RESUMO
Raoultella planticola (R. planticola) is an anaerobic gram-negative bacillus implicated in urinary, intra-abdominal, skin and soft tissue infections, pneumonia and bacteraemia. We depict here the clinical case of a 74-year-old woman, medicated lifelong with phenytoin, with bacteraemia caused by R. planticola, successfully treated with ceftriaxone. To date, a comprehensive literature review, revealed 52 published clinical cases (between 2007- 2019), thirteen of which due to bacteraemia. (AU)
Raoultella planticola (R. planticola) es un bacilo anaerobio Gram negativo implicado en infecciones de partes blandas, urinarias, intra-abdominales, neumonías y episodios de bacteriemia. Presentamos el caso de una mujer de 74 años, tratada con fenitoína de forma crónica, con bacteriemia por R. planticola tratada de forma exitosa con ceftriaxona. Hasta la fecha, tras realizar una revisión de la literatura, se han descrito 52 casos entre 2007 y 2019, trece de los cuales presentaron bacteriemia. (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Bacteriemia , Regionalização da SaúdeRESUMO
OBJECTIVE: To investigate the clinical efficacy of three different healthcare models (Traditional Model, Geriatric Consultant Model, and Orthogeriatric Unit Model) consecutively applied to a single academic center (University Hospital of Salamanca, Spain) for older hip fracture patients. METHODS: We performed a retrospective study, including 2741 hip fracture patients older than 64 years, admitted between 1 January 2003 and 31 December 2014 to the University Hospital of Salamanca. Patients were divided into three groups according to the healthcare model applied. There were 983 patients on the Traditional Model, 945 patients on the Geriatric Consultant Model, and 813 patients on the Orthogeriatric Unit Model. We recorded age and gender of patients, functional status at admission (Barthel Index, Katz Index, and Physical Red Cross Scale), type of fracture, and intervention, and we analyzed the length of stay, time to surgery, post-surgical stay, and in-hospital mortality according to the healthcare model applied. RESULTS: Hip fractures are much more frequent in women, and an increase in the average age of patients was observed along with the study (P < 0.001). The most common type of fracture in the three models studied was an extracapsular fracture, for which the most common surgical procedure used was osteosynthesis. On the functional status of patients, there were no differences on the ambulatory ability previous to fracture, measured by the Physical Red Cross Scale, and the percentage of patients with a slight dependence determined by the Barthel Index (>60) was similar in both groups, but considering the Katz Index, the percentage of patients with a high degree of independence (A-B) was significantly higher for the group of patients treated on the Orthogeriatric Unit Model period (56%, P = 0.009). The Orthogeriatric Unit Model registered the greatest percentage of patients undergoing surgery (96.1%, P < 0.001) and the greatest number of early surgical procedures (<24 h) (24.8%, P < 0.001). The orthogeriatric unit model showed the shortest duration of stay (9 days median), decreasing by one day in respect of each of the other models studied (P < 0.001). Time to surgery was also significantly reduced with the Orthogeriatric Unit Model (median of 3 days, P < 0.001). With regard to in-hospital follow-up, there was a reduction in in-hospital mortality during the study period. We observed differences among the three healthcare models, but without statistical significance. CONCLUSIONS: The healthcare model based on an Orthogeriatric Unit seems to be the most efficient, because it reaches a reduction in time to surgery, with an increased number of patients surgically treated on in the first 24 h, and the greatest frequency of surgically-treated patients.
