Economic impact of improving patient safety using Sugammadex for routine reversal of neuromuscular blockade in Spain.

BACKGROUND: Neuromuscular blocking (NMB) agents are often administered to facilitate tracheal intubation and prevent patient movement during surgical procedures requiring the use of general anesthetics. Incomplete reversal of NMB, can lead to residual NMB, which can increase the risk of post-operative pulmonary complications. Sugammadex is indicated to reverse neuromuscular blockade induced by rocuronium or vecuronium in adults. The aim of this study is to estimate the clinical and economic impact of introducing sugammadex to routine reversal of neuromuscular blockade (NMB) with rocuronium in Spain. METHODS: A decision analytic model was constructed reflecting a set of procedures using rocuronium that resulted in moderate or deep NMB at the end of the procedure. Two scenarios were considered for 537,931 procedures using NMB agents in Spain in 2015: a scenario without sugammadex versus a scenario with sugammadex. Comparators included neostigmine (plus glycopyrrolate) and no reversal agent. The total costs for the healthcare system were estimated from the net of costs of reversal agents and overall cost offsets via reduction in postoperative pneumonias and atelectasis for which incidence rates were based on a Spanish real-world evidence (RWE) study. The model time horizon was assumed to be one year. Costs were expressed in 2019 euros (€) and estimated from the perspective of a healthcare system. One-way sensitivity analysis was carried out by varying each parameter included in the model within a range of +/- 50%. RESULTS: The estimated budget impact of the introduction of sugammadex to the routine reversal of neuromuscular blockade in Spanish hospitals was a net saving of €57.1 million annually. An increase in drug acquisition costs was offset by savings in post-operative pulmonary events, including 4806 post-operative pneumonias and 13,996 cases of atelectasis. The total cost of complications avoided was €70.4 million. All parameters included in the model were tested in sensitivity analysis and were favorable to the scenario with sugammadex. CONCLUSIONS: This economic analysis shows that sugammadex can potentially lead to cost savings for the reversal of rocuronium-induced moderate or profound NMB compared to no reversal and reversal with neostigmine in the Spanish health care setting. The economic model was based on data obtained from Spain and from assumptions from clinical practice and may not be valid for other countries.

Enfermedades inflamatorias mediadas por inmunidad y otras comorbilidades en pacientes con psoriasis. Características basales de la cohorte de pacientes con psoriasis del estudio AQUILES / Immune-Mediated Inflammatory Diseases and Other Comorbidities in Patients With Psoriasis: Baseline Characteristics of Patients in the AQUILES Study

Introducción y objetivos: Los pacientes con psoriasis presentan con frecuencia comorbilidades, incluyendo otras enfermedades inflamatorias mediadas por inmunidad (EIMI) y factores de riesgo cardiovascular (FRCV). El objetivo de este trabajo es describir la prevalencia basal de otras EIMI y comorbilidades en una cohorte de pacientes con psoriasis. Pacientes y métodos: AQUILES es un estudio observacional prospectivo multicéntrico de 3 cohortes de pacientes (psoriasis, espondiloartritis y enfermedad inflamatoria intestinal [EII]), para evaluar la coexistencia de EIMI y otras comorbilidades. En la cohorte con psoriasis se incluyeron pacientes ≥ 18 años atendidos en consultas hospitalarias de dermatología. Se recogió información sobre datos demográficos y clínicos de acuerdo a un protocolo preespecificado. Resultados: Se incluyeron 528 pacientes con psoriasis (edad media: 46,7 años; 60,2% hombres; 39,8% mujeres; 89,8% psoriasis en placas; mediana de PASI 3,2 [1,5-7,4]). Presentaron otra EIMI 82 pacientes (15,5% [IC 95%: 12,7-18,9]). El 14,0% (IC 95%: 11,3-17,2) presentó espondiloartritis (la mayoría de estos artritis psoriásica [prevalencia 13,1%, IC 95%: 10,5-16,2), el 1,3% EII (IC 95%: 0,6-2,7) y el 0,2% uveítis (IC 95%: 0,1-1,4). La presencia de artritis psoriásica se asoció al sexo masculino (OR: 1,75 [0,98-2,98]) y a la duración de la psoriasis > 8 años (OR: 4,17; [1,84- 9,44]) respecto a < 4 años. El 73,1% presentó al menos un FRCV: tabaquismo (40,5%); obesidad (26,0%); dislipidemia (24,8%); hipertensión arterial (24,3%) y diabetes mellitus (12,3%). Conclusión: Los pacientes con psoriasis presentaron una prevalencia del 15,5% de otras EIMI, discretamente superior a la de población general. Casi tres cuartas partes tuvieron al menos un FRCV (AU)

