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1.
Neurocirugia (Astur) ; 22(3): 264-6, 2011 Jun.
Artículo en Español | MEDLINE | ID: mdl-21743949

RESUMEN

We present a case of recurrent subdural post-surgical empyema by Proprionibacterium acnes after a first drained empyema in which no microbiological diagnosis was reached. P. acnes is a gram-positive anaerobic organism which is part of the saprophytic flora of the skin and others parts of the body. However, it can cause infections, as in the central nervous system, especially post-surgical infections in which can be the second more frequent organism after Staphylococcus aureus. P. acnes grows slowly and shows better growth in liquid anaerobic media. It is usually resistant to metronidazol and sensitive to penicillin. In postoperative central nervous system infections we must take into account the possibility of this organism, process the sample properly and keep touch with the Microbiology Department.


Asunto(s)
Empiema Subdural/cirugía , Infecciones por Bacterias Grampositivas/cirugía , Complicaciones Posoperatorias/cirugía , Propionibacterium acnes/aislamiento & purificación , Infección de la Herida Quirúrgica/cirugía , Anciano , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antibacterianos/uso terapéutico , Terapia Combinada , Craniectomía Descompresiva , Drenaje , Farmacorresistencia Microbiana , Empiema Subdural/tratamiento farmacológico , Empiema Subdural/microbiología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Metronidazol/farmacología , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Propionibacterium acnes/efectos de los fármacos , Propionibacterium acnes/fisiología , Recurrencia , Dehiscencia de la Herida Operatoria , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/microbiología
2.
Neurocir. - Soc. Luso-Esp. Neurocir ; 22(3): 264-266, ene.-dic. 2011. ilus
Artículo en Español | IBECS | ID: ibc-95863

RESUMEN

Se presenta un caso de recidiva de infección postquirúrgica en forma de empiema subdural por Proprionibacterium acnes tras un primer empiemadrenado en el que no se llegó al diagnóstico microbiológico. P acnes es un microorganismo gram positivo, anaerobio, que forma parte de la flora saprófita de la piel y de otras zonas del organismo. Sin embargo puede producir infecciones, entre otras localizaciones, en el sistema nervioso central (SNC), especialmente infecciones postquirúrgicas en las que puede llegar a ser el segundo germen en frecuencia después de Staphylococcusaureus. Es de crecimiento lento y suele crecer mejor en medios anaeróbicos líquidos. Suele ser resistente almetronidazol y sensible a penicilinas. En las infecciones postquirúrgicas del sistema nervioso central hay que tener en cuenta la posibilidad de este microorganismo, procesar las muestras de forma adecuada y mantenernos en contacto con el Servicio de Microbiología (AU)


We present a case of recurrent subdural postsurgical empyema by Proprionibacterium acnes after a first drained empyema in which no microbiological diagnosis was reached. P. acnes is a grampositive anaerobic organism which is part of the saprophytic flora of the skin and others parts of the body. However, it can cause infections, as in the central nervous system, especially postsurgical infections in which can be the second more frequent organism after Staphylococcus aureus. P. acnes grows slowly and shows better growth in liquid anaerobic media. It is usually resistant to metronidazol and sensitive to penicillin. In postoperative central nervous system infections we must take into account the possi- bility of this organism, process the sample properly and keep touch with the Microbiology Department (AU)


Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Hematoma/cirugía , Enfermedad Crónica , Imagen por Resonancia Magnética
3.
Rev. clín. esp. (Ed. impr.) ; 210(11): 545-549, dic. 2010. tab
Artículo en Español | IBECS | ID: ibc-82897

RESUMEN

Introducción. Este estudio se propone evaluar el pronóstico de las infecciones del tracto urinario (ITU) tratadas empíricamente con tratamiento antibiótico inadecuado. Material y método. Estudio de cohortes prospectivo, de pacientes mayores de 18 años de edad, atendidos en un servicio de urgencias hospitalario entre el 01/02 y el 31/05 de 2007 por síntomas miccionales, acompañados de piuria (>10leucocitos/mm3 de orina no centrifugada) o tira reactiva positiva para nitritos-leucocitos y urocultivo con >103 unidades formadoras de colonias. Se consideró que el tratamiento antibiótico prescrito empíricamente era adecuado si la bacteria aislada era sensible y se había prescrito por un tiempo correcto. Se consideró que hubo fracaso terapéutico cuando persistía la sintomatología tras 5 días de tratamiento. Se registraron la edad, el sexo, la presencia de sonda vesical permanente, el tipo de ITU, hospitalización en los 3 meses previos, la procedencia del paciente y las enfermedades asociadas. Resultados. Se aislaron 177 bacterias en 168 pacientes. En 29 casos (17,3%) el microorganismo aislado era resistente al antibiótico prescrito. En tan solo 6 pacientes hubo fracaso terapéutico, aunque no precisaron ingreso hospitalario. Los pacientes que vivían en una residencia de ancianos (13,7 vs 2,2%, p=0,015) o que habían sido ingresados durante los 3 meses previos (20,6 vs 4,3%, p=0,039) presentaron un mayor riesgo de recibir tratamiento inadecuado. Conclusiones. El pronóstico de los pacientes atendidos en Servicios de Urgencias Hospitalarios por ITU con tratamiento antibiótico discordante es favorable en la mayoría de los casos. Sería recomendable la realización de urocultivo en pacientes con mayor riesgo de padecer ITU por un microorganismo resistente(AU)


