Mortality reduction in older COVID-19-patients hospitalized in Spain during the second pandemic wave from the SEMI-COVID-19 Registry.

In 2020, the COVID-19 pandemic followed a two-wave pattern in most countries. Hospital admission for COVID-19 in one wave or another could have affected mortality, especially among the older persons. The objective of this study was to evaluate whether the admission of older patients during the different waves, before SARS-CoV-2 vaccination was available, was associated with a different mortality. We compared the mortality rates of patients hospitalized during 2020 before (first wave) and after (second wave) July 7, 2020, included in the SEMI-COVID-19 Registry, a large, multicenter, retrospective cohort of patients admitted to 126 Spanish hospitals for COVID-19. A multivariate logistic regression analysis was performed to control for changes in either the patient or disease profile. As of December 26, 2022, 22,494 patients had been included (17,784 from the first wave and 4710 from the second one). Overall mortality was 20.4% in the first wave and 17.2% in the second wave (risk difference (RD) - 3.2%; 95% confidence interval (95% CI) - 4.4 to - 2.0). Only patients aged 70 and older (10,973 patients: 8571 in the first wave and 2386 in the second wave) had a significant reduction in mortality (RD - 7.6%; 95% CI - 9.7 to - 5.5) (unadjusted relative risk reduction: 21.6%). After adjusting for age, comorbidities, variables related to the severity of the disease, and treatment received, admission during the second wave remained a protective factor. In Spain, patients aged 70 years and older admitted during the second wave of the COVID-19 pandemic had a significantly lower risk of mortality, except in severely dependent persons in need of corticosteroid treatment. This effect is independent of patient characteristics, disease severity, or treatment received. This suggests a protective effect of a better standard of care, greater clinical expertise, or a lesser degree of healthcare system overload.

Influence of Sepsis on the Middle-Term Outcomes for Urinary Tract Infections in Elderly People.

Urinary tract infection (UTI) is a common condition that predominantly affects elderly people, who are particularly susceptible to developing sepsis. Previous studies have indicated a detrimental effect of sepsis on short-term outcomes in elderly patients with UTI, but there is a lack of data about the middle-term prognosis. The aim of this study was to investigate the influence of sepsis on the middle-term prognosis of patients aged 65 years or older with complicated community-acquired UTIs. A prospective observational study of patients admitted to a hospital with UTI. We conducted a comparison of epidemiological and clinical variables between septic and nonseptic patients with UTI, as well as their 6-month case-fatality rate. A total of 412 cases were included, 47.8% of them with sepsis. Septic patients were older (83 vs. 80 years, p < 0.001), but did not have more comorbidities. The short-term case-fatality rate was higher in septic patients and this difference persisted at 6 months (34% vs. 18.6%, p = 0.003). Furthermore, age older than 75 years, Barthel index <40 and healthcare-associated UTI were also associated with the middle-term case-fatality rate. In conclusion, the detrimental impact of sepsis is maintained on the middle-term prognosis of elderly patients with UTI. Age, functional status and healthcare-associated UTIs also play significant roles in shaping patient outcomes.

Risk Factors for Bacteremia and Its Clinical Impact on Complicated Community-Acquired Urinary Tract Infection.

Bacteremia has been associated with severity in some infections; however, its impact on the prognosis of urinary tract infections (UTIs) is still disputed. Our goal is to determine the risk factors for bacteremia and its clinical impact on hospitalized patients with complicated community-acquired urinary tract infections. We conducted a prospective observational study of patients admitted to the hospital with complicated community-acquired UTIs. Clinical variables and outcomes of patients with and without bacteremia were compared, and multivariate analysis was performed to identify risk factors for bacteremia and mortality. Of 279 patients with complicated community-acquired UTIs, 37.6% had positive blood cultures. Risk factors for bacteremia by multivariate analysis were temperature ≥ 38 °C (p = 0.006, OR 1.3 (95% CI 1.1-1.7)) and procalcitonin ≥ 0.5 ng/mL (p = 0.005, OR 8.5 (95% CI 2.2-39.4)). In-hospital and 30-day mortality were 9% and 13.6%, respectively. Quick SOFA (p = 0.030, OR 5.4 (95% CI 1.2-24.9)) and Barthel Index <40% (p = 0.020, OR 4.8 (95% CI 1.3-18.2)) were associated with 30-day mortality by multivariate analysis. However, bacteremia was not associated with 30-day mortality (p = 0.154, OR 2.7 (95% CI 0.7-10.3)). Our study found that febrile community-acquired UTIs and elevated procalcitonin were risk factors for bacteremia. The outcomes in patients with bacteremia were slightly worse, but without significant differences in mortality.

