Safety and efficacy of daptomycin in outpatient parenteral antimicrobial therapy: a prospective and multicenter cohort study (DAPTODOM trial).

BACKGROUND: Daptomycin is an optimal choice for outpatient parenteral antibiotic therapy (OPAT) because of its safety, once-daily administration and its activity against Gram-positive bacteria. Although daptomycin is increasingly being used in OPAT, limited information about its safety in this scenario is available. METHODS: We performed a prospective multicentre pilot study to evaluate the safety of daptomycin in outpatients with proved or suspected Gram-positive infections (DAPTODOM). The primary objective was to evaluate the safety and the secondary objective to evaluate the efficacy in OPAT. We also looked at the development of daptomycin resistance in those cases with microbiological failure. RESULTS: We included 54 patients from 12 Spanish hospitals, 67% male with a mean age of 67.1 years. Most patients (87%) had chronic underlying diseases. The main reason for inclusion was skin and soft-tissue infections in 52%, followed by bacteremia or endocarditis in 34%. Staphylococcus aureus accounted for 44% of the isolates (24% were methicillin-resistant), coagulase-negative staphylococci 15% and enterococci 7%. Two patients (4%) had to be readmitted because of complications; only one patient had an adverse effect related to daptomycin (increase in serum creatine kinase levels), which disappeared after discontinuation (2%). At the end of follow-up, 96% of patients had good outcome and only 4% of patients did not have a clinical or microbiological cure. The use of a 2-minute bolus in 18 cases was not associated with adverse effects. CONCLUSIONS: Daptomycin was safe and efficacious in outpatients with Gram-positive bacterial infections and can be administered in 2-minute bolus infusion.

[Home treatment of patients with pancreatic fistula]. / Tratamiento domiciliario de pacientes con fístula pancreática.

INTRODUCTION: Hospital-at-home (HaH) has been previously described as a useful model to shorten length of hospital stay. Nevertheless, few experiences have been reported on the effectiveness of this scheme in patients with postoperative complications. We described the results of home management of patients with pancreatic fistula. PATIENTS AND METHOD: A retrospective analysis was performed on the clinical data more six patients with postoperative pancreatic fistula attended in our hospital-at-home unit. RESULTS: All patients were male with ages ranging from 42 to 72 years (mean 59). The average hospital stay was 53 days (range 27 to 91). All patients, but one, presented pancreatic drainage more than 100 mL at the time of HaH admission. During HaH period hospital level treatments such as complex cures, intraabdominal lavages, specific laboratory tests, intravenous antimicrobial therapy and CT scanning were performed. The average time to closure of fistula was 93 days, of which 38 (41%) days were spent at home. At the end of HaH period all patients recovered and expressed a high degree of satisfaction. CONCLUSIONS: Our data suggest that hospital-at-home is an effective model to shorten length of hospital stay in selected patients with postoperative pancreatic fistulas.

Tratamiento domiciliario de pacientes con fístula pancreática / Home treatment of patients with pancreatic fistula

Introducción. La hospitalización a domicilio (HaD) se ha descrito como un modelo útil para acortar la estancia hospitalaria. Sin embargo, se han comunicado pocas experiencias sobre la eficacia de este recurso en pacientes con complicaciones posquirúrgicas. Nosotros describimos el resultado del manejo domiciliario de pacientes con fístulas pancreáticas. Pacientes y método. Se realizó un análisis retrospectivo de los datos clínicos de 6 pacientes con fístula pancreática posquirúrgica atendidos en nuestra unidad de hospitalización a domicilio. Resultados. Todos los pacientes eran varones con edades comprendidas entre los 42 y los 72 años (media, 59). La estancia hospitalaria media fue de 53 días (rango, 27-91 días). Todos los pacientes, excepto uno, presentaban un débito pancreático de más de 100 ml en el momento de la admisión en HaD. Durante el período de HaD se realizaron cuidados de rango hospitalario, como curas complejas, lavados intraabdominales, pruebas específicas de laboratorio, terapia antimicrobiana intravenosa y escáner. La duración media para el cierre de las fístulas fue de 93 días, de los cuales 38 (41%) transcurrieron en el domicilio. Al final del período de HaD todos los pacientes se habían curado y mostraron un alto grado de satisfacción. Conclusiones. Nuestros datos indican que la hospitalización a domicilio es un modelo eficaz para acortar la estancia hospitalaria en pacientes seleccionados con fístulas pancreáticas posquirúrgicas (AU)

Introduction. Hospital-at-home (HaH) has been previously described as a useful model to shorten length of hospital stay. Nevertheless, few experiences have been reported on the effectiveness of this scheme in patients with postoperative complications. We described the results of home management of patients with pancreatic fistula. Patients and method. A retrospective analysis was performed on the clinical data more six patients with postoperative pancreatic fistula attended in our hospital-at-home unit. Results. All patients were male with ages ranging from 42 to 72 years (mean 59). The average hospital stay was 53 days (range 27 to 91). All patients, but one, presented pancreatic drainage more than 100 mL at the time of HaH admission. During HaH period hospital level treatments such as complex cures, intraabdominal lavages, specific laboratory tests, intravenous antimicrobial therapy and CT scanning were performed. The average time to closure of fistula was 93 days, of which 38 (41%) days were spent at home. At the end of HaH period all patients recovered and expressed a high degree of satisfaction. Conclusions. Our data suggest that hospital-at-home is an effective model to shorten length of hospital stay in selected patients with postoperative pancreatic fistulas (AU)

Sinusitis maxilar aguda en una paciente infectada por el VIH / Acute maxillary sinusitis in a patient with VIH infection

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Coma vigil tras meningitis por listeria monocytogenes / Coma vigil after meningitis due to Listeria monocytogenes

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