): 444-447, 2020 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-32957746

RESUMO

OBJECTIVE: Co-circulation of the two Influenza B lineages hinders forecast of strain to include in trivalent vaccine. Autonomous Communities such as Cantabria continue without supplying tetravalent vaccine. The aim of this study was to analyse epidemiological characteristics of influenza type B in Cantabria (2019-2020 season) as well as to establish the predominant lineage and its relation to the recommended vaccine. METHODS: Retrospective study whereby flu diagnosis and lineage analysis were determined by RT-PCR. RESULTS: All samples belonged to the Victoria lineage. Most prevalent viral co-infection was due to SARS-CoV-2. The population affected by influenza B was mainly paediatric and non-vaccinated patients more frequently required hospital admittance. CONCLUSIONS: Influenza type B has a higher incidence in the paediatric population and type A affects more the adult population. Only 28.8% of patients with Influenza B that presented with some underlying condition or risk factor were vaccinated. This shows the need to increase coverage with tetravalent vaccines in order to reduce the burden of disease associated with the Influenza B virus.


Assuntos
COVID-19/epidemiologia , Vírus da Influenza B , Influenza Humana/epidemiologia , Pandemias , SARS-CoV-2 , Adulto , COVID-19/virologia , Distribuição de Qui-Quadrado , Criança , Coinfecção/epidemiologia , Coinfecção/virologia , Epidemias , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Influenza Humana/virologia , Masculino , Estudos Retrospectivos , Estações do Ano , Espanha/epidemiologia , Estatísticas não Paramétricas
5.
Int J Antimicrob Agents ; 52(5): 577-585, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29969692

RESUMO

PURPOSE: There are few data in the literature regarding sepsis or septic shock due to extended-spectrum ß-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septic patients with bloodstream infection (BSI) caused by ESBL-E. METHODS: Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts. RESULTS: 367 septic patients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. ß-lactam/ß-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy. CONCLUSIONS: BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome.


Assuntos
Técnicas de Apoio para a Decisão , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/mortalidade , Enterobacteriaceae/enzimologia , Sepse/diagnóstico , Sepse/mortalidade , beta-Lactamases/metabolismo , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Quimioterapia Combinada , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sepse/tratamento farmacológico , Sepse/microbiologia , Análise de Sobrevida , Resultado do Tratamento , Inibidores de beta-Lactamases/uso terapêutico , beta-Lactamas/uso terapêutico
6.
An Sist Sanit Navar ; 40(3): 433-442, 2017 Dec 29.
Artigo em Espanhol | MEDLINE | ID: mdl-29149110

RESUMO

BACKGROUND: The percentage of the older population is progressively increasing as are diseases associated with aging such as cognitive decline (CD) and dementia. Observational epidemiological studies suggest that diets rich in omega 3 polyunsaturated fatty acids (w3-PUFA) might reduce the risk of CD and dementia. The main objective was to assess whether there is sufficient scientific evidence about the relationship between w3-PUFA supplementation in patients aged 65 or older and cognitive performance. METHODS: We used the Pubmed data base to search for articles related to w3-PUFA and CD or dementia. Initially we identified 582 articles, after applying the eligibility criterion we included six studies in this systematic review. RESULTS: The studies included were heterogeneous regarding population, measurement of exposure and outcome. Therefore, it was not possible to conduct a quantitative analysis. Two studies found that w3-PUFA supplementation decreased the risk of Alzheimer and improved cognitive performance. Two studies found an improvement in only one of the domains of cognitive performance (visual analogical classification and verbal fluency) and another two did not find any evidence of protection. CONCLUSIONS: We found few studies to support or refute the evidence that w3-PUFA supplementation in patients aged 65 or older improves cognitive performance or prevents dementia.


Assuntos
Cognição/fisiologia , Demência/prevenção & controle , Suplementos Nutricionais , Ácidos Graxos Ômega-3/efeitos adversos , Idoso , Humanos
7.
Clin Microbiol Infect ; 19(10): 962-8, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23279375

RESUMO

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.


Assuntos
Bacteriemia/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Infecções Urinárias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Bacteriemia/complicações , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia , Infecções Urinárias/mortalidade , Adulto Jovem
8.
Rev Clin Esp ; 202(5): 249-54, 2002 May.
Artigo em Espanhol | MEDLINE | ID: mdl-12060537

RESUMO

INTRODUCTION: Tuberculosis (TB) is an underreported condition to the Communicable Diseases Control System (CDCS). The objective of this work was to estimate the actual incidence of tuberculosis and the epidemiological characteristics of the diseases in the Zaragoza province. MATERIAL AND METHODS: Retrospective study in which the capture-recapture method was used to estimate the number of tuberculosis cases, by using the microbiology laboratories and the CDSC as data sources. The socio-demographic and clinical characteristics of diagnosed patients throughout three years in this province were analyzed. RESULTS: The mean annual incidence rate of TB was 22.02 per 100,000 inhabitants according to microbiological data, and 48.5 per 100,000 according to the capture-recapture method. A total of 569 patients were studied, and 400 of them were males (70.3%). The mean age was 43.2 years, and the 25-34 year-old group had the highest number of cases (27.9%). Twenty-three percent of cases were co-infected with HIV, and 77.4% were parenteral drug abusers, and 4.4% immigrants. CONCLUSIONS: The capture-recapture method has demonstrated to be useful to know the relevance of TB in our setting. The actual incidence of tuberculosis was higher than that pointed out by the CDCS. Relevant differences were observed regarding incidence rates by age and sex groups. HIV infection and immigration do not appear to explain the frequency of this disease in our setting.


Assuntos
Vigilância da População/métodos , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Tuberculose/diagnóstico
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