Advantages of plasmatic CXCL-10 as a prognostic and diagnostic biomarker for the risk of rejection and subclinical rejection in kidney transplantation.

This study evaluate the potential of plasmatic CXCL-10 (pCXCL-10) as a pre&post transplantation prognostic and diagnostic biomarker of T-cell-mediated rejection (TCMR), antibody-mediated rejection (ABMR) and subclinical rejection (SCR) risk in adult kidney recipients considering BKV and CMV infections as possible clinical confounder factors. Twenty-eight of 100 patients included experienced rejection (TCMR:14; ABMR:14); 8 SCR; 13 and 16 were diagnosed with BKV and CMV infection, respectively. Pre-transplantation pCXCL-10 was significantly increased in TCMR and ABMR and post-transplantation in TCMR, ABMR and SCR compared with nonrejectors. All CMV+ patients showed pCXCL-10 levels above the cutoff values established for rejection whereas the 80% of BKV+ patients showed pCXCL-10 concentration < 100 pg/mL. pCXCL-10 could improve pre-transplantation patient stratification and immunosuppressive treatment selection according to rejection risk; and after kidney transplantation could be a potential early prognostic biomarker for rejection. Clinical confounding factor in BKV+ and particularly in CMV+ patients must be discarded.

The impact of individual sonographer variation on the detection of small for gestational age fetuses using a third trimester growth scan.

OBJECTIVES: Detection of small for gestational age (SGA) fetuses in a third trimester ultrasound could be affected by variation in sonographer performance. METHODS: Retrospective analysis of all singleton, non-anomalous ultrasound examinations between 35+0 -36+6 weeks gestation, in a single institution where a universal 36-week scan is offered. Screen positive was defined as estimated fetal weight (EFW) <10th centile; SGA was birthweight <10th centile. Individual sonographers' distributions of head circumference (HC), abdominal circumference (AC) and femur length (FL) were used to assess sonographers' screen positive rate (SPR), detection rate (DR) and true positive rate (TPR). Univariate and multivariate regression analysis was performed to assess the association between the sonographers' mean and SD (SD) for HC, AC, FL and their SPR, DR and TPR. RESULTS: There were 27 sonographers performing more than 50 examinations per year, a total of 5691 scans. The mean incidence of SGA was 10.0%. For an overall SPR of 9.4%, the overall DR was 43.8% (95% CI: 39.6% - 48.1%) and the overall TPR was 46.5% (95% CI: 42.9% - 50.2%). Higher AC scatter (SD difference up to 11.6 mm) was associated with higher SPR (P = 0.001). Lower mean FL (difference up to 3.6 mm) was associated with higher SPR (P = 0.003) and higher DR (P = 0.002). As a result, DR varied amongst different sonographers between 14.3% and 85.7% and TPR varied between 8.3% and 100.0%. CONCLUSIONS: Monitoring of individual AC and FL distributions is a simple and effective tool for institutional quality assurance.

Early prognostic performance of miR155-5p monitoring for the risk of rejection: Logistic regression with a population pharmacokinetic approach in adult kidney transplant patients.

Previous results from our group and others have shown that urinary pellet expression of miR155-5p and urinary CXCL-10 production could play a key role in the prognosis and diagnosis of acute rejection (AR) in kidney transplantation patients. Here, a logistic regression model was developed using NONMEM to quantify the relationships of miR155-5p urinary expression, CXCL-10 urinary concentration and tacrolimus and mycophenolic acid (MPA) exposure with the probability of AR in adult kidney transplant patients during the early post-transplant period. Owing to the contribution of therapeutic drug monitoring to achieving target exposure, neither tacrolimus nor MPA cumulative exposure was identified as a predictor of AR in the studied population. Even though CXCL-10 urinary concentration showed a trend, its effect on AR was not significant. In contrast, urinary miR155-5p expression was prognostic of clinical outcome. Monitoring miR155-5p urinary pellet expression together with immunosuppressive drug exposure could be very useful during routine clinical practice to identify patients with a potential high risk of rejection at the early stages of the post-transplant period. This early risk assessment would allow for the optimization of treatment and improved prevention of AR.

High SARS-CoV-2 Infection Rates Among Special Forces Police Units During the Early Phase of the COVID-19 Pandemic in Ecuador.