Introduction and objectives: Patients with psoriasis often have comorbidities, including other immune-mediated inflammatory diseases (IMIDs), and cardiovascular risk factors. In this article we describe the baseline prevalence of comorbidities----including other IMIDs----in a cohort of patients with psoriasis. Patients and methods: AQUILES was a prospective observational multicenter study of 3 patient cohorts (patients with psoriasis, spondyloarthritis, or inflammatory bowel disease) undertaken to investigate the prevalence of comorbidities, including other IMIDs, in these settings. The psoriasis cohort comprised patients aged at least 18 years who were seen in hospital dermatology clinics. A predefined protocol was used to collect demographic and clinical data. Results: The study enrolled 528 patients with psoriasis (60.2% men and 39.8% women). Mean age was 46.7 years; 89.8% of the participants had plaque psoriasis, and the median Psoriasis Area Severity Index score (PASI) was 3.2 (1.5-7.4). Comorbid IMIDs were present in 82 (15.5%) of the patients (CI 95%, 12.7%-18.9%). Spondyloarthritis was observed in 14% of patients (95% CI, 11.3%-17.2%), mostly in the form of psoriatic arthritis, for which the overall prevalence was 13.1% (95% CI, 10.5%-16.2%). Inflammatory bowel disease was present in 1.3% (95% CI, 0.6%-2.7%) and uveitis in .2% (95% CI, 0.1%-1.4%). Psoriatic arthritis was associated with male sex (odds ratio, 1.75 [.98-2.98]) and a disease duration of over 8 years (OR, 4.17 [1.84-9.44] vs a duration of < 4 years). In 73.1%, at least 1 cardiovascular risk factor was identified: smoking (40.5%), obesity (26.0%), dyslipidemia (24.8%), hypertension (24.3%), and diabetes mellitus (12.3%). Conclusion: In patients with psoriasis the prevalence of other IMIDs was 15.5%, a level slightly higher than that found in the general population. Nearly three-quarters of these patients had at least 1 cardiovascular risk factor (AU)

Immune-mediated inflammatory diseases and other comorbidities in patients with psoriasis: baseline characteristics of patients in the AQUILES study.

INTRODUCTION AND OBJECTIVES: Patients with psoriasis often have comorbidities, including other immune-mediated inflammatory diseases (IMIDs), and cardiovascular risk factors. In this article we describe the baseline prevalence of comorbidities-including other IMIDs-in a cohort of patients with psoriasis. PATIENTS AND METHODS: AQUILES was a prospective observational multicenter study of 3 patient cohorts (patients with psoriasis, spondyloarthritis, or inflammatory bowel disease) undertaken to investigate the prevalence of comorbidities, including other IMIDs, in these settings. The psoriasis cohort comprised patients aged at least 18 years who were seen in hospital dermatology clinics. A predefined protocol was used to collect demographic and clinical data. RESULTS: The study enrolled 528 patients with psoriasis (60.2% men and 39.8% women). Mean age was 46.7 years; 89.8% of the participants had plaque psoriasis, and the median Psoriasis Area Severity Index score (PASI) was 3.2 (1.5-7.4). Comorbid IMIDs were present in 82 (15.5%) of the patients (CI 95%, 12.7%-18.9%). Spondyloarthritis was observed in 14% of patients (95% CI, 11.3%-17.2%), mostly in the form of psoriatic arthritis, for which the overall prevalence was 13.1% (95% CI, 10.5%-16.2%). Inflammatory bowel disease was present in 1.3% (95% CI, 0.6%-2.7%) and uveitis in .2% (95% CI, 0.1%-1.4%). Psoriatic arthritis was associated with male sex (odds ratio, 1.75 [.98-2.98]) and a disease duration of over 8 years (OR, 4.17 [1.84-9.44] vs a duration of < 4 years). In 73.1%, at least 1 cardiovascular risk factor was identified: smoking (40.5%), obesity (26.0%), dyslipidemia (24.8%), hypertension (24.3%), and diabetes mellitus (12.3%). CONCLUSION: In patients with psoriasis the prevalence of other IMIDs was 15.5%, a level slightly higher than that found in the general population. Nearly three-quarters of these patients had at least 1 cardiovascular risk factor.

