Staphylococcus aureus bacteremia in a secondary level Spanish hospital: clinical implications of high vancomycin MIC.

OBJECTIVE: One of the most controversial issues in recent years has been the clinical significance of high vancomycin MIC in Staphylococcus aureus bacteremia. The aim of this study was to elucidate the clinical implication that this parameter has in the staphylococcal bacteremia of a second level hospital. METHODS: Retrospective descriptive study between January 2014 and September 2016 with 138 records from the blood culture Severo Ochoa University Hospital registry. A total of 98 cases were finally analized. Microbiological analysis of vancomycin MIC was performed using micro dilution technique. RESULTS: The mean age was 71.4 ± 12.45 and 63.26% of the patients had a Charlson index ≥6. A 30.61% were carriers of a venous central catheter. The most frequent source was venous central catheter (26.53%). There were 14.24% metastatic events. Global mortality rate at 30 days was 25.51%. The 43.87% of strains had a vancomycin MIC ≥ 2 mg/L. High vancomycin MIC was significantly associated with persistent bacteremia (OR 3.12 [1.13-8.93]), maintaining this statistical significance in methicillin-resistant S. aureus (MRSA) group (p =0.001) but no in methicillin-susceptible S. aureus (MSSA) group (p = 0.13). Persistent bacteremia was also significantly related with permanent catheter carriers (OR 4.18 [1.38-12.61]), peripheric catheter source (OR 5.18 [1.13-8.93]) and metastatic complications (OR 3.82 [1.03- 12.81]). There was no significant association between high vancomycin MIC and mortality. CONCLUSIONS: High vancomycin MIC may be useful in daily clinical practice as a marker of poor clearance of S. aureus bacteremia, specially when is due to MRSA strains.

[Retrospective study of early readmissions at an internal medicine service]. / Estudio retrospectivo de los reingresos precoces de un servicio de medicina interna.

OBJECTIVE: To determine the frequency of hospital re-admissions to an Internal Medicine Department at a Community General Hospital as well as variables associated with them. METHODS: Analysis of hospital discharges during 1997. Data were provided by the Coding and Filing Service, and included sociodemographic data and aspects related to medical care to each patient, as well as discharge DRF according to the HCFA version. A logistic regression model was developed to identify variables independently associated with early re-admission risk (less than 30 days after discharge). RESULTS: The rate of early re-admission was 7.4%. The variables associated with a higher risk of admission included age, a hospital stay longer than the mean at first admission, and AIDS-associated conditions and heart diseases as main discharge diagnoses. CONCLUSIONS: Based on our data, we cannot consider the readmission rates as a reliable index in itself to be assessed negatively, as some re-admissions come unexpectedly and/or are unavoidable.

[Uric acid calculi: infrequent cause of acute renal failure]. / Litiasis úrica: causa infrecuente de fracaso renal agudo.

We reviewed the clinical histories of 14 patients diagnosed of acute obstructive renal failure due to bilateral or unilateral uric calculi in patients with only one functioning kidney for a period of 14 years (1974-1987). Urine was alkalinized in all patients. The increase in urine pH was effective in resolving the obstruction in 12 patients. The alkalinizing methods which succeeded in permeabilizing the urinary tract, considering each functioning kidney independently were: intravenous in 5/21, upstream urethral catheterism in 9/21 and by nephrostomy catheter in 5/21. Surgery was performed in 2 patients. In the later the calculi were of double composition. The most frequent complications were: urinary infection in 7/14 patients, chronic renal failure in 4/14 patients, sepsis in 3/14 patients and bacteremia in 2/14 patients. None of the patients died.