[Epidemiology and risk factors of patients with intra-abdominal postsurgical infection treated with tigecycline: a cohort study]. / Estudio de una cohorte de pacientes tratados con tigeciclina por infección intraabdominal tras cirugía abdominal compleja: epidemiologia y factores pronósticos.

OBJECTIVE: To study a cohort of patients with intra-abdominal postsurgical infection treated with tigecycline to analyze its effectiveness and mortality related factors. METHODS: Prospective study of patients with intra-abdominal postsurgical infection with microbiological isolation and treated with tigecycline. RESULTS: Out of 103 patients only 61 full fit inclusion criteria. Mean age was 67 year-old and 72% were male. Charlson score was ≥ 3 in 65.5%, being diabetes and colon cancer the most prevalent diseases. Cancer surgery was the most frequent procedure (n=44, 72%) and previous antibiotic administration was present in 43 cases (69%). Pitt score was ≥ 3 in 69% and most prevalent bacteria were Escherichia coli (38 %), Enterococcus spp. (34%; mainly Enterococcus faecium) and Klebsiella pneumoniae together with Enterobacter cloacae (28%). Tigecycline was prescribed alone (17; 28%) or in combination with other antibiotics (44; 72%), mainly meropenem (25; 57%) or amikacin (19, 43%). 11 patients died (18%), all of which suffered extended cancer surgery and isolation of extended-spectrum betalactamase producing Enterobacteriaceae. Factors statistically associated to death in univariate analysis were Charlson score >3, pH <7.3 and leucocyte count >20.000 cells/mm3. CONCLUSIONS: As being a cohort of patients treated with tigecycline, E. faecium isolation was very frequent. Non-fatal evolution was achieved in 82% cases, being tigecycline a potentially good option in the empiric treatment of very severe infections.

Evening chronotype associates with obesity in severely obese subjects: interaction with CLOCK 3111T/C.

BACKGROUND: Chronotype has been related to obesity and metabolic disturbances. However, little is known about the relationship between circadian preferences and genetic background in CLOCK genes with obesity and weight loss among severely obese patients after bariatric surgery. OBJECTIVES: The research goals were (1) to examine whether evening chronotype is related to obesity and weight loss evolution in severely obese followed during 6 years after bariatric surgery and (2) to examine potential interactions between circadian preferences and CLOCK 3111T/C for obesity in this population. SUBJECTS/METHODS: Participants (n=252, 79% female; age (mean±s.d.): 52±11 years; body mass index (BMI): 46.4±6.0 kg m-2) were grouped into evening and morning types. Obesity and weight loss parameters, energy and macronutrients intake, energy expenditure, chronotype, meal timing, sleep duration and CLOCK genotype were studied. RESULTS: Evening-type subjects showed significantly higher initial body weight (P=0.015) and BMI (P=0.014) than morning types. Moreover, evening-type, when compared with morning types, lost less weight (percentage of excess weight loss) after bariatric surgery (P=0.015). Weight-loss progression between the two chronotype groups differed significantly from the fourth year after the bariatric surgery toward a higher weight regain among evening types (P<0.05). We also detected a significant interaction between CLOCK 3111T/C SNP and chronotype for body weight at baseline (P<0.001). Specifically, among carriers of the risk allele C, evening types showed higher body weight than morning types (P=0.012). In addition, CLOCK 3111T/C SNP significantly associated with obesity and sleep duration in the older subjects. CONCLUSIONS: Evening chronotype is associated with higher obesity in severely obese subjects and with lower weight loss effectiveness after bariatric surgery. In addition, circadian preferences interact with CLOCK 3111T/C for obesity. The circadian and genetic assessment could provide tailored weight loss recommendations in subjects who underwent bariatric surgery.

DOSE REFERENCE LEVELS IN SPANISH INTRAORAL DENTAL RADIOLOGY: STABILISATION OF THE INCORPORATION OF DIGITAL SYSTEMS IN DENTAL CLINICAL PRACTICES.

A total of 34 044 official quality assurance reports in dental radiodiagnostic surgery from 16 regions of Spain, compiled from 2002 to 2014, were studied in order to determine the progress of diagnostic reference levels (DRLs) for obtaining diagnostic images under normal conditions for clinical practice in Spanish dental clinics. A DRL of 2.8 mGy was set in 2014, which represents a 41.7 % decrease compared with that of 2002 (4.8 mGy). Over the same time period, the mean dose fell by 55.2 %. However, over the last 3 y, the stabilisation of the mean dose administered to patients has been observed with only a 6.7 % reduction in DRLs, which corresponds to the stabilisation of dental radiodiagnostic surgery on replacing the use of radiographic film with digital imaging systems.

