Results of an early intervention programme for patients with bacteraemia: analysis of prognostic factors and mortality.

BACKGROUND: Bacteraemia is a common cause of morbidity and mortality in patients admitted to hospital. The aim of this study is to analyse the results of a two-year programme for the early optimisation of antibiotic treatment in patients admitted to the Costa del Sol Hospital (Marbella. Spain). METHODS: A prospective two-year cohort study was conducted, evaluating all episodes of bacteraemia at the Costa del Sol Hospital. Epidemiological and microbiological characteristics, any modification of the initial antibiotic treatment, prognostic risk stratification, early mortality related to the episode of bacteraemia, and mortality after the seventh day, were included in the analysis. RESULTS: Seven hundred seventy-three episodes of bacteraemia were treated, 61.6% males and 38.4% females. The mean age was 65.2 years. The condition was most commonly acquired in the community (41.4%). The bacteraemia was most frequently urological in nature (30.5%), and E coli was the microorganism most frequently isolated (31.6%). In 51.1% of the episodes, a modification was made to optimise the treatment. In the first week, 8.2% died from bacteraemia, and 4.5% had died when they were located. The highest rates of death were associated with older patients, nosocomial acquisition, no source, McCabe score rapidly fatal, Charlson index ≥3, Pitt index ≥3 and treatment remained unmodified. CONCLUSION: The existence of bacteraemia control programmes and teams composed of clinicians who are experienced in the treatment of infectious diseases, can improve the disease outcome by enabling more severe episodes of bacteraemia to be recognised and their empirical treatment optimised.

[Present situation of antibiotic resistances in tonsillar infections]. / Situación actual de las resistencias a antibióticos en infecciones amigdalares.

OBJECTIVE: To obtain the main responsible organisms, its sensitivity and resistances to antibiotics in tonsillitis. MATERIAL AND METHODS: We have studied the post-surgical tonsils, carrying out a microbiologic study, its culture and sensitivity. RESULTS: The most frequent isolated organisms were Staphylococcus aureus (29.3%), followed by Streptococcus pyogenes (23.4%), and Haemophilus influenzae (12.1%). The highest resistances were for the S. aureus (penicillin 91%, erythromycin 18% and 5% to the rest of the beta-lactams), followed by H. influenzae (50% clarithromycin, 30% amoxyciIlin and 2% cephalosporins) and S. pyogenes (28% erytromycin, 10% clindamycin and 3% penicillin). CONCLUSIONS: We noticed the minimal resistance found to cephalosporins, and for this reason they appear to be the safest option, except in children under five years old, in which amoxicillin is still the first line treatment, because the causative agent is S. pyogenes, sensitive to that antibiotic.

Situación actual de las resistencias a antibióticos en infecciones amigdalares / Present situation of antibiotic resistances in tonsillar infections

Objetivo: Obtener los principales microorganismos y resistencias a antibióticos en infecciones amigdalares. Material y métodos: Realizamos un estudio microbiológico con antibiograma de amígdalas palatinas postquirúrgicas. Resultados: Los microorganismos más aislados han sido el Staphylococcus aureus (29,3%) seguido del Streptococcus pyogenes (23,4%), y del Haemophilus influenzae (12,1%). Las mayores resistencias fueron para el S. aureus (91% a la penicilina, 18% a la eritromicina y un 5% al resto de β-lactámicos), seguido del H. influenzae (50% a la claritromicina, 30% a la amoxicilina y 2% a cefalosporinas) y por último el S. pyogenes (28% a la eritromicina, 10% a la clindamicina y 3% a la penicilina). Conclusiones: Destacamos la mínima resistencia encontrada a las cefalosporinas por lo que parece ser el grupo antibiótico más seguro, excepto en los niños menores de 5 años en los cuales la amoxicilina sigue siendo de primera elección dado que están provocadas por S. pyogenes sensibles a dicho antibiótico

Objective: To obtain the main responsible organisms, its sensitivity and resistances to antibiotics in tonsillitis. Material and methods: We have studied the post-surgical tonsils, carrying out a microbiologic study, its culture and sensitivity. Results: The most frequent isolated organisms were Staphylococcus aureus (29.3%), followed by Streptococcus pyogenes (23.4%), and Haemophilus influenzae (12.1%). The highest resistances were for the S. aureus (penicillin 91%, erythromycin 18% and 5% to the rest of the β-lactams), followed by H. influenzae (50% clarithromycin, 30% amoxycillin and 2% cephalosporins) and S. pyogenes (28% erytromycin, 10% clindamycin and 3% penicillin). Conclusions: We noticed the minimal resistance found to cephalosporins, and for this reason they appear to be the safest option, except in children under five years old, in which amoxicillin is still the first line treatment, because the causative agent is S. pyogenes, sensitive to that antibiotic