Clinical predictors of methicillin-resistant Staphylococcus aureus in nosocomial and healthcare-associated pneumonia: a multicenter, matched case-control study.

The situations in which coverage for methicillin-resistant Staphylococcus aureus (MRSA) in the empirical treatment of nosocomial pneumonia (NP) or severe healthcare-associated pneumonia (HCAP) is needed are poorly defined, particularly outside intensive care units (ICUs). Our aim was to characterize if the risk of MRSA NP/HCAP can be defined by clinical variables. We designed an observational, retrospective, multicenter, case-control study to analyze the association between defined clinical variables and risk of MRSA NP/HCAP in non-ICU patients using conditional multivariable logistic regression. Cases and controls (1:2) with microbiological diagnosis were included. Controls were matched for hospital, type of pneumonia (NP or HCAP), and date of isolation. A total of 140 cases (77 NP and 63 HCAP) and 280 controls were studied. The variables associated with the risk of MRSA pneumonia were: (i) respiratory infection/colonization caused by MRSA in the previous year [odds ratio (OR) 14.81, 95% confidence interval (CI) 4.13-53.13, p < 0.001]; (ii) hospitalization in the previous 90 days (OR 2.41, 95% CI 1.21-4.81, p = 0.012); and (iii) age (OR 1.02, 95% CI 1.001-1.05, p = 0.040). The area under the receiver operating characteristic (ROC) curve for the multivariable model was 0.72 (95% CI 0.66-0.78). The multivariate model had a sensitivity of 74.5% (95% CI 65.3-83.6), a specificity of 63.3% (95% CI 56.0-70.6), a positive predictive value of 52.5% (95% CI 43.9-61.2), and a negative predictive value of 82.0% (95% CI 75.3-88.8) for the observed data. Clinical predictors of MRSA NP/HCAP can be used to define a low-risk population in whom coverage against MRSA may not be needed.

Are hip hemiarthroplasty and total hip arthroplasty infections different entities? The importance of hip fractures.

Hip hemiarthroplasty (HHA) and total hip arthroplasty (THA) infections are usually considered as one entity; however, they may show important differences. We analyze these differences, as well as predictors of treatment failure (TF) and poor functional status among patients with prosthetic hip infections (PHIs). A multicenter cohort study of consecutive patients with PHIs was performed. The main outcome variable was TF after the first surgical treatment performed to treat the infection. Multivariate analysis was used to identify predictors of TF. A total of 127 patients with PHI were included (43 HHA, 84 THA). Patients with HHA infections were more frequently women (88% vs. 54%; p < 0.001), had comorbidities (86% vs. 67%, p = 0.02), and were older (median age 79 vs. 65 years, p < 0.001), and the reason for arthroplasty was more frequently a fracture (100% vs. 18%, p < 0.001). Failure of initial treatment and crude mortality were more frequent among HHA patients (44% vs. 23%, p = 0.01 and 28% vs. 7%, p = 0.001, respectively). However, HHA was not associated with TF in the multivariate analysis when hip fracture was considered; thus, variables independently associated with TF were hip fracture, inadequate surgical management, prosthesis retention, and higher C-reactive protein level. Failure of the first surgical treatment was associated with poorer functional status. HHA and THA infections showed significant differences in epidemiology, clinical features, and outcome. Although patients with HHA infections had a higher risk of TF, this was related to the reason for hip implant: a hip fracture. Success of the initial management of infection is a predictor of better clinical and functional outcome.

Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals.