Introduction. This study aims to evaluate the prognosis of urinary tract infections (UTI) treated empirically with inadequate antibiotic treatment. Material and Methods. Prospective cohort study of patients over 18 years of age, attended in the hospital emergency service between 01/02 and 31/05 of 2007, due to micturation symptoms, accompanied by pyuria (>10leukocytes/mm3 of uncentrifuged urine) or positive reactive strip for nitrites-leukocytes and urine culture with >103 colony forming units. It was considered that the antibiotic treatment prescribed empirically was adequate if the bacteria isolated was sensitive and had been prescribed for the correct time. It was considered that there was therapeutic failure when the symptoms persisted after 5 days of treatment. Age, gender, presence of indwelling bladder catheter, type of UTI, hospitalization in the previous 3 months, origin of the patient and associated diseases were recorded. Results. A total of 177 bacteria were isolated in 168 patients. In 29 cases (17.3%), the microorganism isolated was resistant to the antibiotic prescribed. There was thereaputic failure in only 6 patients, although they did not required hospital admission. The patients who lived in a residential home for the elderly (13.7% vs 2.2%, P=0.015) or who had been hospitalized during the previous 3 months (20.6% vs 4.3%, p=0.039) had a greater risk of receiving inadequate treatment. Conclusions. The prognosis of the patients attended in the emergency hospital service due to UTI with discordant antibiotic treatment is favorable in most of the cases. Performing urine culture in patients with greater risk of suffering UTI due to a resistant microorganism would be recommendable(AU)


Asunto(s)
Humanos , Masculino , Femenino , Pronóstico , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico , Antibacterianos/uso terapéutico , Urgencias Médicas/epidemiología , Medicina de Emergencia , Ofloxacino/uso terapéutico , Estudios de Cohortes , Estudios Prospectivos , Bacteriuria/complicaciones , Bacteriuria/diagnóstico , Hepatopatías/complicaciones , Fosfomicina/uso terapéutico , Cefuroxima/uso terapéutico , Oportunidad Relativa
4.
Rev Clin Esp ; 210(11): 545-9, 2010 Dec.
Artículo en Español | MEDLINE | ID: mdl-21035115

RESUMEN

INTRODUCTION: This study aims to evaluate the prognosis of urinary tract infections (UTI) treated empirically with inadequate antibiotic treatment. MATERIAL AND METHODS: Prospective cohort study of patients over 18 years of age, attended in the hospital emergency service between 01/02 and 31/05 of 2007, due to micturation symptoms, accompanied by pyuria (>10 leukocytes/mm(3) of uncentrifuged urine) or positive reactive strip for nitrites-leukocytes and urine culture with >10(3) colony forming units. It was considered that the antibiotic treatment prescribed empirically was adequate if the bacteria isolated was sensitive and had been prescribed for the correct time. It was considered that there was therapeutic failure when the symptoms persisted after 5 days of treatment. Age, gender, presence of indwelling bladder catheter, type of UTI, hospitalization in the previous 3 months, origin of the patient and associated diseases were recorded. RESULTS: A total of 177 bacteria were isolated in 168 patients. In 29 cases (17.3%), the microorganism isolated was resistant to the antibiotic prescribed. There was thereaputic failure in only 6 patients, although they did not required hospital admission. The patients who lived in a residential home for the elderly (13.7% vs 2.2%, P = 0.015) or who had been hospitalized during the previous 3 months (20.6% vs 4.3%, p = 0.039) had a greater risk of receiving inadequate treatment. CONCLUSIONS: The prognosis of the patients attended in the emergency hospital service due to UTI with discordant antibiotic treatment is favorable in most of the cases. Performing urine culture in patients with greater risk of suffering UTI due to a resistant microorganism would be recommendable.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Errores de Medicación , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Adulto Joven
5.
Rev Clin Esp ; 209(9): 409-14, 2009 Oct.
Artículo en Español | MEDLINE | ID: mdl-19852908

RESUMEN

BACKGROUND: Early antibiotic administration to patients diagnosed of community-acquired pneumonia (CAP) has been associated with a lower mortality. In the USA, its administration within four hours has been implanted as a quality standard. The objective of this work was to analyze, in a Spanish emergency department, the performance with patients with CAP, focusing on the administration of the first dose of antibiotic. PATIENTS AND METHOD: Clinics, welfare and organizational aspects have been analysed on 93 patients diagnosed of CAP in an emergency department in order to identify their influence on antibiotic administration within 4 hours. RESULTS: 46.2% of patients received antibiotics within 4 hours. The fact that patients were assisted in the higher complexity level showed a positive association with the antibiotic administration within 4 hours. On the contrary, presence of more than 10 patients waiting to be admitted showed a negative association. CONCLUSIONS: Early antibiotic administration in the CAP is possible. On order to guarantee a higher number of patients taking antibiotics within 4 hours we have to improve quality of care in both the emergency department (to guarantee correct classification according to the level of complexity) and in the hospital (management of beds to avoid delay in the admission of the patients).


