The hidden side of infective endocarditis: Diagnostic and management of 500 consecutive cases in noncardiac surgery centers (2009-2018).

BACKGROUND: We aimed to describe infective endocarditis cases from noncardiac surgery centers, as current knowledge on infective endocarditis is derived mostly from cardiac surgery hospitals. METHODS: An observational retrospective study (2009-2018) was conducted in 9 noncardiac surgery hospitals in Central Catalonia. All adult patients diagnosed with definitive infective endocarditis were included. Transferred and nontransferred cohorts were compared, and a logistic regression model was used to ascertain the prognostic factors. RESULTS: Overall, 502 infective endocarditis episodes were included: 183 (36.5%) were transferred to the cardiac surgery center, whereas 319 were not, with (18.7%) and without (45%) surgical indications. Cardiac surgery was performed in 83% of transferred patients. In-hospital (14% vs 23%) and 1-year (20% vs 35%) mortality rates were significantly lower in transferred patients (P < .001). Among the patients not undergoing cardiac surgery despite an indication, 55 (54%) died within 1 year. The multivariate analysis identified the following independent predictive factors for in-hospital mortality: Staphylococcus aureus infective endocarditis (odds ratio: 1.93 [1.08, 3.47]), heart failure (odds ratio: 3.87 [2.28, 6.57]), central nervous system embolism (odds ratio: 2.95 [1.41, 5.14]), and Charlson score (odds ratio: 1.19 [1.09, 1.30]), whereas community acquisition (odds ratio: 0.52 [0.29, 0.93]), cardiac surgery (odds ratio: 0.42 [0.20, 0.87]), but not transfer (odds ratio: 1.23 [0.84, 3.95]) were identified as protective factors. One-year mortality was associated with S. aureus infective endocarditis (odds ratio: 1.82 [1.04, 3.18]), heart failure (odds ratio: 3.74 [2.27, 6.16]), and Charlson score (odds ratio: 1.23 [1.13, 1.33]), whereas cardiac surgery (odds ratio: 0.41 [0.21, 0.79]) was identified as a protective factor. CONCLUSION: Patients not transferred to a referral cardiac surgery center have a worse prognosis compared to those ultimately transferred, as cardiac surgery is associated with lower mortality rates.

[Clinical-epidemiological characteristics and antiretroviral treatment trends in a cohort of HIV infected patients. The PISCIS Project]. / Características clinicoepidemiológicas y tendencias en el tratamiento antirretroviral de una cohorte de pacientes con infección por el virus de la inmunodeficiencia humana. Cohorte PISCIS.

BACKGROUND AND OBJECTIVE: The aims of this study were to describe the process of implementation of the PISCIS cohort, and to describe the clinical and epidemiological characteristics and trends of antiretroviral treatment (ART) among patients enrolled from 1998 through 2003. PATIENTS AND METHOD: Prospective cohort study of HIV-infected patients aged > or = 16 years newly attended in 10 Catalonian hospitals and one Balearic Islands hospital. Analysis were done using the Mantel's chi2 test for trend. RESULTS: A total of 5,968 patients (mean age 39 yrs; 75% men) were recruited with a mean follow-up of 26.4 months (13,130 person-years). A total of 2,763 patients were newly diagnosed and among these, the most frequent transmission route was the heterosexual one (43%), followed by homosexual (31%). We observed an increasing trend in the proportion of persons < 35 years and immigrants. Among newly diagnosed, 43% had < 200 CD4 T cells/microl in the nearest determination from HIV diagnosis. In the year 2003, 83% of patients were on ART. A decrease of the protease inhibitor-based regimen (from 85% in 1998 to 25% in 2003; p < 0.001) and an increase of nucleoside and non-nucleoside analogue reverse transcriptase inhibitors-containing regimens were observed over time among naive patients who started ART with three or more drugs. CONCLUSIONS: HIV infected patients' cohorts are feasible in our setting and are an important tool in clinical and public health. The heterosexual route of transmission was the most frequent among newly diagnosed patients. The diagnosis delay is high and, on the other hand, ARV regimens have been changing according to the recommended guidelines.

