Oral fosfomycin for treatment of acute bacterial prostatitis caused by multidrug-resistant Enterobacterales.

To assess the feasibility of oral fosfomycin-tromethamine (FT) for the management of acute bacterial prostatitis (ABP) caused by multidrug-resistant (MDR) Enterobacterales. An observational study of adult patients diagnosed with ABP from Vall d'Hebron University Hospital (Barcelona, Spain), treated with oral FT. The primary outcome was clinical cure defined as symptom relief at the control visit, 2-4 weeks post-end of treatment. Secondary outcomes included microbiological cure, relapse, and adverse events related to the treatment. Eighteen patients with ABP caused by Enterobacterales (15 Escherichia coli and three Klebsiella pneumoniae) were included. Microorganisms were MDR bacteria [14 extended-spectrum beta-lactamase (ESBL) producers and two carbapenemase producing K. pneumoniae]. Patients received treatment with FT 3 g/48 hours during a median of 14 days (Q25-Q75, 12-17.75). Fifteen patients received a lead-in phase of intravenous suitable antimicrobial during a median of 7 days (Q25-Q75, 3.75-8). No patient had to stop treatment due to adverse events, and the only side effect reported in two patients was diarrhea. Clinical cure was achieved in all (18/18) patients and microbiological cure in 11/12 patients. After a median of follow-up of 5 months (Q25-Q75, 2-11), 2/18 patients relapsed with an orchitis and a new episode of ABP. FT is an attractive step-down therapy for ABP in patients with resistance or side effects to first-line drugs. The availability of oral treatment could reduce the use of the carbapenems, with a benefit in the quality of life of the patient, health costs, and an ecological impact. IMPORTANCE We present a brief but largest and interesting experience in which we use fosfomycin-tromethamine (FT) for the treatment of acute bacterial prostatitis (ABP) due to multiresistant bacteria. Our study provides new data that help to consider FT as a plausible alternative for treating ABP in patients with resistance or side effects to first-line drugs. The availability of an alternative oral treatment to avoid the use of the carbapenems could have important benefits in terms of quality of life of the patient, health costs, and an ecological impact.

Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19

ABSTRACT Background: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. Objectives: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). Methods: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. Results: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom were discharged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176-3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A total of 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). Conclusion: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.

Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19.

BACKGROUND: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. OBJECTIVES: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). METHODS: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. RESULTS: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom weredischarged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176 3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A totalof 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). CONCLUSION: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.

[Characteristics of acute bacterial prostatitis in elderly patients attended in the Emergency Department]. / Características de la prostatitis aguda en los pacientes ancianos atendidos en el servicio de urgencias.

OBJECTIVE: To compare the characteristics of acute bacterial prostatitis between patients ≥75 years old with those <75 years old attended in the Emergency Department. MATERIAL AND METHODS: A descriptive and observational study was conducted with a prospective follow-up including all consecutive patients with acute bacterial prostatitis that were admitted during one year to the Emergency Department of a tertiary-care hospital. Data were collected for demographic variables, comorbidities, clinical and microbiological findings, treatment, outcome, and re-consultation at 30 days follow-up. Patients were compared depending on age. RESULTS: A total of 241 episodes of acute bacterial prostatitis were included. The mean age was 62.9±16 years, and 64 patients (26.5%) were ≥75 years old. In the microbiology findings, 104 out of 215 (48.4%) of urine cultures and 25 out of 136 (18.4%) blood cultures were positive. Escherichia coli was the most frequent isolation, with resistance rates in elderly patients above 30% for ciprofloxacin, amoxicillin-clavulanic, and cotrimoxazole, and 15.4% of extended spectrum beta-lactamase producing strains. In the univariate analysis, previous manipulation of the urinary tract, history of cancer, previous antibiotic treatment, resistant E. coli strains, renal impairment, and admission to the hospital were more frequent among patients ≥75 years. Nonetheless, in the multivariate analysis only inadequate empirical antibiotic treatment was found to be significantly more frequent in elderly patients (P=.004). CONCLUSIONS: Drug-resistance patterns to commonly used antibiotics should be considered when choosing empirical treatment for acute bacterial prostatitis in the Emergency Department setting, especially for patients ≥75 years.

180-day risk of mortality in older patients admitted to short-stay units: the 6-Month Short-Stay Unit (6M UCE) Score. / Modelo de riesgo de mortalidad a 180 días en los pacientes ancianos ingresados en unidades de corta estancia: 6M UCE-SCORE.