Background: At the beginning of the COVID-19 pandemic, health workers and first-responders, such as police officers, were in charge of trying to contain a disease that was unknown at that time. The lack of information and the tremendous need to contain new outbreaks put police officers at higher risk. Methodology: A cross-sectional study was conducted to describe SARS-CoV-2 infection rates among Police Special Forces Officers in Quito, Ecuador. In this study, 163 community-dwelling police officers from elite divisions voluntarily participated in our SARS-CoV-2 detection program using reverse transcription quantitative real-time PCR (RT-qPCR). Results: A total of 20 out of 163 police officers tested positive for SARS-CoV-2, yielding an infection rate of 12.3%. Within this cohort, 10% (2/20) of SARS-CoV-2 positive individuals were potentially super spreaders with viral loads over 108 copies/ul. About 85% of the SARS-CoV-2 positive individuals were asymptomatic and 15% reported mild symptoms related to COVID-19. Conclusions: We found a high SARS-CoV-2 infection rate within the special forces police officers that, beyond a high health risk for themselves, their families, and coworkers. Our results point out the need for permanent SARS-CoV-2 testing among asymptomatic essential workers and first-responders to avoid local outbreaks and to prevent work-place absenteeism among police special units.

Epilepsia en la consulta de Gastroenterología / Epilepsy at the Gastroenterology consultation

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Meropenem population pharmacokinetics in patients with decompensated cirrhosis and severe infections.

OBJECTIVES: Meropenem pharmacokinetics (PK) may be altered in patients with cirrhosis, hampering target attainment. We aimed to describe meropenem PK in patients with decompensated cirrhosis and severe bacterial infections, identify the sources of PK variability and assess the performance of different dosing regimens to optimize the PK/pharmacodynamic (PD) target. METHODS: Serum concentrations and covariates were obtained from patients with severe infections under meropenem treatment. A population PK analysis was performed using non-linear mixed-effects modelling and the final model was used to simulate meropenem exposure to assess the PTA. RESULTS: Fifty-four patients were enrolled in the study. Data were best described by a one-compartment linear model. The estimated typical mean value for clearance (CL) was 8.35 L/h and the estimated volume of distribution (V) was 28.2 L. Creatinine clearance (CLCR) and MELD score significantly influenced meropenem CL, and acute-on-chronic liver failure (ACLF) significantly affected V. Monte Carlo simulations showed that a lower meropenem dose would be needed as CLCR decreases and as the MELD score increases. Patients with ACLF would have lower peak meropenem concentrations but similar steady-state concentrations compared with patients with no ACLF. CONCLUSIONS: Our study identified two new covariates that influence meropenem PK in patients with decompensated cirrhosis in addition to CLCR: MELD score and ACLF. Dosing regimens are recommended to reach several PK/PD targets considering these clinical variables and any MIC within the susceptibility range.

Curvas de Crecimiento Intrauterino Calculadas a Partir de Peso, Talla y Perímetro Cefálico en Recién Nacidos del Hospital de Especialidades José Carrasco Arteaga. Cuenca, 2014 - 2015 / Intrauterine Growth Curves Calculated from Weight, Size and Cephalic Perimeter in Newborns of Hospital de Especialidades José Carrasco Arteaga. Cuenca, 2014 ­ 2015

INTRODUCCIÓN: La determinación de la normalidad y morbimortalidad en recién nacidos se fundamenta en clasificarlos usando curvas de crecimiento intrauterino basadas en la antropometría neonatal; estos datos varían según factores raciales, genéticos, ambientales y estilos de vida maternos, por este motivo la OMS recomienda la construcción de curvas propias de cada comunidad. El objetivo del estudio fue determinar curvas de crecimiento intrauterino calculadas a partir de peso, talla y perímetro cefálico en recién nacidos del Hospital de Especialidades José Carrasco Arteaga, de enero 2014 a junio 2015. MÉTODOS: Se realizó un estudio descriptivo, de corte transversal con recién nacidos vivos, sin malformaciones congénitas o genéticas y procedentes todos ellos de gestaciones únicas, atendidos en el Hospital de Especialidades José Carrasco Arteaga, durante el periodo enero 2014 a junio 2015. Los datos se obtuvieron mediante la observación indirecta, basada en los datos de las historias clínicas y se analizaron en los programas Excel 2010 y SPSS versión 15. RESULTADOS: 2 165 recién nacidos cumplieron criterios de inclusión, con ligero predominio de recién nacidos de sexo masculino (50.07% versus 49.93%). El mayor número de nacimientos se registraron durante las 38 y 39 semanas de gestación. Se obtuvo para un recién nacido a término peso promedio 3 070.7 gramos, talla 48.6 centímetros y perímetro cefálico 34.2 centímetros. CONCLUSIONES: Las curvas que se emplean actualmente para la estratificación de los recién nacidos, podrían no ser representativas de la realidad local, por lo que sería necesario el desarrollo de curvas con las poblaciones de cada sector para evitar sesgos erróneos por la variabilidad étnica.(AU)

