Infección urinaria por enterococos: Factores de riesgo y mortalidad. Estudio observacional / Urinary tract infection caused by Enterococcus spp.: risk factors and mortality. An observational study

Antecedentes y objetivo Los enterococos son una causa frecuente de infecciones del tracto urinario (ITU). Este trabajo pretende definir los factores de riesgo asociados con las ITU causadas por enterococos y determinar su mortalidad global y los factores de riesgo predictivos. Materiales y métodos Se llevó a cabo un estudio retrospectivo sobre las ITU bacteriémicas por enterococos en pacientes hospitalizados. Se compararon 106 sujetos hospitalizados por ITU bacteriémicas por enterococos con una muestra aleatoria de 100 pacientes hospitalizados por ITU bacteriémicas por otras enterobacterias. Resultados Se analizó un total de 106 sujetos hospitalizados por ITU por enterococos, 51 de ellos con hemocultivos positivos concomitantes. La distribución por especies fue: 83% por Enterococcus faecalis (E. faecalis) y 17% por Enterococcus faecium (E. faecium). La puntuación media en el índice de comorbilidad de Charlson fue de 5,9 ± 2,9. Al comparar las ITU bacteriémicas por enterococos con las causadas por otras enterobacterias se identificaron los siguientes factores predictivos independientes de ITU bacteriémicas por enterococos: sexo masculino, uropatía obstructiva, infección nosocomial, cánceres de vías urinarias y tratamiento antibiótico previo. En conjunto, la mortalidad hospitalaria fue del 16,5% y se asoció con una mayor puntuación de la escala para la evaluación del daño orgánico secuencial (SOFA) (> 4), a enfermedades concomitantes graves, como inmunodepresión, hemopatía maligna y nefrostomía, y a la especie E. faecium y su patrón de resistencia a la ampicilina o la vancomicina (p < 0,05). Un tratamiento antibiótico empírico adecuado no se relacionó con un mejor pronóstico (p > 0,05). Conclusiones Los enterococos son una causa frecuente de ITU complicadas en pacientes con factores de riesgo. La elevada mortalidad vinculada con la severidad de la infección y el grado de comorbilidad podrían justificar un tratamiento empírico en pacientes de riesgo (AU)

Background and objective Urinary tract infections (UTIs) are frequently caused by Enterococcus spp. This work aims to define the risk factors associated with UTIs caused by Enterococci and to determine its overall mortality and predictive risk factors. Materials and methods A retrospective study was conducted on bacteremic UTIs caused by Enterococcus spp. among inpatients. We compared 106 inpatients with bacteremic UTIs caused by Enterococcus spp. vs. a random sample of 100 inpatients with bacteremic UTIs caused by other enterobacteria. Results A total of 106 inpatients with UTIs caused by Enterococcus spp. were analyzed, 51 of whom had concomitant positive blood cultures. Distribution by species was 83% E. faecalis and 17% E. faecium. The mean Charlson Comorbidity Index score was 5.9 ± 2.9. Upon comparing bacteremic UTIs caused by Enterococcus spp. vs. bacteremic UTIs caused by others enterobacteria, we found the following independent predictors of bacteremic UTI by Enterococcus: male sex, obstructive uropathy, nosocomial infection, cancers of the urinary system, and previous antimicrobial treatment. Overall, inpatient mortality was 16.5% and was associated with a higher Sequential Organ Failure Assessment (SOFA) score (>4); severe comorbidities such as immunosuppression, malignant hemopathy, and nephrostomy; and Enterococcus faecium species and its pattern of resistance to ampicillin or vancomycin (p< 0.05). Appropriate empiric antibiotic therapy was not associated with a better prognosis (p >0.05). Conclusions Enterococcus spp. is a frequent cause of complicated UTI in patients with risk factors. High mortality secondary to a severe clinical condition and high comorbidity may be sufficient for justifying the implementation of empiric treatment of at-risk patients (AU)

Urinary tract infection caused by Enterococcus spp.: Risk factors and mortality. An observational study.

BACKGROUND AND OBJECTIVE: Urinary tract infections (UTIs) are frequently caused by Enterococcus spp. This work aims to define the risk factors associated with UTIs caused by Enterococci and to determine its overall mortality and predictive risk factors. MATERIALS AND METHODS: A retrospective study was conducted on bacteremic UTIs caused by Enterococcus spp. among inpatients. We compared 106 inpatients with bacteremic UTIs caused by Enterococcus spp. vs. a random sample of 100 inpatients with bacteremic UTIs caused by other enterobacteria. RESULTS: A total of 106 inpatients with UTIs caused by Enterococcus spp. were analyzed, 51 of whom had concomitant positive blood cultures. Distribution by species was 83% E. faecalis and 17% E. faecium. The mean Charlson Comorbidity Index score was 5.9±2.9. Upon comparing bacteremic UTIs caused by Enterococcus spp. vs. bacteremic UTIs caused by others enterobacteria, we found the following independent predictors of bacteremic UTI by Enterococcus: male sex, obstructive uropathy, nosocomial infection, cancers of the urinary system, and previous antimicrobial treatment. Overall, inpatient mortality was 16.5% and was associated with a higher Sequential Organ Failure Assessment (SOFA) score (>4); severe comorbidities such as immunosuppression, malignant hemopathy, and nephrostomy; and Enterococcus faecium species and its pattern of resistance to ampicillin or vancomycin (p<0.05). Appropriate empiric antibiotic therapy was not associated with a better prognosis (p>0.05). CONCLUSIONS: Enterococcus spp. is a frequent cause of complicated UTI in patients with risk factors. High mortality secondary to a severe clinical condition and high comorbidity may be sufficient for justifying the implementation of empiric treatment of at-risk patients.

Is cystic echinoccocosis re-emerging in western Spain?

Cystic echinococcosis (CE) remains an important health problem in many areas of the world, including the Mediterranean region. We performed a retrospective study of cases reported from 1998 to 2012 in order to review and update the epidemiology of this disease in a highly endemic area situated in western Spain. A total of 471 patients were diagnosed with hydatid disease. Of these cases, 55·8% were male, with an average age of 62·3 ± 19·5 years. More importantly, 1·5% of patients were children, and 20·5% were aged <45 years. An active therapeutic approach was implemented for 92·6% of the CE patients with primary diagnoses; however, a 'watch and wait' strategy was used in 59·3% of all secondary CE diagnoses. The incidence rate of hydatid disease was significantly higher compared to the incidence described in the Notifiable Disease System in this area. Furthermore, a significant decrease in hydatid incidence during the years included in the study was observed (ß = -0·4357, P < 0·001). CE incidence has diminished in recent years, although active transmission remains in paediatric cases. Additionally, CE incidence remains high in our region despite public health plans for its control. The documented incidence of CE disease clearly underestimates the real numbers.

Fiebre tras apendicectomía / Fever secondary to appendicectomy

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