Clinical Features and Risk Factors for Mortality Among Long-term Care Facility Residents Hospitalized Due to COVID-19 in Spain.

BACKGROUND: COVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents. METHODS: This is a cross-sectional analysis within a retrospective cohort of hospitalized patients ≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis. RESULTS: Of 6 189 patients ≥75 years, 1 185 (19.1%) were LTCF residents and 4 548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs 82.1 years), mostly female (61.6% vs 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p < .001). Mortality risk factors in LTCF residents were severe functional dependence (adjusted odds ratios [aOR]: 1.79; 95% confidence interval [CI]: 1.13-2.83; p = .012), dyspnea (1.66; 1.16-2.39; p = .004), SatO2 < 94% (1.73; 1.27-2.37; p = .001), temperature ≥ 37.8°C (1.62; 1.11-2.38; p = .013); qSOFA index ≥ 2 (1.62; 1.11-2.38; p = .013), bilateral infiltrates (1.98; 1.24-2.98; p < .001), and high C-reactive protein (1.005; 1.003-1.007; p < .001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR: 0.74, 95%CI: 0.62-0.87; p < .001). CONCLUSION: Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.

Antimicrobial management in community acquired pneumonia in hospital at home: Is there room for improvement?

INTRODUCTION: Community Acquired Pneumonia (CAP) is common disease that can be treated in Hospital At Home (HAH). In this paper we evaluate the room of improvement in the use of antibiotics in CAP in HH. METHODS: Patients with CAP were retrospectively recruited in two Spanish hospitals from 1/1/18 to 10/30/19. Demographic, clinical and quality of antibiotic prescription variables were recorded. Subsequently, we created a new variable that collected six quality of care indicator, categorizing and comparing patients into two groups: good quality of care (4 or more indicators performed) or poor quality of care (3 or less indicators performed). RESULTS: We recruited 260 patients. The request for diagnostic tests and the adequacy to Clinical Practice Guidelines were 85.4% and 85.8% respectively. Percentages of de-escalation (53.7%) and sequential therapy (57.7%) when indicated were low. The average length of treatment was 7.3 days for intravenous and 9.5 days for total. Quality of prescription was good in 134 (63.2%) patients, being more frequent in those who were admitted directly to HAD from the emergency room. It was also associated with less readmission at 30 days. CONCLUSION: There is a wide room for improvement in some fields of antimicrobials use in HAH that could stimulate the implementation of Antimicrobial Stewardship Programs.

Manejo antibiótico en neumonía adquirida en la comunidad en la hospitalización a domicilio: ¿Hay margen de mejora? / Antimicrobial management in community acquired pneumonia in hospital at home: Is there room for improvement?

Introducción: La neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente que puede ser abordada en hospitalización a domicilio (HAD). En el presente trabajo evaluamos el margen de mejora con el uso de antibióticos en la NAC en HAD. Métodos: Se reclutaron retrospectivamente todos los pacientes con NAC en dos hospitales españoles desde el 01 de enero de 2018 al 30 de octubre de 2019. Se registraron variables demográficas, clínicas y sobre calidad de prescripción antibiótica. Posteriormente se construyó una variable que recogía seis indicadores de calidad asistencial, categorizando y comparando a los pacientes en dos grupos: buena calidad asistencial (cuatro o más indicadores realizados) o mala calidad asistencial (tres o menos indicadores realizados). Resultados: Obtuvimos una muestra de 260 pacientes. La solicitud de pruebas diagnósticas y la adecuación a las guías de práctica clínica fue del 85,4 y 85,8%, respectivamente. Los porcentajes de realización de desescalada (53,7%) y terapia secuencial (57,7%) cuando estaban indicadas fueron bajos. La duración media del tratamiento fue de 7,3 días para el intravenoso y 9,5 días para el total. La calidad de prescripción fue buena en 134 (63,2%) pacientes, siendo más frecuente en aquellos que ingresaron directamente en HAD desde urgencias. También se asoció a menor reingreso a 30 días. Conclusión: Existe un amplio margen de mejora en algunos aspectos con el uso de antimicrobianos en HAD, que podría motivar la implementación de programas de optimización del uso de antibióticos.(AU)

Introduction: Community Acquired Pneumonia (CAP) is common disease that can be treated in Hospital At Home (HAH). In this paper we evaluate the room of improvement in the use of antibiotics in CAP in HH. Methods: Patients with CAP were retrospectively recruited in two Spanish hospitals from 1/1/18 to 10/30/19. Demographic, clinical and quality of antibiotic prescription variables were recorded. Subsequently, we created a new variable that collected six quality of care indicator, categorizing and comparing patients into two groups: good quality of care (4 or more indicators performed) or poor quality of care (3 or less indicators performed). Results: We recruited 260 patients. The request for diagnostic tests and the adequacy to Clinical Practice Guidelines were 85.4% and 85.8% respectively. Percentages of de-escalation (53.7%) and sequential therapy (57.7%) when indicated were low. The average length of treatment was 7.3 days for intravenous and 9.5 days for total. Quality of prescription was good in 134 (63.2%) patients, being more frequent in those who were admitted directly to HAD from the emergency room. It was also associated with less readmission at 30 days. Conclusion: There is a wide room for improvement in some fields of antimicrobials use in HAH that could stimulate the implementation of Antimicrobial Stewardship Programs. (AU)

[Atypical presentation of microscopic polyangiitis]. / Presentación atípica de poliangeítis microscópica.

Microscopic polyangiitis is a systemic vasculitis that affects small caliber vessels, with renal and lung compromise. We present the case of a patient with an atypical presentation of this disease and an onset characterized by central nervous system affection in the form of a motor deficit.

Presentación atípica de poliangeítis microscópica / Atypical presentation of microscopic polyangiitis

La poliangeítis microscópica es una vasculitis sistémica que afecta a pequeños vasos, con afectación renal y pulmonar. A continuación se presenta el caso clínico de un paciente con manifestación atípica de esta enfermedad, que debutó con afectación del sistema nervioso central, en forma de déficit motor (AU)

Microscopic polyangiitis is a systemic vasculitis that affects small caliber vessels, with renal and lung compromise. We present the case of a patient with an atypical presentation of this disease and an onset characterized by central nervous system affection in the form of a motor deficit (AU)