BACKGROUND: Determination of normality or morbidity in newborns is based on the classification using intrauterine growth curves based on neonatal anthropometry. Data may vary according to race, genetics, environmental exposures and maternal lifestyles. For that reason, the WHO recommends the construction of community specific growth curves. The aim of this study was to determine intrauterine growth curves calculated from weight, height and cephalic perimeter in newborns of Hospital José Carrasco Arteaga, from January 2014 to June 2015. METHODS: A descriptive, cross-sectional study was performed; the universe included newborns without congenital or genetic malformations and from single gestations, attended at Hospital José Carrasco Arteaga, from January 2014 to June 2015. Data was obtained through indirect observation; information was analyzed in Excel 2010 and SPSS 15. RESULTS: 2 165 newborns met inclusion criteria, with a slight predominance of male newborns (50.07% versus 49.93%). The highest number of births was registered during 38 and 39 weeks of gestation. An average full-term weight of 3 070.7 grams, size 48.6 centimeters and head circumference of 34.2 centimeters was obtained. CONCLUSIÓN: The curves currently used for the stratification of newborns, may not be representative of local population; so, it would be necessary to develop specific growth curves to avoid erroneous biases due to ethnic variability.(AU)

La realidad virtual como método de enseñanza de la reanimación cardiopulmonar: un estudio aleatorizado / Virtual reality in cardiopulmonary resuscitation training: a randomized trial

Objetivos: Analizar la eficacia de la realidad virtual (RV) en la formación en reanimación cardiopulmonar (RCP). Método: Estudio experimental, analítico, transversal para analizar el aprendizaje en RCP a través de la RV, en el que los participantes fueron asignados aleatoriamente en grupo control (GC) y grupo RV (GRV). Resultados: La nota del test fue de GRV fue 9,28 (DE 0,91) y el de GC 7,78 (DE 1,63) [diferencia de medias 1,49 (IC95% 0,96-2,02), p < 0,001]. El ritmo medio de las compresiones fue 97,5 (DE 9,7) compresiones/min para el GRV y 80,9 (DE 7,7) compresiones/min para el GC [diferencia de medias 16,6 (IC95% 15,0-18,2), p = 0,003]. La profundidad media fue 34,0 (DE 6,5) mm para el GRV y 27,3 (DE 4,9) mm para el GC [diferencia de medias 6,7 (IC95% 5,77,8), p < 0,001]. Conclusión: La RV es un método de enseñanza de RCP capaz de mejorar los conocimientos teóricos y habilidades prácticas

Objective: To assess the efficacy of virtual reality (VR) in cardiopulmonary resuscitation (CPR) training. Method: Experimental, analytic, cross-sectional study of a CPR training method using VR. Participants were randomly assigned to train in a control group or a VR group. Results: The mean (SD) scores on a scale of 10 after training were 9.28 (0.91) in the VR group and 7.78 (1.63) in the control group, for a mean difference of 1.49 (95% CI, 0.96-2.02; P<.001). The VR group achieved a mean of 97.5 (9.7) compressions/min, versus 80.9 (7.7) compressions/min in the control group, for a mean difference of 16.6 compressions/min (95% CI, 15.0-18.2; P=.003). The mean compression depth in the VR group was 34.0 (6.5) mm, versus 27.9 (4.9) mm in the control group, for a mean difference of 6.7 (95% CI, 5.7-7.8; P<.001). Conclusion: Training with VR can improve CPR theoretical knowledge and practical skills

Respuesta de los autores: Soporte vital en centros escolares / Reply: Life support in schools

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Virtual reality in cardiopulmonary resuscitation training: a randomized trial. / La realidad virtual como método de enseñanza de la reanimación cardiopulmonar: un estudio aleatorizado.