Risk Factors and the Impact of Multidrug-Resistant Bacteria on Community-Acquired Urinary Sepsis.

Risk factors for multidrug-resistant bacteria (MDRB) in nosocomial urinary tract infection (UTI) have been widely studied. However, these risk factors have not been analyzed in community-acquired urinary sepsis (US), nor have its outcomes been studied. The aim of our study is to determine risk factors for MDRB in community-acquired US and its influence on outcomes. Prospective observational study of patients with community-acquired US admitted to a university hospital. We compared epidemiological and clinical variables and outcomes of US due to MDRB and non-MDRB. Independent risk factors for MDRB were analyzed using logistic regression. A total of 193 patients were included, 33.7% of them with US due to MDRB. The median age of patients was 82 years. Hospital mortality was 17.6%, with no difference between the MDRB and non-MDRB groups. The length of hospital stay was 5 (4-8) days, with a non-significant tendency to longer hospital stays in the MDRB group (6 (4-10) vs. 5 (4-8) days, p = 0.051). Healthcare-associated US was found to be an independent risk factor for MDR bacteria by multivariate analysis. In conclusion, the impact of MDR bacteria on the outcomes of community-acquired urinary sepsis was mild. Healthcare-associated US was an independent risk factor for MDR bacteria.

Lactate/albumin ratio prognostic value for mortality in patients older than 65 years with complicated urinary tract infection.

BACKGROUND: Lactate to albumin ratio (LAR) is an emerging sepsis biomarker that has been tested for mortality in patients with sepsis of different focus. Our goal is to evaluate the prognostic value of LAR in patients admitted to the hospital due to complicated urinary tract infections. METHODS: Prospective observational study of patients older than 65 years diagnosed with UTI. Area under the ROC curve, sensibility, and specificity to predict 30-day mortality were calculated for LAR, qSOFA and SOFA. RESULTS: 341 UTI cases were analyzed. 30-day mortality (20.2% vs. 6.7%, p < 0.001) and longer hospital stay (5 [4-8] vs. 4 [3-7], p 0.018) were associated with LAR ≥ 0.708. LAR has no statistically significant differences compared to qSOFA and SOFA for predicting 30-day mortality (AUROC 0.737 vs. 0.832 and 0.777 respectively, p 0.119 and p 0.496). The sensitivity of LAR was similar to the sensitivity of qSOFA and SOFA (60.8% vs. 84.4% and 82.2, respectively, p 0.746 and 0.837). However, its specificity was lower than the specificity of qSOFA (60.8% vs. 75%, p 0.003), but similar to the specificity of SOFA (60.8% vs. 57.8%, p 0.787). CONCLUSION: LAR has no significant differences with other well-stablished scores in sepsis, such as qSOFA and SOFA, to predict 30-day mortality in patients with complicated UTI.

Fluoroquinolones Are Useful as Directed Treatment for Complicated UTI in a Setting with a High Prevalence of Quinolone-Resistant Microorganisms.

Fluoroquinolones (FQs) have been widely used for treating urinary tract infections (UTIs); however, the increasing emergence of resistant strains has compromised their use. We aimed to know the usefulness of FQs for the treatment of community-acquired UTI in a setting with a high prevalence of fluoroquinolone-resistant microorganisms. A prospective observational study of patients diagnosed with community-acquired UTI was conducted, in which their outcomes according to whether they had FQs or not in their empirical and directed treatments were compared. A multivariate analysis was performed to identify risk factors for UTIs due to ciprofloxacin-resistant microorganisms. A total of 419 patients were included; 162 (38.7%) patients were treated with FQs, as empirical treatment in 27 (6.4%), and as directed treatment in 135 (32.2%). In-hospital mortality (2.2% vs. 6.6%, p 0.044) and 30-day mortality (4.4 vs. 11%, p 0.028) were both lower in the group of patients directly treated with FQ, while there were no differences when FQs were used as empirical treatment. A total of 37.2% of the cases were resistant to ciprofloxacin, which was associated with healthcare-associated UTI (OR 2.7, 95% CI 2-3.7) and prior exposure to FQs (OR 2.7, 95 % CI 1.9-3.7). In conclusion, our findings show that in a setting with a high prevalence of community-acquired UTI caused by quinolone-resistant microorganisms, FQs as directed treatment for community-acquired UTI were associated with better outcomes than other antibiotics, but their use as empirical treatment is not indicated, even in those cases without risk factors for quinolones resistance.

