Población muy anciana institucionalizada de Barcelona: valoración de la fragilidad según el índice frágil-VIG y análisis de la adecuación terapéutica según los criterios STOPP-frail / Very elderly institutionalised population of Barcelona: Evaluation of frailty according to the Frail-VIG index and analysis of therapeutic appropriateness according to the STOPP-frail criteria

Introducción: Frecuentemente en pacientes muy ancianos institucionalizados coexiste fragilidad y polifarmacia, por ello es importante valorar el grado de fragilidad y la adecuación terapéutica en este grupo poblacional. El objetivo de este estudio es valorar el grado de fragilidad de una población muy mayor institucionalizada y analizar la prescripción. Material y métodos: Estudio observacional y transversal de una población de 85 años o más, institucionalizada en una residencia geriátrica de Barcelona. Se valoró la fragilidad utilizando el Índice Frágil-VIG y la adecuación de la prescripción de cada grupo según los criterios STOPP-Frail. Resultados: Se incluyeron 79 pacientes con una media de 90,9+/-4,2 años. La mayoría (96,2%) tenían algún grado de fragilidad. Con fragilidad leve había un 21,5%, moderada un 37,7% y severa un 38%. Para estos 3 grupos, la mediana de fármacos fue de 7. En la mayoría de las prescripciones de los grupos no hallamos diferencias estadísticamente significativas. Solo existían diferencias para los que tenían dificultad en tomar la medicación, los que tomaban medicación para la hipertrofia prostática y suplementos nutricionales. Se encontró en los 3 grupos que hasta un tercio de la prescripción era inadecuada y que incluso algunas prescripciones estaban contraindicadas en los pacientes más frágiles. Conclusión: Nuestra población anciana tiene un elevado índice de fragilidad con alta prevalencia de polimedicación y prescripción inadecuada. La escasa individualización de la prescripción con relación al grado de fragilidad, sobre todo en aquellos con corto pronóstico de vida, nos indica una situación que debe mejorarse

Introduction: As frailty and multiple drug therapy often coexists in institutionalised elderly patients, it is important to assess the level of frailty and therapeutic appropriateness in this population group. The aim of the study is to: assess the frailty level of institutionalised elderly patients and to analyse their prescriptions. Material and methods: An observational and cross-sectional study of a geriatric population of 85 years or older, institutionalised in a nursing home in Barcelona. Frailty was assessed using the Frail-VIG index, and the adequacy of the prescription of each group was done according to the STOPP-Frail Criteria. Results: The study included 79 patients, with a mean age of 90.9+/-4.2 years. Most of them (96.2%) had some degree of frailty. Slight frailty was observed in 21.5%, moderate in 37.7%, and advanced in 38%. The patients were prescribed a median of 7 drugs. No statistically significant differences were found in the majority of the prescriptions of the frailty groups. Differences were only found for those who had difficulty taking the medication, those who took medication for prostatic hypertrophy, and nutritional supplements. In all 3 groups, it was found that up to one third of the prescription was inappropriate, and some were even contraindicated in the most frail patients. Conclusion: The elderly study population has a high frailty index with a high prevalence of multiple drug therapy with inappropriate prescription. The poor individualisation of these prescriptions in relation to the level of frailty, especially in those with short life prognosis, is a situation that should be improved

[Very elderly institutionalised population of Barcelona: Evaluation of frailty according to the Frail-VIG index and analysis of therapeutic appropriateness according to the STOPP-frail criteria]. / Población muy anciana institucionalizada de Barcelona: valoración de la fragilidad según el índice frágil-VIG y análisis de la adecuación terapéutica según los criterios STOPP-frail.