Cellular changes in the hamster testicular interstitium with ageing and after exposure to short photoperiod.

The aim of this study was to evaluate the cellular changes that occur in the hamster testicular interstitium in two very different physiological situations involving testicular involution: ageing and exposure to a short photoperiod. The animals were divided into an 'age group' with three subgroups - young, adult and old animals - and a 'regressed group' with animals subjected to a short photoperiod. The testicular interstitium was characterised by light and electron microscopy. Interstitial cells were studied histochemically with regard to their proliferation, terminal deoxynucleotidyl transferase (TdT)-mediated dUTP in situ nick end labelling (TUNEL+) and testosterone synthetic activity. We identified two types of Leydig cell: Type A cells showed a normal morphology, while Type B cells appeared necrotic. With ageing, pericyte proliferation decreased but there was no variation in the index of TUNEL-positive Leydig cells. In the regressed group, pericyte proliferation was greater and TUNEL-positive cells were not observed in the interstitium. The testicular interstitium suffered few ultrastructural changes during ageing and necrotic Leydig cells were observed. In contrast, an ultrastructural involution of Leydig cells with no necrosis was observed in the regressed group. In conclusion, the testicular interstitium of Mesocricetus auratus showed different cellular changes in the two groups (age and regressed), probably due to the irreversible nature of ageing and the reversible character of changes induced by short photoperiod.

Cell proliferation in the seminiferous and epididymal epithelia of Sus domesticus.

It is important to understand the proliferative activity of the different structures of the male reproductive apparatus in livestock species, such as Sus domesticus, to ensure reproductive efficiency. The main aims of this study were (a) to evaluate the proliferative activity of the spermatogonia in the different stages of the seminiferous cycle and (b) to study the cell proliferation in the epididymal epithelium in each region, identifying the different cells involved. For this, the testes and epididymis of three healthy, sexually mature Sus domesticus boars were used. The organs were processed for light microscopy, and immunohistochemical techniques were used to detect proliferating cell nuclear antigen. The cells immunostaining positively and negatively for proliferating cell nuclear antigen were counted and several parameters and indexes were calculated to evaluate the proliferation in both epithelia, taking into account the stage of the seminiferous epithelium cycle, and, in the case of the epididymal epithelium, the different regions and cells are the same. Finally, a contrast analysis of equality between pairs of means was carried out followed by a least significant differences test, in which differences were considered significant at P < 0.05. In the seminiferous epithelium, the greatest total number of spermatogonia and proliferating spermatogonia was observed in the postmeiotic stages (mainly VII and VIII). The proliferation index of the spermatogonia increased from the meiotic to postmeiotic stages. As regards the epididymal epithelium, the total proliferation index was higher in the caput. In each region, the clear and principal cells showed the highest proliferation index with respect to the total number of cells counted, whereas the proliferation index of each cell with respect to the same type was higher in the clear cells, followed by the narrow and principal cells. In conclusion, the proliferative activity of spermatogonia in the seminiferous epithelium of Sus domesticus is stage-dependent, and mainly occurs in the postmeiotic stages. In the epididymal epithelium, proliferative activity takes place in several cell types and is dependent on the anatomical region of the epididymis. We think that these results may be of importance for understanding the pathologic or reproductive processes in which cell proliferation is involved in the male reproductive system.

Histological changes in connective tissue of rat tails after bipolar radiofrequency treatment.

Radiofrequency (RF) has been included in the techniques used in aesthetic surgery/medicine. To date, no studies have performed a histological assessment of changes in the tissue after application of bipolar radiofrequency (BRF) with low energy and frequency. The aim of this study was to examine changes that are produced in connective tissue, principally in the fibroblasts, following BRF treatment. Four groups of rats received a different number of RF sessions (1, 2, 3 and 5). The following parameters were determined: the number of fibroblasts/unit area (FA), the proliferation index (PI), the Heat shock Protein 47 index (HSPI) and the percentage of connective tissue (PC). For statistical analysis, two subgroups (A and B) were made for the variables FA, PI and PC, and another two subgroups (C and D) for the variable HSPI. Significant differences for FA, PI and PC were observed between subgroups A and B, FA and PI having higher values in A, while PC had higher values in B. The HSPI in subgroup C showed significantly higher values than in D. Low energy and frequency BRF led to an increase in the number, proliferation and biosynthetic activity of fibroblasts. The resulting stress suffered by fibroblasts as a result of heat may be associated with the phenomenon of hormesis.

Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients.

UNLABELLED: ` BACKGROUND: Predictive models to identify low-risk febrile neutropenia (FN) have been developed with heterogeneous samples, which included stable and unstable patients, solid tumours, acute leukaemia and bone marrow transplantation. These models fail to recognise 5-15% of cases with unexpected complications, and literature specifically addressing apparently stable patients (ASPs) is scarce. METHODS: We reviewed 861 episodes of FN in outpatients with solid tumours, including 692 (80%) episodes with apparent clinical stability. We aimed to investigate the prognosis of this latter group and explore the possibility of stratifying it according to the presenting features. A case-control study was performed and the MASCC index was evaluated. RESULTS: The rates of complications and bacteraemia in ASPs were 7.3% and 6.2%, respectively. The MASCC index yielded a low sensitivity to detect complications (36%). Prognostic factors were identified: ECOG performance status ≥2, chronic bronchitis, chronic heart failure, stomatitis NCI grade ≥2, monocytes <200 mm(-3) and stress hyperglycaemia. CONCLUSION: A very simple assessment is useful to classify the patients with FN according to the risk of complications. A few additional variables may predict the clinical course of the patients. We additionally show that the MASCC index applied to this specific group has a low sensitivity to predict complications.

Chemical genoprotection: reducing biological damage to as low as reasonably achievable levels.

OBJECTIVES: The aim of this study was to evaluate the antioxidant substances present in the human diet with an antimutagenic protective capacity against genotoxic damage induced by exposure to X-rays in an attempt to reduce biological damage to as low a level as reasonably possible. METHODS: Ten compounds were assessed using the lymphocyte cytokinesis-block micronucleus (MN) cytome test. The compounds studied were added to human blood at 25 µM 5 min before exposure to irradiation by 2 Gy of X-rays. RESULTS: The protective capacity of the antioxidant substances assessed was from highest to lowest according to the frequency of the MN generated by X-ray exposure: rosmarinic acid = carnosic acid = δ-tocopherol = l-acid ascorbic = apigenin = amifostine (P < 0.001) > green tea extract = diosmine = rutin = dimetylsulfoxide (P < 0.05) > irradiated control. The reduction in genotoxic damage with the radiation doses administered reached 58%, which represents a significant reduction in X-ray-induced chromosomal damage (P < 0.001). This degree of protection is greater than that obtained with amifostine, a radioprotective compound used in radiotherapy and which is characterised by its high toxicity. CONCLUSION: Several antioxidant substances, common components of the human diet and lacking toxicity, offer protection from the biological harm induced by ionizing radiation. Administering these protective substances to patients before radiological exploration should be considered, even in the case of small radiation doses and regardless of the biological damage expected.

Response to sham and active gamma ventral capsulotomy in otherwise intractable obsessive-compulsive disorder.

This case regards a 34-year-old woman with severe and refractory obsessive-compulsive disorder, who was enrolled in a double-blind, randomized controlled trial of radiosurgery. She was at first submitted to a sham radiosurgical procedure, and 1 year later to an active intervention. Opposite clinical responses were observed in the follow-up of these different phases. During the sham surgery follow-up, no improvements were observed, but a remarkable amelioration was seen a few months after the active procedure. Detailed descriptions of psychopathological changes and neuroimaging findings as well as a discussion regarding the surgical technique are provided.

Is it true that the radiation dose to which patients are exposed has decreased with modern radiographic films?

