[Use and abuse of intravenous catheters in conventional hospital wards]. / Uso y abuso de los catéteres intravenosos en las plantas de hospitalizacion convencional.

BACKGROUND: Information regarding the use intravenous catheters (IVC) in conventional hospital units and its consequence in terms of intravenous catéter-related bacteremia (ICRB) is scarce. OBJECTIVES: To evaluate the use of IVC in patients admitted in conventional wards of a general hospital and to measure IVCRB incidence in such patients. METHODS: We evaluated during one week IVC use in adult patients admitted in 12 de Octubre Hospital and we calculated la incidence density of ICRB. RESULTS: We evaluated the clinical charts of 731 patients (284 from medical wards and 447 from surgical wards), of which 338 (46.2%) had a peripheral VC inserted and 63 (8.6%) a central IVC. Central IVC had been inserted for a mean time 11.5 days globally (CI 95% 5.57-17.42), being 28.3 in medical wards and 8.32 days in surgical wards (p = 0.2). In 27.7 % of the patients with IVC intravenous antimicrobials was the only reason for the use of such catheters in spite of adequate oral tolerance in 30 % of the patients with central IVC an specific note explaining the reason for implanting such catheter was lacking in the clinical chart. IVCRB was detected in 12/401 patients (3%). The incidence density of IVCRB in central IVC was 8.28 per 1000 catheter-days. CONCLUSIONS: There are some aspects that could be clearly improved regarding the prevention of IVCRB, mostly in the indications, the excess of time those catheters are kept implanted and in the lost chances for catheter withdrawal when switch-therapy could be performed.

[Mitro-aortic endocarditis caused by Listeria monocytogenes]. / Endocarditis mitroaórtica por Listeria monocytogenes.

A case of Listeria monocytogenes valvular endocarditis is reported. This patient required mitral and aortic valve replacement by Björk-Shiley mechanical prostheses. Patient clinical condition was progressively deteriorated, affecting the left ventricular function, increasing the size of vegetations and the presence of aortic annular abscess. This case represents the 48th reported in the literature and the third in our country. We here comment about the clinical aspects and the treatment of this infrequent entity.

[Endocarditis of a natural valve caused by coagulase-negative staphylococci]. / Endocarditis sobre válvula nativa por estafilococo coagulasa negativo.

Eleven patients with endocarditis of a natural valve due to coagulase-negative staphylococci are reported. Nine had some underlying heart disease. The course was subacute in seven and acute (two weeks or less) in the remaining four. All patients developed complications: heart failure in nine, arterial emboli in eight, atrioventricular conduction disorders in four, development of paravalvular and/or myocardial abscesses in four, and perforation or rupture of valve leaflets in four. Eight patients were cured, seven of them requiring surgical treatment. Three of the isolated coagulase-negative staphylococci strains were methicillin-resistant; two of them caused community-acquired endocarditis. Natural valve endocarditis due to coagulase-negative staphylococci usually has a subacute course with a tendency to develop severe complications. This makes surgical therapy necessary in a sizeable number of patients.

[Current treatment of candidemia in non-neutropenic patients. Amphotericin B or fluconazole? A retrospective study of 62 consecutive patients]. / Tratamiento actual de la candidemia en pacientes no neutropénicos. Anfotericina B o fluconazol? Estudio retrospectivo de 62 casos consecutivos.

BACKGROUND: To analyze the epidemiologic characteristics of non-neutropenic patients with candidemia in a general hospital and the advantages and disadvantages of treatment with amphotericin B or fluconazole. PATIENTS AND METHODS: A total of 62 adult non-neutropenic patients with candidemia and treated with amphotericin B (n = 35) or fluconazole (n = 27) were studied. All episodes were considered to be associated with infection in a vein catheter. The demographic characteristics, risk factors for the development of candidemia, Candida species recovered from blood culture, underlying diseases, and clinical manifestations in both groups were compared. The evolution regarding secondary effects developed with both drugs, therapy failures, long term complications, and overall mortality rate associated with candidemia were analyzed. RESULTS: Both groups were comparable with the exception of the percentage of patients infected with species different from Candida albicans, which was higher in the group of patients who received amphotericin B (57%) than in the fluconazole group (26%) (p = 0.02), and in that patients with severe renal failure or AIDS had received preferentially fluconazole. There were no statistically significant differences regarding the evolution of patients treated with amphotericin B or fluconazole with the following factors: therapy failure (27% versus 19%; p = 0.7), overall mortality rate (40% versus 44%; p = 0.6), and mortality directly related to candidemia (33% versus 30%). Mortality was significantly higher among patients who had not their vein catheters removed early (78%) compared with those who had their vein catheters removed early (34%) (p = 0.01). Sixty-six percent of patients treated with amphotericin developed some severe secondary effect, whereas no patient in the fluconazole group developed such effects. CONCLUSIONS: Both amphotericin B and fluconazole seem to be effective drugs for the treatment of vein catheter related candidemia in the non-neutropenic patient, although fluconazole is far less toxic. The early removal of the vein catheter plays a prognostic role with at least the same relevance than the type of antifungal therapy chosen.