Sex differences in aged 80 and over hospitalized patients with community-acquired UTI: A prospective observational study.

Aim: This study aimed to evaluate clinically significant sex differences that could have an effect on the choice of treatment and outcomes of urinary tract infection (UTI) in aged 80 and over hospitalized patients with community-acquired UTI. Methods: This was a prospective study of 161 patients aged 80 and over admitted to hospital with community-acquired UTI. Epidemiological, clinical, laboratory and microbiologic variables were compared between both sexes. Multivariate analysis was performed using logistic regression to determine the variables independently associated with sex. Results: In a population of 91 (56.52%) women and 70 (43.48%) men, aged 80 and over, we found that women were more likely to have cognitive impairment (p = 0.035) and less likely to have chronic obstructive pulmonary disease (COPD) (p = 0.006) and indwelling urinary catheter (p < 0.001) than men. Levels of creatinine were higher in men than in women (p = 0.008). Septic shock at presentation was more frequent in the male group (p = 0.043). Men had a higher rate of polymicrobial infection (p = 0.035) and Pseudomonas aeruginosa infection (p = 0.003). Factors independently associated with sex by multivariate analysis were septic shock, cognitive impairment, COPD and indwelling urinary catheter. Conclusion: Men aged 80 and over with community-acquired UTI had more septic shock at admission to hospital and higher rates of indwelling urinary catheter, while women had more cognitive impairment. There were no differences in outcomes between sexes.

Comparison of quick Pitt to quick sofa and sofa scores for scoring of severity for patients with urinary tract infection.

Quick Pitt (qPitt), which includes temperature, systolic blood pressure, respiratory rate, cardiac arrest, and mental status, is a new prognostic score derived from the Pitt Bacteremia score. The aim of our study is to compare qPitt with quick SOFA (qSOFA) and SOFA for scoring of severity in patients with urinary tract infection (UTI). Prospective observational study of patients diagnosed with UTI. Area under the ROC curve, sensibility, and specificity to predict 30-day mortality were calculated for qPitt, qSOFA and SOFA and compared. 382 UTI cases were analyzed. Thirty-day mortality (18.8% vs. 5.9%, p < 0.001) and longer hospital stay (6 [1-11] vs. 4 [1-7] days, p < 0.001) were associated with qPitt ≥ 2. However, qPitt had a worse performance to predict 30-day mortality compared to qSOFA and SOFA (AUROC 0.692 vs. 0.832 and 0.806, respectively, p = 0.010 and p = 0.041). The sensitivity of qPitt was lower than the sensitivity of qSOFA and SOFA (70.45 vs. 84.09 for both qSOFA and SOFA, p < 0.001), with a specificity lower than qSOFA and similar to SOFA (60.36 vs. 82.25 and 63.61, p < 0.001 and p = 0.742, respectively). Quick Pitt had moderate prognostic accuracy and performed worse than qSOFA and SOFA scores for predicting mortality in patients with UTI.

Pregnancy and systemic lupus erythematosus in Spain: Has anything changed in the 21st century?

OBJECTIVE: To analyse a cohort of pregnant patients with systemic lupus erythematosus and compare the outcomes of both the disease and pregnancy with the results of previous studies conducted in the same geographical area. PATIENTS AND METHODS: Retrospective cohort study of 37 women with systemic lupus erythematosus (64 pregnancies) followed in a multidisciplinary unit. Comparative study with similar Spanish studies identified after literature search. RESULTS: Our cohort was characterized by an older age and by the presence of non-Caucasian patients. Although we found no clinical differences, from the serological point of view our cohort presented a higher frequency of antiphospholipid antibodies. Patients included in this study were treated more frequently with antimalarials and low-dose aspirin. Systemic lupus erythematosus flare frequency was very similar between the different studies, and we did not identify clear predictors for them. Although the rate of live births was similar among studies, the obstetric outcome of our series was better with a very low rate of preeclampsia, preterm birth and low birth weight newborn. The only predictor of adverse obstetric event was age. CONCLUSIONS: Although changes in the therapeutic attitude and planning of pregnancy in recent years have not had a direct impact on the rate of systemic lupus erythematosus flares during pregnancy, they have meant an improvement in the obstetric results. The introduction of new variables independent of the disease such as age at conception, socio-cultural origin, or the availability of multidisciplinary units should be considered in the results of future studies.