OBJECTIVES: To determine whether the radiation dose administered to patients has decreased with new radiographic films and digital imaging systems. METHODS: A total of 10 171 official reports on radiological practice in dental surgeries (covering the years 1996-2003) from 16 Spanish autonomous regions were studied, analysing the type of film used, the exposure times and the radiation doses administered in each dental clinic for four different teeth: upper molar, lower molar, upper incisor and lower incisor. RESULTS: The Agfa Dentus M2 radiographic film needed the longest exposure times for all of the teeth (0.6 s, 0.5 s, 0.4 s and 0.4 s, respectively) followed in decreasing order by Ultraspeed, Insight, Ektaspeed and the digital systems, the decrease with respect to the first reaching as much as 60%. Regarding the dose administered, Agfa Dentus M2 used the highest dose (3.1 mGy) followed by Ultraspeed (2.7 mGy), Insight (2.2 mGy), Ektaspeed (2.2 mGy) and, finally, the digital systems (1.1 mGy). Statistical analysis showed significant differences between the doses administered for the digital systems with respect to the radiographic films (P < 0.001) and with respect to manual or automatic processing (P < 0.001). However, there were no significant differences in dose between the different types of films themselves, or between the radiographic developing processes themselves (manual and automatic). CONCLUSION: Not even the use of the most sensitive of modern films has brought about a reduction of the dose administered to patients in Spain. Only digital systems, it seems, will bring about reduction in this dose.

Attitudes toward organ donation in rural areas of southeastern Spain.

OBJECTIVE: Rural areas present a worse attitude toward organ donation. However, the factors conditioning this attitude are not well known. Our aim was to determine the profile of the population opposed to donation in rural areas. MATERIALS AND METHODS: A random sample stratified by age and sex was obtained from municipalities with less than 10,000 inhabitants. Attitudes toward donation were assessed by a questionnaire which evaluated variables that may influence these attitudes. A descriptive statistical study used the Student t test and chi-square test as well as a logistic regression analysis. RESULTS: Among 181 respondents, 63% were in favor of donation and 37% against or undecided. Among the reasons to be against donation were rejection of body mutilation (43%) and fear of apparent death (41%). The psychosocial variables against donation were age >or=44 years, primary education or below, no previous experience with donation, no prosocial activities, an unfavorable opinion of the partner, and fear of corpse mutilation. The variables persisting in the multivariate analysis were level of education, previous experience, prosocial activities, and fear of corpse manipulation. CONCLUSIONS: Among the rural population the profile of a person opposed to donation was someone older than 44 years, with a low level of education and no previous experience with donation, who does not participate in prosocial activities and is opposed to corpse manipulation.

The effect of the flavonoid diosmin, grape seed extract and red wine on the pulmonary metastatic B16F10 melanoma.

OBJECTIVE: To study the effect of different phenolic compounds and red wine on pulmonary metastatic melanoma. METHODS: Swiss mice were inoculated with 500000 melanocytes B16F10 and given oral doses of diosmin, grape seed extract (GSE) and red wine. A macroscopic count was made of the metastatic nodules on the lung surface and a microscopic study by image analysis of five sections, calculating the implantation percentage and tumoral growth and invasion indices. RESULTS: Macroscopically, the group treated with diosmin showed the greatest reduction (52%) in the number of metastatic nodules compared with the control group, which was treated with ethanol, while GSE and red wine caused decreases of 26.07 and 28.81%, respectively. Microscopically, there was a decrease in the implantation percentage after the administration of diosmin (79.4%) and red wine (20.19%), and an increase of 2.12% after the administration of GSE, all relative to the ethanol-treated control. As regards the growth index, diosmin produced a reduction of 67.44% and red wine a reduction of 20.62%, while GSE again produced an increase (25.33%). The reductions in the invasion index were 45.23, 31.65 and 17.57% with diosmin, GSE and red wine, respectively. CONCLUSIONS: Diosmin originated the greatest reduction in pulmonary metastases, both at the macroscopic and microscopic levels.

The status of Spain's dental practices following the European Union directive concerning radiological installations.

OBJECTIVES: To assess the influence of new European Union (EU) legislation on dental radiology practices and the reduction in patient radiation exposure. STUDY DESIGN: A total of 7176 official reports from Spanish dental offices or clinics covering the period 1996 to 2001 were analyzed. RESULTS: Of the dental radiological installations inspected in 2001, 72.79% used the kilovoltage recommended by the EU (70 kVp) and 98.85% used at least 1.5 mm Al filtration. At least 90.11% of the installations had a focal film distance of 20 cm although there were no cases with a rectangular collimator as adapted to the size of film. Thirty percent of the installations showed a mechanical fault every year. In 17.62% of cases the radiological film was stored in the exposure room. Few clinics (10.24%) used high-speed films and only 11.95% of clinics employed digital systems. The mean dose received by patients fell during the 5 years studied by 18.75%. Radiological equipment fulfilling the EU specifications emitted significantly lower doses than other nonapproved equipment. CONCLUSIONS: The introduction of legislation has resulted in a gradual improvement in dental radiology practices.

