RESUMEN
DENOVA-score is useful to stratify the risk of infective endocarditis (IE) in Enterococcus faecalis bacteremia. Recently, time to positive (TTP) of blood cultures has also been related with a higher risk of IE. The objective was to evaluate DENOVA- score with TTP to improve its specificity. We performed a retrospective, case-control study in adult patients with E. faecalis bacteremia. Thirty-nine patients with definite E. faecalis IE and 82 with E. faecalis bacteremia were included. The addition of a TTP ≤ 8 h to DENOVA-score did not improve the diagnostic accuracy of this score.
Asunto(s)
Bacteriemia , Cultivo de Sangre , Endocarditis Bacteriana , Enterococcus faecalis , Infecciones por Bacterias Grampositivas , Humanos , Enterococcus faecalis/aislamiento & purificación , Bacteriemia/diagnóstico , Bacteriemia/microbiología , Estudios Retrospectivos , Cultivo de Sangre/métodos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Estudios de Casos y Controles , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/sangre , Factores de Tiempo , Adulto , Anciano de 80 o más Años , Sensibilidad y Especificidad , Valor Predictivo de las PruebasRESUMEN
Clostridium difficile infection (CDI) is characterized by a high delayed and unrelated mortality. Predicting delayed mortality in CDI patients could allow the implementation of interventions that could reduce these events. A prospective multicentric study was carried out to investigate prognostic factors associated with mortality. It was based on a cohort (July 2015 to February 2016) of 295 patients presenting with CDI. Logistic regression was used and the model was calibrated using the Hosmer-Lemeshow test. The mortality rate at 75 days in our series was 18%. Age (>65 years), comorbidity (defined by heart failure, diabetes mellitus with any organ lesion, renal failure, active neoplasia or immunosuppression) and fecal incontinence at clinical presentation were associated with delayed (75-day) mortality. When present, each of the aforementioned variables added one point to the score. Mortalities with 0, 1, 2 and 3 points were 0%, 9.4%, 18.5% and 38.2%, respectively. The area under the ROC curve was 0.743, and the Hosmer-Lemeshow goodness-of-fit test p value was 0.875. Therefore, the prediction of high delayed mortality in CDI patients by our scoring system could promote measures for increasing survival in suitable cases.
Asunto(s)
Infecciones por Clostridium/mortalidad , Anciano , Infecciones por Clostridium/complicaciones , Comorbilidad , Femenino , Humanos , Masculino , Estudios Prospectivos , Análisis de Supervivencia , Factores de TiempoAsunto(s)
Endocarditis , Infecciones por Pseudomonas , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Compuestos de Azabiciclo/farmacología , Compuestos de Azabiciclo/uso terapéutico , Ceftazidima/farmacología , Ceftazidima/uso terapéutico , Combinación de Medicamentos , Farmacorresistencia Bacteriana Múltiple , Endocarditis/tratamiento farmacológico , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosaRESUMEN
Positron emission tomography (18FDG PET-CT) is a widely used method to help in the diagnosis of infective endocarditis (IE). Lipomatous hypertrophy of the interatrial septum (LHIS) is an uncommon fat deposition in the region of the interatrial septum. PET-CT images of LHIS may be indistinguishable from changes associated with IE.
Asunto(s)
Antiinfecciosos Urinarios/uso terapéutico , Cefalosporinas/uso terapéutico , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Ácido Penicilánico/análogos & derivados , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Ácido Penicilánico/uso terapéutico , Infecciones por Pseudomonas/microbiología , Enfermedades Cutáneas Bacterianas/microbiología , Infecciones de los Tejidos Blandos/microbiología , TazobactamRESUMEN
BACKGROUND: Treatment optimization for serious infections, such as Staphylococcus aureus bacteremia (SAB), is a challenge for antimicrobial stewardship teams. Currently, SAB guidelines recommend a completely intravenous therapy (CIT). OBJECTIVES: The objective of the study was to analyze the usefulness and safety of oral sequential therapy (OST) in SAB. PATIENTS AND METHODS: We conducted a retrospective, observational study in a tertiary teaching hospital in Spain. The inclusion criteria were complicated and non-complicated monomicrobial SAB and an adequate duration of therapy, with patients classified into OST or CIT. The primary endpoint was the 90-day recurrence of S. aureus infection. We also analyzed the mortality, the length of the hospital stay, and the duration of the intravenous antibiotic administration. RESULTS: Of a total of 201 patients with SAB, 125 (62%) underwent OST. The most commonly administered oral antibiotic was trimethoprim-sulfamethoxazole (66% of patients). Of those administered OST, 43% had complicated bacteremia (most with an osteoarticular source of infection), and 6% had an intravascular device. The 90-day recurrence rate was 4%, with no differences between the two groups. The duration of the therapy (22 [16-28] vs. 13 days [8-17] for CIT and OST, respectively; p < 0.001) and the hospital stay (36 [27-71] vs. 18 days [13-29] for CIT and OST, respectively; p < 0.001) were shorter for OST. MRSA was related with mortality (OR 4.4, 95% CI [1.67-11.37]; p = 0.003). CONCLUSIONS: OST for properly selected patients with SAB could be a safe therapeutic option and can reduce their use of CIT and their hospital stay.