Embarazo y lupus eritematoso sistémico en España: ¿ha cambiado algo en el siglo xxi? / Pregnancy and Systemic Lupus Erythematosus in Spain: Has Anything Changed in the 21st Century?

Objetivo: Analizar una cohorte de pacientes embarazadas con lupus eritematoso sistémico y comparar los desenlaces tanto de la enfermedad como del embarazo con los resultados de estudios previos realizados en la misma área geográfica. Pacientes y métodos: Estudio de cohortes retrospectivo de 37 mujeres con lupus eritematoso sistémico (64 embarazos) seguidas en una consulta multidisciplinar. Estudio comparativo con los estudios españoles similares identificados tras revisión bibliográfica. Resultados: Nuestra cohorte se caracterizó por una edad más elevada y por la presencia de pacientes de origen no caucásico. Aunque no encontramos diferencias clínicas relevantes, serológicamente nuestra cohorte presentó una mayor frecuencia de anticuerpos antifosfolípido. Las pacientes incluidas en este estudio fueron tratadas más frecuentemente con antipalúdicos y aspirina. La frecuencia de brotes fue muy similar entre los distintos estudios, y no identificamos predictores claros para los mismos. Aunque la tasa de nacidos vivos fue similar, el desenlace obstétrico de nuestra serie fue mejor, con una baja tasa de preeclampsia, parto pretérmino y recién nacido de bajo peso. El único predictor de acontecimiento obstétrico adverso fue la edad. Conclusiones: Si bien los cambios en la actitud terapéutica y la planificación del embarazo no han tenido un impacto directo sobre la tasa de reactivación del lupus eritematoso sistémico durante el embarazo, sí que han supuesto una mejoría en los resultados obstétricos. La introducción de nuevas variables independientes de la enfermedad como la edad en la concepción, la procedencia sociocultural, o la disponibilidad de unidades multidisciplinares deberán ser consideradas en los resultados de próximos estudios.(AU)

Objective: To analyse a cohort of pregnant patients with systemic lupus erythematosus and compare the outcomes of both the disease and pregnancy with the results of previous studies conducted in the same geographical area. Patients and methods: Retrospective cohort study of 37 women with systemic lupus erythematosus (64 pregnancies) followed in a multidisciplinary unit. Comparative study with similar Spanish studies identified after literature search. Results: Our cohort was characterized by an older age and by the presence of non-Caucasian patients. Although we found no clinical differences, from the serological point of view our cohort presented a higher frequency of antiphospholipid antibodies. Patients included in this study were treated more frequently with antimalarials and low-dose aspirin. Systemic lupus erythematosus flare frequency was very similar between the different studies, and we did not identify clear predictors for them. Although the rate of live births was similar among studies, the obstetric outcome of our series was better with a very low rate of preeclampsia, preterm birth and low birth weight newborn. The only predictor of adverse obstetric event was age. Conclusions: Although changes in the therapeutic attitude and planning of pregnancy in recent years have not had a direct impact on the rate of systemic lupus erythematosus flares during pregnancy, they have meant an improvement in the obstetric results. The introduction of new variables independent of the disease such as age at conception, socio-cultural origin, or the availability of multidisciplinary units should be considered in the results of future studies.(AU)

Clinical impact of multidrug-resistant bacteria in older hospitalized patients with community-acquired urinary tract infection.

