[Evolution of antimicrobial resistance and mortality in Staphylococcus aureus endocarditis during 15 years in a university hospital]. / Evolución de la resistencia antimicrobiana y mortalidad en la endocarditis por Staphylococcus aureus durante 15 años en un hospital universitario.

OBJECTIVE: One of the most aggressive microorganisms in infective endocarditis (IE) is Staphylococcus aureus. We analyse the resistance of S. aureus to antibiotics and its impact on the clinical course of IE in a recent 15-year period. METHODS: Retrospective study of patients with IE in a university hospital from 2005 to 2019. Bivariate and multivariate analysis of severity at admission, comorbidities, minimum inhibitory concentrations (MIC) and mortality. RESULTS: Of the 293 IE cases, 66 (22.5%) were due to S. aureus, and 21 (7.2%) were methicillin-resistant S. aureus (MRSA). The prevalence of strains with a MIC to vancomycin ≥ 1mg/L increased from 4.8% to 63.6% (p <0.001) and the cases of MRSA from 38 to 27.3% (p = 0.045). Older age (p= 0.02), comorbidity (p <0.01) and nosohusial origin (p = 0.01), were factors associated with MRSA. But the antimicrobial resistance and severity on admission were not associated with exitus; predictive factors were the right-sided IE (OR = 0.08; 95% CI: 0.01-0.51), comorbidities (OR per Charlson index point = 1.30; 95% CI: 1.01-1.69) and creatinine on admission (OR per mg / dL = 1.56; 95% CI = 1.01- 2.35; p = 0.04). CONCLUSIONS: We have experienced an increase in IE cases with MIC to vancomycin ≥ 1mg/L, without significant variation in infections due to MRSA. Antimicrobial resistance was not associated with mortality, but comorbidity and left involvement were predictive factors.

Anatomía angiográfica femoral y complicaciones derivadas del cateterismo cardiaco / Femoral angiographic anatomy and complications arising from cardiac catheterisation

INTRODUCCIÓN: Las complicaciones vasculares derivadas del cateterismo cardiaco por vía femoral prolongan la estancia hospitalaria y ponen en peligro la integridad de los pacientes. Conocer la anatomía angiográfica podría ayudar a predecir la aparición de complicaciones. OBJETIVOS: Averiguar los factores relacionados con una anatomía angiográfica femoral desfavorable para el acceso vascular y si ésta se asocia a una mayor frecuencia de complicaciones derivadas del cateterismo cardiaco. MÉTODOS: Estudio observacional prospectivo de todos los pacientes a los que se les realizó cateterismo por vía femoral entre mayo de 2011 y abril de 2012 en un hospital universitario. Se analizaron las variables relacionadas con una anatomía vascular desfavorable y con la aparición de complicaciones derivadas del procedimiento. RESULTADOS: Entre 917 procedimientos se produjeron 35 complicaciones (3,8%). Los pacientes con una angiografía femoral de riesgo presentaban mayor edad (67 [60-76] vs 65 [55-73] años, p < 0,001), menor aclaramiento de creatinina (73,6 [54-95,2] vs 84,4 [64-106,8] ml/min, p < 0,001) y mayor frecuencia de diabetes (47,7 vs 35,1%, p < 0,001). Aunque una anatomía vascular desfavorable no se asoció significativamente con la aparición de complicaciones (5,4 vs 3,1%, p = 0,103), los operadores la tomaron en cuenta para decidir el tipo de hemostasia posterior. En el análisis multivariable solo fue significativo el cruce de heparinas (OR = 3,19; IC 95%, 1,44-7,06; p = 0,004). CONCLUSIONES: La edad, la diabetes y la función renal se asocian a un acceso femoral desfavorable. Las complicaciones del cateterismo no se relacionan con la anatomía angiográfica, aunque esta es útil para el manejo del punto de acceso

INTRODUCTION: Vascular complications during cardiac catheterization using the femoral artery extend hospital stay and jeopardize the integrity of patients. Knowing the angiographic anatomy could help to predict the development of complications. OBJECTIVES: To investigate the factors associated with unfavorable femoral anatomy and vascular access, and whether it is associated with more complications during cardiac catheterization. METHODS: Prospective observational study of all patients who underwent catheterization between May 2011 and April 2012 at a university hospital. We analyzed the variables related with an unfavorable vascular anatomy and with the development of complications arising from the procedure. RESULTS: Of the 917 procedures, there were 35 complications (3.8%). Patients with femoral angiography were older (67 [60-76] vs 65 [55-73] years, P<0.001), with lower creatinine clearance (73.6 [54-95.2] vs 84.4 [64 to 106.8] mL/min, P<0.001), and higher frequency of diabetes (47.7 vs. 35.1%, P<0.001). Although unfavorable vascular anatomy was not significantly associated with the occurrence of complications (5.4 vs 3.1%, P=0.103), operators took it into account when choosing the type of subsequent hemostasis. In the multivariate analysis only crossing heparins was significantly related with the development of complications (OR = 3.19, 95% CI, 1.44 to 7.06, P=0.004). CONCLUSIONS: Age, diabetes and kidney function are associated with an unfavorable femoral access. Catheterization complications are not directly related to the angiographic anatomy, although it is useful for management of the access point

Endocarditis infecciosa en la Unidad de Medicina Intensiva / Infectious endocarditis in the intensive care unit