Asunto(s)
Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos , Bacteriemia/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/efectos de los fármacos , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Administración Intravenosa , Administración Oral , Anciano , Anciano de 80 o más Años , Bacteriemia/microbiología , Bacteriemia/mortalidad , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidad , Centros de Atención TerciariaRESUMEN
Recurrence of Clostridium difficile infection (CDI) has major consequences for both patients and the health system. The ability to predict which patients are at increased risk of recurrent CDI makes it possible to select candidates for treatment with new drugs and therapies (including fecal microbiota transplantation) that have proven to reduce the incidence of recurrence of CDI. Our objective was to develop a clinical prediction tool, the GEIH-CDI score, to determine the risk of recurrence of CDI. Predictors of recurrence of CDI were investigated using logistic regression in a prospective cohort of 274 patients diagnosed with CDI. The model was calibrated using the Hosmer-Lemeshow test. The tool comprises four factors: age (70-79 years and ≥80 years), history of CDI during the previous year, direct detection of toxin in stool, and persistence of diarrhea on the fifth day of treatment. The functioning of the GEIH-CDI score was validated in a prospective cohort of 183 patients. The area under the ROC curve was 0.72 (0.65-0.79). Application of the tool makes it possible to select patients at high risk (>50%) of recurrence and patients at low risk (<10%) of recurrence. GEIH-CDI score may be useful for clinicians treating patients with CDI.
Asunto(s)
Infecciones por Clostridium/diagnóstico , Técnicas de Apoyo para la Decisión , Recurrencia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Candida/aislamiento & purificación , Cateterismo Venoso Central/instrumentación , Cateterismo Periférico/instrumentación , Catéteres de Permanencia/microbiología , Contaminación de Equipos , Medición de Riesgo , Adulto , Anciano , Bacteriemia/epidemiología , Candidiasis/diagnóstico , Candidiasis/epidemiología , Candidiasis/etiología , Candidiasis/transmisión , Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/etiología , Infecciones Relacionadas con Catéteres/transmisión , Catéteres Venosos Centrales/microbiología , Coinfección , Femenino , Fungemia/epidemiología , Fungemia/etiología , Fungemia/transmisión , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
No disponible
Asunto(s)
Adulto , Femenino , Humanos , Persona de Mediana Edad , Fallo Hepático Agudo/complicaciones , Fallo Hepático Agudo/diagnóstico , Tirotoxicosis/complicaciones , Tirotoxicosis/diagnóstico , Tiroidectomía/métodos , Trasplante de Hígado/métodos , Trasplante de Hígado/tendencias , Crisis Tiroidea/complicaciones , Crisis Tiroidea/cirugía , Fallo Hepático Agudo/fisiopatología , Tirotoxicosis/fisiopatología , Pruebas de Función de la Tiroides/instrumentación , Pruebas de Función de la Tiroides/métodos , Pruebas de Función de la Tiroides , Enfermedades de la Tiroides/cirugíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Absceso Encefálico/complicaciones , Isquemia Encefálica/complicaciones , Infarto Cerebral/complicaciones , Factores de RiesgoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres Venosos Centrales , Pronóstico , Candida , Candida/aislamiento & purificación , Antifúngicos/uso terapéutico , Infecciones Relacionadas con Catéteres/fisiopatología , Catéteres Venosos Centrales/microbiologíaRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Clavícula/lesiones , Clavícula , Clavícula/virología , Osteomielitis/complicaciones , Osteomielitis , Osteomielitis/virología , Escherichia coli , Escherichia coli/aislamiento & purificación , Antiinflamatorios/uso terapéutico , Tomografía Computarizada de Emisión/instrumentación , Tomografía Computarizada de Emisión/métodos , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Ciprofloxacina/uso terapéutico , Diagnóstico DiferencialAsunto(s)
Adenoma/sangre , Infecciones por VIH/complicaciones , Hipercalcemia/etiología , Hormona Paratiroidea/sangre , Neoplasias de las Paratiroides/sangre , Adenoma/complicaciones , Adenoma/diagnóstico , Adenoma/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía , CintigrafíaRESUMEN
BACKGROUND: Although there is a great concern regarding rational use of drugs, the available evidence for the most appropriate strategies to improve prescribing is scarce. GOAL: The goal of this study was to evaluate the effectiveness of the combination of feedback of individualized prescribing data and educational recommendations for improving the quality of prescribing in general practice. METHOD: A quasiexperimental intervention study was conducted in which prescribing rates of 282 family physicians before and after the intervention were compared. Physicians assigned to the individualized feedback group (n = 195) received individual instruction with specific recommendations for improvement according to their baseline prescribing quality levels, whereas physicians in the minimal intervention group (n = 87) only received standard nonindividualized prescribing data for the practice group as a whole. RESULTS: A trend toward increasing high pharmacologic intrinsic value in both groups was observed. Overprescription of antibiotics showed a decrease in the individualized feedback group (P = 0.006) and it did not change in the minimal intervention group. A different trend in the values in each group was observed with nonsteroidal antiinflammatory drugs, although it was not statistically significant. Overprescription of antiulcerative agents decreased among physicians in the individualized feedback group (P = 0.003); however, there were not statistically significant differences as compared with the minimal intervention group. Changes in indicators of drug selection were more favorable for the group with individualized feedback, although no statistically significant differences were observed. Pharmaceutical expenditure increased significantly in the minimal intervention group as compared with the individualized feedback group, with an approximate difference of dollars 7.87 per inhabitant and trimester (P = 0.003). CONCLUSION: The intervention showed that improving the quality of prescribing was feasible, particularly in overprescribing, and was associated with considerable savings in pharmaceutical costs.