Metabolic syndrome in Spanish patients with psoriasis needing systemic therapy: Prevalence and association with cardiovascular disease in PSO-RISK, a cross-sectional study.

BACKGROUND: Increasing evidence indicates a relationship between psoriasis and metabolic syndrome (MS). We evaluated the prevalence of MS in patients receiving systemic treatment for psoriasis in Spain, and its relationship to cardiovascular disease (CVD). METHODS: This cross-sectional, multicenter, non-interventional study enrolled 368 patients with moderate-to-severe psoriasis requiring systemic treatment. Clinical parameters for psoriasis, CV risk factors, MS and CVD were assessed. Descriptive and logistic regression analyses were performed. RESULTS: 352 patients were included (median psoriasis duration: 18 years, plaque psoriasis [95.7%], psoriatic arthritis [22.8%]). Overall, 132 patients (37.5%) fulfilled diagnostic criteria for MS; the most prevalent MS components were high blood pressure and increased waist circumference. Patients with MS were older, more likely to be obese and to have a sedentary lifestyle and hypercholesterolemia than those without MS. CVD was more prevalent in patients with MS than in those without (29.5% versus 15.9%, p = 0.002), particularly coronary heart disease (CHD), myocardial infarction and heart failure. MS was independently associated with CVD (OR 1.98, p = 0.018) and CHD (OR 2.02, p = 0.044). CONCLUSION: The prevalence of MS was high among patients with moderate-to-severe psoriasis requiring systemic treatment, and was associated with a higher prevalence of CVD. Dermatologists should consider implementing simple screening protocols.

[HDL cholesterol and cardiovascular disease in a population with hypertension and type 2 diabetes mellitus. RICARHD Study]. / Colesterol HDL y enfermedad cardiovascular en una población con hipertensión y diabetes mellitus tipo 2. Estudio RICARHD.

OBJECTIVE: To assess the prevalence of low serum levels of HDL cholesterol (HDL-C) and its relationship with the presence of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (DM) and arterial hypertension attended in Internal Medicine and Nephrology offices. METHODS: Cross-sectional, multicenter study, conducted in diabetic patients with hypertension, aged >/= 55 years old. Demographic, clinical and biochemical data were obtained from the patient's hospital records. Low HDL-C was defined as <40 mg/dl (men) or <46 mg/dl (women). The relationship between low HDL-C and CVD was assessed using logistic regression models. RESULTS: In 2,021 patients (mean age: 68.6 years, 48.9% women, 51.1% with established CVD), the prevalence of low HDL-C was 33.7% (95% CI: 31.5-35.7), it being higher in women (38.0%) than in men (29.6%, p<0.001), and higher in patients with previous CVD (37.3% vs. 29.9% in patients without CVD, p=0.001). In the multivariate analysis that included cardiovascular risk factors, an independent relationship between low HDL-C levels and CVD was observed (OR for CVD in patients with low HDL-C: 1.46 [CI 95%: 1.19-1.79, p<0.001]), compared to patients with normal HDL-C blood levels. A second model which was also adjusted for left ventricular hypertrophy and renal disease showed a similar association (OR 1.55 [1.21-2.00], p=0.001). This association was stronger in women than in men. CONCLUSIONS: One out of three patients with diabetes and hypertension examined in Internal Medicine and Nephrology outpatient offices had low serum levels of HDL-C. Low HDL-C showed an independent relationship with a higher prevalence of CVD.

Colesterol HDL y enfermedad cardiovascular en una población con hipertensión y diabetes mellitus tipo 2. Estudio RICARHD / HDL cholesterol and cardiovascular disease in a population with hypertension and type 2 diabetes mellitus. RICARHD Study