INTRODUCTION: Previous studies have described some risk factors for multidrug-resistant (MDR) bacteria in urinary tract infection (UTI). However, the clinical impact of MDR bacteria on older hospitalized patients with community-acquired UTI has not been broadly analyzed. We conducted a study in older adults with community-acquired UTI in order to identify risk factors for MDR bacteria and to know their clinical impact. METHODS: Cohort prospective observational study of patients of 65 years or older, consecutively admitted to a university hospital, diagnosed with community-acquired UTI. We compared epidemiological and clinical variables and outcomes, from UTI due to MDR and non-MDR bacteria. Independent risk factors for MDR bacteria were analyzed using logistic regression. RESULTS: 348 patients were included, 41.4% of them with UTI due to MDR bacteria. Median age was 81 years. Hospital mortality was 8.6%, with no difference between the MDR and non-MDR bacteria groups. Median length of stay was 5 [4-8] days, with a longer stay in the MDR group (6 [4-8] vs. 5 [4-7] days, p = 0.029). Inadequate empirical antimicrobial therapy (IEAT) was 23.3%, with statistically significant differences between groups (33.3% vs. 16.2%, p < 0.001). Healthcare-associated UTI variables, in particular previous antimicrobial therapy and residence in a nursing home, were found to be independent risk factors for MDR bacteria. CONCLUSIONS: The clinical impact of MDR bacteria was moderate. MDR bacteria cases had higher IEAT and longer hospital stay, although mortality was not higher. Previous antimicrobial therapy and residence in a nursing home were independent risk factors for MDR bacteria.

Prognostic accuracy of Quick SOFA in older adults hospitalised with community acquired urinary tract infection.

INTRODUCTION: Quick [Sepsis-related] Sequential Organ Failure Assessment (qSOFA) is a prognostic score based on sepsis-3 definition, easy to carry out, whose application has been studied in older adults with sepsis from different sources and respiratory sepsis. However, to date no study has analysed its prognostic accuracy in older adults admitted to hospital with community urinary tract infection. METHODS: In a prospective study of 282 older adults admitted to hospital with community acquired urinary tract infection, the application of qSOFA to predict hospital mortality was analysed. The predictive capacity of qSOFA for in-hospital mortality was compared with Systemic Inflammatory Response Syndrome score (SIRS) and Sequential Organ Failure Assessment (SOFA), which require laboratory test in order to be calculated. RESULTS: In a population with a median age of 81 years, where 51.8% were males and 10.6% had septic shock, qSOFA showed sensibility and specificity of 88.46 and 75.78% and area under the receiver operating characteristic curves (AUROC) of 0.810. AUROC for qSOFA was significantly higher than that of SIRS (AUROC 0.597, P = .005) and with no statistical differences with SOFA (AUROC 0.841, P = .635). CONCLUSION: qSOFA showed a better predictive prognostic accuracy than SIRS and similar to SOFA in older adults admitted to hospital with community acquired urinary tract infection, having the advantage of not requiring laboratory tests.

Severity Scores in COVID-19 Pneumonia: a Multicenter, Retrospective, Cohort Study.

BACKGROUND: Identification of patients on admission to hospital with coronavirus infectious disease 2019 (COVID-19) pneumonia who can develop poor outcomes has not yet been comprehensively assessed. OBJECTIVE: To compare severity scores used for community-acquired pneumonia to identify high-risk patients with COVID-19 pneumonia. DESIGN: PSI, CURB-65, qSOFA, and MuLBSTA, a new score for viral pneumonia, were calculated on admission to hospital to identify high-risk patients for in-hospital mortality, admission to an intensive care unit (ICU), or use of mechanical ventilation. Area under receiver operating characteristics curve (AUROC), sensitivity, and specificity for each score were determined and AUROC was compared among them. PARTICIPANTS: Patients with COVID-19 pneumonia included in the SEMI-COVID-19 Network. KEY RESULTS: We examined 10,238 patients with COVID-19. Mean age of patients was 66.6 years and 57.9% were males. The most common comorbidities were as follows: hypertension (49.2%), diabetes (18.8%), and chronic obstructive pulmonary disease (12.8%). Acute respiratory distress syndrome (34.7%) and acute kidney injury (13.9%) were the most common complications. In-hospital mortality was 20.9%. PSI and CURB-65 showed the highest AUROC (0.835 and 0.825, respectively). qSOFA and MuLBSTA had a lower AUROC (0.728 and 0.715, respectively). qSOFA was the most specific score (specificity 95.7%) albeit its sensitivity was only 26.2%. PSI had the highest sensitivity (84.1%) and a specificity of 72.2%. CONCLUSIONS: PSI and CURB-65, specific severity scores for pneumonia, were better than qSOFA and MuLBSTA at predicting mortality in patients with COVID-19 pneumonia. Additionally, qSOFA, the simplest score to perform, was the most specific albeit the least sensitive.

The Prognostic Value of Eosinophil Recovery in COVID-19: A Multicentre, Retrospective Cohort Study on Patients Hospitalised in Spanish Hospitals.