Objetivo: Conocer las características, evolución y pronóstico de los pacientes con endocarditis infecciosa que requieren tratamiento en la Unidad de Medicina Intensiva. Diseño: Estudio observacional de cohortes prospectivo en pacientes ingresados por endocarditis infecciosa. Ámbito: Hospital Universitario Nuestra Señora de Candelaria, centro con 824 camas y población asignada de 493.145 personas. Pacientes: Todos los pacientes diagnosticados de endocarditis siguiendo los criterios de Duke entre el 1 de enero de 2005 y el 31 de julio de 2011. Variables de interés: Variables demográficas, clínicas, scores de gravedad, hallazgos microbiológicos y ecocardiográficos, mortalidad intrahospitalaria y complicaciones. Resultados: De 102 pacientes diagnosticados de endocarditis, 38 (37%) ingresaron en Medicina Intensiva. Comparándolos con los que no lo hicieron, sufrieron con más frecuencia afectación mitral (OR= 7,13; IC del 95%, 2,12-24; p= 0,002) y embolia cerebral (OR= 3,89; IC del 95%, 1,06-14,3; p= 0,041). La mortalidad fue mayor (42,1 vs 18,8%, p= 0,011), así como la proporción de cirugías urgentes (45,8 vs 5,9%, p<0,001). Resultaron predictores de mortalidad la infección por Estafilococo aureus (OR= 3,49; IC 95%: 1,02-11,93; p=0,046), la insuficiencia cardiaca (OR=4,18; IC 95%: 1,17-14,94; p=0,028), el embolismo cerebral (OR= 8,45; IC 95%: 1,89-37,74; p=0,005) y la puntuación en el score SAPS II al ingreso (OR=1,09; IC 95% 1,04-1,15; p<0,001). Conclusiones: Una elevada proporción de pacientes con endocarditis requieren ingreso en la Unidad de Medicina Intensiva, presentando un pronóstico mucho más desfavorable. La infección por E. aureus, la insuficiencia cardiaca, el embolismo cerebral y la puntuación SAPS II resultan predictores de mortalidad intrahospitalaria (AU)

Objective: To study the characteristics, evolution and prognosis of patients with infectious endocarditis requiring treatment in the Intensive Care Unit. Design: A prospective, observational cohort study of patients admitted due to infectious endocarditis. Setting: Nuestra Señora de Candelaria University Hospital, a third - level center with a recruitment population of 493,145. Patients: All patients consecutively diagnosed with infectious endocarditis in our center according to the Duke criteria, between 1 January 2005 and 31 July 2011. Study variables: Demographic data, clinical severity scores, microbiological and echocardiographic data, hospital mortality and complications. Results: Out of 102 patients diagnosed with endocarditis, 38 (37%) were admitted to Intensive Care. Compared with those patients not admitted to the ICU, these subjects suffered more frequent mitral valve alterations (OR= 7.13; 95%CI: 2.12-24; p= 0.002) and cerebral embolism (OR= 3.89; 95%CI: 1.06-14.3; p= 0.041). In turn, mortality was greater (42.1% vs 18.8%, p= 0.011), as was the proportion of emergency surgeries (45.8% vs 5.9%, p<0.001). The identified mortality predictors were Staphylococcus aureus infection (OR= 3.49; 95%CI 1.02-11.93; p=0.046), heart failure (OR=4.18; 95%CI: 1.17-14.94; p=0.028), cerebral embolism (OR= 8.45; 95%CI: 1.89-37.74; p=0.005) and the SAPS II upon admission (OR=1.09; 95%CI: 1.04-1.15; p<0.001). Conclusions: A large proportion of patients with endocarditis require admission to the Intensive Care Unit, presenting a much poorer prognosis. Staphylococcus aureus infection, heart failure, cerebral embolism and SAPS II scores are independent predictors of hospital mortality (AU)

[Infectious endocarditis in the intensive care unit]. / Endocarditis infecciosa en la Unidad de Medicina Intensiva.

OBJECTIVE: To study the characteristics, evolution and prognosis of patients with infectious endocarditis requiring treatment in the Intensive Care Unit. DESIGN: A prospective, observational cohort study of patients admitted due to infectious endocarditis. SETTING: Nuestra Señora de Candelaria University Hospital, a third - level center with a recruitment population of 493,145. PATIENTS: All patients consecutively diagnosed with infectious endocarditis in our center according to the Duke criteria, between 1 January 2005 and 31 July 2011. STUDY VARIABLES: Demographic data, clinical severity scores, microbiological and echocardiographic data, hospital mortality and complications. RESULTS: Out of 102 patients diagnosed with endocarditis, 38 (37%) were admitted to Intensive Care. Compared with those patients not admitted to the ICU, these subjects suffered more frequent mitral valve alterations (OR= 7.13; 95%CI: 2.12-24; p= 0.002) and cerebral embolism (OR= 3.89; 95%CI: 1.06-14.3; p= 0.041). In turn, mortality was greater (42.1% vs 18.8%, p= 0.011), as was the proportion of emergency surgeries (45.8% vs 5.9%, p<0.001). The identified mortality predictors were Staphylococcus aureus infection (OR= 3.49; 95%CI 1.02-11.93; p=0.046), heart failure (OR=4.18; 95%CI: 1.17-14.94; p=0.028), cerebral embolism (OR= 8.45; 95%CI: 1.89-37.74; p=0.005) and the SAPS II upon admission (OR=1.09; 95%CI: 1.04-1.15; p<0.001). CONCLUSIONS: A large proportion of patients with endocarditis require admission to the Intensive Care Unit, presenting a much poorer prognosis. Staphylococcus aureus infection, heart failure, cerebral embolism and SAPS II scores are independent predictors of hospital mortality.