RESUMEN
BACKGROUND: There is limited knowledge about risk factors for Clostridioides difficile infection (CDI) and recurrent CDI in solid organ transplant (SOT) recipients. METHODS: A case-control study of CDI in SOT recipients compared with controls (SOT recipients who did not present CDI). RESULTS: Sixty-seven patients from 1089 SOT recipients (6.2%) suffered at least one episode of CDI. The mean age was 55 ± 12 years and 20 cases (69%) were men. The accumulated incidence was 8% in liver transplantation, 6.2% in lung transplantation, 5.4% in heart transplantation, and 4.7% in kidney transplantation. Twenty-nine cases (43.3%) were diagnosed during the first 3 months after SOT. Forty-one cases (61.2%) were hospital acquired. Thirty-one patients with CDI presented with mild-moderate infection (46.3%), 30 patients with severe infection (44.8%), and 6 patients with severe-complicated disease (9%). Independent variables found to be related with CDI were hospitalization in the previous 3 months (odds ratio: 2.99; [95% confidence interval 1.21-7.37]) and the use of quinolones in the previous month (odds ratio: 3.71 [95% confidence interval 1.16-11.8]). Eleven patients (16.4%) had at least one recurrence of CDI. Previous treatment with amoxicillin-clavulanate, severe-complicated index episode, and high serum creatinine were associated with recurrent CDI in the univariant analysis CONCLUSIONS: Liver transplant recipients presented the highest incidence of CDI among SOT recipients. Risk factors for CDI were hospitalization in the previous 3 months and the use of quinolones in the previous month.
Asunto(s)
Clostridioides difficile , Infecciones por Clostridium , Trasplante de Órganos , Adulto , Anciano , Estudios de Casos y Controles , Clostridioides , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/epidemiología , Diarrea , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Órganos/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Receptores de TrasplantesRESUMEN
OBJETIVOS: Describir la epidemiologia de las Enterobacterias portadoras de carbapenemasas (EPC) en un hospital de tercer nivel. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo, se incluyeron todos los pacientes con muestra positiva para EPC atendidos en hospitalización o en el servicio de Urgencias, entre el 1 Enero de 2014 y el 31 de Diciembre de 2016. RESULTADOS: Se incluyeron 272 pacientes (316 muestras): 155 (57%) varones. Media de edad de 70,4 años (IC 95% 68,2-72,7). Media del índice de Charlson 3,6 (IC95% 3,4-3,8). En el 63,2% la adquisición fue nosocomial, en el 35,3% fue asociada a cuidados sanitarios (ACS). Presentaron infección el 55,1%, siendo la más frecuente la infección del tracto urinario (ITU) (58,7%). Las especies más frecuentes fueron Klebsiella pneumoniae (62,7%) y Enterobacter cloacae (10,1%). Los tipos de carbapenemasa más frecuente fueron OXA-48 (53,8%) y VIM (43%). La adquisición nosocomial se asoció con el género masculino, trasplante, inmunosupresión, ingreso en Unidad de Cuidados Intensivos (UCI) o Servicio Quirúrgico, tratamiento antibiótico previo, Enterobacter, VIM, infecciones respiratorias e intraabdominales. La adquisición ACS se asoció con mayor edad y comorbilidad, procedencia de residencia, sondaje vesical, mayor número de procedimientos ambulatorios, ingreso hospitalario previo, K. pneumoniae y E. coli, OXA-48, coproducción de betalactamasas de espectro extendido, ITU y sepsis. CONCLUSIONES: Los pacientes que adquieren la EPC en residencias presentan frecuentemente infección. Los pacientes con adquisición nosocomial se colonizan por EPC en la UCI, en relación a procedimientos invasivos y trasplante. Esta población presenta mayor mortalidad por desarrollar infecciones respiratorias por EPC
