Comparative Analysis of Dalbavancin versus Other Antimicrobial Options for Gram-Positive Cocci Infections: Effectiveness, Hospital Stay and Mortality.

Dalbavancin is a new antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococci, and offers the possibility of administering intravenous therapy once weekly in an ambulatory setting. We conducted a multicenter observational case-control study, comparing all patients who received dalbavancin (cases) with hospitalized patients who were treated instead with daptomycin, linezolid or vancomycin (controls), based on clinical diagnosis, main microorganism involved, and age. The primary outcome was the length of hospital stay after starting the study antimicrobial. Secondary outcomes were 7-day and 30-day efficacy, 30-day mortality, 90-day recurrence, 90-day and 6-month hospitalization, presence of adverse events and healthcare-associated infections; 161 patients (44 cases and 117 controls) were included. Bivariate analysis showed that dalbavancin reduced the total length of hospital stay (p < 0.001), with fewer 90-day recurrences (p = 0.005), 6-month hospitalizations related to the same infection (p = 0.004) and non-related hospitalizations (p = 0.035). Multivariate analyses showed that length of hospital stay was significantly shorter in patients treated with dalbavancin (-12.05 days 95% CI [-17.00, -7.11], p < 0.001), and 30-day efficacy was higher in the dalbavancin group (OR 2.62 95% CI [1.07, 6.37], p = 0.034). Although sample size of the study may be a limitation, we can conclude that Dalbavancin is a useful antimicrobial drug against Gram-positive infections, including multidrug-resistant pathogens, and allows for a remarkable reduction in length of hospital stay with greater 30-day efficacy.

Comorbidities and Mortality in Patients With COVID-19 Aged 60 Years and Older in a University Hospital in Spain / Comorbilidades y mortalidad en pacientes con COVID-19 de 60 años o mayores en un hospital universitario en España

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Variability of revascularization techniques among Catalan hospitals and impact on leg salvage in patients with peripheral arterial disease.

BACKGROUND: Indications for the revascularization treatment of peripheral arterial disease (PAD) generate much discussion, and practice varies significantly among hospitals. This study looked at patients with PAD admitted to all hospitals of the Catalan Health Service and analyzed patterns of revascularization techniques with subsequent amputation procedures. METHODS: We used the clinical-administrative registry of admissions of all patients in the hospitals of Catalonia, north-east Spain, between 2009 and 2014. We analyzed the clinical course of patients admitted with PAD throughout their successive hospital admissions. Variability between hospitals was described for the revascularization techniques and amputations performed. Endovascular outcomes were compared with those from open surgery. RESULTS: Annually, there were 9,828 admissions with PAD and 631 major amputations. Eight hospitals accounted for 52% of all admissions, and endovascular techniques occurred predominantly in high-tech, high-resolution or reference hospitals. The ratio of admissions involving endovascular techniques/open surgery varied from 0.02 to 3.73 according to the hospital, and had a correlation of -0.175 (P=0.447) with the percentage of performed major amputations and of 0.122 (P=0.598) ratio of minor / major amputations. At the end of the 6 studied years, endovascular revascularization resulted in lower patency and more minor amputations than open surgery, but had the same percentage of major amputations (10.3% vs. 10.7%, P=0.526) and lower in-hospital mortality (7.1% vs. 9.5%, P<0.0001). CONCLUSIONS: Interventions of PAD are centralized in complex hospitals and have an important variability depending on the treating hospital. Hospital variability in revascularization techniques seems to have no impact on leg salvage. Endovascular and surgical revascularization would result in similar percentages of major amputations.