OBJECTIVES: To assess the efficacy of virtual reality (VR) in cardiopulmonary resuscitation (CPR) training. MATERIAL AND METHODS: Experimental, analytic, cross-sectional study of a CPR training method using VR. Participants were randomly assigned to train in a control group or a VR group. RESULTS: The mean (SD) scores on a scale of 10 after training were 9.28 (0.91) in the VR group and 7.78 (1.63) in the control group, for a mean difference of 1.49 (95% CI, 0.96-2.02; P<.001). The VR group achieved a mean of 97.5 (9.7) compressions/min, versus 80.9 (7.7) compressions/min in the control group, for a mean difference of 16.6 compressions/min (95% CI, 15.0-18.2; P=.003). The mean compression depth in the VR group was 34.0 (6.5) mm, versus 27.9 (4.9) mm in the control group, for a mean difference of 6.7 (95% CI, 5.7-7.8; P<.001). CONCLUSION: Training with VR can improve CPR theoretical knowledge and practical skills.

OBJETIVO: Analizar la eficacia de la realidad virtual (RV) en la formación en reanimación cardiopulmonar (RCP). METODO: Estudio experimental, analítico, transversal para analizar el aprendizaje en RCP a través de la RV, en el que los participantes fueron asignados aleatoriamente en grupo control (GC) y grupo RV (GRV). RESULTADOS: La nota del test fue de GRV fue 9,28 (DE 0,91) y el de GC 7,78 (DE 1,63) [diferencia de medias 1,49 (IC95% 0,96-2,02), p < 0,001]. El ritmo medio de las compresiones fue 97,5 (DE 9,7) compresiones/min para el GRV y 80,9 (DE 7,7) compresiones/min para el GC [diferencia de medias 16,6 (IC95% 15,0-18,2), p = 0,003]. La profundidad media fue 34,0 (DE 6,5) mm para el GRV y 27,3 (DE 4,9) mm para el GC [diferencia de medias 6,7 (IC95% 5,7- 7,8), p < 0,001]. CONCLUSIONES: La RV es un método de enseñanza de RCP capaz de mejorar los conocimientos teóricos y habilidades prácticas.

Learning cardiopulmonary resuscitation theory with face-to-face versus audiovisual instruction for secondary school students: a randomized controlled trial. / Ensayo clínico aleatorizado controlado que compara la formación presencial frente a la no presencial en el aprendizaje teórico de la reanimación cardiopulmonar entre los estudiantes de secundaria.

OBJECTIVES: To compare secondary students' learning of basic life support (BLS) theory and the use of an automatic external defibrillator (AED) through face-to-face classroom instruction versus educational video instruction. MATERIAL AND METHODS: A total of 2225 secondary students from 15 schools were randomly assigned to one of the following 5 instructional groups: 1) face-to-face instruction with no audiovisual support, 2) face-to-face instruction with audiovisual support, 3) audiovisual instruction without face-to-face instruction, 4) audiovisual instruction with face-to-face instruction, and 5) a control group that received no instruction. The students took a test of BLS and AED theory before instruction, immediately after instruction, and 2 months later. RESULTS: The median (interquartile range) scores overall were 2.33 (2.17) at baseline, 5.33 (4.66) immediately after instruction (P<.001) and 6.00 (3.33) (P<.001). All groups except the control group improved their scores. Scores immediately after instruction and 2 months later were statistically similar after all types of instruction. CONCLUSION: No significant differences between face-to-face instruction and audiovisual instruction for learning BLS and AED theory were found in secondary school students either immediately after instruction or 2 months later.

OBJETIVO: Comparar la formación presencial, mediante una clase teórica, frente a la formación no presencial, con un método audiovisual con y sin refuerzo posterior, en el aprendizaje teórico del soporte vital básico (SVB) y el desfibrilador externo automático (DEA) entre los estudiantes de secundaria. METODO: Se llevó a cabo un ensayo clínico aleatorizado que incluyó a 2.225 estudiantes de secundaria procedentes de 15 centros educativos que fueron asignados al azar a uno de los siguientes cinco grupos: 1) Grupo formación presencial sin refuerzo; 2) Grupo formación presencial con refuerzo; 3) Grupo formación audiovisual sin refuerzo; 4) Grupo formación audiovisual con refuerzo; 5) Grupo control. Se realizó un test sobre aspectos teóricos del SVB y DEA antes, después y a los 2 meses de la estrategia formativa. RESULTADOS: Los resultados mostraron diferencias estadísticamente significativas en todos los grupos, excepto el grupo control, entre la puntuación obtenida en el test basal 2,33 (RIC 2,17) y el test inmediato 5,33 (RIC 4,66) (p < 0,001), y entre el test basal y el test final 6,00 (RIC 3,33) (p < 0,001). No hubo diferencias en el aprendizaje inmediato y a los 2 meses entre los diferentes tipos de formaciones. CONCLUSIONES: No se encontraron diferencias entre la formación presencial mediante charlas teóricas y la formación no presencial con método audiovisual en el aprendizaje teórico inmediato y a los dos meses en el aprendizaje teórico del SVB y el DEA entre los estudiantes de secundaria.