INTRODUCTION: As frailty and multiple drug therapy often coexists in institutionalised elderly patients, it is important to assess the level of frailty and therapeutic appropriateness in this population group. The aim of the study is to: assess the frailty level of institutionalised elderly patients and to analyse their prescriptions. MATERIAL AND METHODS: An observational and cross-sectional study of a geriatric population of 85 years or older, institutionalised in a nursing home in Barcelona. Frailty was assessed using the Frail-VIG index, and the adequacy of the prescription of each group was done according to the STOPP-Frail Criteria. RESULTS: The study included 79 patients, with a mean age of 90.9±4.2 years. Most of them (96.2%) had some degree of frailty. Slight frailty was observed in 21.5%, moderate in 37.7%, and advanced in 38%. The patients were prescribed a median of 7 drugs. No statistically significant differences were found in the majority of the prescriptions of the frailty groups. Differences were only found for those who had difficulty taking the medication, those who took medication for prostatic hypertrophy, and nutritional supplements. In all 3 groups, it was found that up to one third of the prescription was inappropriate, and some were even contraindicated in the most frail patients. CONCLUSION: The elderly study population has a high frailty index with a high prevalence of multiple drug therapy with inappropriate prescription. The poor individualisation of these prescriptions in relation to the level of frailty, especially in those with short life prognosis, is a situation that should be improved.

Abordaje del riesgo de delirium en una unidad de ortogeriatría / Aproach to the risk of delirium in an orthogeriatric unit

Introducción: El objetivo de este estudio es evaluar la eficacia de un cambio en la estrategia de manejo del riesgo de delirium en una unidad de ortogeriatría. Material y métodos: Estudio prospectivo, comparativo, no aleatorizado de 2 cohortes de pacientes. Una cohorte (grupo control) tratado con la terapia estándar con tramadol de rescate y diazepam, y otra cohorte (grupo experimental) tratado con morfina a dosis bajas de rescate junto con benzodiacepinas de vida media corta y tratamiento preventivo con neurolépticos, en los pacientes de alto riesgo. Resultados: Se ha incluido a 85 pacientes (42 en el grupo control y 43 en el grupo experimental). Edad media: 85 años (71-105). Un total de 29 pacientes (34%) han tenido un episodio de delirium durante el ingreso actual, 16 pacientes (38%) en el grupo control y 13 pacientes (30%) en el grupo experimental, respectivamente (p=0,498). La duración media del delirium en los 29 pacientes que lo presentaron fue de 5,3 días. Esta duración fue en el grupo control de 6,6 días y en el grupo experimental de 3,8 días, respectivamente (p=0,031). En el grupo de pacientes que tenían antecedente de delirium previo, se aprecia que hay una menor incidencia de delirium durante el ingreso actual en el grupo experimental (80% vs. 17%, p=0,036). Conclusiones: La terapia experimental ha resultado eficaz, ya que se ha podido observar una tendencia a disminuir la incidencia del delirium y en los casos que lo han presentado la terapia sirvió para disminuir su duración con diferencias estadísticamente significativas

Introduction: The objective of this study is to evaluate the efficacy of a change in the management of the risk of delirium in an orthogeriatric unit. Material and methods: Prospective, comparative, non-randomised study of two cohorts of patients. One cohort (control group) treated with standard therapy with tramadol rescue and diazepam and another cohort (experimental group) treated with rescue with morphine at low doses and short half-life benzodiazepines as well as preventive treatment with neuroleptics in patients at high risk. Results: Eighty-five patients were included (42 in the control group and 43 in the experimental group). Mean age: 85 (71-105). Twenty-nine patients (34%) had an episode of delirium during the current admission, 16 patients (38%) in the control group and 13 patients (30%) in the experimental group respectively (P=.498). The mean duration of delirium in the 29 patients who presented it was 5.3 days. This duration in the control group was 6.6 days and in the experimental group 3.8 days (P=.031). In the group of patients who had previous delirium, a lower incidence of delirium was seen during the current admission in the experimental group (80% vs 17% P=.036). Conclusions: Experimental treatment has been effective since a trend to a lower incidence of delirium has been observed. In the patients who have suffered an episode of delirium, the treatment served to decrease its duration with statistically significant differences

Aproach to the risk of delirium in an orthogeriatric unit. / Abordaje del riesgo de delirium en una unidad de ortogeriatría.