OBJECTIVES: A decrease in blood cell counts, especially lymphocytes and eosinophils, has been described in patients with serious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but there is no knowledge of their potential role of the recovery in these patients' prognosis. This article aims to analyse the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. DESIGN: This work was a retrospective, multicentre cohort study of 9644 hospitalised patients with confirmed COVID-19 from the Spanish Society of Internal Medicine's SEMI-COVID-19 Registry. SETTING: This study examined patients hospitalised in 147 hospitals throughout Spain. PARTICIPANTS: This work analysed 9644 patients (57.12% male) out of a cohort of 12,826 patients ≥18 years of age hospitalised with COVID-19 in Spain included in the SEMI-COVID-19 Registry as of 29 May 2020. MAIN OUTCOME MEASURES: The main outcome measure of this work is the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Univariate analysis was performed to determine possible predictors of death, and then multivariate analysis was carried out to control for potential confounders. RESULTS: An increase in the eosinophil count on the seventh day of hospitalisation was associated with a better prognosis, including lower mortality rates (5.2% vs. 22.6% in non-recoverers, OR 0.234; 95% CI, 0.154 to 0.354) and lower complication rates, especially regarding the development of acute respiratory distress syndrome (8% vs. 20.1%, p = 0.000) and ICU admission (5.4% vs. 10.8%, p = 0.000). Lymphocyte recovery was found to have no effect on prognosis. Treatment with inhaled or systemic glucocorticoids was not found to be a confounding factor. CONCLUSION: Eosinophil recovery in patients with COVID-19 who required hospitalisation had an independent prognostic value for all-cause mortality and a milder course.

COVID-19 in older adults: What are the differences with younger patients?

AIM: The present study aimed both to gain knowledge on the distinctive clinical characteristics of older adults with coronavirus disease 2019 (COVID-19), in comparison with those of younger patients, and to identify risk factors for mortality. METHODS: A retrospective observational study was carried out of patients consecutively admitted to Doctor Peset University Hospital, Valencia (Spain) for COVID-19 from 11 March to 28 April 2020. Every case was diagnosed by reverse transcription polymerase chain reaction or by serology test to detect antibodies. Demographic details, clinical characteristics, laboratory findings on admission and complications of each case were collected from electronic medical records. RESULTS: The dataset comprised 340 patients. Of them, 152 (44.6%) were aged >70 years. Comorbidities were more common in the older groups. Confusion was more common in older adults, whereas typical symptoms of COVID-19, such as fever, cough and myalgia, were less common. Oxygen saturation ≤93% on room air, neutrophilia, D-dimer >0.5 µg/mL, creatinine >1.5 mg/dL, lactate dehydrogenase ≥250 U/L and elevation of creatine kinase were higher in the older adult groups. Complications during hospitalization, such as acute respiratory distress syndrome (53.3% vs 33.2%, P < 0.001), acute kidney injury (11.8% vs 5.3%; P = 0.030) and mortality (28.9% vs 6.5%; P < 0.001) were more common in patients aged >70 years. Oxygen saturation ≤93% on room air on admission was a predictor of mortality (odds ratio 11.65, 95% confidence interval 3.26-41.66, P < 0.001) in patients aged >70 years. CONCLUSIONS: Older adults with COVID-19 have more atypical presentation, more complications and higher mortality. Oxygen saturation ≤93% on room air on admission is a predictive factor of death. Geriatr Gerontol Int 2021; 21: 60-65.

Variables electrocardiográficas asociadas a la aparición de eventos cardiovasculares adversos en el infarto agudo de miocardio sin elevación del segmento ST / Electrocardiographic variables associated to the occurrence of adverse cardiovascular events in non-ST elevation acute myocardial infarction

