Reappraisal of the outcome of healthcare-associated and community-acquired bacteramia: a prospective cohort study.

BACKGROUND: Healthcare-associated (HCA) bloodstream infections (BSI) have been associated with worse outcomes, in terms of higher frequencies of antibiotic-resistant microorganisms and inappropriate therapy than strict community-acquired (CA) BSI. Recent changes in the epidemiology of community (CO)-BSI and treatment protocols may have modified this association. The objective of this study was to analyse the etiology, therapy and outcomes for CA and HCA BSI in our area. METHODS: A prospective multicentre cohort including all CO-BSI episodes in adult patients was performed over a 3-month period in 2006-2007. Outcome variables were mortality and inappropriate empirical therapy. Adjusted analyses were performed by logistic regression. RESULTS: 341 episodes of CO-BSI were included in the study. Acquisition was HCA in 56% (192 episodes) of them. Inappropriate empirical therapy was administered in 16.7% (57 episodes). All-cause mortality was 16.4% (56 patients) at day 14 and 20% (71 patients) at day 30. After controlling for age, Charlson index, source, etiology, presentation with severe sepsis or shock and inappropriate empirical treatment, acquisition type was not associated with an increase in 14-day or 30-day mortality. Only an stratified analysis of 14th-day mortality for Gram negatives BSI showed a statically significant difference (7% in CA vs 17% in HCA, p = 0,05). Factors independently related to inadequate empirical treatment in the community were: catheter source, cancer, and previous antimicrobial use; no association with HCA acquisition was found. CONCLUSION: HCA acquisition in our cohort was not a predictor for either inappropriate empirical treatment or increased mortality. These results might reflect recent changes in therapeutic protocols and epidemiological changes in community pathogens. Further studies should focus on recognising CA BSI due to resistant organisms facilitating an early and adequate treatment in patients with CA resistant BSI.

[Chemical composition of the virgin oil obtained by mechanical pressing form several grape seed varieties (Vitis vinifera L.) with emphasis on minor constituents]. / Composición química del aceite virgen obtenido por extracción mecánica de algunas variedades de uva (Vitis vinifera L.) con énfasis en los componentes minoritarios.

The chemical composition of the virgin oils obtained by mechanical pressing of grape seed belonging of the varieties Syrah and Tintorera as well as a mixture of seeds of the varieties Syrah, Tempranillo and Merlot was determined. Official analytical methods were employed for the determination of two quality indexes (acidity and peroxide value), fatty acids profile and for the quantification of the most important minor constituents. The acidity and the peroxide values were in agreement with the values reported by the Codex Alimentarius for good quality edible oils. The linoleic acid was the fatty acid most abundant in all samples, representing around the 65%, followed by the monounsaturated oleic acid with concentrations close to 25%. The total phytosterol concentrations were between 5179 and 5480 mg/kg, where the beta-sytosterol represented more than the 66% in all grape seed oils. The cholesterol was detected in the oils from the varieties Syrah and Tintorera in concentrations below the maximum allowed for vegetable edible oils. The ester 1-buthyl-3-methylacetate was the most abundant in the volatile fraction with concentrations of 5.4; 6.8 and 11.0 mg/kg for Syrah, Tintorera and the seeds mixture respectively. Other volatile compounds also present were the Trans-2-hexenal (0.1 to 0.5 mg/kg), E-2-pentenal (3.1 to 4.2 mg/kg), hexanal (1.4 to 1.9 mg/kg) and heptanal (0.1 to 0.3 mg/kg). These compounds may be the responsible for the fruity flavor detected in all virgin oils studied. The alpha and gamma isomers of the tocotrienols accounted for more than the 80% of the tocochromanols present in the oils, while the tocopherols represented only the 10% The deep green color observed in all oil samples was associated to the presence of chlorophylls and other vegetable pigments