Late onset prosthetic joint infection caused by Parvimonas micra.

Parvimonas micra (P.micra) is a difficult to culture gram positive anaerobic microorganism, typically found in the human microbiota, specially in the oral cavity. There are limited cases in literature reporting prosthetic joint infection due to this bacteria, although its isolation has been reported in different settings in later years. We present the case of a late onset knee prosthetic joint infection caused by Parvimonas micra in an 87 year old woman treated with antibiotics and two-step surgery with prosthetic material removal, antibiotic-loaded cement spacer placement and new prosthetic material replacement after 2 weeks of intravenous antimicrobial therapy followed by 6 weeks of oral therapy.

Alopecia areata as a paraneoplastic syndrome of gastric cancer.

Alopecia areata produces hair loss in circular patches by an immune mechanism. The association with hematologic malignancies and with digestive tumors has been described. We report the case of a man who presented alopecia areata and two months later he was diagnosed with gastric adenocarcinoma.

[Chronic obstructive pulmonary disease: differences between men and women]. / Enfermedad pulmonar obstructiva: diferencias entre hombres y mujeres.

Chronic obstructive pulmonary disease (COPD) has increased its prevalence in females. Women have been described as more symptomatic. There are few studies considering gender differences in COPD. The aim of our study was to determine the influence of gender on quality of life, symptoms, treatment, risk factors and cardiovascular disease in a population of patients with COPD. In this prospective observational cross-sectional study, the included COPD patients were consecutively admitted between September 1, 2008 to March 1, 2010. We registered age, sex, smoking history, risk factors and cardiovascular disease, treatment and severity of COPD. We measured ankle-brachial index (ABI) and performed EuroQol-5D. Two hundred forty six patients were included (195 men). There were more former smokers among men (68.7% vs. 15.7%, p < 0.001), men had a lower FEV1 (48.7% ± 15.7 vs. 58.2% ± 10.9 of theoretical, p < 0.001) and higher frequency of ischemic heart disease (16.4% vs. 5.9%, p = 0.04). Women showed a higher prevalence of COPD without exposure to smoke cigarette (64.7% vs. 7.2%, p < 0.001), more symptoms of anxiety and depression (p = 0.004) and less frequently altered ABI (20% vs. 41. 6%, p = 0.01).There were differences in COPD with respect to sex with more severe pulmonary and cardiovascular disease in men and more symptoms of anxiety and depression in women.

Outpatient therapy with piperacillin/tazobactam using elastomeric pumps in patients with Pseudomonas aeruginosa infection.

The aim of this study was to evaluate the efficacy and safety of outpatient antimicrobial therapy with piperacillin-tazobactam in continuous infusion using elastomeric pumps and to evaluate the economic impact compared with conventional hospital treatment in patients with Pseudomonas aeruginosa (PA) infections. This is an observational study. Patients with PA infection treated with continuous piperacillin-tazobactam infusion using elastomeric pumps in our hospital between January 2015 and December 2017 were included. Primary outcomes were mortality during antibiotic treatment and mortality at 30 days. Secondary outcomes were reinfection or relapse at 30 days and clinical cure rate. The cost of each episode was compared with theoretical cost of the same treatment using conventional hospitalization. 35 patients were included. One patient (2.9%) died during the treatment. Overall 30-day mortality was 5.7%. No death was related to infection by PA. One patient (2.9%) had a reinfection at 30 days. Cure was achieved in 93% of patients at the end of treatment. There were no severe complications related to elastomeric pumps. Treatment cost with outpatient antimicrobial therapy was 67% lower than theoretical cost with conventional hospital treatment. Oupatient antimicrobial therapy with piperacillin-tazobactam in continuous infusion using elastomeric pumps in patients with PA infections is safe and effective with lower costs.

Outpatient Parenteral Antimicrobial Therapy With Ceftolozane/Tazobactam via Continuous Infusion for Multidrug-Resistant Pseudomonas aeruginosa Osteomyelitis.

We present a case of Pseudomonas aeruginosa osteomyelitis treated with surgery and antibiotic therapy with ceftolozane-tazobactam in continuous infusion at home using an elastomeric pump. We discuss the use of ceftolozane-tazobactam in continuous infusion administered at home as an effective alternative for the treatment of multidrug-resistant Pseudomonas aeruginosa osteomyelitis.

Treatment duration of complicated urinary tract infections by extended-spectrum beta-lactamases producing enterobacterales.

BACKGROUND: Urinary tract infections caused by extended-spectrum beta-lactamase producing Enterobacterales (ESBL-EB) are a problem increasing in our clinical practice. OBJECTIVES: The aim of this study was to evaluate the clinical outcome in patients who received short (≤ 7 days) versus long courses (>7 days) of antimicrobial therapy for complicated ESBL-EB urinary tract infections. METHODS: This is a retrospective and observational study. Positive urine cultures for ESBL-EB in our hospital between March 2015 and July 2017 were identified. Patients with complicated urinary tract infection were included. Differences between treatment groups (7 days or less vs more than 7 days) were analyzed according to baseline characteristics and severity of clinical presentation. Primary outcome was all cause 30-day mortality. Secondary outcome was a combined item of all cause mortality and reinfection by the same enterobacteria at 30 days. RESULTS: 273 urine cultures were positive for ESBL-EB during the study period. 75 episodes were included, 40 in the long treatment group and 35 in the short treatment group. Mean treatment duration in short and long treatment groups was 6,1 and 13,8 days respectively. Mortality at 30 days was 5,7% in the short treatment group and 5% in the long treatment group without significant differences (P = 0,8). Mortality or reinfection by the same ESBL-EB at 30 days was 8,6% in the short treatment group and 10% in the long treatment group, without significant differences (P = 0,8). CONCLUSIONS: Short courses of antimicrobial treatment seems to be effective as treatment of complicated urinary tract infections by ESBL-EB.