INTRODUCTION: The objective of this study is to evaluate the efficacy of a change in the management of the risk of delirium in an orthogeriatric unit. MATERIAL AND METHODS: Prospective, comparative, non-randomised study of two cohorts of patients. One cohort (control group) treated with standard therapy with tramadol rescue and diazepam and another cohort (experimental group) treated with rescue with morphine at low doses and short half-life benzodiazepines as well as preventive treatment with neuroleptics in patients at high risk. RESULTS: Eighty-five patients were included (42 in the control group and 43 in the experimental group). Mean age: 85 (71-105). Twenty-nine patients (34%) had an episode of delirium during the current admission, 16 patients (38%) in the control group and 13 patients (30%) in the experimental group respectively (P=.498). The mean duration of delirium in the 29 patients who presented it was 5.3 days. This duration in the control group was 6.6 days and in the experimental group 3.8 days (P=.031). In the group of patients who had previous delirium, a lower incidence of delirium was seen during the current admission in the experimental group (80% vs 17% P=.036). CONCLUSIONS: Experimental treatment has been effective since a trend to a lower incidence of delirium has been observed. In the patients who have suffered an episode of delirium, the treatment served to decrease its duration with statistically significant differences.

Prevalencia y valor pronóstico al año de la anemia en pacientes ingresados en una unidad geriátrica de agudos / Anemia in elderly patients admitted to an acute geriatric ward

Objetivo: Analizar la prevalencia y características de pacientes con anemia ingresados en una unidad geriátrica de agudos, y su valor pronóstico de mortalidad al año. Material y métodos: Estudio descriptivo prospectivo en el que se incluyó a los pacientes ingresados en la unidad de geriatría. Se diagnosticó la anemia según los criterios de la Organización Mundial de la Salud. A todos los enfermos se les realizó una valoración geriátrica integral. Un año más tarde se realizó seguimiento vía telefónica y se valoró mortalidad y situación funcional. Resultados: Se incluyó a 145 pacientes, edad media de 81 años, de los cuales 93 (64,13%) presentaban anemia. Los tipos más frecuentes de anemia fueron la de procesos crónicos y la ferropénica. El índice de Barthel fue menor en los pacientes con anemia (p < 0,05). La mortalidad al año fue del 47,9%, sin diferencias significativas entre pacientes con y sin anemia (OR 2,07; [0,98-4,4]). Los valores del IB, el índice de Charlson, el Mini Nutritional Assessment method y el Mini Examen Cognoscitivo de Lobo basales fueron significativamente peores en los pacientes que fallecieron. Conclusión: La anemia es un enfermedad muy prevalente en pacientes de edad avanzada que ingresan por un proceso agudo y se asocia con una peor situación funcional (AU)

Objective: To describe the characteristics, prevalence and prognostic of anemia in older patients admitted to an acute geriatric unit. Material and methods: A prospective descriptive study was conducted on patients admitted to a geriatric unit. Anemia was defined using the World Health Organization criteria. A comprehensive geriatric assessment was performed on all patients. When possible, a telephone follow-up re-evaluation (mortality, functional status) was performed one year after discharge. Results: A total of 145 patients were studied. The mean age was 81 years, and 93 (64.13%) were anemic. Chronic diseases and iron deficiency anemia were the most frequent. Anemic patients had lower scores in the Barthel Index (P<.05). The mortality one year after discharge was 47.9%, with no differences between anemic or non-anemic patients (OR 2.07, [0.98-4.4]). All the geriatric indexes (Barthel index; Charlson comorbidity index, Mini-mental state examination and Mini Nutritional Assessment) showed worse scores in patients who died one year after discharge. Conclusions: The prevalence of anemia in the elderly admitted to a geriatric unit is elevated, and associated with a poorer functional status (AU)

[Anemia in elderly patients admitted to an acute geriatric ward]. / Prevalencia y valor pronóstico al año de la anemia en pacientes ingresados en una unidad geriátrica de agudos.

