RESUMEN
Objective: To describe and quantify resource use and direct health costs associated with skin and skin structure infections (SSSIs) caused by Gram-positive bacteria in adults receiving outpatient parenteral antimicrobial therapy (OPAT), administered by Hospital at Home units (HaH) in Spain. Material and method: Observational, multicenter, retrospective study. We included patients of both sexes included in the HaH-based OPAT Registry during 2011 to 2017 who were hospitalized due to SSSIs caused by Gram-positive bacteria. Resource use included home visits (nurses and physician), emergency room visits, conventional hospitalization stay, HaH stay and antibiotic treatment. Costs were quantified by multiplying the natural units of the resources by the corresponding unit cost. All costs were updated to 2019 euros. Results: We included 194 episodes in 189 patients from 24 Spanish hospitals. The most frequent main diagnoses were cellulitis (26.8%) and surgical wound infection (24.2%), and 94% of episodes resulted in clinical improvement or cure after treatment. The median HaH stay was 13 days (interquartile range [IR]:8-22.7), and the conventional hospitalization stay was 5 days (IR: 1-10.7). The mean total cost attributable to the complete infectious process was 7,326 (95% confidence interval: 6,316-8,416). Conclusions: Our results suggest that OPAT administered by HaH is a safe and efficient alternative for the management of these infections and could lead to lower costs compared with hospital admission. (AU)
Objetivo: Describir y cuantificar el uso de recursos y costes directos sanitarios asociados con las infecciones de piel y tejidos blandos (IPPB) causadas por microorganismos grampositivos en adultos que recibieron tratamiento antimicrobiano domiciliario endovenoso (TADE), administrado en unidades de hospitalización a domicilio (HaD) en España. Material y métodos: Estudio observacional, multicéntrico, retrospectivo. Se incluyeron pacientes adultos de ambos sexos, incluidos en el Registro TADE en el periodo 2011 a 2017y cuyo motivo de ingreso fue una IPPB causada por un microorganismo Grampositivo. El uso de recursos incluyó las visitas a domicilio (enfermería y médico), visitas a urgencias, estancia en hospitalización convencional, estancia en HaD y tratamiento antibiótico. Los costes se cuantificaron multiplicando las unidades naturales de los recursos por el coste unitario correspondiente. Todos los costes fueron actualizados a euros de 2019. Resultados: Se incluyeron 194 episodios (189 pacientes) procedentes de 24 centros españoles. Los diagnósticos principales más frecuentes fueron celulitis (26,8%) e infección por herida quirúrgica (24,2%). El 94% de los episodios resultaron en una mejoría o curación clínica al finalizar el tratamiento. La mediana de la estancia en HaD fue de 13 días (rango intercuartílico [RI]:8-22,7), con una estancia previa en hospitalización convencional de 5 días (RI: 1-10,7). El coste total promedio atribuible al proceso infecciosos completo fue de 7.326 (intervalo de confianza del 95%: 6.316-8.416). Conclusiones: Este estudio sugiere que el TADE administrado en HaD es una alternativa segura y eficiente para el manejo de estas infecciones y podría conducir a menores costes en comparación con el ingreso hospitalario. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedades Cutáneas Infecciosas/economía , Antiinfecciosos/uso terapéutico , Estudios Retrospectivos , Bacterias Grampositivas , EspañaRESUMEN
BACKGROUND: Atrial fibrillation (AF) is well-known risk factor for cardiac embolic events, especially cerebrovascular events. The association between AF and lipid markers was evaluated. Among all these markers, lipoprotein(a), or (Lp(a), was also investigated. The aim of our study was to evaluate the characteristics of the lipid profile in patients with AF, focusing on Lp(a) levels. MATERIAL/METHODS: One hundred and one patients with AF were included in the study group. We used 101 patients without AF, matched by sex and age with the study group, as the control group. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, Lp(a), and the LDL/HDL, COL/LDL, and COL/HDL indexes were measured. The study was performed in Spain with a Caucasian population. RESULTS: Among all the variables included there was statistical difference only between groups in the COL/HDL index, showing a greater value in the group of patients with AF. No difference was found in Lp(a) levels between the groups. CONCLUSIONS: Although some studies have tried to show a possible relationship between AF and high Lp(a) levels, we found no such relationship in our study, although ethnic differences could explain, at least in part, these results in our patients when compared with other ethnic populations.
Asunto(s)
Fibrilación Atrial , Lípidos/sangre , Lipoproteína(a)/sangre , Anciano , Biomarcadores/sangre , Estudios de Casos y Controles , Colesterol/sangre , Colesterol/genética , HDL-Colesterol/sangre , HDL-Colesterol/genética , LDL-Colesterol/sangre , LDL-Colesterol/genética , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Lípidos/genética , Lipoproteína(a)/genética , Lipoproteínas LDL/sangre , Lipoproteínas LDL/genética , Masculino , Factores de Riesgo , Triglicéridos/sangre , Triglicéridos/genética , Población Blanca/genéticaRESUMEN
The very few reference epidemiological studies on myelodysplastic syndromes (MDS) have been carried out in Europe: Germany, France, UK and Sweden. We present the first Spanish study on the incidence and characteristics of MDS. The incidence rates, distribution by FAB subtypes, sex and age groups are within the ranges established by the reference studies with minimal differences which we point out and attempt to explain.