Ensayo clínico aleatorizado controlado que compara la formación presencial frente a la no presencial en el aprendizaje teórico de la reanimación cardiopulmonar entre los estudiantes de secundaria / Learning cardiopulmonary resuscitation theory with face-to-face versus audiovisual instruction for secondary school students: a randomized controlled trial

Objetivo. Comparar la formación presencial, mediante una clase teórica, frente a la formación no presencial, con un método audiovisual con y sin refuerzo posterior, en el aprendizaje teórico del soporte vital básico (SVB) y el desfibrilador externo automático (DEA) entre los estudiantes de secundaria. Método. Se llevó a cabo un ensayo clínico aleatorizado que incluyó a 2.225 estudiantes de secundaria procedentes de 15 centros educativos que fueron asignados al azar a uno de los siguientes cinco grupos: 1) Grupo formación presencial sin refuerzo; 2) Grupo formación presencial con refuerzo; 3) Grupo formación audiovisual sin refuerzo; 4) Grupo formación audiovisual con refuerzo; 5) Grupo control. Se realizó un test sobre aspectos teóricos del SVB y DEA antes, después y a los 2 meses de la estrategia formativa. Resultados. Los resultados mostraron diferencias estadísticamente significativas en todos los grupos, excepto el grupo control, entre la puntuación obtenida en el test basal 2,33 (RIC 2,17) y el test inmediato 5,33 (RIC 4,66) (p < 0,001), y entre el test basal y el test final 6,00 (RIC 3,33) (p < 0,001). No hubo diferencias en el aprendizaje inmediato y a los 2 meses entre los diferentes tipos de formaciones. Conclusión. No se encontraron diferencias entre la formación presencial mediante charlas teóricas y la formación no presencial con método audiovisual en el aprendizaje teórico inmediato y a los dos meses en el aprendizaje teórico del SVB y el DEA entre los estudiantes de secundaria (AU)

Objective. To compare secondary students' learning of basic life support (BLS) theory and the use of an automatic external defibrillator (AED) through face-to-face classroom instruction versus educational video instruction. Methods. A total of 2225 secondary students from 15 schools were randomly assigned to one of the following 5 instructional groups: 1) face-to-face instruction with no audiovisual support, 2) face-to-face instruction with audiovisual support, 3) audiovisual instruction without face-to-face instruction, 4) audiovisual instruction with face-to-face instruction, and 5) a control group that received no instruction. The students took a test of BLS and AED theory before instruction, immediately after instruction, and 2 months later. Results. The median (interquartile range) scores overall were 2.33 (2.17) at baseline, 5.33 (4.66) immediately after instruction (P<001) and 6.00 (3.33) (P <001). All groups except the control group improved their scores. Scores immediately after instruction and 2 months later were statistically similar after all types of instruction. Conclusion. No significant differences between face-to-face instruction and audiovisual instruction for learning BLS and AED theory were found in secondary school students either immediately after instruction or 2 months later (AU)

Understanding and Resetting Radiation Sensitivity in Rectal Cancer.