[Brucella hepatic abscess. Report of a case and review of the literature]. / Absceso hepático por Brucella. Descripción de un caso y revision de la literatura.

Hepatic involvement in infections caused by Brucella organisms is common but the production of liver abscess is exceptional. Therefore, the most appropriate therapeutic approach is unclear. The use of antibiotics can be effective but in some cases abscess drainage is required. We report here a case of brucellar hepatic abscess and a review of fourteen cases reported in the literature. An emphasis is laid on the clinical, laboratory and radiological findings, treatment, and patient evolution. On the basis of the reported cases a therapeutic approach is proposed.

Uso y abuso de los catéteres intravenosos en las plantas de hospitalizacion convencional / Use and abuse of intravenous catheters in convetntional hospitals wards

Antecedentes: Existe escasa información acerca del uso de catéteres venosos (CVs) en unidades de hospitalización convencionales y la incidencia bacteriemia relacionada con catéteres venosos (BRCV) en dichas unidades. Objetivos: Evaluar el uso de catéteres venosos (CVs) en pacientes ingresados en plantas convencionales de un hospital general y las consecuencias en términos de BRCV. Métodos: Se evaluó durante una semana el uso de catéteres venosos y la densidad de incidencia de BRCV en pacientes adultos ingresados en los servicios de hospitalización del hospital 12 de Octubre de Madrid. Resultados: Se analizaron las historias clínicas de 731 pacientes (284 en servicios médicos y 447 en servicios quirúrgicos), de los cuales 338 (46,2%) eran portadores en ese momento de un CV periférico y 63 (8,6%) de un CV central. La media de días de colocación de un CV central fue globalmente de 11,5 (IC 95% 5,57-17,42), 28,3 en los servicios médicos días y 8,32 en los servicios quirúrgicos (p = 0,2). En el 27,7% de los pacientes con CVs la única indicación para el uso de un CV fue la administración intravenosa de antibióticos a pesar de que el paciente toleraba por vía oral y en un 30% de las ocasiones no había ninguna especificación en la historia que permitiera aclarar cuál era la indicación para la colocación del CV. Se detectó BRCV en 12/401 pacientes (3%). La densidad de incidencia de BRC en CV centrales fue de 8,28 por cada 1.000 días de catéter. Conclusiones: Existen claros aspectos que deben mejorarse en cuanto a la prevención de la BRC, fundamentalmente respecto al ajuste de las indicaciones, el tiempo que permanecen los catéteres centrales implantados y, sobre todo, en cuanto a las oportunidades perdidas de retirar el catéter secuenciando la medicación a vía oral

Background: Information regarding the use intravenous catheters (IVC) in conventional hospital units and its consequence in terms of intravenous catéter-related bacteremia (ICRB) is scarce. Objectives: To evaluate the use of IVC in patients admitted in conventional wards of a general hospital and to measure IVCRB incidence in such patients. Methods: We evaluated during one week IVC use in adult patients admitted in 12 de Octubre Hospital and we calculated la incidence densitity of ICRB. Results: We evaluated the clinical charts of 731 patients (284 from medical wards and 447 from surgical wards), of which 338 (46.2%) had a peripheral VC inserted and 63 (8.6%) a central IVC. Central IVC had been inserted for a mean time 11.5 days globally (CI 95% 5.57-17.42), being 28.3 in medical wards and 8.32 days in surgical wards (p=0.2). In 27.7 % of the patients with IVC intravenous antimicrobials was the only reason for the use of such catheters in spite of adequate oral tolerance in 30 % of the patients with central IVC an specific note explaining the reason for implanting such catheter was lacking in the clinical chart. IVCRB was detected in 12/401 patients (3%). The incidence density of IVCRB in central IVC was 8.28 per 1000 catheter-days. Conclusions: There are some aspects that could be clearly improved regarding the prevention of IVCRB, mostly in the indications, the excess of time those catheters are kept implanted and in the lost chances for catheter withdrawal when switch-therapy could be performed