Differential characteristics of bacteraemias according to age in a community hospital. / Características diferenciales en las bacteriemias según la edad en un hospital comunitario.

OBJECTIVE: To describe the characteristics of bacteraemias, according to age, in a community hospital. MATERIAL AND METHOD: A prospective study of bacteraemias was conducted in 2011. The patients were classified into 3 age groups: younger than 65 years, 65 to 79, and 80 or older. The study collected variables on the patients and episodes. RESULTS: The study analysed 233 bacteraemias in 227 patients (23.8% in those younger than 65 years; 38.3% in the 65 to 79 age group; and 37.9% in the 80 years or older group). The most common underlying disease in all the groups was diabetes mellitus. In the most elderly patients, the Charlson index was highest, there was a lower proportion of exogenous factors, and almost 25% were severely dependent (Barthel index<20). Escherichia coli was the most common germ, and the main focus was urological. The patients aged 80 years or older had predominantly healthcare-associated infections, less severe symptoms (sepsis) (66.3%) and higher mortality (29.1%) compared with the younger patients. CONCLUSIONS: The very elderly patients with bacteraemia presented fewer exogenous factors, greater comorbidity and a poorer functional situation. The most common focus was urological and the origin was healthcare related. Despite their less severe clinical presentation, these patients' mortality was greater, and their degree of dependence was a highly relevant independent risk factor.

[Spontaneous pneumothorax and Pneumocystis carinii pneumonia. Something more than a casual association?]. / Neumotórax espontáneo y neumonía por Pneumocystis carinii. Algo más que una asociación casual?

The association of spontaneous pneumothorax and Pneumocystis pneumonia is not frequent. The medical literature reports a ratio between 0 and 5.7%. In 18 patients admitted in our hospital, in the last two years, and diagnosed of AIDS and Pneumocystis pneumonia, we observed two cases of pneumothorax spontaneous. They represent the 11%. In one of them spontaneous pneumothorax was the first manifestation and in the other a complication of the illness. It was not possible to isolate an agent different from Pneumocystis carinii. Considering the lack of predisposition factors and the previous clinical history, we think that Pneumocystis carinii is by itself the agent responsible of this complication. In view of this possibility, spontaneous pneumothorax in a patient who belongs to an AIDS' risk group will alert the clinician to the possibility of infection with Pneumocystis carinii.

[Severe hypoxemia due to a right-left shunt at the level of the foramen ovale. A complication of right ventricular infarct]. / Hipoxemia grave por cortocircuito derecha-izquierda a nivel del foramen oval. Una complicación del infarto de ventrículo derecho.

A 76-year-old woman with an inferior wall myocardial infarction, with right ventricular involvement, developed severe arterial hypoxemia with neurological involvement. Pulmonary edema or embolism and chronic obstructive pulmonary disease were ruled-out, and a right-to-left shunt was demonstrated by contrast echocardiography at the level of the foramen ovale. After inotropic support and oxygen supplementation, the patient recovered, although with significant neurological sequelae. No focal lesions were detected in the central nervous system by computerized tomography. Hypoxemia improved, coinciding with the disappearance of right-to-left shunt by contrast echocardiography.