OBJECTIVE: The aim of the study was to explore specific microRNAs (miRs) in rectal cancer that would predict response to radiation and identify target pathways that may be exploited for neoadjuvant therapies. SUMMARY BACKGROUND DATA: Chemoradiotherapy (CRT) response is a predictor of survival in rectal cancer. Studies have demonstrated changes in RNA expression correlate with chemoradiation sensitivity across cancers. METHODS: Forty-five rectal cancer patients, partial responders (PR = 18), nonresponders (NR = 13), and complete responders (CR = 14) to CRT, as defined by a tumor regression score, were examined. miRs differentially expressed, using NanoString microArray profiling, were validated with qPCR. We quantified 1 miR and its downstream targets in patient samples. Chemosensitivity was measured in HCT-116, a human colorectal carcinoma cell line, using inhibitors of SHP2 and RAF. RESULTS: miR-451a, 502-5p, 223-3p, and 1246 were the most upregulated miRs (>1.5-fold change) in a NanoString profiling miR panel. qPCR revealed a decrease in expression of miR-451a in NRs. EMSY and CAB39, both downstream targets of miR-451a and involved in carcinogenesis (shown in TCGA) were increased in NRs (qPCR). Both targets are associated with worse survival in colorectal cancer. Inhibition of miR-451a in HCT-116 cells significantly decreased cell proliferation with treatment of SHP2 and RAF inhibitors. CONCLUSIONS: An integrated analysis of rectal cancer miRs may yield biomarkers of radioresistance and offer treatment targets for resensitization.

Related factors to semi-recumbent position compliance and pressure ulcers in patients with invasive mechanical ventilation: An observational study (CAPCRI study).

BACKGROUND: Semi-recumbent position is recommended to prevent ventilator-associated pneumonia. Its implementation, however, is below optimal. OBJECTIVES: We aimed to assess real semi-recumbent position compliance and the degree of head-of-bed elevation in Spanish intensive care units, along with factors determining compliance and head-of-bed elevation and their relationship with the development of pressure ulcers. Finally, we investigated the impact that might have the diagnosis of pressure ulcers in the attitude toward head-of-bed elevation. METHODS: We performed a prospective, multicenter, observational study in 6 intensive care units. Inclusion criteria were patients ≥18 years old and expected to remain under mechanical ventilator for ≥48h. Exclusion criteria were patients with contraindications for semi-recumbent position from admission, mechanical ventilation during the previous 7 days and prehospital intubation. Head-of-bed elevation was measured 3 times/day for a maximum of 28 days using the BOSCH GLM80(®) device. The variables collected related to patient admission, risk of pressure ulcers and the measurements themselves. Bivariate and multivariate analyses were carried out using multiple binary logistic regression and linear regression as appropriate. Statistical significance was set at p<0.05. All analyses were performed with IBM SPSS for Windows Version 20.0. RESULTS: 276 patients were included (6894 measurements). 45.9% of the measurements were <30.0°. The mean head-of-bed elevation was 30.1 (SD 6.7)° and mean patient compliance was 53.6 (SD 26.1)%. The main reasons for non-compliance according to the staff nurses were those related to the patient's care followed by clinical reasons. The factors independently related to semi-recumbent position compliance were intensive care unit, ventilation mode, nurse belonging to the research team, intracranial pressure catheter, beds with head-of-bed elevation device, type of pathology, lateral position, renal replacement therapy, nursing shift, open abdomen, abdominal vacuum therapy and agitation. Twenty-five patients (9.1%) developed a total of 34 pressure ulcers. The diagnosis of pressure ulcers did not affect the head-of-bed elevation. In the multivariate analysis, head-of-bed elevation was not identified as an independent risk factor for pressure ulcers. CONCLUSIONS: Semi-recumbent position compliance is below optimal despite the fact that it seems achievable most of the time. Factors that affect semi-recumbent position include the particular intensive care unit, abdominal conditions, renal replacement therapy, agitation and bed type. Head-of-bed elevation was not related to the risk of pressure ulcers. Efforts should be made to clarify semi-recumbent position contraindications and further analysis of its safety profile should be carried out.

Nosocomial candidemia at a general hospital: prognostic factors and impact of early empiric treatment on outcome (2002–2005)

Objectives: To evaluate epidemiological and clinical prognosis factors related to mortality and impact of early empiric treatment on patients with nosocomial candidemia (NC).Patients and methods: Observational study of a cohort of 107 adult patients with NC admitted at a tertiary hospital (2002–5). Results. In bivariate analysis, risk factors significantly associated with mortality rate (49.5%) were: age >65 years, previous steroid treatment, solid organ transplant, acute severity of illness, shock, renal failure and respiratory distress at onset, delayed or inadequate antifungal treatment, non-removal of central venous catheter and associated post-surgical bacterial sepsis or respiratory infection. In multivariate analysis, risk factor associated with mortality was acute severity of illness at onset (OR 76.9; CI 12.5–500) being early and adequate treatment (OR 11.8; CI 1.7–81.2) and early (<48h) removing of central venous catheter (OR 12.2; CI 1.9–74.9) factors associated with cure; there was no statistically significant difference between fungistatic (azoles) or fungicidal (amphotericin or caspofungin) treatment. Conclusions: Acute severity of illness at onset is associated with mortality in patients with NC whereas early and adequate treatment and early removing of central venous catheter are associated with cure (AU)

