RESUMEN
BACKGROUND: The objective of this study is to analyze the factors that are associated with the adequacy of empirical antibiotic therapy and its impact in mortality in a large cohort of patients with extended-spectrum ß-lactamase (ESBL)--producing Escherichia coli and Klebsiella spp. bacteremia. METHODS: Cases of ESBL producing Enterobacteriaceae (ESBL-E) bacteremia collected from 2003 through 2008 in 19 hospitals in Spain. Statistical analysis was performed using multivariate logistic regression. RESULTS: We analyzed 387 cases ESBL-E bloodstream infections. The main sources of bacteremia were urinary tract (55.3%), biliary tract (12.7%), intra-abdominal (8.8%) and unknown origin (9.6%). Among all the 387 episodes, E. coli was isolated from blood cultures in 343 and in 45.71% the ESBL-E was multidrug resistant. Empirical antibiotic treatment was adequate in 48.8% of the cases and the in hospital mortality was 20.9%. In a multivariate analysis adequacy was a risk factor for death [adjusted OR (95% CI): 0.39 (0.31-0.97); P = 0.04], but not in patients without severe sepsis or shock. The class of antibiotic used empirically was not associated with prognosis in adequately treated patients. CONCLUSION: ESBL-E bacteremia has a relatively high mortality that is partly related with a low adequacy of empirical antibiotic treatment. In selected subgroups the relevance of the adequacy of empirical therapy is limited.
Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Infecciones por Escherichia coli/tratamiento farmacológico , Escherichia coli/enzimología , Infecciones por Klebsiella/tratamiento farmacológico , Klebsiella/enzimología , beta-Lactamasas/metabolismo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/microbiología , Bacteriemia/mortalidad , Niño , Preescolar , Estudios de Cohortes , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/mortalidad , Femenino , Humanos , Lactante , Recién Nacido , Klebsiella/aislamiento & purificación , Infecciones por Klebsiella/microbiología , Infecciones por Klebsiella/mortalidad , Masculino , Persona de Mediana Edad , España , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
An unhealthy diet, consisting mainly of saturated and trans fats intake, is one of the strongest factors contributing to the development of cardiovascular disease. With an historical approach, this paper aims to describe policies regarding trans fats in Argentina. Main global strategies which inspired local interventions are included: from North Karelia memorable project, through the Global Strategy on Diet, Physical Activity and Health to the Argentinian experience which made it possible to replace 70% of partially hydrogenated oil from the market.
La mala alimentación, en particular el consumo de grasas saturadas y trans, es un factor de primer orden para el desarrollo de enfermedad cardiovascular. Mediante un relato histórico, el presente trabajo pretende describir las políticas referidas a grasas trans en Argentina. Se incluyen referencias a las principales estrategias mundiales que inspiraron intervenciones locales, desde el memorable proyecto de Karelia del Norte, pasando por la Estrategia Mundial sobre Régimen Alimentario, Actividad Física y Salud, hasta la experiencia Argentina que llevó a reemplazar el 70% del aceite parcialmente hidrogenado del mercado.