OBJECTIVES: To develop a multidimensional score to assess risk of death for patients of advanced age 180 days after their admission to short-stay units (SSUs). MATERIAL AND METHODS: Prospective, multicenter, observational and analytical study of a cohort of patients aged 75 years or older who were admitted to 5 Spanish SSUs between February 1 and April 30, 2014. We recorded demographic and clinical data as well as geriatric assessment scores. A multilevel logistic regression model was developed to identify independent factors associated with 180-day mortality. The model was used to construct a scale for scoring risk. RESULTS: Data for 593 patients with a mean (SD) age of 83.4 (5.9) years entered the model; 359 (60.7%) were women. Ninety-two patients (15.5%) died within 180 days of SSU admission. Factors included in the final risk score were age over 85 years (1 point), male sex (1), loss of appetite or weight loss in the 3 months before admission (1), acute confusional state (2), functional dependence for basic activities of daily living at admission (2), and pressure ulcers (2). Low risk was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 9 points. Mortality rates at 180 days in these 3 risk groups were 5%, 18%, and 54%, respectively. The area under the receiver operating characteristic curve for the model after boots trapping was 0.72 (95% CI, 0.65-0.78). CONCLUSION: The SSU score could be useful for stratifying risk of death within 6 months of SSU admission of older patients, so that type of care can be tailored to risk.

OBJETIVO: Diseñar una escala de puntuación multidimensional con el fin de estratificar el riesgo de mortalidad a 180 días entre los ancianos ingresados en las unidades de corta estancia (UCE). METODO: Estudio analítico observacional de cohortes prospectivo multicéntrico que seleccionó todos los pacientes 75 años ingresados en 5 UCE españolas del 1 de febrero al 30 de abril de 2014. Se recogieron variables demográficas, clínicas y de la valoración geriátrica. Se derivó un modelo de regresión logística multinivel para identificar los factores independientemente asociados con la mortalidad a 180 días y después se construyó una escala de puntuación. RESULTADOS: Se incluyeron 593 pacientes (edad media 83,4 años, DE: 5,9; 359 mujeres, 60,7%), y 92 (15,5%) fallecieron a los 180 días. La escala de puntuación 6M UCE-SCORE incluyó la edad 85 años (1 punto), sexo varón (1 punto), presencia de pérdida de apetito o peso involuntaria en los últimos 3 meses (1 punto), síndrome confusional agudo (2 puntos), dependencia en las actividades básicas de la vida diaria al ingreso (2 puntos) y úlceras por presión (2 puntos). Se categorizó a los pacientes en bajo (0-2 puntos), intermedio (3-5 puntos) y alto (6-9 puntos) riesgo, con una mortalidad a 180 días de 5%, 18% y 54%, respectivamente. El ABC COR del modelo tras remuestreo fue de 0,72 (IC95%: 0,65-0,78). CONCLUSIONES: La escala de puntuación 6M UCE-SCORE podría ser de utilidad a la hora de estratificar el riesgo a 6 meses entre los ancianos ingresados en las UCE con el fin de diseñar un plan individualizado de cuidados.

[Factors associated with emergency department revisits for acute bacterial prostatitis]. / Factores asociados a la reconsulta en urgencias en la prostatitis aguda bacteriana.

OBJECTIVES: To analyze factors associated with revisits by patients with acute bacterial prostatitis treated in a hospital emergency department. MATERIAL AND METHODS: Descriptive analysis and prospective follow-up of a cohort of patients with acute bacterial prostatitis treated in an emergency department. RESULTS: We included 241 episodes of acute bacterial prostatitis. The mean (SD) age was 63 (16) years. Seventy-three percent reported dysuria, 64% had fever, and between 15.4% and 22.4% had medical histories of cancer, urethral/bladder catheterization, or prostate adenoma. Positive urine cultures were obtained for 48.1% and positive blood cultures for 17.6%. Escherichia coli was the bacterium isolated most often, and 27.7% of the cultures showed resistance to ciprofloxacin and amoxicillin-clavulanic acid. Twenty-nine patients (12%) revisited within 30 days. The only factors associated with revisiting were performance of a rectal examination (odds ratio [OR], 9.23; 95% CI, 1.12-75.82) and bacteremia (OR, 3.81; 95% CI, 1.31-11.04) (P<.05). CONCLUSION: Factors associated with revisiting for acute bacterial prostatitis were bacteremia and performance of a rectal examination.

OBJETIVO: Analizar los factores asociados a la reconsulta del paciente con prostatitis aguda bacteriana (PAB) atendido en el servicio de urgencias hospitalario (SUH). METODO: Estudio analítico de cohorte observacional con seguimiento prospectivo de las PAB atendidas en el SUH durante un año. RESULTADOS: Se registraron 241 episodios de PAB. La edad media fue de 63 (DE: 16) años. Presentaron disuria el 73%, fiebre el 64% y antecedentes de cáncer, manipulación previa de la vía urinaria o adenoma prostático entre el 15,4- 22,4%. El 48,1% de los urocultivos y el 17,6% de los hemocultivos resultaron positivos. Escherichia coli fue el aislamiento mayoritario, presentando con resistencias en el 27,7% a ciprofloxacino y amoxicilina/clavulánico. A los 30 días reconsultaron 29 pacientes (12%). El tacto rectal, con odss ratio (OR) 9,23 (IC 95%: 1,12-75,82), y la bacteriemia, con OR de 3,81 (IC 95%: 1,31-11,04), fueron las únicas variables asociadas a la reconsulta (p <0,05). CONCLUSIONES: Los factores relacionados con la reconsulta del enfermo con PBA fueron la presencia de bacteriemia y el tacto rectal.