Objetivos: Valorar los factores pronósticos clínicos y epidemiológicos que se asocian a mortalidad y el impacto del tratamiento empírico en la evolución de los pacientes con candidemia nosocomial (CN).Pacientes y métodos: Estudio observacional de una cohorte de pacientes adultos que presentaron CN durante su ingreso en un hospital universitario (enero 2002 a mayo 2005). Los casos de CN se identificaron a partir de la revisión en el laboratorio de microbiología de los hemocultivos positivos para Candida spp. Resultados: Se incluyeron 107 pacientes; la mortalidad fue del 49,5%. En el estudio bivariado los factores asociados de forma estadísticamente significativa a fallecimiento fueron: edad >65 años, uso previo de corticoides, antecedente de trasplante de órgano sólido, situación de gravedad clínica inicial crítica, presencia de shock, insuficiencia renal, distress respiratorio, desarrollo de fenómenos de coagulación intravascular diseminada, el tratamiento antifúngico tardío o inadecuado, la no retirada del catéter venoso central y la presencia concomitante de sepsis bacteriana. En el análisis multivariante se asoció a fallecimiento la situación clínica inicial crítica (OR 76,9; IC 12,5–500), siendo el tratamiento precoz y adecuado (OR 11,8; IC 1,7–81,2) y la retirada precoz (<48h) del catéter venoso central (OR 12,2; IC 1,9–74,9) los factores asociados a curación. El uso de antifúngicos fungistáticos (azoles) o fungicidas (anfotericina y caspofungina) no se asoció a diferencias en el pronóstico. Conclusiones: En pacientes con CN la gravedad al diagnóstico se asocia a mortalidad mientras que el tratamiento precoz y adecuado y la retirada precoz del catéter venoso central se asociaron a curación (AU)

Nosocomial candidemia at a general hospital: prognostic factors and impact of early empiric treatment on outcome (2002-2005).

OBJECTIVES: To evaluate epidemiological and clinical prognosis factors related to mortality and impact of early empiric treatment on patients with nosocomial candidemia (NC). PATIENTS AND METHODS: Observational study of a cohort of 107 adult patients with NC admitted at a tertiary hospital (2002-5). RESULTS: In bivariate analysis, risk factors significantly associated with mortality rate (49.5%) were: age >65 years, previous steroid treatment, solid organ transplant, acute severity of illness, shock, renal failure and respiratory distress at onset, delayed or inadequate antifungal treatment, non-removal of central venous catheter and associated post-surgical bacterial sepsis or respiratory infection. In multivariate analysis, risk factor associated with mortality was acute severity of illness at onset (OR 76.9; CI 12.5-500) being early and adequate treatment (OR 11.8; CI 1.7-81.2) and early (<48h) removing of central venous catheter (OR 12.2; CI 1.9-74.9) factors associated with cure; there was no statistically significant difference between fungistatic (azoles) or fungicidal (amphotericin or caspofungin) treatment. CONCLUSIONS: Acute severity of illness at onset is associated with mortality in patients with NC whereas early and adequate treatment and early removing of central venous catheter are associated with cure.

Nosocomial candidemia at a general hospital: The change of epidemiological and clinical characteristics. A comparative study of 2 cohorts (1993–1998 versus 2002–2005)

