[Bacteraemia in adult patients discharged from Emergency department]. / Bacteriemia en pacientes adultos dados de alta en el servicio de urgencias.

INTRODUCTION: Bacteraemia is a marker of severity of infectious processes. However, sometimes in Emergency Department blood cultures are drawn from patients who are discharged without results being available. MATERIAL AND METHODS: Prospective study of bacteraemia was conducted on adult patients from Emergency Department of tertiary university hospital from March 2014 to February 2015. Epidemiological, clinical and microbiological data were collected from patients admitted and discharged. After the detection of bacteraemia, the microbiology department telephoned the physician responsible (patients admitted) or Primary Care physician (patients discharged). RESULTS: A total of 429 episodes of bacteraemia were included, of which 13.52% were discharged. These patients were younger (68.5 vs 73.59 years, P=.0001), had a lower Charlson index (1.603 vs 2.309, P=.0013) and lower severity (septic shock 0 vs 34; P<.0001) than admitted patients. After the call to Primary Care, oral antibiotics were started in 10.3%, a change in oral antibiotic in 6.9%, 12% were admitted to hospital, and the rest of them continued same treatment. The 30-day mortality rate was 0%. CONCLUSIONS: There was a significant number of patients with bacteraemia were discharged from Emergency Department. To discharge a clinically stable patient with blood cultures taken in Emergency Department is safe, if there is a re-assessment of the patient if these cultures are positive.

Antimicrobial activity of ceftolozane-tazobactam against multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa clinical isolates from a Spanish hospital.

OBJECTIVE: Our objective was to evaluate the in vitro activity of ceftolozane-tazobactam against multidrug resistant (MDR) and extensively drug-resistant (XDR) non metallo-ß-lactamase producing Pseudomonas aeruginosa clinical isolates at Hospital Universitario Miguel Servet (Zaragoza, Spain) from February 2016 to October 2017. METHODS: We evaluated the in vitro activity of ceftolozane-tazobactam and other antipseudomonal antibiotics against 12 MDR and 117 XDR non metallo-ß-lactamase producing P. aeruginosa isolates. Ceftolozane-tazobactam minimal inhibitory concentrations (MICs) were determined by MIC gradient diffusion test strip. RESULTS: Among the 129 MDR/XDR isolates included, 119 (92.2%) were susceptible to ceftolozane-tazobactam, and ten (7.8%) were resistant. MIC50 was 2 mg/L, and MIC90 4 mg/L. Ceftolozane-tazobactam was the second most active antibiotic after colistin, overtaking amikacin. CONCLUSIONS: Ceftolozane-tazobactam is a valuable treatment option for MDR and XDR P. aeruginosa infections in our setting.

The aetiological agents of tinea capitis in Zaragoza (Spain).

Between 1977 and 1997, 190 cases of tinea capitis were observed. The age groups most commonly infected were 1-10 years old. The following dermatophytes were isolated: Microsporum canis (119), Trichophyton mentagrophytes (57), Trichophyton tonsurans (seven), Trichophyton verrucosum (three), Trichophyton violaceum (one), Trichophyton schoenleinii (one), Trichophyton soudanense (one) and Microsporum audouinii (one).

[Bacteremia in the elderly: associated and prognostic factors]. / Bacteriemia en el anciano: factores asociados y pronósticos.

BACKGROUND: Bacteremia is associated with high morbidity and mortality rates and its prevalence increases with age. The objective of the present investigation was to know the epidemiology, associated factors and prognosis in patients with bacteremia in our environment and in relation with age. METHODS: Two hundred and twenty-nine episodes of bacteremia were prospectively studied; 97 (42%) cases corresponded to patients aged > 70 years. The prognostic factors were evaluated by the univariate and multivariate analysis in the whole cohort and univariate study of associated factors for an age > 70 years. RESULTS: The etiology, infectious sources, nosocomial acquisition, and complications apart from shock (p = 0.02) were similar in the elderly patients. The associations of diabetes (p = 0.05), COPD and/or heart disease (p = 0.01), and exitus were higher for patients > 70 years. The main independent prognostic factor in the series was disseminated intravascular coagulation (p < 0.001, multivariate OR 14.2). CONCLUSIONS: Patients older than 70 years have a higher incidence of shock and mortality associated with infection. The higher overall mortality rate in the series was associated with disseminated intravascular coagulation and multisystemic failure irrespective of age.