Objetivo: Evaluar la prevalencia del colesterol HDL (c-HDL) bajo y su asociación con la presencia de enfermedad cardiovascular (ECV) en pacientes con diabetes mellitus (DM) tipo 2 e hipertensión arterial atendidos en consultas de medicina interna y nefrología. Métodos: Estudio transversal multicéntrico, realizado en diabéticos hipertensos de 55 años o más. Los datos demográficos, clínicos y bioquímicos se recogieron de las historias clínicas. Se definió el c-HDL bajo como inferior a 40 mg/dl (varones) e inferior a 46 mg/dl (mujeres). Se valoró la asociación entre c-HDL bajo y ECV mediante modelos de regresión logística. Resultados: En 2.021 pacientes (edad media 68,6 años; 48,9% mujeres; 51,1% con ECV establecida), la prevalencia de c-HDL bajo fue del 33,7% (intervalo de confianza [IC] 95%: 31,5-35,7), mayor en mujeres (38,0%) que en varones (29,6%, p<0,001) y mayor en los pacientes con ECV (37,3% frente a 29,9% en sujetos sin ECV, p=0,001). En un análisis multivariante que incluyó los factores de riesgo cardiovascular se observó una asociación independiente entre c-HDL bajo y ECV (odds ratio [OR] para ECV en sujetos con c-HDL bajo: 1,46 [1,19-1,79; p<0,001], respecto a sujetos con c-HDL normal). Un segundo modelo ajustado, además, por la hipertrofia ventricular izquierda y el daño renal mostró una asociación similar (OR 1,55 [1,21-2,00], p=0,001). La magnitud de la asociación fue superior en la mujer que en el hombre. Conclusiones: Uno de cada tres diabéticos hipertensos atendidos en consultas de medicina interna y nefrología presentó una concentración baja de c-HDL. La concentración baja de c-HDL se asoció, de forma independiente, a una mayor prevalencia de ECV (AU)

Objective To assess the prevalence of low serum levels of HDL cholesterol (HDL-C) and its relationship with the presence of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (DM) and arterial hypertension attended in Internal Medicine and Nephrology offices. Methods Cross-sectional, multicenter study, conducted in diabetic patients with hypertension, aged ≥ 55 years old. Demographic, clinical and biochemical data were obtained from the patient's hospital records. Low HDL-C was defined as <40 mg/dl (men) or <46 mg/dl (women). The relationship between low HDL-C and CVD was assessed using logistic regression models. Results: In 2,021 patients (mean age: 68.6 years, 48.9% women, 51.1% with established CVD), the prevalence of low HDL-C was 33.7% (95% CI: 31.5-35.7), it being higher in women (38.0%) than in men (29.6%, p<0.001), and higher in patients with previous CVD (37.3% vs. 29.9% in patients without CVD, p=0.001). In the multivariate analysis that included cardiovascular risk factors, an independent relationship between low HDL-C levels and CVD was observed (OR for CVD in patients with low HDL-C: 1.46 [CI 95%: 1.19-1.79, p<0.001]), compared to patients with normal HDL-C blood levels. A second model which was also adjusted for left ventricular hypertrophy and renal disease showed a similar association (OR 1.55 [1.21-2.00], p=0.001). This association was stronger in women than in men. Conclusions: One out of three patients with diabetes and hypertension examined in Internal Medicine and Nephrology outpatient offices had low serum levels of HDL-C. Low HDL-C showed an independent relationship with a higher prevalence of CVD (AU)

Prevalence of low HDL cholesterol, and relationship between serum HDL and cardiovascular disease in elderly Spanish population: the PREV-ICTUS study.

OBJECTIVE: To assess the prevalence of low serum high-density lipoprotein cholesterol (HDL-C) concentration and the relationship between HDL-C and established cardiovascular disease (CVD) in an elderly Mediterranean population. METHODS: Analysis of Prevención del Riesgo de Ictus, a population-based study on Spanish subjects aged > or = 60 years. Low HDL-C was defined following the European guidelines for cardiovascular prevention [men: < 40 mg/dl (< 1.0 mmol/l); women: < 46 mg/dl (< 1.2 mmol/l)]. The relationship between low HDL-C or HDL-C concentration (in quintiles) and CVD was assessed through multivariate models that included cardiovascular risk factors, statins and subclinical organ damage. RESULTS: On 6010 subjects (71.7 years, 53.5% women), low HDL-C was present in 17.5% [95% confidence interval (CI): 16.5-18.5] and was more frequent in women [20.4% (19.0-21.8) vs. 14.1% (12.8-15.4) in men p < 0.001] and in patients with diabetes, CVD or statin therapy. Low HDL-C was independently associated with CVD [adjusted odds ratio (OR): 1.46, 95% CI: 1.22-1.74, p < 0.001]. The prevalence of CVD was higher as HDL-C concentration was lower (chi-square trend < 0.001). Compared with the highest quintile [> 65 mg/dl (> 1.67 mmol/l)], adjusted OR for CVD were 1.39 (1.10-1.76), 1.41 (1.11-1.80), 1.49 (1.18-1.89) and 1.91 (1.52-2.39), respectively for those in the fourth [57-65 mg/dl (1.46-1.67 mmol/l)], third [51-56 mg/dl (1.31-1.45 mmol/l)], second [46-50 mg/dl (1.18-1.30 mmol/l)] and first [< 46 mg/dl (< 1.18 mmol/l)] quintiles of HDL-C. This association was seen in males and females. CONCLUSIONS: A total of 17.5% of this Spanish population aged > or = 60 years had low HDL-C. We found a strong, independent and inverse association between HDL-C concentrations and established CVD, even at ranges of HDL-C considered as normal.