Introducción: La frecuencia de infarto agudo de miocardio sin elevación del segmento ST se está incrementando y, con ella, los resultados adversos en pacientes con enfermedad coronaria isquémica aguda. Objetivo: Identificar las variables electrocardiográficas asociadas a la aparición de eventos cardiovasculares adversos en el infarto agudo de miocardio sin elevación del segmento ST. Método: Se realizó un estudio transversal, de tipo correlacional, con 68 pacientes con infarto agudo de miocardio sin elevación del segmento ST atendidos en el Hospital Arnaldo Milián Castro, en la provincia de Villa Clara. Se estudiaron los hallazgos electrocardiográficos y eventos cardiacos adversos durante el ingreso. Se hicieron análisis bivariados para establecer la relación de ambas variables, utilizando el estadígrafo chi cuadrado y el riesgo relativo. Resultados: Los hallazgos electrocardiográficos más frecuentes fueron la inversión de la onda T (#8805; 2mm), depresión del segmento ST y el QT corregido largo mediante la fórmula de Bazzet. El 26,5 por ciento presentaron eventos cardiovasculares adversos. La depresión del segmento ST, el QT largo corregido y la elevación del segmento ST en aVR se asociaron significativamente con eventos adversos intrahospitalarios (p lt; 0,05). Conclusiones: La asociación de la depresión del segmento ST, la elevación del segmento ST en aVR y el QT largo corregido con la ocurrencia de eventos cardiovasculares adversos intrahospitalarios, sugiere que estos hallazgos se pueden tener en cuenta como posibles indicadores de evolución desfavorable en pacientes con infarto agudo de miocardio sin elevación del segmento ST(AU)

Introduction: The frequency of non-ST elevation acute myocardial infarction is on the increase, and so is the number of adverse results in patients with acute ischemic coronary disease. Objective: Identify the electrocardiographic variables associated to the occurrence of adverse cardiovascular events in non-ST elevation acute myocardial infarction. Method: A cross-sectional correlational study was conducted of 68 patients with non-ST elevation acute myocardial infarction cared for at Arnaldo Milián Castro Hospital in the province of Villa Clara. Attention was paid to electrocardiographic findings and adverse cardiac events occurring during the hospital stay. Bivariate analyses were performed to establish the relationship between the two variables, using the chi square statigram and relative risk estimation. Results: The most common electrocardiographic findings were T-wave inversion (#8805; 2 mm), ST depression and long corrected QT by Bazzet's formula. Of the total study subjects 26.5 percent had adverse cardiovascular events. ST depression, long corrected QT and ST elevation in aVR were significantly associated to in-hospital adverse events (p < 0.05). Conclusions: Association of ST depression, ST elevation in aVR and long corrected QT with the occurrence of adverse in-hospital cardiovascular events suggests that these findings may be taken into account as possible indicators of an unfavorable evolution in patients with non-ST elevation acute myocardial infarction(AU)

Pregnancy and Systemic Lupus Erythematosus in Spain: Has Anything Changed in the 21st Century? / Embarazo y lupus eritematoso sistémico en España: ¿ha cambiado algo en el siglo xxi?

OBJECTIVE: To analyse a cohort of pregnant patients with systemic lupus erythematosus and compare the outcomes of both the disease and pregnancy with the results of previous studies conducted in the same geographical area. PATIENTS AND METHODS: Retrospective cohort study of 37 women with systemic lupus erythematosus (64 pregnancies) followed in a multidisciplinary unit. Comparative study with similar Spanish studies identified after literature search. RESULTS: Our cohort was characterized by an older age and by the presence of non-Caucasian patients. Although we found no clinical differences, from the serological point of view our cohort presented a higher frequency of antiphospholipid antibodies. Patients included in this study were treated more frequently with antimalarials and low-dose aspirin. Systemic lupus erythematosus flare frequency was very similar between the different studies, and we did not identify clear predictors for them. Although the rate of live births was similar among studies, the obstetric outcome of our series was better with a very low rate of preeclampsia, preterm birth and low birth weight newborn. The only predictor of adverse obstetric event was age. CONCLUSIONS: Although changes in the therapeutic attitude and planning of pregnancy in recent years have not had a direct impact on the rate of systemic lupus erythematosus flares during pregnancy, they have meant an improvement in the obstetric results. The introduction of new variables independent of the disease such as age at conception, socio-cultural origin, or the availability of multidisciplinary units should be considered in the results of future studies.

Predictive factors for Enterococcus faecalis in complicated community-acquired urinary tract infections in older patients.