OBJECTIVE: To describe the characteristics, prevalence and prognostic of anemia in older patients admitted to an acute geriatric unit. MATERIAL AND METHODS: A prospective descriptive study was conducted on patients admitted to a geriatric unit. Anemia was defined using the World Health Organization criteria. A comprehensive geriatric assessment was performed on all patients. When possible, a telephone follow-up re-evaluation (mortality, functional status) was performed one year after discharge. RESULTS: A total of 145 patients were studied. The mean age was 81 years, and 93 (64.13%) were anemic. Chronic diseases and iron deficiency anemia were the most frequent. Anemic patients had lower scores in the Barthel Index (P<.05). The mortality one year after discharge was 47.9%, with no differences between anemic or non-anemic patients (OR 2.07, [0.98-4.4]). All the geriatric indexes (Barthel index; Charlson comorbidity index, Mini-mental state examination and Mini Nutritional Assessment) showed worse scores in patients who died one year after discharge. CONCLUSIONS: The prevalence of anemia in the elderly admitted to a geriatric unit is elevated, and associated with a poorer functional status.

Antibioticoterapia intravenosa domiciliaria en el tratamiento de las infecciones causadas por microorganismos multirresistentes / Home intravenous antimicrobial therapy in multi-drug resistant microorganism infections

Background: Although home intravenous antimicrobial infusion therapy (HIVAIT) has proved its safety and efficacy in a great number of common infections, there are few published studies about its role in the treatment of infections caused by multi-drug resistant microorganisms. Our objectives are to study clinical and epidemiological characteristics of patients with multi-drug resistant microorganism infections treated with HIVAIT, and its usefulness in this type of infections. Methods: We analyzed all patients diagnosed of infections requiring HIVAIT and admitted to our Hospital at Home Unit (HHU) from March 2007 to February 2010. Subjects were divided into two groups: patients with multi-drug resistant microorganism infections as a study group, and the remaining patients as a control group. Results: A total of 487 patients were included, 82 in the study group. Comorbidity and physical dependence were higher in this group than in the control group (p=0.000 and p=0.002 respectively). The majority of patients were discharged because of a satisfactory clinical evolution. However, 17 (20.7%) patients in the study group required readmission to hospital during treatment and another 22 (26.8%) were re-admitted to hospital 3 months after discharge from HHU. There were significant differences between the results from the control group in clinical readmissions. Conclusions: Patients with multi-drug resistant microorganism infections and HIVAIT have higher comorbidity, physical dependence, and frequency of hospital readmissions. However, HIVAIT is useful in this kind of infections if the patients are appropriately selected (AU)

Fundamento: La antibioticoterapia intravenosa domiciliaria (AID) ha demostrado su seguridad y eficacia en un gran número de infecciones comunes. Sin embargo, existen pocos trabajos publicados sobre su papel en el tratamiento de las infecciones causadas por bacterias multirresistentes. Los objetivos de este trabajo son definir las características clínicas y epidemiológicas de los pacientes con infecciones causadas por microorganismos multirresistentes tratados con AID, así como estudiar su utilidad en este tipo de infecciones. Material y método: Analizamos todos los pacientes que por requerir AID ingresaron en nuestra Unidad de Hospitalización a Domicilio (UHD) desde marzo de 2007 hasta febrero de 2010. Los pacientes se dividieron en dos grupos: los pacientes con infecciones causadas por microorganismos multirresistentes fueron incluidos en el grupo a estudio, mientras que el resto de pacientes formó el grupo control. Resultados: Se incluyeron 487 pacientes, de los cuales 82 formaron el grupo a estudio. La comorbilidad y la dependencia física en este grupo fueron mayores que en el grupo control (p=0,000 y p=0,002 respectivamente). La mayoría de los pacientes tuvieron una evolución clínica satisfactoria. Sin embargo, 17 (20,7%) pacientes del grupo a estudio reingresaron durante el tratamiento y otros 22 (26,8%) reingresaron 3 meses después del alta definitiva de nuestra unidad, siendo las diferencias entre ambos grupos estadísticamente significativas. Conclusiones: Los pacientes con infecciones causadas por microorganismos multirresistentes y AID tienen mayor comorbilidad, dependencia física y frecuencia de reingresos hospitalarios. Sin embargo, la AID es útil en el tratamiento de este tipo de infecciones en pacientes adecuadamente seleccionados (AU)