OBJECTIVE: To describe the epidemiology of Enterobacterales producing carbapenemases (EPC) in a tertiary hospital. MATERIAL AND METHODS: A retrospective observational study, all patients with a positive sample for EPC treated in hospitalization or in the Emergency Department were included, between January 1, 2014 and December 31, 2016. RESULTS: A total of 272 patients (316 samples) were included: 155 (57%) male. Mean age of 70.4 years (95% CI 68.2 -72.7). Mean Charlson index was 3.6 (95% CI 3.4-3.8). In 63.2% the acquisition was nosocomial, in 35.3% it was health-care associated (HA). 55.1% presented infection, the most frequent infection was urinary tract infection (UTI) (58.7%). The most frequent species were Klebsiella pneumoniae (62.7%) and Enterobacter cloacae (10.1%). The most frequent types of carbapenemase were OXA-48 (53.8%) and VIM (43%). The nosocomial acquisition was associated with the male gender, transplantation, immunosuppression, admission to the Intensive Care Unit (ICU) or surgical service, prior antibiotic treatment, Enterobacter, VIM, respiratory and intra-abdominal infections. The HA acquisition was associated with age and comorbidity, nursery home origin, bladder catheterization, greater number of outpatient procedures, previous hospital admission, K. pneumoniae and E. coli, OXA-48, coproduction of extended spectrum betalactamases, UTI and sepsis. CONCLUSIONS: Patients who acquire EPC in nursery homes frequently have an infection. Patients with nosocomial acquisition are colonized by EPC in the ICU, in relation to invasive procedures and transplantation. This population has a higher mortality due to developing respiratory infections by EPC
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Inmunoglobulina G/sangre , Sarampión/inmunología , Virus del Sarampión/inmunología , Factores de Edad , Estudios Transversales , Modelos Logísticos , Oportunidad Relativa , Estudios Seroepidemiológicos , Factores Sexuales , EspañaRESUMEN
Introducción y objetivos: El uso de dispositivos cardiacos implantables (DCI) se ha expandido en los últimos años. La infección relacionada con estos dispositivos es una de las principales complicaciones y se asocia con grandes morbilidad, mortalidad y costes. El objetivo del estudio es construir una puntuación predictiva del riesgo de infección del DCI. Métodos: Se diseñó un estudio retrospectivo de casos y controles anidado. Tanto los casos como los controles pertenecían a una cohorte que incluía a todos los pacientes sometidos a un procedimiento relacionado con un DCI entre enero de 2009 y diciembre de 2015. Los casos se definieron como pacientes con infección, y se seleccionó aleatoriamente a 3 controles de la cohorte por cada caso incluido. Resultados: Durante el periodo de estudio, se realizaron 2.323 procedimientos. Se identificaron en total 33 infecciones relacionadas con el DCI. Se seleccionó como controles a 99 pacientes. Se identificaron como factores de riesgo independientes el índice de Charlson (OR=1,33; IC95%, 1,07-1,67), la anticoagulación oral (OR=3,51; IC95%, 1,44-8,54), la revisión o el reemplazo de un dispositivo anterior (OR=2,75; IC95%, 1,12-6,71) y la presencia de más de 2 cables (OR=3,42; IC95%, 1,25-9,37). Se generó una escala de riesgo predictivo y se denominó CIED-AI (índice de Charlson, más de 2 cables/electrodos, revisión/reemplazo del dispositivo, anticoagulación oral, infección previa). Esta puntuación presentó un área bajo la curva receiver operating characteristic de 0,79 (IC95%, 0,71-0,88). Conclusiones: La puntuación CIED-AI puede ayudar a identificar a los pacientes con mayor riesgo de infección que serían candidatos a medidas de prevención intensivas