AntecedentesLa candidemia nosocomial (CN) se asocia a una elevada mortalidad y a un aumento de la estancia hospitalaria y del coste económico de la misma.ObjetivosAnalizar las características epidemiológicas y clínicas de dos cohortes de pacientes no pediátricos que desarrollaron CN.MétodosEstudio retrospectivo, observacional y comparativo de pacientes con CN. Los casos se identificaron a partir de los resultados de los hemocultivos (Laboratorio de Microbiología de nuestro centro). Se estudiaron las diferencias referentes a aspectos epidemiológicos, clínicos, microbiológicos y de laboratorio de las 2 cohortes: 1993–1998 (P1) y 2002–2005 (P2). Los paciente estudiados en P1 fueron 80, y 107 en P2.ResultadosLa incidencia fue 9/10000 en P1 y 15,8/10000 ingresos en P2 (p<0,05); la edad media fue 52 y 61 años en P1 y P2, respectivamente (p<0,05); 66% y 49% de los casos correspondían a Candida albicans en P1 y P2, respectivamente (p<0,05); 12% de los pacientes en P1 y 25% en P2 eran diabéticos (p<0,05). Todos los pacientes habían recibido previamente al menos un ciclo de tratamiento antibiótico de amplio espectro. Hubo diferencias estadísticamente significativas (p<0,05) en los siguientes factores predisponentes: portadores de vía venosa central (100% en P1 y 91% en P2) y cirugía previa (43% en P1 y 78% en P2). La gravedad del diagnóstico y el desarrollo de complicaciones fue más frecuente en P2 (p<0,05). La mortalidad fue similar en P1 y P2 (51% y 49,5%, respectivamente).ConclusionesLa frecuencia de CN ha aumentando y las especies de Candida no-C. albicans son ahora más frecuentes que C. albicans. Aunque la gravedad y el desarrollo de complicaciones son ahora más frecuentes, la mortalidad se ha mantenido estable(AU9

BackgroundNosocomial candidemia (NC) is associated with high mortality, increased hospital stay and greater economical cost.AimsTo evaluate epidemiological and clinical aspects of 2 different cohorts of non-paediatric patients with NC.MethodsA retrospective observational and comparative study of patients with NC. Patients were identified by review of results of blood cultures from the hospital microbiology laboratory. We analysed epidemiological, clinical, microbiological and laboratory data and changes in the 2 cohorts: 1993–1998 (P1) and from 2002 to 2005 (P2).ResultsEighty patients were studied during P1 and 107 during P2; incidence was 9/10,000 in P1 and 15.8/10,000 admitted patients in P2 (p<0.05). Mean age was 52 years in P1 and 61 years in P2 (p<0.05); 66% and 49% NC were due to Candida albicans in P1 and P2, respectively (p<0.05); diabetes was present in 12% in P1 and in 25% in P2 (p<0.05). All of the patients had previously received at least one course of broad-spectrum antibiotics. A statistically significant difference (p<0.05) in predisposing conditions was identified in central intravenous line rate (100% in P1 and 91% in P2) and previous surgery (43% in P1 and 78% in P2). Acute severity of illness at onset and complications were more frequent in P2 (p<0.05). Mortality rate was similar in P1 and P2 (51% and 49.5%, respectively).ConclusionsFrequency of NC has increased and non-albicans Candida is now more frequent than C. albicans. Although acute severity of illness at onset and complications are now more frequent, mortality remains the same(AU)

Nosocomial candidemia at a general hospital: the change of epidemiological and clinical characteristics. A comparative study of 2 cohorts (1993-1998 versus 2002-2005).

BACKGROUND: Nosocomial candidemia (NC) is associated with high mortality, increased hospital stay and greater economical cost. AIMS: To evaluate epidemiological and clinical aspects of 2 different cohorts of non-paediatric patients with NC. METHODS: A retrospective observational and comparative study of patients with NC. Patients were identified by review of results of blood cultures from the hospital microbiology laboratory. We analysed epidemiological, clinical, microbiological and laboratory data and changes in the 2 cohorts: 1993-1998 (P1) and from 2002 to 2005 (P2). RESULTS: Eighty patients were studied during P1 and 107 during P2; incidence was 9/10,000 in P1 and 15.8/10,000 admitted patients in P2 (p<0.05). Mean age was 52 years in P1 and 61 years in P2 (p<0.05); 66% and 49% NC were due to Candida albicans in P1 and P2, respectively (p<0.05); diabetes was present in 12% in P1 and in 25% in P2 (p<0.05). All of the patients had previously received at least one course of broad-spectrum antibiotics. A statistically significant difference (p<0.05) in predisposing conditions was identified in central intravenous line rate (100% in P1 and 91% in P2) and previous surgery (43% in P1 and 78% in P2). Acute severity of illness at onset and complications were more frequent in P2 (p<0.05). Mortality rate was similar in P1 and P2 (51% and 49.5%, respectively). CONCLUSIONS: Frequency of NC has increased and non-albicans Candida is now more frequent than C. albicans. Although acute severity of illness at onset and complications are now more frequent, mortality remains the same.