Hipertrofia ventricular izquierda por electrocardiograma o ecocardiograma y complicaciones cardiovasculares en hipertensos tratados de la Comunidad Autónoma de Madrid. Estudio MAVI-HTA / Left ventricular hypertrophy seen by electrocardiogram or echocardiogram and cardiovascular complications in hypertense subjects treated in the regional Community of Madrid. Anatomical modifications of left ventricle-HBP (AMLV-HBP) study

Objetivos. Evaluar la prevalencia de hipertrofia ventricular izquierda electrocardiográfica (HVI-ECG) y ecocardiográfica (HVI-ECO) en pacientes hipertensos en la Comunidad de Madrid, y su relación con la enfermedad cardiovascular (ECV) establecida. Pacientes y métodos. Estudio epidemiológico, transversal y multicéntrico en centros de Atención Primaria de la Comunidad Autónoma de Madrid. Se incluyeron pacientes hipertensos de edad >= 50 años. Se recogieron datos demográficos, antropométricos, de presión arterial, factores de riesgo y enfermedades cardiovasculares. La HVI-ECG se evaluó con los criterios de voltaje de Cornell y Sokolow-Lyon, y la HVI-ECO mediante la masa ventricular izquierda (MVI) utilizando la fórmula de Devereux. Resultados. En 620 pacientes evaluables, 71 presentaron HVI-ECG (prevalencia del 11,5 %, similar en varones [10,6 %] y en mujeres [12,1 %; p = 0,565], sin asociación con la edad). En 580 pacientes con ecocardiograma, la prevalencia de HVI-ECO (MVI indexada por la superficie corporal >= 125 g/m2 [varones] y >= 110 g/m2 [mujeres]) fue de 56,4 %, mayor en mujeres (66,6 % frente a 42,4 % en hombres; p < 0,001), y mayor en edades más avanzadas (p tendencia lineal < 0,001). En el análisis multivariante no se observó asociación entre HVI-ECG y prevalencia de ECV. Sin embargo, los pacientes con HVI-ECO presentaron, respecto a los pacientes sin HVI-ECO, una prevalencia más de tres veces superior de ECV (odds ratio: 3,48 [intervalo de confianza 95 %: 1,75-6,74]). Conclusiones. La prevalencia de HVI-ECG fue del 11,5 %, mientras que por ECO ascendió a 56,4 %, y ésta se asoció a una prevalencia de ECV tres veces superior. Determinados pacientes hipertensos podrían beneficiarse del ecocardiograma en la valoración del riesgo cardiovascular

Objective. To assess the prevalence of left ventricular hypertrophy using electrocardiogram (ECG-LVH) and echocardiogram (ECHO-LVH) in hypertensive patients of the Autonomic Community of Madrid and its relationship to established cardiovascular disease (CVD). Patients and methods. Cross-sectional multicenter, epidemiological study conducted in Primary Health Care Centers of the Madrid Community. Hypertensive patients aged 50 years or more were included. Demographic, anthropometric, blood pressure, cardiovascular risk factors and disease data were obtained. ECG-LVH was assessed using the voltage criteria of Cornell and Sokolow-Lyon and ECHO-LVH by calculating the left ventricular mass (LVM) with the Devereux equation. Results. A total of 71 out of 620 evaluable patients had ECG-LVH (prevalence 11.5 %, similar in men and in women [10.6 % vs. 12.1 %; p = 0.565]), with no association to age. Prevalence of ECHO-LVH (LVM indexed by body surface >= 125 g/m2 [men] and >= 110 g/m2 [women]) in 580 patients with echocardiographic evaluation was 56.4 %, this being greater in women (66.6 % vs. 42.4 % in men; p < 0.001) and in older subjects (p linear trend < 0,001). In the multivariate analysis, no association was observed between ECG-LVH and established CVD. However, patients with ECHO-LVH, compared to those without ECHO-LVH, had more than a three-fold prevalence of CVD (OR 3.48 [95 % CI: 1.75-6.74]). Conclusions. Prevalence of ECG-LVH was 11.5 %, while it increased to 56.4% when the ECHO-LVH was used. The latter was associated to a three-fold prevalence of CVD. Some hypertensive patients could benefit from an echocardiogram in the assessment of their cardiovascular risk