[Home intravenous antimicrobial therapy in multi-drug resistant microorganism infections]. / Antibioticoterapia intravenosa domiciliaria en el tratamiento de las infecciones causadas por microorganismos multirresistentes.

BACKGROUND: Although home intravenous antimicrobial infusion therapy (HIVAIT) has proved its safety and efficacy in a great number of common infections, there are few published studies about its role in the treatment of infections caused by multi-drug resistant microorganisms. Our objectives are to study clinical and epidemiological characteristics of patients with multi-drug resistant microorganism infections treated with HIVAIT, and its usefulness in this type of infections. METHODS: We analyzed all patients diagnosed of infections requiring HIVAIT and admitted to our Hospital at Home Unit (HHU) from March 2007 to February 2010. Subjects were divided into two groups: patients with multi-drug resistant microorganism infections as a study group, and the remaining patients as a control group. RESULTS: A total of 487 patients were included, 82 in the study group. Comorbidity and physical dependence were higher in this group than in the control group (p=0.000 and p=0.002 respectively). The majority of patients were discharged because of a satisfactory clinical evolution. However, 17 (20.7%) patients in the study group required readmission to hospital during treatment and another 22 (26.8%) were re-admitted to hospital 3 months after discharge from HHU. There were significant differences between the results from the control group in clinical readmissions. CONCLUSIONS: Patients with multi-drug resistant microorganism infections and HIVAIT have higher comorbidity, physical dependence, and frequency of hospital readmissions. However, HIVAIT is useful in this kind of infections if the patients are appropriately selected.

Tratamiento antibiótico intravenoso domiciliario del absceso hepático: seguridad, eficacia y factores pronósticos de reingreso hospitalario / Home intravenous antibiotic therapy of hepatic abscess: Safety, efficacy and predictive factor of hospital readmission

Fundamento y objetivo: Existen pocos datos en la bibliografía sobre el tratamiento antibiótico intravenoso de abscesos hepáticos en unidades de hospitalización a domicilio (UHD). Nuestros objetivos fueron analizar las características de los pacientes con abscesos hepáticos ingresados en nuestra UHD, la eficacia y la seguridad del tratamiento antibiótico intravenoso y los factores de riesgo de reingreso hospitalario. Pacientes y método: Se incluyeron en el estudio todos los pacientes ingresados en nuestra UHD para tratamiento antibiótico intravenoso por absceso hepático desde marzo de 2006 hasta junio de 2009. Resultados: Se incluyeron 30 pacientes en el estudio. Cinco pacientes (16,6%) presentaron flebitis durante el tratamiento y no se observó ningún efecto secundario mayor. La reducción media (desviación estándar) del tamaño durante el ingreso en la UHD fue del 49,3% (36,6). El número de reingresos totales fue de 9 (30%), 6 (20%) durante el período de ingreso en la UHD y 3 (10%) el año posterior. Cuatro pacientes (13,3%) fallecieron durante el seguimiento. Los pacientes que reingresaron tuvieron un tamaño medio del absceso al alta de la UHD mayor respecto de los que no lo tuvieron (4,5 frente a 1,5cm; p=0,001), así como un menor porcentaje de disminución de su tamaño durante el ingreso en la UHD (el 19 frente al 64%; p=0,001). Las mujeres reingresaban más que los varones (el 77,8 frente al 28,6%; p=0,02), pero aquéllas presentaron una menor puntuación de Barthel (75 frente a 92; p=0,01). Conclusiones: El tratamiento antibiótico intravenoso domiciliario en el tratamiento del absceso hepático parece una alternativa segura y eficaz en la mayoría de los pacientes. El tamaño y reducción del absceso al alta, el sexo y el grado de dependencia del paciente constituyeron las principales variables de reingreso (AU)

