Tratamiento de la infección respiratoria por Pseudomonas aeruginosa en pacientes adultos en hospitalización a domicilio: características clínicas y evolutivas así como análisis de los factores pronósticos de recidiva / Treatment of respiratory infection by Pseudomonas aeruginosa in adult patients within a hospital at home service: clinical characteristics and analysis of prognostic factors for relapse

Introducción: Las infecciones respiratorias por Pseudomonas aeruginosa se asocian a mala función respiratoria, calidad de vida baja y frecuencia alta de hospitalización. Métodos: Estudio prospectivo de 6 años (2000¿2005) de pacientes ingresados en hospitalización a domicilio con infección respiratoria por P. aeruginosa para administración de tratamiento antibiótico parenteral. Se analizan variables clínicas, tratamiento, recidiva, tiempo libre de recidiva (TLR) y factores pronósticos. Resultados: Se registraron 111 episodios en 81 pacientes. Las bronquiectasias fue la afección más frecuente (57%). El tratamiento más administrado fue ceftazidima y tobramicina (61%). La estancia media fue de 14 días. El 80% tenía un grado de obstrucción respiratoria G-MG (grave-muy grave). El 35% finalizó el tratamiento con cultivo positivo. La mediana de seguimiento hasta la recidiva fue de 144 días. El 65% de los episodios recidivaron, y con más frecuencia los que tenían bronquiectasias, mayor grado de obstrucción respiratoria y llevaban aerosolterapia. El TLR en los pacientes con grado de obstrucción G-MG se redujo de 1.080 a 139 días, los que terminaban con cultivo positivo de 248 a 78 días y los que en el antibiograma tenían alguna resistencia frente a antibióticos antiseudomónicos, de 390 a 97 días. El análisis multivariante mostró la independencia de la gravedad en el grado de obstrucción respiratoria y la resistencia antibiótica en el incremento de la probabilidad de recidivar. Conclusión: Los pacientes infectados por P. aeruginosa en peor situación clínica, o con alguna resistencia antibiótica frente a antibióticos antiseudomónicos, recidivan más y probablemente en menos tiempo que los demás. Los servicios de hospitalización a domicilio son una buena alternativa para reducir el prolongado tiempo de ingreso de estos pacientes (AU)

Introduction: Pseudomonas aeruginosa respiratory infections are associated with poor respiratory function, low quality of life, and a high relapse rate. Methods: A 6-year prospective study (2000¿2005) was carried out. Patients with P. aeruginosa respiratory infection admitted to a Hospital at Home service for parenteral antibiotic treatment were enrolled in the study. Clinical response to treatment, relapse, and relapse-free time, were analyzed as primary endpoints. Results: A total of 111 episodes were recorded in 81 patients. Bronchiectasia was the most common associated disease (57%). Ceftazidime and tobramycin were the first-line therapies used (61%). The average length of stay was 14 days. Among the total, 80% of patients had severe/very severe respiratory obstruction, and 35% were culture-positive at the end of treatment. Median follow-up to relapse was 144 days; 65% of episodes relapsed. Relapse was associated with bronchiectasia, aerosol therapy, and more severe respiratory obstruction. In the patients with severe/very severe obstruction, there was a decrease in relapse-free time from 1080 to 139 days, in those with positive culture at the end of therapy from 248 to 78 days, and in those with resistance to any antipseudomonal antibiotic, from 390 to 97 days. On multivariate analysis, severity of respiratory obstruction and the antibiotic resistance were independent risk factors for relapse. Conclusion: Patients infected by P. aeruginosa in poor clinical condition or showing resistance to any antipseudomonal antibiotics have a higher probability of relapse, and a shorter time to relapse than other patients with this infection. The Hospital at Home Service is a good approach to reducing the long-term hospital stay in these patients (AU)

[Treatment of respiratory infection by Pseudomonas aeruginosa in adult patients within a hospital at home service: clinical characteristics and analysis of prognostic factors for relapse]. / Tratamiento de la infección respiratoria por Pseudomonas aeruginosa en pacientes adultos en hospitalización a domicilio: características clínicas y evolutivas así como análisis de los factores pronósticos de recidiva.

INTRODUCTION: Pseudomonas aeruginosa respiratory infections are associated with poor respiratory function, low quality of life, and a high relapse rate. METHODS: A 6-year prospective study (2000-2005) was carried out. Patients with P. aeruginosa respiratory infection admitted to a Hospital at Home service for parenteral antibiotic treatment were enrolled in the study. Clinical response to treatment, relapse, and relapse-free time, were analyzed as primary endpoints. RESULTS: A total of 111 episodes were recorded in 81 patients. Bronchiectasia was the most common associated disease (57%). Ceftazidime and tobramycin were the first-line therapies used (61%). The average length of stay was 14 days. Among the total, 80% of patients had severe/very severe respiratory obstruction, and 35% were culture-positive at the end of treatment. Median follow-up to relapse was 144 days; 65% of episodes relapsed. Relapse was associated with bronchiectasia, aerosol therapy, and more severe respiratory obstruction. In the patients with severe/very severe obstruction, there was a decrease in relapse-free time from 1080 to 139 days, in those with positive culture at the end of therapy from 248 to 78 days, and in those with resistance to any antipseudomonal antibiotic, from 390 to 97 days. On multivariate analysis, severity of respiratory obstruction and the antibiotic resistance were independent risk factors for relapse. CONCLUSION: Patients infected by P. aeruginosa in poor clinical condition or showing resistance to any antipseudomonal antibiotics have a higher probability of relapse, and a shorter time to relapse than other patients with this infection. The Hospital at Home Service is a good approach to reducing the long-term hospital stay in these patients.

Hospitalización a domicilio y uso inadecuado de la hospitalización en cirugía general / Domiciliary hospitalization and inadequate use of hospital admission in general surgery

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Assessing quality of end-of-life hospital care in a southern European regional health service.

OBJECTIVES: During the final period of life, patients with cancer in the Basque Country are given treatment in different types of hospital care. This study compared the quality of care according to the type of care in one of the autonomous communities in Spain. METHODS: A retrospective study was carried out of cancer patients who died in conventional hospital services, home hospitalization services, and palliative care units. In addition to hospital stay and readmission number, variables based on the recommendations of Spanish Society for Palliative Care were studied. RESULTS: End-of-life was diagnosed in 57 percent of a sample of 486 patients, 3 days before death (median). The use of symptom control scales was only documented in the clinical records of eight patients. Sociofamily evaluation was not found. Patients in conventional hospital services were less frequently diagnosed with end-of-life and agony and were significantly different from the rest in the reasons for admission, symptoms assessed, drugs used, administration routes, and dosage forms. Pain was evaluated in 50 percent of the patients and was better controlled in palliative care units. Patients not diagnosed with agony (52 percent) were more frequently not given specific treatment. CONCLUSIONS: End-of-life in cancer patients was diagnosed too late. The quality of care in palliative care units and by home hospitalization service was better than that in conventional hospitalization. Nevertheless, there were areas for improvement in the three modalities of care.

Bacteriemia por Providencia rettgeri / Bacteremia due to providencia rettgeri

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