Evaluation of response to conventional chemotherapy and radiotherapy by perfusion computed tomography in non-small cell lung cancer (NSCLC).

BACKGROUND: To evaluate changes in perfusion computed tomography (PCT) parameters induced by treatment with conventional chemotherapy (CCT) alone or with CCT and radiation therapy (RT) in patients with non-small cell lung cancer (NSCLC) and to determine whether these changes correlate with response as defined by the response evaluation criteria in solid tumours version 1.1 (RECIST-1.1). METHODS: Fifty-three patients with a histological diagnosis of NSCLC prospectively underwent PCT of the whole tumour, before/after CCT or before/after CCT and RT. Blood flow (BF), blood volume (BV), permeability (PMB), and mean transit time (MTT) were compared before and after treatment and with the response as defined by RECIST-1.1. The relationship between changes in the perfusion parameters and in tumour size was also evaluated. RESULTS: PCT parameters decreased after treatment, significantly for BV (p = 0.002) and MTT (p = 0.027). The 30 patients with partial response had a significant decrease of 21% for BV (p = 0.006) and 17% for MTT (p = 0.031). A non-significant decrease in all perfusion parameters was found in patients with stable disease (p > 0.137). In patients with progressive disease, MTT decreased by 10% (p = 0.465) and the other parameters did not significantly vary (p > 0.809). No significant correlation was found between changes in size and PCT parameters (p > 0.145). CONCLUSIONS: Treatment of NSCLC with platinum derivatives, with or without RT, induces changes in PCT parameters. Partial response is associated with a significant decrease in BV and MTT, attributable to the effect of the treatment on tumour vascularisation.

Characteristics of computed tomography perfusion parameters in non-small-cell-lung-cancer and its relationship to histology, size, stage an treatment response.

OBJECTIVES: To analyze computed tomography perfusion (CTP) parameters in NSCLC. MATERIALS AND METHODS: Prospective study, 152 patients with NSCLC. CTP parameters were correlated with histology, stage, size and response to conventional chemotherapy/radiotherapy. RESULTS: Neuroendocrine tumours presented higher BV (p 0.002). Negative correlation of PMB (p 0.003) and positive of MTT (p 0.046) with T stage was found. BF showed negative correlation with size. No differences were found with the RECIST levels of response to chemotherapy/radiotherapy. CONCLUSIONS: CTP parameters were highly variable. Neuroendocrine tumours presented higher BV and PMB values. Perfusion parameters do not differ depending on the stage and do not predict response to treatment.

Pseudomonas aeruginosa urinary tract infections in hospitalized patients: Mortality and prognostic factors.

BACKGROUND: The aim of this study was to analyze the mortality and predictors of 30-day mortality among hospitalized patients with Pseudomonas aeruginosa urinary tract infection (PAUTI) and the impact of antibiotic treatment on survival. METHODS: Patients admitted to our hospital with PAUTI or those diagnosed of PAUTI during hospitalization for other disease between September 2012 and September 2014 were included. Repeated episodes from the same patient were excluded. Database with demographic, clinical and laboratory ítems was created. Empirical and definitive antibiotic therapy, antimicrobial resistance and all-cause mortality at 30 and 90 days were included. RESULTS: 62 patients were included, with a mean age of 75 years. 51% were male. Mortality was 17.7% at 30 days and 33.9% at 90 days. Factors associated with reduced survival at 30 days were chronic liver disease with portal hypertension (P<0,01), diabetes mellitus (P = 0,04) chronic renal failure (P = 0,02), severe sepsis or septic shock (P<0,01), Charlson index > 3 (P = 0.02) and inadequated definitive antibiotic treatment (P<0,01). Independent risk factors for mortality in multivariate analysis were advanced chronic liver disease (HR 77,4; P<0,01), diabetes mellitus (HR 3,6; P = 0,04), chronic renal failure (HR 4,1; P = 0,03) and inadequated definitive antimicrobial treatment (HR 6,8; P = 0,01). CONCLUSIONS: PAUTI are associated with high mortality in hospitalized patients, which increases significantly in those with severe comorbidity such as chronic renal failure, advanced liver disease or diabetes mellitus. Inadequated antibiotic treatment is associated with poor outcome, which remarks the importance of adjusting empirical antibiotic treatment based on the microbiological susceptibility results.

Antiphospholipid syndrome mimicking multiple sclerosis in two patients.

Antiphospholipid syndrome can sometimes mimic multiple sclerosis symptoms and, therefore, present difficulties at the time of diagnosis. We describe the cases of two young women with recurrent neurological deficiencies, the presence of antiphospholipid antibodies in serum, and typical demyelinating lesions on magnetic resonance imaging. Initiation of anticoagulant therapy did not result in any new neurological events in either patient.

[Bacterial endogenous endophthalmitis]. / Endoftalmite bacteriana endógena.

Endogenous bacterial endophthalmitis is an uncommon disease, secondary to hematogenous spread of a septic focus. Despite advances in diagnostic and therapeutic methods, it remains a potential cause of blindness. We report a case of a diabetic patient with endogenous endophthalmitis of the right eye secondary to an Escherichia coli bacteremia of urinary origin. The evolution was torpid, with loss of visual acuity and evisceration of the right eye.