Introduction and objectives: The use of cardiac implantable electronic devices (CIEDs) has expanded in recent years. Infection related to these devices constitutes one of the main complications and is associated with high morbidity, mortality, and financial cost. The aim of this study was to construct a predictive risk score of acquiring CIED infection. Methods: We designed a retrospective, nested case-control study. Both cases and controls belonged to a cohort that included all patients who underwent a CIED-related procedure between January 2009 and December 2015. Cases were defined as patients with infection, and 3 infection-free controls were randomly selected from the cohort for each case included. Results: During the study period, 2323 procedures were performed. A total of 33 CIED-related infections were identified. Ninety-nine patients were selected as controls. Independent risk factors were the Charlson index (OR, 1.33; 95%CI, 1.07-1.67), oral anticoagulation (OR, 3.51; 95%CI, 1.44-8.54), revision or replacement of a previous device (OR, 2.75; 95%CI, 1.12-6.71) and the presence of more than 2 leads (OR, 3.42; 95%CI, 1.25-9.37). A predictive risk score was generated and denominated CIED-AI (Charlson Index, more than 2 leads/Electrodes, Device revision/replacement, oral Anticoagulation, previous Infection). This score had an area under the receiver operating characteristic curve of 0.79 (95%CI, 0.71-0.88). Conclusions: The CIED-AI score may help to identify patients at higher risk of infection, who could be candidates for intensive preventive measures
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Corazón Auxiliar/efectos adversos , Infecciones Relacionadas con Prótesis/prevención & control , Ajuste de Riesgo/métodos , Factores de Riesgo , Endocarditis Bacteriana/complicaciones , Stents Liberadores de Fármacos/estadística & datos numéricos , Profilaxis Antibiótica/métodos , Estudios Retrospectivos , Estudios de Casos y Controles , Valor Predictivo de las PruebasRESUMEN
INTRODUCTION AND OBJECTIVES: The use of cardiac implantable electronic devices (CIEDs) has expanded in recent years. Infection related to these devices constitutes one of the main complications and is associated with high morbidity, mortality, and financial cost. The aim of this study was to construct a predictive risk score of acquiring CIED infection. METHODS: We designed a retrospective, nested case-control study. Both cases and controls belonged to a cohort that included all patients who underwent a CIED-related procedure between January 2009 and December 2015. Cases were defined as patients with infection, and 3 infection-free controls were randomly selected from the cohort for each case included. RESULTS: During the study period, 2323 procedures were performed. A total of 33 CIED-related infections were identified. Ninety-nine patients were selected as controls. Independent risk factors were the Charlson index (OR, 1.33; 95%CI, 1.07-1.67), oral anticoagulation (OR, 3.51; 95%CI, 1.44-8.54), revision or replacement of a previous device (OR, 2.75; 95%CI, 1.12-6.71) and the presence of more than 2 leads (OR, 3.42; 95%CI, 1.25-9.37). A predictive risk score was generated and denominated CIED-AI (Charlson Index, more than 2 leads/Electrodes, Device revision/replacement, oral Anticoagulation, previous Infection). This score had an area under the receiver operating characteristic curve of 0.79 (95%CI, 0.71-0.88). CONCLUSIONS: The CIED-AI score may help to identify patients at higher risk of infection, who could be candidates for intensive preventive measures.
Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Desfibriladores Implantables/efectos adversos , Ecocardiografía Transesofágica/métodos , Marcapaso Artificial/efectos adversos , Infecciones Relacionadas con Prótesis/diagnóstico , Medición de Riesgo/métodos , Anciano , Arritmias Cardíacas/terapia , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/prevención & control , Estudios Retrospectivos , Factores de Riesgo , España/epidemiologíaRESUMEN
Background: Clinical features of Clostridium difficile infection (CDI) cases diagnosed by detection of polymerase chain reaction (PCR), with negative toxin enzyme immunoassay results (EIA) have not been fully elucidated. The purpose of this study was to determine the magnitude of CDI patients who had negative EIA toxin determinations but positive PCR tests, and their differences in clinical presentation. Methods: We performed a retrospective study comparing the clinical features of CDI cases detected by EIA (toxins A + B) with cases detected by PCR (toxin negative, PCR positive) over a 16-month period. Only patients with an initial Clostridium difficile infection episode that fulfilled a standardized definition were included. Results: During the study period, 107 episodes of CDI were detected. Seventy-four patients (69%) had positive glutamate dehydrogenase (GDH) antigen and EIA determinations (EIA positive patients). Thirty-three patients (31%) had GDH positive, negative toxin EIA and positive PCR determination (PCR positive patients). PCR positive patients were younger, 57 (27) years (mean [SD]), than EIA positive patients, 71 (16) years, (p < 0.001). Fewer PCR positive patients were receiving proton pump inhibitors (21 patients, 64%) than EIA positive patients (61 patients, 82%, p = 0.034). The clinical presentation was similar in both groups. In the multivariate analysis, lower age was identified as the only independent variable associated with PCR positive patients. Conclusions: One third of Clostridium difficile infection patients present negative toxin EIA and PCR positive tests. Performing PCR determination after the negative EIA test is more relevant in younger patients (AU)
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Clostridioides difficile/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Reacción en Cadena de la Polimerasa , Diarrea/inducido químicamente , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Bombas de Protones/uso terapéutico , Estudios Retrospectivos , Glutamato Deshidrogenasa/análisis , Clostridioides difficile/patogenicidad , Enterocolitis Seudomembranosa/microbiología , Enterocolitis Seudomembranosa/patología , Fiebre/complicaciones , Análisis MultivarianteRESUMEN
BACKGROUND: Clinical features of Clostridium difficile infection (CDI) cases diagnosed by detection of polymerase chain reaction (PCR), with negative toxin enzyme immunoassay results (EIA) have not been fully elucidated. The purpose of this study was to determine the magnitude of CDI patients who had negative EIA toxin determinations but positive PCR tests, and their differences in clinical presentation. METHODS: We performed a retrospective study comparing the clinical features of CDI cases detected by EIA (toxins A + B) with cases detected by PCR (toxin negative, PCR positive) over a 16-month period. Only patients with an initial Clostridium difficile infection episode that fulfilled a standardized definition were included. RESULTS: During the study period, 107 episodes of CDI were detected. Seventy-four patients (69%) had positive glutamate dehydrogenase (GDH) antigen and EIA determinations (EIA positive patients). Thirty-three patients (31%) had GDH positive, negative toxin EIA and positive PCR determination (PCR positive patients). PCR positive patients were younger, 57 (27) years (mean [SD]), than EIA positive patients, 71 (16) years, (p < 0.001). Fewer PCR positive patients were receiving proton pump inhibitors (21 patients, 64%) than EIA positive patients (61 patients, 82%, p = 0.034). The clinical presentation was similar in both groups. In the multivariate analysis, lower age was identified as the only independent variable associated with PCR positive patients. CONCLUSIONS: One third of Clostridium difficile infection patients present negative toxin EIA and PCR positive tests. Performing PCR determination after the negative EIA test is more relevant in younger patients.
Asunto(s)
Clostridioides difficile , Enterocolitis Seudomembranosa/diagnóstico , Adulto , Anciano , Pruebas Diagnósticas de Rutina , Diarrea/etiología , Femenino , Glutamato Deshidrogenasa/sangre , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Estudios RetrospectivosRESUMEN
BACKGROUND: Despite the growing incidence of Clostridium difficile diarrhea (CCD) in patients with inflammatory bowel disease (IBD), little is known about the associated risk factors. METHOD: A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD. RESULTS: Three cases (20%) with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22). Ten cases (67%) received treatment with proton pump inhibitors (PPIs) versus 2 (13%) in the control group (IBD without CCD, p = 0.001). Seven cases underwent colonoscopy and pseudomembranes were seen in one (14%). Fourteen (93%) patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years), a higher degree of community-acquired infection (13 patients, 87%), immunosuppressive treatment (7 patients, 47%) and less patients had received previous antibiotic treatment (3 patients, 20%) than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66% and 80%, respectively p = 0.266). CONCLUSIONS: CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial) and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable.