AIM: Risk factors for complicated community acquired Enterococcus faecalis urinary tract infection (UTI) in older patients are not well known. METHODS: We identified the predictive factors for E. faecalis on a cohort of 659 older patients admitted to hospital with complicated UTI. We also examined the adequacy of empirical antimicrobial therapy and outcomes in E. faecalis UTI. Multivariable logistic regression was used to identify predictors of E. faecalis UTI. RESULTS: A total of 87 (13.2%) patients had E. faecalis UTI; of these 63.2% were men, their mean age was 82.3 years and they had a great number of comorbidities. Severe sepsis or septic shock was present in 50.5%, and bacteremia was present in 26%. Indwelling urinary catheter and previous urinary instrumentation were risk factors for E. faecalis UTI by multivariate analysis (OR 2.05; 95% CI 1.15-3.65 and OR 2.16; 95% CI 1.08-4.34, respectively). Inadequate empirical antimicrobial therapy was higher in E. faecalis UTI than in UTI caused by Gram-negative microorganisms (66.6% vs 19%, P < 0.001). No significant differences in length of hospital stay or mortality were noted between E. faecalis and Gram-negative UTI. CONCLUSIONS: In older patients admitted to hospital with complicated community-acquired UTI, E. faecalis should be considered for empirical treatment if the patient has a urinary catheter or previous urinary tract instrumentation in order to avoid inadequate empirical antibiotic therapy. Geriatr Gerontol Int 2019; ••: ••-••.

Community-onset Pseudomonas aeruginosa urinary sepsis in elderly people: Predictive factors, adequacy of empirical therapy and outcomes.

Purpose To know the predictive factors for Pseudomonas aeruginosa (PA) urinary sepsis in hospitalised elderly patients coming from community, the adequacy of empirical antibiotic therapy and its outcomes. Methods Retrospective case-control study conducted between 2007 and 2017. Patients aged 65 years or older with PA urinary sepsis were included as cases. Three age-matched controls, with urinary sepsis caused by other microorganisms, were selected for each case. Predictors for PA urinary sepsis were determined by logistic regression analysis. Adequacy of empirical antibiotic therapy and outcomes were compared between both groups. Results A total of 332 patients, from which 83 were cases, were included. Predictive factors for PA urinary sepsis were as follows: male sex (OR 3.16, 95% CI 1.61-6.10; P < .001), urinary catheter (OR 3.25, 95% CI 1.73-6.11; P < .001) and healthcare-associated infection (OR 5.52, 95% CI 1.76 -17.29; P = .003). Inadequate empirical antimicrobial therapy (IEAT) and length of hospital stay were higher in PA group (42% vs 24%, P = .002; 7.45 ± 4.36 days vs 6.43 ± 3.82 days, P = .045, respectively), but mortality was not different (7.2% vs 8.8%, P = .648). Conclusions Pseudomonas aeruginosa urinary sepsis in elderly people was associated with male sex, urinary catheter and healthcare-associated infection. These infections had a higher rate of IEAT and a longer hospital stay than urinary sepsis caused by other microorganisms.

Prospective cohort study of risk factors for extended-spectrum ß-lactamase-producing Escherichia coli urinary tract infections in elderly patients admitted to hospital.

BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli are currently common in community-onset infections, limiting therapeutic options. In this work we aim to identify the prevalence of and risk factors for ESBL-producing E. coli in elderly patients with urinary tract infections (UTI) admitted to hospital. METHODS: Prospective cohort study on elderly patients with E. coli UTI admitted to a university hospital in Spain, from January 2013 to December 2015. Clinical features, microbiology and outcomes were recorded from the electronic medical records and reviewed by two researchers. Cases were segregated according to ESBL-producing E. coli. Risk factors for ESBL-producing E. coli were analysed by multivariate analysis. RESULTS: The prevalence of ESBL-producing E. coli was 27.4% (85/310). Healthcare-associated UTI was the only risk factor for ESBL-producing E. coli (OR 6.79; 95% CI 3.22-14.31, P < .001) by multivariate analysis. ESBL-producing E. coli was 43.9% in the healthcare-associated UTI group and 8.9% in the community-acquired UTI group (P < .001). Inadequate empirical antibiotic therapy and length of stay in hospital were higher in the ESBL-producing E. coli group than in the non-ESBL-producing E. coli group (62.3% vs 5.3% and 6.60 ± 3.69 days vs 5.61 ± 3.16 days, respectively). Mortality was not significantly different between groups (13% in ESBL-producing E. coli group vs 7.5% in non-ESBL-producing E. coli group, P = .140). SUMMARY: Healthcare-associated UTI was a risk factor for ESBL-producing E. coli in elderly patients with UTI admitted to hospital. Our results might help clinicians in choosing empirical antibiotics in an overall high rate setting of ESBL-producing E. coli.