[Carbapenem resistance in Pseudomonas aeruginosa isolated from urine cultures: prevalence and risk factors]. / Resistencia a carbapenemas en Pseudomonas aeruginosa aisladas en urocultivos: prevalencia y factores de riesgo.

OBJECTIVE: Pseudomonas aeruginosa is a non-fermentative gram-negative bacillus with a great ability to develop resistance to multiple antibiotics, including carbapenems, which is a growing problem worldwide. The aim of this study was to analyse the prevalence of carbapenem-resistant P. aeruginosa (CRPA) in urine cultures and to determine the risk factors associated with the development of carbapanem resistance. METHODS: Positive urine cultures to P. aeruginosa between September 2012 and September 2014 were identified. We excluded repetitive cultures from the same patient. We created a database with different variables, including antimicrobial resistance. The prevalence of carbapenem resistance and the risk factors for growth of CRPA were analysed. RESULTS: Ninety-one patients with positive urine cultures to P. aeruginosa were included. The prevalence of CRPA was 22%. The risk factors to CRPA infection in the univariate analysis were: congestive heart failure (p=0.02), previous treatment with ampicillin (p=0.04), meropenem (p=0.04), piperacillin-tazobactam (p=0.01), trimethoprim-sulfamethoxazole (p= 0.01) and previous treatment with more than one antibiotic (p<0.01). Only congestive heart failure (p<0.01) and previous treatment with more than one antibiotic (p<0.01) showed statistically significant differences in the multivariate analysis. CONCLUSIONS: The prevalence of CRPA in urine cultures is high in our population. We should assess the presence of risk factors as previous treatment with more than one antibiotic or comorbidities such as heart failure, in order to select an appropriate empirical treatment in patients with severe urinary tract infections.

Síndrome papular purpúrico en guante y calcetín / Papular purpuric gloves and socks syndrome

No disponible

Dabigatrán: experiencia en la práctica clínica habitual / Dabigatran: experience in standard clinical practice

Introducción y objetivos. Dabigatrán es un fármaco anticoagulante, inhibidor directo de la trombina, aprobado para la prevención de ictus isquémico secundario a fibrilación auricular no valvular. El objetivo de este estudio fue determinar la eficacia de dabigatrán en la práctica clínica para la prevención de eventos isquémicos cerebrales asociados a fibrilación auricular no valvular, así como su perfil de tolerancia y seguridad. Material y métodos. Estudio descriptivo y retrospectivo en el que se incluyó a todos los pacientes que iniciaron tratamiento anticoagulante con dabigatrán entre los meses de noviembre de 2011 y septiembre de 2012. Se realizó seguimiento desde el comienzo del tratamiento hasta junio de 2013. Se determinó la incidencia de eventos isquémicos de origen cerebral, cardíaco y periférico, así como la aparición de efectos adversos y complicaciones hemorrágicas, determinando su localización y gravedad. Resultados. Se analizó a 316 pacientes con una edad media de 76,46±8,37 años, de los que el 53,5% eran varones. Dos pacientes (0,55/100 pacientes-año) presentaron ictus isquémico (incluyendo una amaurosis fugax). Ocho (2,18/100 pacientes-año) tuvieron un evento adverso isquémico, que fue de origen cardíaco en 5 (1,36/100 pacientes-año) casos y periférico en 3 (0,81/100 pacientes-año). Cuarenta (10,91/100 pacientes-año) tuvieron una complicación hemorrágica: 32 hemorragias menores (8,73/100 pacientes-año) y 8 mayores (2,18/100 pacientes-año). Conclusiones. Dabigatrán en la práctica clínica habitual es eficaz en la prevención de ictus y presenta un perfil de seguridad similar al reportado en los ensayos clínicos (AU)

Introduction and objectives. Dabigatran is an anticoagulant drug and a direct thrombin inhibitor and has been approved for the prevention of ischaemic stroke secondary to nonvalvularauricular auricular fibrillation. The aim of this study was to determine the efficacy of dabigatran in clinical practice for preventing cerebral ischaemic events associated with nonvalvularauricular auricular fibrillation, as well as its tolerance and safety profile. Material and methods. A descriptive and retrospective study was conducted, which included all patients who started anticoagulant treatment with dabigatran between November 2011 and September 2012. Follow-up was performed from the start of treatment until June 2013. The incidence of ischaemic events of cerebral, cardiac and peripheral origin was recorded, as was the onset of adverse effects and haemorrhagic complications, whose location and severity were determined. Results. We analysed 316 patients, with a mean age of 76.46±8.37 years, of whom 53.5% were men. Two patients (0.55/100 patient-years) presented ischaemic stroke (including one amaurosis fugax). Eight (2.18/100 patient-years) patients had an adverse ischaemic event, whose origin was cardiac in 5 (1.36/100 patient-years) cases and peripheral in 3 (0.81/100 patient-years). Forty (10.91/100 patient-years) patients had a haemorrhagic complication: 32 minor (8.73/100 patient-years) and 8 major (2.18/100 patient-years) haemorrhages. Conclusions. Dabigatran is effective in standard clinical practice in preventing stroke and has a safety profile similar to that reported in the clinical trials (AU)

Dabigatran: Experience in standard clinical practice. / Dabigatrán: experiencia en la práctica clínica habitual.

INTRODUCTION AND OBJECTIVES: Dabigatran is an anticoagulant drug and a direct thrombin inhibitor and has been approved for the prevention of ischaemic stroke secondary to nonvalvularauricular auricular fibrillation. The aim of this study was to determine the efficacy of dabigatran in clinical practice for preventing cerebral ischaemic events associated with nonvalvularauricular auricular fibrillation, as well as its tolerance and safety profile. MATERIAL AND METHODS: A descriptive and retrospective study was conducted, which included all patients who started anticoagulant treatment with dabigatran between November 2011 and September 2012. Follow-up was performed from the start of treatment until June 2013. The incidence of ischaemic events of cerebral, cardiac and peripheral origin was recorded, as was the onset of adverse effects and haemorrhagic complications, whose location and severity were determined. RESULTS: We analysed 316 patients, with a mean age of 76.46±8.37 years, of whom 53.5% were men. Two patients (0.55/100 patient-years) presented ischaemic stroke (including one amaurosis fugax). Eight (2.18/100 patient-years) patients had an adverse ischaemic event, whose origin was cardiac in 5 (1.36/100 patient-years) cases and peripheral in 3 (0.81/100 patient-years). Forty (10.91/100 patient-years) patients had a haemorrhagic complication: 32 minor (8.73/100 patient-years) and 8 major (2.18/100 patient-years) haemorrhages. CONCLUSIONS: Dabigatran is effective in standard clinical practice in preventing stroke and has a safety profile similar to that reported in the clinical trials.