Asunto(s)
Clostridioides difficile , Diarrea/microbiología , Enterocolitis Seudomembranosa/microbiología , Enfermedades Inflamatorias del Intestino/microbiología , Adulto , Factores de Edad , Infecciones Comunitarias Adquiridas , Infección Hospitalaria , Diarrea/tratamiento farmacológico , Diarrea/etiología , Enterocolitis Seudomembranosa/complicaciones , Enterocolitis Seudomembranosa/tratamiento farmacológico , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Inhibidores de la Bomba de Protones/uso terapéutico , Factores de RiesgoRESUMEN
INTRODUCCIÓN: a pesar de la incidencia creciente de diarrea por Clostridium difficile (DCD) en pacientes con enfermedad inflamatoria intestinal (EII) disponemos de un conocimiento limitado de factores de riesgo. MÉTODO: estudio retrospectivo comparando casos de DCD en pacientes con EEI con pacientes portadores de EEI que no desarrollaron DCD. También se realizó una comparación con pacientes que desarrollaron DCD, pero que no padecían EII. RESULTADOS: tres casos (20 %) con EII y DCD habían recibido antibióticos durante los tres meses previos frente a ninguno de los controles (EEI sin DCD, p = 0,22). Diez casos (67 %) estaban recibiendo tratamiento con un inhibidor de la bomba de protones (IBP) frente a dos (13 %) entre los controles (EEI sin DCD, p = 0,001). Se visualizaron pseudomembranas en uno (14 %) de los siete casos en los que se hizo colonoscopia. Hubo respuesta favorable a metronidazol en 14 pacientes (93 %). Los pacientes con EEI y DCD presentaron menor edad (36 ± 10 años), mayor grado de adquisición comunitaria de la infección (13 pacientes, 87 %) y tratamiento inmunosupresor (7 pacientes, 47 %) junto a menos pacientes con tratamiento antibiótico previo (3 pacientes, 20 %) que los pacientes con DCD pero sin EII. La proporción de pacientes que recibían tratamiento con un IBP era similar (66 % y 80 %, respectivamente; p = 0,266). CONCLUSIONES: los casos de DCD en portadores de EEI se caracterizan por afectar a pacientes más jóvenes, mayoritaria adquisición comunitaria (y menor nosocomial), guardar más relación con el tratamiento previo con IBP que con el tratamiento antibiótico y presentar evolución clínica favorable
BACKGROUND: Despite the growing incidence of Clostridium difficile diarrhea (CCD) in patients with inflammatory bowel disease (IBD), little is known about the associated risk factors. METHOD: A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD. RESULTS: Three cases (20 %) with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22). Ten cases (67 %) received treatment with proton pump inhibitors (PPIs) versus 2 (13 %) in the control group (IBD without CCD, p = 0.001). Seven cases underwent colonoscopy and pseudomembranes were seen in ne (14 %). Fourteen (93 %) patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years), a higher degree of communityacquired infection (13 patients, 87 %), immunosuppressive treatment (7 patients, 47 %) and less patients had received previous antibiotic treatment (3 patients, 20 %) than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66 % and 80 %, respectively p = 0.266). CONCLUSIONS: CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial) and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable
Asunto(s)
Humanos , Masculino , Femenino , Clostridioides difficile/aislamiento & purificación , Factores de Riesgo , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/diagnóstico , Enfermedades Inflamatorias del Intestino/microbiología , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Diarrea/complicaciones , Diarrea/diagnóstico , Diarrea/microbiología , Colonoscopía , Metronidazol/uso terapéutico , Estudios Retrospectivos , Prednisona/uso terapéutico , Inmunosupresores/uso terapéuticoRESUMEN