Asunto(s)
Antibacterianos/administración & dosificación , Neumonía Bacteriana/tratamiento farmacológico , Anciano , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Neumonía Bacteriana/diagnóstico , Estudios Retrospectivos
6.
Rev. clín. esp. (Ed. impr.) ; 209(9): 409-414, oct. 2009. tab, graf
Artículo en Español | IBECS | ID: ibc-73785

RESUMEN

Introducción: La administración precoz de antibiótico en pacientes diagnosticados de una neumonía adquirida en comunidad (NAC) condiciona una disminución de la mortalidad. En EE. UU. Se ha implantado como estándar de calidad su administración en las primeras cuatro horas. El objetivo de este trabajo ha sido analizar retrospectivamente en un Servicio de Urgencias hospitalario (SUH) de nuestro medio la actuación con estos pacientes en lo que respecta a la administración de la primera dosis de antibiótico. Pacientes y método: Se han analizado aspectos clínicos, asistenciales y organizativos en 93 pacientes diagnosticados de NAC en un SUH para identificar su influencia en la administración de antibiótico en un plazo inferior a 4 horas. Resultados: El 46,2% de los pacientes recibió el antibiótico en las primeras cuatro horas. La asistencia en el área de mayor complejidad se asoció de forma positiva con la administración del antibiótico en las cuatro primeras horas. Por el contrario, la presencia de un mayor número de pacientes pendientes de ingreso en el SUH condicionó un menor cumplimiento de esta medida. Conclusiones: La administración precoz de antibiótico en la NAC es posible. El incremento en el cumplimiento de esta medida debe contemplar la mejora de la calidad asistencial tanto en aspectos organizativos propios del SUH (por ejemplo, con una adecuada clasificación inicial que garantice la atención de los pacientes acorde a su nivel de complejidad) como ajenos a él (gestión de camas hospitalarias que evite la demora en el ingreso desde el servicio) (AU)


Background: Early antibiotic administration to patients diagnosed of community-acquired pneumonia (CAP) has been associated with a lower mortality. In the USA, its administration within four hours has been implanted as a quality standard. The objective of this work was to analyze, in a Spanish emergency department, the performance with patients with CAP, focusing on the administration of the first dose of antibiotic. Patients and method: Clinics, welfare and organizational aspects have been analysed on 93 patients diagnosed of CAP in an emergency department in order to identify their influence on antibiotic administration within 4 hours. Results: 46.2% of patients received antibiotics within 4 hours. The fact that patients were assisted in the higher complexity level showed a positive association with the antibiotic administration within 4 hours. On the contrary, presence of more than 10 patients waiting to be admitted showed a negative association. Conclusions: Early antibiotic administration in the CAP is possible. On order to guarantee a higher number of patients taking antibiotics within 4 hours we have to improve quality of care in both the emergency department (to guaranty correct classification according to the level of complexity) and in the hospital (management of beds to avoid delay in the admission of the patients) (AU)


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Urgencias Médicas , Neumonía/complicaciones , Neumonía/tratamiento farmacológico , Estudios Retrospectivos , Frecuencia Cardíaca/fisiología , Modelos Logísticos
10.
Rev Clin Esp ; 194(6): 472-6, 1994 Jun.
Artículo en Español | MEDLINE | ID: mdl-8079017

RESUMEN

This paper studies the prevalence of antibodies against hepatitis B and C virus in 14 patients with essential mixed cryoglobulinemia (EMC), comparing the results with those of 14 systemic erythematosus lupus (SEL) patients and 14 health people. Our results show a very low positivity rate of virus B markers in patients with EMC. In other hand, 10 of 14 patients with EMC have antibodies against hepatitis C virus, both with ELISA and Innolia confirmatory method--and none SEL patient or health people. We conclude, according with other published series, that a very high prevalence of antibodies against hepatitis C is found in patients with EMC.


Asunto(s)
Crioglobulinemia/inmunología , Hepacivirus/inmunología , Adulto , Anciano , Biomarcadores/sangre , Crioglobulinemia/epidemiología , Femenino , Anticuerpos Antihepatitis/sangre , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Humanos , Lupus Eritematoso Sistémico/epidemiología , Lupus Eritematoso Sistémico/inmunología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Seroepidemiológicos , España/epidemiología
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