Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with urinary tract infections in the emergency department.

OBJECTIVE: To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED). METHODS: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of ≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value. CONCLUSION: The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED.

[Recommendations for the care of patients with community-acquired pneumonia in the Emergency Department]. / Recomendaciones para la atención del paciente con neumonía adquirida en la comunidad en los Servicios de Urgencias.

The incidence of community-acquired pneumonia (CAP) ranges from 2-15 cases / 1,000 inhabitants / year, being higher in those older than 65 years and in patients with high co-morbidity. Around 75% of all CAP diagnosed are treated in the Emergency Department (ED). The CAP represents the main cause for sepsis and septic shock in ED, and the most frequent cause of death and admission to the Intensive Care Unit (ICU) due to infectious disease. Overall mortality is 10-14% according to age and associated risk factors. Forty to 60% of CAP will require hospital admission, including observation units (with very variable ranges from 22-65% according to centers, seasonal of the year and patients´ characteristics). Between the admissions, 2-10% will be in the ICU. All of previously mentioned reflects the importance of the CAP in the ED, as well as the "impact of the emergency care on the patient with CAP", as it is the establishment where the initial, but key decisions, are made and could condition the outcome of the illness. It is known the great variability among physicians in the diagnostic and therapeutic management of CAP, which is one of the reasons that explains the great differences in the admission rates, achievement of the microbiological diagnosis, request for complementary studies, the choice of antimicrobial treatment, or the diversity of applied care. In this sense, the implementation of clinical practice guidelines with the use of the severity scores and the new tools available, such as biomarkers, can improve patient care with CAP in ED. Therefore, a multidisciplinary group of emergency professionals and specialists involved in the care process of CAP has designed a guideline with several recommendations for decisions-making during the key moments in patients with CAP attended in the ED.

When, where and how should a patient with community acquired pneumonia be admitted?

Community-acquired pneumonia is the leading cause of death (10-14%) from infectious disease and the source of many sepsis and septic shock cases attended in the emergency departments. There is great variability in the admission rates (22-61%), and 10-20% of such admissions have to be done in the intensive care unit. The correct determination of need for admission (when), admission site (where) and burden of delivered care (how) will determine the patient's prognosis, request for basic and microbiological studies, antibiotic regimen (via and duration), clinical follow-up intensity and, consequently, the use of socio-health resources (costs). This article aims to orient decision-making, taking into account the new trends in prognostic evaluation tendencies and the current alternatives to the classic hospital admission.

[Characteristics and epidemiological changes for patients with community-acquired pneumonia in hospital emergency departments]. / Características y cambios epidemiológicos de los pacientes con neumonía adquirida en la comunidad en los servicios de urgencias hospitalarios.

BACKGROUND: The aim of this paper is to determine both the prevalence of community-acquired pneumonia (CAP) in the A & E Department and the most relevant epidemiological changes in the last decade, as well as the profile and management of these patients. METHODS: Descriptive cross-sectional analysis at 49 Spanish A & E Departments during 12 months. All patients with infections, respiratory infection or CAP diagnosis were included. All patients attended to in A & E during the study were recorded as well. RESULTS: CAP has increased its prevalence among patients in the A & E Departments in the past decade (0.85% to 1.35%, p <0.001). Fifty-one per cent were over 70 years old. Sixty-nine point eight per cent had some underlying disease and 17.8% had risk factors. Eleven point seven per cent met sepsis criteria, 4.6% severe sepsis and 3% septic shock. Thirty-seven per cent of patients were directly discharged from the A & E Departments. CONCLUSIONS: The impact and prevalence of CAP in A & E Departments has increased in the last decade. It is the most common cause of sepsis, severe sepsis and septic shock, admission to intensive care units and death due to infectious disease.

[Cellulitis after a cat bite]. / Celulitis tras mordedura de gato.

Animal bite wounds are common. Domestic companion animals inflict the majority of these wounds. The most important percentage of contagions are due to cat bites, and often by Pasteurella species. We present two cases of Pasteurella multocida infection after a cat bite.Thus, in this article we review the most relevant clinical features related with this aetiological agent and some aspects about antimicrobial susceptibility.

Infections in diabetic foot ulcers.

Foot ulcers and infections are common in diabetic patients. A 30-month-long descriptive study was conducted in our hospital in which we analyzed microbiological isolates of all patients admitted with diabetic foot infections. The predominant flora identified were Staphylococcus aureus and coagulase-negative Staphylococcus, followed by Enterococcus spp., Streptococcus spp., and enterobacteriaceaes. In 27 positive cultures (42%) polymicrobial flora were found. There were only 5% anaerobic bacteria. There appears to be a relationship between the sample collection system and microbiological isolates.

[Primary adrenal insufficiency. Addison's disease]. / Insuficiencia corticosuprarrenal primaria. Enfermedad de Addison.

Addison's disease is due to an insufficiency of corticosuprarrenal hormones to maintain the peripheral needs and its clinical sign is a constitutional syndrome with cutaneous hyperpigmentation and low blood pre-assure. The ethiology has drastically variated in the last century; being the origin almost exclusively tuberculous at the beginning of 1900 and mainly autoimmune actually. Nowadays it is difficult to understand Addison's disease out of the context of autoimmune polyglandular syndromes in view of the frequent association to other endocrinopathies. The present article pretend to realize a vision of the global disease related to these multiple endocrine deficits.

[Late diagnosis of Turner syndrome: therapeutic implications]. / Diagnóstico tardío del síndrome de Turner: implicaciones terapéuticas.

We report the case of a patient with Turner's syndrome, whose special peculiarity is that its clinical signs have gone unnoticed despite the presence of several morphological features and functional disorders which must have induced it precociously. It's about a 58 years old patient with an aortic metalic valve in treatment with dicumarinics, who came to emergencies with a severe anemic syndrome because of a peptic ulcer propitiated by the hypoprotrombinaemia. In the physical examination some typical signs of the syndrome were detected. The karyotype verified the existance of Turner (45X0). We insist on the need of an early diagnosis, in order to prevent the short stature and to offer a satisfactory sexual development, and we include an actualization of the different approachments in the therapy and management of the disease.