Complicaciones neurológicas en pacientes críticos por SARS-CoV-2 / Neurological complications in critical patients with COVID-19

INTRODUCCIÓN: Nos proponemos analizar las complicaciones neurológicas de los pacientes con infección grave por SARS-CoV-2 que han requerido ingreso en unidad de cuidados intensivos (UCI). PACIENTES Y MÉTODOS: Estudio descriptivo retrospectivo, observacional, de pacientes consecutivos ingresados en UCI por infección respiratoria grave por SARS-CoV-2 desde el 1 de abril hasta el 1 de junio de 2020. RESULTADOS: Registramos 30 pacientes con síntomas neurológicos, 21 hombres (72,40%), edad media: 57,41 años ± 11,61 desviación estándar (DE). Estancia media en UCI: 18,83 ± 14,33 DE. A nivel sindrómico: 28 pacientes (93,33%) con síndrome confusional agudo, 15 (50%) con patología neuromuscular, 5 (16,66%) con cefalea, 4 (13,33%) con patología cerebrovascular y 4 (13,33%) con encefalopatías/encefalitis. Punción lumbar normal en 6 pacientes (20%). La RMN craneal o TAC craneal mostró alteraciones en 20 casos (66,6%). Se realizó EEG en todos los pacientes (100%), alterado en 8 pacientes (26,66%). En 5 de los 15 pacientes con miopatía clínica se ha podido confirmar con ENMG. Hemos encontrado relación entre la mayor edad y los días de ingreso en UCI (p = 0,002; IC95%: 4,032-6,022; OR: 3,594). CONCLUSIONES: La infección grave por COVID-19 afecta mayoritariamente a hombres, similar a lo descrito en otras series. La mitad de nuestros pacientes presenta una miopatía aguda, y casi la totalidad de los pacientes salen de la UCI con síndromes confusionales agudos que evolucionan a una resolución completa, sin correlacionarse con los resultados del EEG o de pruebas de neuroimagen. La mayor edad se asocia con un mayor número de días de estancia en UCI

INTRODUCTION: We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. PATIENTS AND METHODS: We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. RESULTS: We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P = .002; 95%CI: 4.032-6.022; OR: 3,594). CONCLUSIONS: Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay

Neurological complications in critical patients with COVID-19. / Complicaciones neurológicas en pacientes críticos por SARS-CoV-2.

INTRODUCTION: We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. PATIENTS AND METHODS: We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. RESULTS: We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P=.002; 95%CI: 4.032-6.022; OR: 3,594). CONCLUSIONS: Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay.

[Neurological complications in critical patients with COVID-19]. / Complicaciones neurológicas en pacientes críticos por SARS-CoV-2.

Introduction: We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. Patients and methods: We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. Results: We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P = .002; 95% CI: 4.032-6.022; OR: 3,594). Conclusions: Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay.

Safety and Efficacy of Prolonged Use of Dalbavancin in Bone and Joint Infections.

Dalbavancin is a lipoglycopeptide with potent activity against Gram-positive microorganisms, a long half-life, a favorable safety profile, and a high concentration in bone, which makes it an interesting alternative for treatment of osteoarticular infections. We performed a multicentric retrospective study of all patients with an osteoarticular infection (septic arthritis, spondylodiscitis, osteomyelitis, or orthopedic implant-related infection) treated with at least one dose of dalbavancin between 2016 and 2017 in 30 institutions in Spain. In order to evaluate the response, patients with or without an orthopedic implant were separated. A total of 64 patients were included. Staphylococcus epidermidis and Staphylococcus aureus were the most frequent microorganisms. The reasons for switching to dalbavancin were simplification (53.1%), adverse events (25%), or failure (21.9%). There were 7 adverse events, and no patient had to discontinue dalbavancin. In 45 cases, infection was related to an orthopedic implant. The implant material was retained in 23 cases, including that in 15 (65.2%) patients that were classified as cured and 8 (34.8%) that presented improvement. In 21 cases, the implants were removed, including those in 16 (76.2%) cases that were considered successes, 4 (19%) cases were considered improved, and 1 (4.8%) case that was considered a failure. Among the 19 cases without implants, 14 (73.7%) were considered cured, 3 (15.8%) were considered improved, and 2 (10.5%) were considered failures. The results show that dalbavancin is a well-tolerated antibiotic, even when >2 doses are administered, and is associated with a high cure rate. These are preliminary data with a short follow-up; therefore, it is necessary to gain more experience and, in the future, to establish the most appropriate dose and frequency.

[Utility of anaerobic blood cultures in extra-hospitalary bacteremias]. / Utilidad de los medios de crecimiento para anaerobios en las bacteriemias de origen extrahospitalario.

