Analysis of viral pneumonia and risk factors associated with severity of influenza virus infection in hospitalized patients from 2012 to 2016.

BACKGROUND: Influenza viruses cause pneumonia in approximately one-third of cases, and pneumonia is an important cause of death. The aim was to identify risk factors associated with severity and those that could predict the development of pneumonia. METHODS: This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during four influenza seasons in Spain (October to May) from to 2012-2016. RESULTS: Overall, 666 patients with laboratory-confirmed influenza were included, 93 (14%) of which were severe; 73 (10.9%) were admitted to Intensive Care Unit (ICU), 39 (5.8%) died, and 185 (27.7%) developed pneumonia. Compared to less severe cases, patients with severe disease: were less vaccinated (40% vs. 28%, p = 0.021); presented with more confusion (26.9% vs. 6.8%), were more hypoxemic (Horowitz index (PaO2/FiO2) 261 vs. 280), had higher C-reactive protein (CRP) (12.3 vs. 4.0), had more coinfections (26.8% vs. 6.3%) and had more pleural effusion (14% vs. 2.6%) (last six all p < 0.001). Risk factors significantly associated with severity were pneumonia [OR (95% CI) = 4.14 (2.4-7.16)], history of heart disease (1.84, 1.03-3.28), and confusion at admission (4.99, 2.55-9.74). Influenza vaccination was protective (0.53, 0.28-0.98). Compared to those without pneumonia, the pneumonia group had higher CRP (11.3 vs. 4.0, p < 0.001), lower oxygen saturation (92% vs. 94%, p < 0.001), were more hypoxic (PaO2/FiO2 266 vs. 281, p < 0.001), and incurred more mechanical ventilation, septic shock, admission to the ICU, and deaths (all four p < 0.001). Higher CRP and lower oxygen saturation were independent variables for predicting the development of pneumonia. CONCLUSIONS: Pneumonia, history of heart disease, confusion and no influenza vaccination were independent variables to present complications in patients admitted with influenza infection.

Espondilitis infecciosa en Baleares: análisis de 51 casos / Infectious spondylitis in the Balearic Islands: An analysis of 51 cases

Introducción: La espondilitis infecciosa (EI) es una entidad poco frecuente cuya incidencia ha aumentado en los últimos años. El objetivo de este estudio ha sido describir los casos con EI y realizar una comparación con el resto de series publicadas. Material y métodos: Estudio retrospectivo donde se describen datos epidemiológicos, microbiológicos y clínicos de los pacientes diagnosticados de EI durante un periodo de 10 años (2004-2014) en 2 hospitales de Mallorca. Resultados: Se incluyó un total de 51 pacientes, con una edad mediana de 66 años (rango 22-85). El 72,5% (37/51) fueron varones. El tiempo medio transcurrido desde el inicio de la clínica hasta el diagnóstico fue de 80,1 ± 125,1 días. En 36 ocasiones (70,6%) el origen fue hematógeno. El factor predisponente más frecuente fue presentar bacteriemia previa (10 [43,5%] de origen urinario). Presentaron fiebre 35 pacientes (68,8%), dolor 32 (62,7%), radiculalgia 14 (27,5%) y parálisis/paresia 10 (19,6%). La prueba diagnóstica más utilizada fue la resonancia magnética (46 [90,2%]), resultando patológica en todos los casos. El microorganismo etiológico más frecuente fue Staphylococcus aureus (23 [52,3%]). Los hemocultivos resultaron positivos en 27/41 ocasiones (65,8%) y la punción percutánea en 11/22 (50%). Veintitrés pacientes (45,1%) desarrollaron abscesos paravertebrales, epidurales o del psoas, 7 (13,7%) déficits neurológicos residuales y 6 (11,8%) dolor crónico. Un paciente (1,9%) falleció por motivos relacionados con la infección. Conclusiones: La EI es poco frecuente. Su origen usualmente es hematógeno. La bacteriemia previa es el factor predisponente más importante. El diagnóstico es habitualmente tardío, siendo Staphylococcus aureus el germen implicado con mayor frecuencia. La realización de punciones percutáneas acompañando a los hemocultivos aumenta la rentabilidad diagnóstica (AU)