[Sildenafil as a substitute for subcutaneous prostacyclin in pulmonary hypertension]. / Sildenafilo como sustituto de prostaciclina subcutánea en la hepertensión pulmonar.

Subcutaneous prostacyclin (treprostinil) is an effective short-term treatment for pulmonary hypertension. The most frequently described adverse effect-pain in the area of injection-rarely requires that treatment be withdrawn. Sildenafil is a selective fosfodiesterase-5 inhibitor with pulmonary vasodilating effects. We describe the use of sildenafil as a substitute for treprostinil in a patient with pulmonary hypertension associated with lupus erythematosus. Treatment with treprostinil was discontinued due to uncontrollable abdominal pain.

Sildenafilo como sustituto de prostaciclina subcutánea en la hipertensión pulmonar / Sildenafil as a substitute for subcutaneous prostacyclin in pulmonary hypertension

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Successful heart transplantation in patients with inherited myopathies associated with end-stage cardiomyopathy.

UNLABELLED: Inherited myopathies in patients with secondary end-stage cardiomyopathies have always been considered a relative contraindication for cardiac transplantation. High operative risk related to muscle impairment and potential graft involvement secondary to the underlying myopathy have been the two main reasons implicated in the poor prognosis. OBJECTIVE: The aim of this study was to evaluate the outcome in patients who underwent cardiac transplantation in our hospital due to end-stage cardiomyopathy secondary to inherited myopathies. METHODS: Among 311 patients who underwent heart transplantation in our hospital, five (2%) had end-stage cardiomyopathies related to inherited myopathies. Four patients had muscular dystrophy (three Becker's muscular dystrophy and one hips-dystrophy) and the fifth desminopathy. In one patient cardiomyopathy was the initial manifestation of the disease. Mean age at the time of transplantation was 38.6 years (range from 24 to 55). The mean follow-up after transplantation was 57.4 months (range from 13 to 128). The intraoperative and postoperative course of these individuals did not show higher complication rates than other patients. All recipients experienced successful rehabilitation; no evidence of graft dysfunction has been detected during follow-up. All of them are alive with a good performance status. CONCLUSIONS: In our experience, patients who underwent heart transplantation due to end-stage cardiomyopathy secondary to inherited myopathy with only a mild degree of muscle impairment did not display higher postoperative nor long-term complications compared to other recipients.

[Brucella hepatic abscess. Report of a case and review of the literature]. / Absceso hepático por Brucella. Descripción de un caso y revision de la literatura.

Hepatic involvement in infections caused by Brucella organisms is common but the production of liver abscess is exceptional. Therefore, the most appropriate therapeutic approach is unclear. The use of antibiotics can be effective but in some cases abscess drainage is required. We report here a case of brucellar hepatic abscess and a review of fourteen cases reported in the literature. An emphasis is laid on the clinical, laboratory and radiological findings, treatment, and patient evolution. On the basis of the reported cases a therapeutic approach is proposed.

Absceso hepático por Brucella. Descripción de un caso y revisión de la literatura / Brucella hepatic abscess. A case report and literature review

La afectación hepática en las infecciones por Brucella es frecuente, pero la aparición de un absceso hepático es excepcional, por lo que no está claro cuál es la aproximación terapéutica inicial más apropiada. La antibioterapia puede ser eficaz, pero en algunos casos es necesario el drenaje del absceso.Describimos un caso de absceso hepático por Brucella y una revisión de 14 casos recogidos de la literatura, en especial la forma de presentación clínica, las anomalías bioquímicas y radiológicas, los tratamientos empleados y la evolución de los pacientes. Se propone una aproximación terapéutica farmacológica basada en los casos publicados (AU)

Sepsis por Acinetobacter baumanniiadquirida en la comunidad de evolución fatal

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