Características clinicoepidemiológicas y tendencias en el tratamiento antirretroviral de una cohorte de pacientes con infección por el virus de la inmunodeficiencia humana. Cohorte PISCIS / Clinical-epidemiological characteristics and antiretroviral treatment trends in a cohort of HIV infected patients. The PISCIS Project

FUNDAMENTO Y OBJETIVO: Los objetivos de este estudio fueron describir el proceso de implementación de la cohorte PISCIS y las características clínico epidemiológicas y las tendencias en el tratamiento antirretroviral (TARV) de los pacientes con infección por el virus de la inmunodeficiencia humana (VIH) incluidos desde 1998 hasta 2003.PACIENTES Y MÉTODO: Estudio de cohorte prospectivo de pacientes con infección por el VIH de 16 años de edad o mayores atendidos en primera visita en 10 hospitales de Cataluña y uno de las Baleares. El análisis estadístico de las tendencias se realizó mediante el test de la χ2 de Mantel. RESULTADOS: Se incluyó a un total de 5.968 pacientes (edad media: 39,5 años; 75% varones) con un tiempo medio de seguimiento de 26,4 meses (13.130 personas-año). Del total, 2.763 fueron nuevos diagnósticos, en los que la vía de transmisión más frecuente fue la heterosexual (43%), seguida de la homosexual (31%). Se observó una tendencia significativamente creciente en la proporción de sujetos de edad inferior a 35 años e inmigrantes. Un 43% tenían una cifra de linfocitos CD4 inferior a 200 células/µl en la determinación más cercana al diagnóstico de la infección por el VIH. Del total, un 87% estaban en TARV en el año 2003. Entre los pacientes no tratados previamente que iniciaron pautas de TARV con 3 o más fármacos, se observó una disminución de las pautas que incluían inhibidores de la proteasa (del 85% en 1998 al 25% en 2003; p < 0,001), mientras que aumentaron otras que contenían inhibidores de la transcriptasa inversa no análogos y análogos de los nucleósidos. CONCLUSIONES: Las cohortes de pacientes con infección por el VIH son viables en nuestro medio y tienen gran utilidad clínica y en salud pública. La vía de transmisión más frecuente entre los nuevos diagnósticos es la heterosexual, el retraso en el diagnóstico es elevado y las pautas de TARV han ido cambiando para adaptarsea las recomendadas por las guías

BACKGROUND AND OBJECTIVE: The aims of this study were to describe the process of implementation of the PISCIS cohort, and to describe the clinical and epidemiological characteristics and trends of antiretroviral treatment(ART) among patients enrolled from 1998 through 2003.PATIENTS AND METHOD: Prospective cohort study of HIV-infected patients aged ≥ 16 years newly attended in 10Catalonian hospitals and one Balearic Islands hospital. Analysis were done using the Mantel’s χ2 test for trend. RESULTS: A total of 5,968 patients (mean age 39 yrs; 75% men) were recruited with a mean follow-up of 26.4months (13,130 person-years). A total of 2,763 patients were newly diagnosed and among these, the most frequent transmission route was the heterosexual one (43%), followed by homosexual (31%). We observed an increasing trend in the proportion of persons < 35 years and immigrants. Among newly diagnosed, 43% had <200 CD4 T cells/µl in the nearest determination from HIV diagnosis. In the year 2003, 83% of patients were on ART. A decrease of the protease inhibitor-based regimen (from 85% in 1998 to 25% in 2003; p < 0.001)and an increase of nucleoside and non-nucleoside analogue reverse transcriptase inhibitors-containing regimens were observed over time among naïve patients who started ART with three or more drugs. CONCLUSIONS: HIV infected patients’ cohorts are feasible in our setting and are an important tool in clinical and public health. The heterosexual route of transmission was the most frequent among newly diagnosed patients. The diagnosis delay is high and, on the other hand, ARV regimens have been changing according to the recommended guidelines