Introduction: Vertebral osteomyelitis (VO) is a rare entity, although its incidence has increased in recent years. The objective is to describe the patients with this infection in our environment and a comparison with other published series. Methods: A retrospective review was conducted of epidemiological, clinical, microbiological, treatment, complications and evolution data of patients with VO during 10 years (2004-2014) in two hospitals of Mallorca. Results: 51 cases, median age 66 (range 22-85) years, 37 (72.5%) men with a mean onset of symptoms of 80.1 ± 125.1 days. In thirty-six (70.6%) cases the origin of infection was considered hematogenous, although previous bacteremia was documented in 23 (45%) cases, being of urinary in 10 (43.5%) cases. Clinically at the moment of diagnosis 35 (68.8%) had fever, 32 (62.7%) pain, 14 (27.5%) irradiated nerve pain and 10 (19.6%) paralysis/paresia. MRI was the most performed radiological test 46 (90.2%), being pathological in all cases. S. aureus 23 (52.3%) was the most common microbiological isolates. At the moment of the diagnosis, blood cultures were positive in 27 (65.8%) of 41 cases and 11 (50%) of 22 percutaneous puncture was positive. Paraspinal, epidural or psoas abscesses were observed in 23 (45.1%), neurological deficit in 7 (13.7%) and chronic pain in 6 (11.8%). One patient (1.9%) died in relation with infection. Conclusions: Diagnosis was delayed in most cases. Previous bacteremia being main predisposing factor and hematogenous origin the main source of infection. S. aureus was the most isolated. Percutaneous puncture together with blood cultures increase etiologic diagnosis. A high percentage of patients had complications or sequelae (AU)

Infectious spondylitis in the Balearic Islands: An analysis of 51 cases. / Espondilitis infecciosa en Baleares: análisis de 51 casos.

INTRODUCTION: Vertebral osteomyelitis (VO) is a rare entity, although its incidence has increased in recent years. The objective is to describe the patients with this infection in our environment and a comparison with other published series. METHODS: A retrospective review was conducted of epidemiological, clinical, microbiological, treatment, complications and evolution data of patients with VO during 10 years (2004-2014) in two hospitals of Mallorca. RESULTS: 51 cases, median age 66 (range 22-85) years, 37 (72.5%) men with a mean onset of symptoms of 80.1 ± 125.1 days. In thirty-six (70.6%) cases the origin of infection was considered hematogenous, although previous bacteremia was documented in 23 (45%) cases, being of urinary in 10 (43.5%) cases. Clinically at the moment of diagnosis 35 (68.8%) had fever, 32 (62.7%) pain, 14 (27.5%) irradiated nerve pain and 10 (19.6%) paralysis/paresia. MRI was the most performed radiological test 46 (90.2%), being pathological in all cases. S. aureus 23 (52.3%) was the most common microbiological isolates. At the moment of the diagnosis, blood cultures were positive in 27 (65.8%) of 41 cases and 11 (50%) of 22 percutaneous puncture was positive. Paraspinal, epidural or psoas abscesses were observed in 23 (45.1%), neurological deficit in 7 (13.7%) and chronic pain in 6 (11.8%). One patient (1.9%) died in relation with infection. CONCLUSIONS: Diagnosis was delayed in most cases. Previous bacteremia being main predisposing factor and hematogenous origin the main source of infection. S. aureus was the most isolated. Percutaneous puncture together with blood cultures increase etiologic diagnosis. A high percentage of patients had complications or sequelae.

Candidiasis diseminada con afectación miocárdica / Disseminated candidiasis with myocardic affectation

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[Site of care provision, etiology and treatment of community-acquired pneumonia in Palma de Mallorca]. / Lugar de atención, etiología y tratamiento de las neumonías adquiridas en la comunidad de Palma de Mallorca.

BACKGROUND: It is not common that community-acquired pneumonias studies include patients non treated in hospital. The objectives were: to determine the cases managed in the ambulatory setting; to describe the clinical features; to identify the aetiological agents, and to describe the treatment, comparing inpatients with outpatients. PATIENTS AND METHODS: Observational prospective study. Population attended at three teaching primary care centers of Palma de Mallorca (60,450 habitants). Patients (> 14 years) were investigated when diagnosticated of community-acquired pneumoniae, from November 1992 to December 1994. Exclussions: HIV infection, patients living in a nursing home and tuberculosis. Data were collected in both Hospital and primary health care centers. Epidemiological, clinical, radiological and laboratory findings were recorded at the initial visit and 21 days after. RESULTS: 91 cases were investigated. 57% were managed at the primary care centers exclusively, 63.3% of the patients who went initially to the hospital were admitted in; but only 10.9% of those who went initially to the primary care centers (p < 0.005). 24 patients were hospitalized. 56 microbiological agents were identified in 48 patients (52.7%): Mycoplasma pneumoniae (10); Streptococcus pneumoniae (9); Influenza B (8); Chlamydia psittacci (7); Influenza A (7); Coxiella burnetii (5); Chlamydia pneumoniae (4); Legionella (3); Adenovirus (2); and Parainfluenza 3 (1). Mycoplasma was predominant in outpatients: 9 cases. S. pneumoniae in inpatients: 5 cases. Eritromycin was the most common treatment prescribed (76.9% of patients), alone or in combination with other antibiotics. Monotherapy was most common at primary care yield (96.7%) than at the hospital (45.2%) (p < 0.005). CONCLUSIONS: Most of the patients with community-acquired pneumonias are managed at primary health care centers. M. pneumoniae is the predominant microbiological agent in outpatients and S. pneumoniae in inpatients. Erithromycin is the most used antibiotic in both groups of patients.