RESUMEN
OBJECTIVES: During the last decade, some changes in the epidemiology of invasive infections have been reported; however, specific studies with patient-level data are scarce. The aim of this study was to describe and evaluate the epidemiologic changes in bloodstream infections (BSI) during the last decade in Andalucía, Spain. METHODS: Data from two prospective cohorts of BSI in adults with the same methodology performed 10 years apart in 11 hospitals (eight tertiary and three community) in Andalucía, Spain, were compared; the 2006-7 cohort study was performed between October 2006 and March 2007, and the 2016-17 cohort study was performed between October 2016 and March 2017. Population-based incidence rates were calculated and extrapolated for 1 year. Relative risk ratios were calculated between the 2 periods. Multivariate analyses were performed by logistic regression. RESULTS: Overall, 1262 episodes of BSI were included, 563 (44.6%) in 2006-7 and 699 (55.3%) in 2016-17. Multivariate models selected the following changes in patients' features in 2016-17, after controlling for type of acquisition: higher age (odds ratio (OR) = 1.02; 95% confidence interval [CI] 1.01-1.03), lower urinary catheter (OR = 0.37; 95% CI, 0.26-0.48) and lower Pitt score (OR = 0.76; 95% CI, 0.71-0.82). Adjusted estimations considering patients' features and exposure to procedures showed a reduction in coagulase-negative staphylococci (OR = 0.47; 95% CI, 0.32-0.69), and an increase in Proteus spp. (OR = 3.12; 95% CI, 1.18-8.23) and Candida spp. (OR = 3.01; 95% CI, 1.03-8.86). CONCLUSIONS: We found relevant epidemiologic changes in BSI in our area, including rates, frequency of acquisition types, changes in patient's profiles and aetiologic agents.
Asunto(s)
Infecciones Bacterianas/epidemiología , Micosis/epidemiología , Sepsis/microbiología , Anciano , Infecciones Bacterianas/mortalidad , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Mortalidad , Micosis/mortalidad , Estudios Prospectivos , Factores de Riesgo , Sepsis/epidemiología , Sepsis/mortalidad , España/epidemiologíaRESUMEN
Fever of intermediate duration (FID) is a new nosologic entity defined as fever higher than 38 degrees C that has a duration of between 1 and 4 weeks and that after an initial approach has not been diagnosed. It has clinical similarities with fever of unknown origin, but because of characteristic etiologies it requires the term FID. We describe the clinical characteristics and etiology of FID in the south of Spain and create a treatment algorithm. Retrospective study of the medical charts of patients attending at our Service during 2000 and 2005 who had an initial diagnosis of FID and who had a complete follow-up until the resolution of symptoms. Two hundred and thirty-three patients met the inclusion criteria, of whom 164 were men. Median number of days before being referred to our service was 9 (range 2-28). Half of the patients had elevation of transaminases, and CRP and ESR were slightly elevated, 2.8 mg/dl (range 0.1-50) and 16 mm/h (range 1-131) respectively. A final diagnosis was made in 80 patients, with infection with coxiella (32 patients), CMV (16 patients), rickettsial species (11 patients), VEB virus (6 patients), and brucella (5 patients) being the more frequent entities. Doxycycline was the antibiotic most frequently prescribed. Among patients with Q fever, CMV, and rickettsial infection, the majority had abnormal hepatic function, (87%, 93%, and 55% respectively). In FID, a diagnosis is reached in a minority of patients, although the prognosis is excellent in most of them. In our patients the clinical picture of Q fever, CMV, and rickettsial infections included abnormal hepatic function. In addition, these three infections are the most frequently diagnosed so when treating a patient with FID, if elevation of liver enzymes is present patients should start on doxycycline.
Asunto(s)
Infecciones Bacterianas/diagnóstico , Fiebre/epidemiología , Fiebre/etiología , Virosis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Infecciones Bacterianas/microbiología , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Doxiciclina/uso terapéutico , Femenino , Fiebre/terapia , Humanos , Hígado/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Transaminasas/sangre , Virosis/virologíaRESUMEN
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Masculino , Anciano , Humanos , Aneurisma de la Aorta , Aneurisma de la Aorta/complicaciones , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica , Cardiomegalia/complicaciones , Cardiomegalia , Disnea/etiología , Angiografía por Resonancia MagnéticaRESUMEN
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Humanos , Masculino , Adulto , Trasplante de Riñón , Insuficiencia Renal Crónica/cirugía , Diagnóstico Diferencial , Diálisis Renal , CalcinosisRESUMEN
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Humanos , Cálculos Urinarios , Dolor de la Región Lumbar , Diagnóstico DiferencialRESUMEN
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Humanos , Femenino , Anciano , Mioma/complicaciones , Calcinosis/complicaciones , Estreñimiento/etiologíaAsunto(s)
Aneurisma de la Aorta/diagnóstico por imagen , Anciano , Aneurisma de la Aorta/complicaciones , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Cardiomegalia/complicaciones , Cardiomegalia/diagnóstico por imagen , Disnea/etiología , Humanos , Angiografía por Resonancia Magnética , Masculino , Derrame Pleural/etiología , RadiografíaRESUMEN
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Humanos , Hiperpotasemia/epidemiología , Hiperpotasemia/fisiopatología , Canales de Potasio/fisiología , Diuréticos/farmacocinética , Insuficiencia Renal/fisiopatologíaRESUMEN
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Humanos , Masculino , Anciano , Bronquiectasia/diagnóstico , Infecciones del Sistema Respiratorio/etiología , Broncodilatadores/uso terapéutico , Expectorantes/uso terapéutico , Antibacterianos/uso terapéutico , Diagnóstico DiferencialRESUMEN
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