La afectación del intestino delgado por Clostridium difficile constituye una entidad clínica infrecuente.MétodoSe presenta el primer caso de enteritis por C. difficile diagnosticado en España y se realiza una revisión de la literatura médica.ResultadosVarón de 30 años de edad intervenido por recidiva de un tumor germinal retroperitoneal. Siete días después presentó vómitos, diarrea y, finalmente, obstrucción intestinal por seudomembranas originadas por enteritis por C. difficile. En la literatura médica han sido descritos otros 57 casos de enteritis por C. difficile. La edad media era de 52±17 años con un rango desde 18 a 86 años. Veintinueve pacientes (50%) presentaban enfermedad inflamatoria intestinal. Cuarenta y siete (81%) tenían antecedentes de cirugía de colon o intestino delgado. La mortalidad fue más acusada en pacientes de mayor edad y en los que no presentaban enfermedad inflamatoria intestinal.ConclusiónLa enteritis por C. difficile se caracteriza por su elevada gravedad y morta(AU)
A 30-year-old man underwent surgery for recurrence of a retroperitoneal germ cell tumor. Seven days later the patient developed vomiting, diarrhea and, finally, intestinal obstruction due to pseudomembranes caused by CDE. Only 57 cases of CDE have been reported in the literature. The mean age was 52±17 years with a range of 18 to 86 years. Twenty-nine patients (50%) had inflammatory bowel disease. Forty-seven (81%) had a history of colon or small intestine surgery. Mortality was higher in older patients and in those without inflammatory bowel disease (AU)
Asunto(s)
Humanos , Masculino , Adulto , Clostridioides difficile/patogenicidad , Enterocolitis Seudomembranosa/diagnóstico , Enfermedades Inflamatorias del Intestino/complicaciones , Insuficiencia Multiorgánica/fisiopatologíaRESUMEN
INTRODUCTION: Clostridium difficile infection of the small intestine is infrequent. METHOD: We present the first case of C. difficile enteritis (CDE) diagnosed in Spain and provide a review of the literature. RESULTS: A 30-year-old man underwent surgery for recurrence of a retroperitoneal germ cell tumor. Seven days later the patient developed vomiting, diarrhea and, finally, intestinal obstruction due to pseudomembranes caused by CDE. Only 57 cases of CDE have been reported in the literature. The mean age was 52±17 years with a range of 18 to 86 years. Twenty-nine patients (50%) had inflammatory bowel disease. Forty-seven (81%) had a history of colon or small intestine surgery. Mortality was higher in older patients and in those without inflammatory bowel disease. CONCLUSION: CDE is characterized by high severity and mortality.
Asunto(s)
Clostridioides difficile/aislamiento & purificación , Enteritis/microbiología , Enterocolitis Seudomembranosa/diagnóstico , Infecciones Oportunistas/microbiología , Complicaciones Posoperatorias/microbiología , Adulto , Antibacterianos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bleomicina/administración & dosificación , Bleomicina/efectos adversos , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Terapia Combinada , Enteritis/diagnóstico , Enteritis/tratamiento farmacológico , Enteritis/cirugía , Enterocolitis Seudomembranosa/epidemiología , Enterocolitis Seudomembranosa/microbiología , Enterocolitis Seudomembranosa/cirugía , Etopósido/administración & dosificación , Etopósido/efectos adversos , Gastrostomía , Humanos , Ileostomía , Obstrucción Intestinal/etiología , Masculino , Insuficiencia Multiorgánica/etiología , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias de Células Germinales y Embrionarias/secundario , Neoplasias de Células Germinales y Embrionarias/cirugía , Nefrectomía , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/cirugía , Orquiectomía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , España/epidemiología , Sobreinfección , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/patología , Neoplasias Testiculares/cirugíaAsunto(s)
Emigración e Inmigración , Infecciones por VIH/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , África/etnología , Recuento de Linfocito CD4 , América Central/etnología , Estudios de Cohortes , Comorbilidad , Europa (Continente)/etnología , Femenino , Humanos , Masculino , Filipinas/etnología , Estudios Retrospectivos , Factores de Riesgo , Enfermedades de Transmisión Sexual/epidemiología , América del Sur/etnología , España/epidemiologíaRESUMEN
No disponible