[Meal replacement as a dietary therapy for weight control. Assessment in males and females with different degrees of obesity]. / Sustitutivos de una comida como terapia dietética en el control de peso. Evaluación en hombres y mujeres con diferentes grados de obesidad.

Obesity is a metabolic disorder characterized by an increase in the fat in adipose tissue above certain limits, manifested by morphological alterations and excess weight. This condition is one of the most significant epidemics of this century due to over-eating and the ease of access to food. On the other hand, the direct relationship between obesity and the greater risk of suffering cardiovascular disease, diabetes or cancer means that consumers are demanding products, whether medicines or foodstuffs, that will allow them to overcome this situation and improve both their physical appearance and their health. The goal of this project was to identify the efficacy and safety of a dietary product, a meal replacement, within the setting of a balanced hypocaloric diet established for weight loss. To this end, a total of 47 volunteers of both sexes between the ages of 23 and 58, all employees of the Hero España, S.A. company, took part in a test in which eleven of them acted as the "control group" and ate only the low-calorie diet while the rest formed a "problem group" and replaced one meal (with a minimum of 500 calories) with a 200-calorie meal replacement. Participants were subjected to anthropometric measurements, blood pressure testing and a blood chemistry analysis before and after the test period, as well as to weekly weight checks. Those individuals with the highest Body Mass Index showed a greater weight loss than those with a lower index. The volunteers did not note any hunger pangs until three hours after consumption of the meal replacement and the health-status parameters analyzed did not show any anomalous values. Therefore, it is concluded that the replacement product studied allows controlled weight loss over 3 weeks when accompanied by a balanced low-calorie diet and it also produces a sensation of fullness in those consuming it.

Risk factors for malignancy in multinodular goitres.

BACKGROUND: Multinodular goitre (MNG) is quite often associated with thyroid carcinoma, but the risk factors for malignancy are not well known. The aim is to analyse patients with thyroid carcinoma associated with MNG to determine the clinical risk factors for malignancy. METHOD: From a series of 672 MNGs we analysed a subgroup of 59 patients presenting with an associated thyroid carcinoma. The variables analysed were age, sex, family history, cervical radiation therapy, residence in areas of endemic goitre, prior thyroid surgery, time of evolution, asymptomatic status, hyperthyroidism, compressive syndromes, intrathoracic prolongation, goitre consistency and cervical adenopathies. These were compared to MNGs not developing malignancy using the Chi-squared test, Student's t test and a logistic regression test. RESULTS: Of the 59 cases, 37 corresponded to a microcarcinoma (< or =1 cm). The most common histological type was papillary (n=48), followed by follicular (n=6). In 20 cases the carcinoma was multifocal, and capsular involvement was noted in 16 patients, lymph node involvement in five and vascular involvement in another five. The multivariate analysis confirmed the following as independent variables associated with the presence of carcinoma: family history of thyroid pathology (RR=1.6), history of cervical radiation therapy (RR=1.8), recurrent goitre (RR=2.1) and presence of adenopathies on physical exploration (RR=1.6). CONCLUSION: The risk factors for carcinoma associated with MNG are family history of thyroid pathology, personal history of cervical radiation therapy, prior surgery and presence of cervical adenopathies.

Palpable breast lesions: utility of Doppler sonography for diagnosis of malignancy.

This study was designed to find whether there are any differences between benign and malignant palpable breast lesions as they are seen on grey-scale and colour-Doppler and on power-Doppler sonography; to determine which variables for each technique are most helpful in distinguishing any such differences; and to see whether the use of an echo-enhancing agent gives better results in the differential diagnosis. Forty-five palpable breast lesions (16 benign and 29 malignant) were evaluated in a preoperative study using grey-scale sonography, colour-Doppler sonography and power-Doppler sonography before and after administration of an echo-enhancing agent (Levovist). We reached the following conclusions: (1) In the grey-scale ultrasound study of palpable breast lesions the presence of microcalcifications, acoustic shadowing and non-well-defined margins are related to malignancy. (2) Colour- and power-Doppler sonography may help in the differential diagnosis. (3) The use of an echo enhancer (Levovist) accentuates these differences and enables them to be noted in other variables, such as pulsatility index, nodule-to-vascularity ratio and number of poles.