Classification of bloodstream infections (BSIs) as community-acquired (CA), healthcare-associated (HCA) and hospital-acquired (HA) has been proposed. The epidemiology and clinical features of BSI according to that classification in tertiary-care (TH) and community (CH) hospitals were investigated in a prospective cohort of 821 BSI episodes from 15 hospitals (ten TH and five CH hospitals) in Andalucía, Spain. Eighteen percent were CA, 24% were HCA and 58% were HA. The incidence of CA and HCA BSI was higher in CH than in TH (CA: 3.9 episodes per 1000 admissions vs. 2.2, p <0.01; HCA: 5.0 vs. 2.9, p <0.01), whereas the incidence of HA BSI was lower (7.7 vs. 8.7, p <0.01). In CA and HCA BSI, the respiratory tract was more frequently the source in CH than in TH (CA: 30% vs. 15%; HCA: 20% vs. 9%, p ≤0.03). In HCA BSI, chronic renal insufficiency and tunnelled catheters were less frequent in CH than in TH (11% vs. 26% and 7% vs. 19%, p ≤0.03), although chronic ulcers were more frequent (22% vs. 8%, p 0.008). BSIs as a result of methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa were very rare in CA episodes, although extended-spectrum b-lactamase-producing Escherichia coli (ESBLEC) caused a similar proportion of all BSIs in CA, HCA and HA episodes. Multivariate analysis revealed no significant difference in mortality rates in CH and TH. HCA infections should be considered as a separate class of BSI in both TH and CH, although differences between hospitals must be considered. CA BSIs were not caused by multidrug-resistant pathogens, except for ESBLEC.

[Ovarian tumors in pediatrics]. / Tumores de ovario en pediatría.

The occurrence of ovarian tumors in the Hospital Infantil de México in the last 10 years is reviewed with the analysis of frequency by age, type of tumor, relationship with Norris & Jensen's and Groeber's classifications. The signs and symptoms most frequent, laboratory and x-ray studies, preoperative diagnosis and management are discussed. Other methods of diagnosis are likewise discussed and the International Federation of Gyneco-obstetrics' scheme for classification and management is offered for future cases.

[Idiopathic dilatation of the choledochus]. / Dilatación idiopática del colédoco.

In order to modernize some clinical characteristics, their classification, the differential diagnosis and treatment, a review of 18 cases of idiopathic dilatation of the choledochus, seen at the Hospital Infantil de Mexico between 1965 and 1977 was carried on.

[Bezoars in childhood]. / Bezoares en la infancia.

Hospital Infantil de México reports 13 cases of bezoars out of which, 12 were trichobezoars and one fitobezoar. Bezoars are uncommon, but they must be known by the pediatrician as well as by the children surgeon in order to be able to reach a diagnosis and give the treatment. A complete review of the main points is given.

[A case of intestinal trichobezoar]. / Un caso de tricobezoar intestinal

Report is made of a case of an unusual localization of a trichobezoar in a 12 year-old girl, who presented vomiting and abdominal pain as chief complaints. She was found to have an 18 X 5 cm palpable abdominal mass, which upon surgery was localized in terminal ileum and in the pathology report was found to be a trichobezoar. The interest of this case is the unusual localization of a single bezoar and the fact that a resection of 25 cm. of small bowel had to be done, as it was found necrotic at the time of surgery.

[Liver hydatidosis in an eight-year-old child]. / Hidatidosis hepática en un niño de ocho años de edad

The first pediatric case of hepatic hydatidosis diagnosed in Mexico is reported. Previous to surgery, the diagnosis was established, based on a cystic tumor of the liver, the X ray findings, defects in the liver uptake, eosinophilia and Casoni's positive intradermal reaction. Besides, the immunoelectrophoresis test showed specific antibodies. Clinical and epidemiological considerations, related with the pathology and treatment of hydatidic disease are made, stressing the importance to know the symtoms of the illness, in order to establish the diagnosis and treatment. Likewise, the prognosis is evaluated considering the remaining cysts of the liver and the possible seeding of the parasite into the peritoneal cavity. Pertinent literature on the subject is reviewed.

[Corticotherapy in hemangiomas]. / La corticoterapia en los hemangiomas

A group of 17 patients with different types of hemangiomas that were submitted to treatment with steroids (prednisone) is studied. The results obtained are analyzed, together with the indications for the drug, its mechanism of action and the advantages of the doses used. Although this is not a definitive solution in all cases, considering the short number of complications observed, it is believed to be a treatment that be taken into account before more aggresive measures are followed, but it should never be done routinely.