Moving beyond unsolicited consultation: additional impact of a structured intervention on mortality in Staphylococcus aureus bacteraemia.

BACKGROUND: Some evidence-based bundles have tried to standardize the management of Staphylococcus aureus bacteraemia (SAB) to improve the outcome. The aim of our study was to analyse the additional impact on mortality of a structured intervention in patients with SAB. METHODS: Compliance with the bundle was evaluated in an ambispective cohort of patients with SAB, which included a retrospective cohort [including patients treated before and after the implementation of a bacteraemia programme (no-BP and BP, respectively)] and a prospective cohort (i-BP), in which an additional specific intervention for bundle application was implemented. Multivariate logistic regression was used to measure the influence of the independent variables including compliance with the bundle on 14 and 30 day crude mortality. RESULTS: A total of 271 adult patients with SAB were included. Mortality was significantly different among the three groups (no-BP, BP and i-BP): mortality at 14 days was 18% versus 7% versus 2%, respectively, P = 0.002; and mortality at 30 days was 20% versus 12% versus 5%, respectively, P = 0.011. The factors associated with 14 and 30 day mortality in multivariable analysis were heart failure (OR = 7.63 and OR = 2.27, respectively), MRSA infection (OR = 4.02 and OR = 4.37, respectively) and persistent bacteraemia (OR = 11.01 and OR = 7.83, respectively); protective factors were catheter-related bacteraemia (OR = 0.16 and OR = 0.19, respectively) and >75% bundle compliance (OR = 0.15 and OR = 0.199, respectively). Time required to perform the intervention and the follow-up was 50 min (IQR 40-55 min) per patient. CONCLUSIONS: High-level compliance with a standardized bundle of intervention for management of SAB that requires little time was associated with lower mortality at 14 and 30 days.

Clinical Characteristics and Outcome of Lung Transplant Recipients with Respiratory Isolation of Corynebacterium spp.

Although chronic respiratory disease and immunosuppression are risk factors for Corynebacterium species respiratory infection, data are scarce regarding this disease in lung transplantation. Our aim was to describe the clinical characteristics and outcomes of lung transplant recipients (LTR) with respiratory isolation of Corynebacterium spp. This was a retrospective observational study performed at a referral center in Barcelona, Spain (2014 to 2016). We included all LTR in whom Corynebacterium spp. were isolated in at least one good-quality lower respiratory tract specimen. Overall, 24 of 527 (4.6%) LTR at risk during the study period were included. The main epidemiological, clinical, and microbiological data were analyzed. The most frequently isolated species were C. striatum (11/24), C. pseudodiphtheriticum (3/24), and C. amycolatum (3/24). All 19 (76%) patients who underwent bronchoscopy showed abnormalities, mainly mucosal plaques at the bronchial suture and purulent secretions. Clinical cure was achieved in 8/12 (67%) patients who fulfilled the CDC definition of lower respiratory tract infection (LRTI). To assess the clinical relevance of Corynebacterium spp., only patients with monomicrobial isolation (n = 18) were evaluated. LRTI was diagnosed in 9, and a nonsignificant association was found with a significant number of Corynebacterium sp. CFU/ml (7/9 LRTI versus 2/9 non-LRTI, P = 0.057). Persistent infection was associated with metallic bronchial stent implantation (4/4 versus 2/14, P = 0.005). The isolation of Corynebacterium spp. in respiratory specimens of lung transplant recipients may herald a respiratory tract infection or bronchial suture damage. Bronchial stent implantation is a risk factor for the persistence of Corynebacterium species infection.

Clinical peculiarities of patients with scleroderma exposed to silica: A systematic review of the literature.

OBJECTIVE: There are few data regarding the existence of clinical differences between patients with systemic sclerosis (scleroderma) exposed to silica (SSc-si) and "idiopathic" cases (SSc-id). Our goal is to describe the clinical characteristics of patients with SSc-si and see if they differ from the SSc-id cases. METHODS: We performed a systematic review of the literature by searching the MEDLINE, EMBASE and Web of Science databases. We also included our own series of patients diagnosed with SSc-si and SSc-id controls at the "Complejo Hospitalario Universitario de Vigo (CHUVI)" from 1985 to January 2013. RESULTS: The review of the literature disclosed 32 published series, with clinical data of 254 SSc-si patients (96% males). SSc-si represented 37.5-86% of the scleroderma males and 0-2.7% of the scleroderma females. Globally, more than expected proportion of diffuse forms (61%) and interstitial lung disease (81%) were observed in exposed patients. In the present series, the diagnosis of SSc exposure to silica was recorded in nine patients (9.5%), showing predominance of the diffuse form (77%, p = 0.001), positivity for anti-Scl70 (55%, p = 0.001), presence of ILD (78%, p = 0.048) and lower survival (9.2 versus 15.1, p = 0.023). Diffuse variant remained more prevalent analysing exposed versus non-exposed women (50% versus 8%, p = 0,000) and exposed versus non-exposed men (85.8% versus 50%, p = 0,000). CONCLUSION: Silica exposure is a predominant risk factor in male SSc populations. The review of the literature is consistent with an association of SSc-si and diffuse scleroderma. A trend toward lower survival was observed in our series in SSc-si group.