Background and objective: Few data exists in the literature about intravenous antibiotic treatment of hepatic abscess in hospital based care units. Our objectives were to analyze the efficacy and safety of intravenous antibiotic therapy and the predictors of hospital readmission. Patients and methods: The study included all the patients admitted in our home care unit for intravenous antibiotic treatment of hepatic abscess from March 2006 to June 2009. Results: We included 30 patients in the study. Five patients (16,6%) had phlebitis during treatment and none presented a major secondary effect. Mean size reduction of abscess during admission in our home care unit was 49,3% (36,6%). Nine (30%) patients were readmitted, 6 (20%) during admission at home and 3 (10%) along the year after. Four (13.3%) patients died along follow-up. Patients readmitted had a higher mean size of abscess at discharge from our home care unit as compared to the non readmitted ones (4,5 vs 1,5cms P=0,001), besides a minor percentage of reduction of size (19% vs 64% P=0,001). Female patients were readmitted more frequently than male ones (77,8% vs 28,6% P=0,02), but they had minor scores of Barthel scale (75 vs. 92 P=0,01). Conclusions: Home intravenous antibiotic treatment of hepatic abscess seems to be a safe and effective alternative in most patients. The size and reduction of abscess at patient discharge, the female gender and dependence degree constituted the principal predictors of readmission (AU)

[Home intravenous antibiotic therapy of hepatic abscess: Safety, efficacy and predictive factor of hospital readmission]. / Tratamiento antibiótico intravenoso domiciliario del absceso hepático: seguridad, eficacia y factores pronósticos de reingreso hospitalario.

BACKGROUND AND OBJECTIVE: Few data exists in the literature about intravenous antibiotic treatment of hepatic abscess in hospital based care units. Our objectives were to analyze the efficacy and safety of intravenous antibiotic therapy and the predictors of hospital readmission. PATIENTS AND METHODS: The study included all the patients admitted in our home care unit for intravenous antibiotic treatment of hepatic abscess from March 2006 to June 2009. RESULTS: We included 30 patients in the study. Five patients (16,6%) had phlebitis during treatment and none presented a major secondary effect. Mean size reduction of abscess during admission in our home care unit was 49,3% (36,6%). Nine (30%) patients were readmitted, 6 (20%) during admission at home and 3 (10%) along the year after. Four (13.3%) patients died along follow-up. Patients readmitted had a higher mean size of abscess at discharge from our home care unit as compared to the non readmitted ones (4,5 vs 1,5 cms P=0,001), besides a minor percentage of reduction of size (19% vs 64% P=0,001). Female patients were readmitted more frequently than male ones (77,8% vs 28,6% P=0,02), but they had minor scores of Barthel scale (75 vs. 92 P=0,01). CONCLUSIONS: Home intravenous antibiotic treatment of hepatic abscess seems to be a safe and effective alternative in most patients. The size and reduction of abscess at patient discharge, the female gender and dependence degree constituted the principal predictors of readmission.

[Intravenous antibiotic treatment in a hospital based home care unit. Predictors of hospital readmission]. / Antibioterapia intravenosa domiciliaria en una unidad de hospitalización a domicilio: factores pronósticos de reingreso hospitalario.

BACKGROUND AND OBJECTIVE: Intravenous antibiotic therapy at home has showed its efficacy as an alternative to hospitalization care in many infectious pathologies. The objectives of this study are: a) to expose our experience, as hospital at home unit (HHU) integrated within a service of internal medicine, in the antibiotic treatment, and b) to define those parameters that can predict hospital readmissions. PATIENTS AND METHOD: This study included all patients with infectious pathology and intravenous antibiotic therapy who were admitted in our HHU from March 2006 to March 2007. RESULTS: 145 patients were included in this study. Successful treatment was observed in 92% of patients. Eleven patients were re-admitted at hospital during the episode by infectious disease, and only 2 of them showed adverse effects to treatment. Twenty-two patients were re-admitted at hospital 3 months after due to chronic pathology. CONCLUSIONS: Intravenous antibiotic therapy at home is a good alternative in many infectious pathologies. Infectious pathology and baseline state can be predictors of hospital readmissions.