[Spanish short-stay-units: results according to department designated to manage the unit]. / Análisis de los resultados de gestión de las unidades de corta estancia españolas según su dependencia funcional.

OBJECTIVES: To compare the efficiency of short-stay units (SSUs) managed by different departments within hospitals. MATERIAL AND METHODS: Cross-sectional study in 40 hospitals with SSUs. From June 1 to December 31, 2012,we gathered data on clinical caseloads and management. Variables directly related to efficiency were mean length of stay, bed rotation index, and weekend discharge rate. RESULTS: Forty SSUs were studied; 25 (62.5%) were managed by the hospital's emergency department (ED), 9 (22.5%) were managed by the internal medicine department (IMD), 5 (12.5%) were independent, and 1 was jointly managed by the hospital's ED and the IMD. A total of 45 140 patients were discharged from the SSUs. The most common diagnoses were exacerbation of chronic heart or respiratory disease, urinary tract infection, and respiratory infection. Age was the only variable that was related to the hospital department designated to manage these SSUs. The mean ages by management type were as follows: independent SSUs (75.6 years) vs ED-managed SSUs (67.2 years) vs IMD-managed SSUs (57.8 years) (P=.02). Group-by-group comparisons showed that the mean length of stay was shorter in ED-managed SSUs than in IMD-managed units (2.65 vs 3.73 respectively; P=.047), and overall mortality was lower in IMD-managed SSUs than in ED-managed SSUs (0.64% vs 3%; P=.033). However, unforeseen mortality (after excluding patients under palliative care or judged to be in the final hours of life) did not differ significantly between groups. CONCLUSION: We did not detect important differences between SSUs managed by different departments in the hospitals in this series. However, mean length of stay was found to be shorter in ED-managed SSUs than in IMD-managed units.

OBJETIVO: Comparar los resultados de gestión clínica de las unidades de corta estancia (UCE) según su dependencia funcional. METODO: Estudio de análisis transversal realizado en 40 hospitales con UCE (1 junio-31 diciembre 2012). Se recogieron datos de actividad y gestión clínica, considerando como variables directamente relacionadas con la eficiencia la estancia media, el índice de rotación por cama y el porcentaje de altas en fin de semana. RESULTADOS: Se analizaron 40 UCE, 25 (62,5%) dependientes del servicio de urgencias (UCEU), 9 (22,5%) de medicina interna (UCEMI), 5 (12,5%) independientes (UCEI) y 1 con dependencia mixta (UCEU + UCEMI). El número total de altas fue de 45.140. Los diagnósticos más frecuentes fueron la exacerbación de la patología crónica cardiaca y respiratoria, la infección urinaria y la respiratoria. En relación a su dependencia funcional no se observaron diferencias en los parámetros analizados intergrupos salvo en la edad media (UCEI 75,6 años vs UCEU 67,2 vs UCEMI 57,8; p = 0,02). Al realizar la comparación intragrupos, la estancia media fue menor en las UCEU que las UCEMI (2,65 días vs 3,73; p = 0,047) y la mortalidad global menor en las UCEMI que las UCEU (0,64% vs 3%; p = 0,033), pero sin diferencias al comparar la mortalidad no esperada una vez excluidos los pacientes paliativos y/o en situación de últimas horas. CONCLUSIONES: En la serie analizada no se observan diferencias destacables al comparar las UCE en conjunto según dependencia funcional. Sin embargo, en el análisis intragrupos las UCEU lograron menor estancia media que las UCEMI.

[The short stay unit as an alternative to conventional hospitalisation in the treatment of community acquired pneumonia in the over 75 year-old population]. / La unidad de corta estancia como alternativa a la hospitalización convencional en el tratamiento de la neumonía adquirida en la comunidad en la población mayor de 75 años.

INTRODUCTION: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients. The short stay units can be an alternative for patients who need admission with acute illness. MATERIAL AND METHODS: Descriptive and retrospective study in an Short-Stay Unit (SSU) of a 900-bed tertiary-care teaching hospital in the metropolitan area of Barcelona, Spain. PERIOD: a total of 22 months from January 2004 to December 2006. PATIENTS: all patients ≥ 75 years admitted to EDSSU with a diagnosis of CAP. Data were collected for demographic variables, Pneumonia Severity Index score (PSI), microbiological findings, antibiotic treatment, length of stay, mortality rates and new admissions during the 30 days following discharge. RESULTS: 175 consecutive patients ≥ 75 years with pneumonia were admitted to the EDSSU. Mean age was 84.31 years (range 75-100, SD ± 5.76), 92 (52,5%) were men, with 24 being nursing home residents. According to the PSI, 64 cases (36.6%) were scored as III, 97 (55.4%) as IV and 14 (8%) as V. A positive microbiological result was obtained in 46 cases (26.2%). Length of stay on average was 3.29 days (range 1-10, SD ± 1.56) and 19 patients died (10.8%). Six (3.8%) attended the ED in the 30 days following discharge. CONCLUSIONS: In view of our experience, the EDSSU can be an alternative to standard inpatient for elderly patients with pneumonia in PSI risk class III and IV.