OBJECTIVE: To compare the rentability of anaerobic hemocultures with aerobic cultures in patients suffering bacteremia, trying to analyze the rentability of anaerobic cultures. METHODS: There were analyzed all the hemocultures taken by medical decision for one month. There were taken three extractions by patient in different venopunctures points. In each extraction was taken 10 ml (5 ml in aerobic bottle, and 5 ml in anaerobic bottle). There were compared microorganism isolated in aerobic bottles and anaerobic bottles. Three physician analyzed all the clinical dates of the patients with positive hemocultures and classified them as negatives, contaminants and significant. RESULTS: There were taken hemocultures of 180 patients. There were analyzed 152 hemocultures groups (3 extractions aerobic-anaerobic), without studying 28 owe to not following the study protocol 24 (13.3%) or because of not possibility of studying clinical story 4 (2.2%). Aerobic extractions: Negatives 91 (59.86%), contaminants 36 (23.68%), significant with or without contaminant 25 (16.44%). Anaerobic extractions: Negatives 127 (83.5%), contaminants 2 (1.31%); significant with or without contaminant 23 (15.13%). There are 6 (8.6%) significant positive isolated in anaerobic bottles, that were negative in aerobic bottles, and are: 3 E. coli, 1 K. pneumoniae, 1 Peptostreptococcus sp, 1 Bacteroides sp, and over the total significant isolated (31) are the 19.35%. Both anaerobic bacteremias were clinically suspected. Contaminant microorganism more frequently isolated in aerobic bottles was Staphylococcus sp, 25 cases (69.44% of all contaminants). Significant microorganism more frequently isolated was E. coli (in anaerobic bottles too) in 12 cases (38.70%) of all significant isolated, following by Streptococcus pneumoniae with 4 cases (12.9%). CONCLUSIONS: We recommend collection of one aerobic and one anaerobic blood culture bottle per blood culture set because the global rentability of hemocultures is increased significantly.

Utilidad de los medios de crecimiento para anaerobios en las bacteriemias de origen extrahospitalario / Utility of anaerobic blood cultures in extrahospitalary bacteremias

Objetivo: Comparar rentabilidad de extracción de hemocultivos en medios para aerobios frente a anaerobios en bacteriemias diagnosticadas en urgencias, con intención de valorar la utilidad de los medios de cultivo para anaerobios. Metodología: Durante un mes se realizaron hemocultivos a todos los pacientes que por criterio médico lo precisaban. Tres extracciones por sujeto en sitios de venopunción diferentes. En cada extracción se obtenían 10 ml (distribuidos en 5 ml para frasco aerobios, 5 ml para frasco de aerobios). Posteriormente se compararon los frascos de aerobios frente a anaerobios. Se valoraron por tres clínicos todas las historias de los pacientes con hemocultivo positivo, clasificándolos como negativos, contaminantes o significativos. Resultados: Se obtuvieron hemocultivos de un total de 180 pacientes. Se analizaron 152 grupos de hemocultivos (3 extracciones aerobiosanaerobios), sin valorarse los 28 restantes por no seguir el protocolo de estudio 24 (13,3 por ciento); o por no haber podido analizar la historia clínica 4 (2,2 por ciento). Grupo de tres extracciones sólo aerobios: Negativos 91 (59,86 por ciento), contaminantes 36 (23,68 por ciento), verdadero positivo en por lo menos una de las tres con o sin contaminante 25 (16,44 por ciento). Grupo de tres extracciones sólo anaerobios: Negativos 127 (83,5 por ciento), contaminantes 2 (1,31 por ciento) ; verdadero positivo en por lo menos una de las tres con o sin contaminante 23 (15,13 por ciento). Existen 6 casos (8.6 por ciento) de verdaderos positivos en frasco de anaerobios que han sido negativos en los frascos de aerobios y que corresponden a los siguientes gérmenes: 3 E. coli; 1 K. pneumoniae; 1 Peptostreptococcus sp; 1 Bacteroides sp y sobre el total de verdaderos positivos (31) suponen el 19,35 por ciento. Las dos bacteriemias por anaerobios, fueron sospechadas clínicamente. El germen que con más frecuencia fue contaminante en medio de crecimiento para aerobios, es el Staphylococcus sp coagulasa negativo, 25 asos (69,44 por ciento de todos los contaminantes).El germen productor de bacteriemia verdadera más frecuente fue el E. coli (también en anaerobios) con 12 casos (38,70 por ciento de todas las verdaderas bacteriemias), seguido del Streptococcus pneumoniae, 4 casos (12,90 por ciento).Conclusiones: Nuestra recomendación es mantener los cultivos en frascos de anaerobios en las sospechas de bacteriemia puesto que la rentabilidad global de los hemocultivos aumenta de forma significativa (AU)

Linfocitopenia T CD4+ idiopática asociada a criptococosis diseminada / Idiopathic CD4+ T-cell lymphocytopenia associated with disseminated cryptococcosis

No disponible

Respuesta inicial a esteroides de un linfoma no hodgkiniano pulmonar / Initial response to steroides in a case of pulmonary non-Hodgkin lymphoma

No disponible