Antibioterapia intravenosa domiciliaria en una unidad de hospitalización a domicilio: factores pronósticos de reingreso hospitalario / Intravenous antibiotic treatment in a hospital based home care unit. Predictors of hospital readmission

FUNDAMENTO Y OBJETIVO: La antibioterapia domiciliariaes una modalidad asistencial alternativa a lahospitalización a domicilio que ha demostrado suseguridad en un gran número de enfermedades infecciosas.Los objetivos principales de este artículoson: a) exponer nuestra experiencia, como unidadde hospitalización a domicilio (UHD)integrada dentro del servicio de medicina interna,en el tratamiento antibiótico intravenoso, y b) definirlos parámetros que pueden predecir un reingresohospitalario.PACIENTES Y MÉTODO: Se incluyó en el estudio a todoslos pacientes ingresados en nuestra UHD porenfermedad infecciosa subsidiaria de antibioterapiaintravenosa desde marzo de 2006 hasta marzode 2007.RESULTADOS: Se incluyó en el estudio a 145 pacientes.El 92% de los casos recibió el alta porbuena evolución clínica. Once pacientes ingresaronen el hospital durante el episodio clínico comoconsecuencia de la propia infección, y sólo 2 presentaronalgún tipo de reacción adversa a causadel tratamiento. Veintidós pacientes ingresaron enel hospital 3 meses después del alta de la UHD,fundamentalmente por enfermedad crónica.CONCLUSIONES: La antibioterapia intravenosa domiciliariaes una buena opción asistencial en unagran variedad de enfermedades infecciosas. A pesarde ello, la propia infección y el estado basaldel paciente influyen activamente en la probabilidadde reingresos hospitalarios

BACKGROUND AND OBJECTIVE: Intravenous antibiotictherapy at home has showed its efficacy as an alternativeto hospitalization care in many infectiouspathologies. The objectives of this study are: a) toexpose our experience, as hospital at home unit(HHU) integrated within a service of internal medicine,in the antibiotic treatment, and b) to definethose parameters that can predict hospital readmissions.PATIENTS AND METHOD: This study included all patientswith infectious pathology and intravenousantibiotic therapy who were admitted in our HHUfrom March 2006 to March 2007.RESULTS: 145 patients were included in this study.Successful treatment was observed in 92% of patients.Eleven patients were re-admitted at hospitalduring the episode by infectious disease, andonly 2 of them showed adverse effects to treatment.Twenty-two patients were re-admitted athospital 3 months after due to chronic pathology.CONCLUSIONS: Intravenous antibiotic therapy athome is a good alternative in many infectious pathologies.Infectious pathology and baseline statecan be predictors of hospital readmissions

Factores de riesgo de infección por Clostridium difficile en pacientes ancianos. Estudio de casos y controles / Factors for Clostridium difficile-associated diarrhoea in elderly patients. A case-control study

Fundamento: Estudiar los principales factores de riesgo de infección por Clostridium difficile en una unidad de geriatría. Pacientes y método: Estudio de casos y controles retrospectivo. Resultados: El análisis multivariante confirmó la nutrición enteral por sonda nasogástrica (OR = 6,73; IC del 95 por ciento, 1,01-45,35) y los días de tratamiento antibiótico (OR = 1,15; IC del 95 por ciento, 1,01-1,28) como factores de riesgo independientes para la infección por C. difficile. Conclusiones: El tratamiento antibiótico, el sondaje nasogástrico y las características de fragilidad de este grupo de pacientes se asocian a la infección por C. difficile. (AU)