Spigelian hernia: bibliographical study and presentation of a series of 28 patients.

Spigelian hernias are rare defects of the abdominal wall. Our aim is to analyse the bibliography and present a series of 28 patients. A Medline bibliographical study was performed between 1970 and 2000 with analysis of the number of cases, series, ratio of cases to year and type of journal. We also present a personal study and analyse epidemiological, diagnostic, and treatment factors. There are 159 articles, 479 cases, and 19 series of more than five patients published in 85 journals (42.3% medical). Our diagnosis was preoperative in 75%, and programmed surgery was 3.6 times more common than emergency surgery. We found a significant relationship between hospital stay and type of surgery (P < 0.02) and surgical technique used (P < 0.001). We found that spigelian hernias have a multidisciplinary interest; they are given almost equal treatment in medical and surgical journals; preoperative diagnosis can be established in 75% of cases; and the best results are offered by the extraperitoneal laparoscopic approach.

Surgical management and complications of Meckel's diverticulum in 90 patients.

OBJECTIVE: To review controversial aspects of the pathology, management, and complications of Meckel's diverticula. DESIGN: Retrospective study. SETTING: University hospital, Spain. SUBJECTS: 90 patients who had Meckel's diverticula during the 32 year period April 1968-May 2000. MAIN OUTCOME MEASURES: Epidemiological and histopathological findings (including a search for Helicobacter pylori); surgical management and morbidity. RESULTS: There were no differences in sex between patients with asymptomatic and symptomatic disease, although we did find differences in age. Signs of abnormalities on scintigraphy were associated with the presence of ectopic fundal mucosa, although not significantly so. No signs of Helicobacter pylori were found in any of our patients. Morbidity after intestinal resection was higher than after diverticulectomy. CONCLUSIONS: Meckel's diverticulum should be suspected particularly when there are symptoms of obstruction or gastrointestinal bleeding in children. The presence of both ectopic gastric mucosa and ulcers is related to the symptoms and we found no H. pylori in any of the cases.

[Risk factors and prognostics of urinary infections due to gram-negative bacteria]. / Factores de riesgo y pronósticode las infecciones urinarias por gramnegativos.

Urinary infections due to gram-negative bacteria are important because of their high frequency, morbidity and mortality. In order to evaluate the risk factors and prognostics a group of 50 patients with nosocomial urinary infections were studied prospectively and consecutively and were compared with another group of 50 patients with similar characteristics but no infection. The most isolated bacteria were Escherichia coli (68%), followed by Pseudomonas aeruginosa (20%). Bacteremia was found in 22% of the cases. Risk factors included female gender, medical services, nosocomial acquisition, previous use of manipulation techniques such as vesicular probe, prior urinary infections, and the use of cytostatic drugs in the previous six weeks. Mortality was 4%. The factors significantly associated with a poor prognosis were the following: severe underlying disease, a clinically critical situation, previous surgery, complications, type of gram-negative bacteria, use of third generation cephalosporins and ciprofloxacin in the previous six weeks and older age. The mortality of the control group was 8%.

[Risk factors and prognostics of nosocomial infectionof surgical wounds in a general hospital]. / Factores de riesgo y pronósticode la infección nosocomial de la herida quirúrgicaen un hospital general.

Surgical infections due to gram-negative bacteria are important because of their high frequency, morbidity and mortality. In order to evaluate the risk factors and prognostics of gram-negative surgical wound infections a group of 50 patients with surgical infections were studied prospectively and consecutively and were compared with another group of 50 patients with similar characteristics but no infection. No significant differences were observed with respect to age between the two groups. Previous surgery, prior surgical infections and use of wide-spectrum antibiotics in the six weeks before the study were significantly associated with the development of surgical wound infections due to gram-negative bacteria. The most isolated bacteria were Pseudomonas aeruginosa (34%), followed by polymicrobial flora (16%). The factors significantly associated with a poor prognosis were the following: severe underlying disease, a clinically critical situation, previous surgery, arterial hypertension, complications, type of gram-negative bacteria, prior use of wide-spectrum antibiotics in the previous six weeks and older age. No deaths occurred.