[Mortality and prognostic factors in patients admitted with community-acquired bacteremia]. / Mortalidad y factores pronósticos en pacientes hospitalizados por bacteriemia adquirida en la comunidad.

BACKGROUND: Community-acquired bacteremia is a frequently clinical problem and is associated with a high mortality. The Pitt bacteremia score that is calculated using body temperature, mental status, and some respiratory and circulatory features is an useful tool in order to know the prognosis of patients with bacteremia. Objectives were to know microbial etiology of bacteremia in our community, percentage of patients that received an inadequate empiric antibiotic treatment and independent prognostic factors associated with mortality, including Pitt bacteremia score. METHOD: Observational study of a cohort of patients over 18 years admitted at a tertiary hospital due to an infection with a community-acquired bacteremia. Twenty-eight cases were rejected because possible blood culture contamination. RESULTS: Seventy-five patients were included, the mean age was 68.6 +/- 18.2 years, 38 women (51%). Mortality rate was 23% [IC95% 13.8-33.8]. More frequent bacteria isolated were Escherichia coli, Staphylococcus aureus, coagulase negative staphylococci, Pseudomonas aeruginosa, Streptococcus viridans, enterococci and Klebsiella spp. Mortality in patients treated with an inadequate antibiotic therapy (18%, 3 patients) was not lower than in adequately treated patients (24%, 14 patients, p = 0.42). Independent prognostic factors related to mortality were serum albumin concentration, OR = 5.17 (IC 95% 1.45-16.7) for every downing step of 1 g/dl, the Pitt bacteremia score OR = 1.50 (IC 95% 1.01-2.24) for every unit increase, and a high score at McCabe and Jackson classification OR = 5.08 ( IC 95% 1.43-16.7). CONCLUSIONS: An inadequate empiric antibiotic therapy was not associated with a worse vital prognosis. Independent prognostic factors related to mortality were serum albumin concentration, the Pitt bacteremia score, and the McCabe and Jackson classification.

Mortalidad y factores pronósticos en pacientes hospitalizados por bacteriemia adquirida en la comunidad / Mortality and prognostic factors in patients admitted with community-acquired bacteremia

Introducción: La bacteriemia adquirida en la comunidad es un problema frecuente y de elevada mortalidad. El índice de Pitt, calculado en base a la temperatura, el estado mental, y las funciones circulatoria y respiratoria del paciente es una herramienta útil para conocer el pronóstico de pacientes con bacteriemia. Los objetivos fueron conocer la etiología de las bacteriemias adquiridas en la comunidad en nuestro entorno, el porcentaje de pacientes con tratamiento empírico incorrecto, y determinar la mortalidad y los factores independientes asociados con el fallecimiento del paciente, incluido el índice de Pitt. Método: Estudio observacional de una cohorte de pacientes mayores de 18 años ingresados en un hospital terciario por una infección adquirida en la comunidad con bacteriemia. Veintiocho casos fueron desestimados por considerar el aislamiento bacteriano como contaminante. Resultados: Se incluyeron 75 enfermos con un promedio de edad de 68,6 ± 18,2 años, 38 mujeres (51%). La mortalidad fue del 23% [IC95% 13,8 – 33,8]. Las bacterias más frecuentemente aisladas en los hemocultivos fueron Escherichia coli, Staphylococcus aureus, estafilococos coagulasa negativo, Pseudomonas aeruginosa, Streptococcus viridans, enterococos y Klebsiella spp. La mortalidad de los pacientes con un tratamiento antibiótico empírico inadecuado (18%, 3 pacientes) no fue inferior a los que recibieron un tratamiento empírico correcto en urgencias (24 %, 14 pacientes, p = 0,42). Los factores independientes pronósticos de mortalidad, fueron la baja concentración plasmática de albúmina, OR = 5,17 (IC 95% 1,45-16,7) para cada descenso de 1 g/dl, el elevado índice de Pitt OR = 1,50 (IC 95% 1,01-2,24) para cada aumento de una unidad, y la elevada gravedad de la enfermedad de base medida por el índice de McCabe y Jackson OR = 5,08 ( IC 95% 1,43-16,7). Conclusiones: El tratamiento antibiótico empírico incorrecto no influyó en la mortalidad de pacientes con bacteriemia comunitaria. Los factores pronósticos de mortalidad fueron la concentración plasmática de albúmina, el índice de Pitt y la gravedad de la enfermedad de base medida por el índice de McCabe y Jackson

Background: Community-acquired bacteremia is a frequently clinical problem and is associated with a high mortality. The Pitt bacteremia score that is calculated using body temperature, mental status, and some respiratory and circulatory features is an useful tool in order to know the prognosis of partients with bacteremia. Objetives were to know microbial etiology of bacteremia in our community, percentage of patients that received an inadequate empiric antibiotic treatment and indepedent prognostic factors associated with mortality, including Pitt bacteremia score. Method: Observational study of a cohort of patients over 18 years admitted at a tertiary hospital due to an infection with a community-acquired bacteremia. Twenty-eight cases were rejected because possible blood culture contamination. Results: Seventy-five patients were included, the mean age was 68.6 ± 18.2 years, 38 women (51%). Mortality rate was 23% [IC95% 13.8 – 33.8]. More frequent bacteria isolated were Escherichia coli, Staphylococcus aureus, coagulase negative staphilococci, Pseudomonas aeruginosa, Streptococcus viridans, enterococci and Klebsiella spp. Mortality in patients treated with an inadequate antibiotic therapy (18%, 3 patients) was not lower than in adequately treated patients (24%, 14 patients, p=0.42). Indepedent prognostic factors related to mortality were serum albumin concentration, OR=5.17 (IC 95% 1.45-16.7) for every downing step of 1 g/dl, the Pitt bacteremia score OR=1.50 (IC 95% 1.01-2.24) for every unit increase, and a high score at McCabe and Jackson classification OR=5.08 ( IC 95% 1.43-16.7) Conclusions: An inadequate empiric antibiotic therapy was not associated with a worse vital prognosis. Indepedent prognostic factors related to mortality were serum albumin concentration, the Pitt bacteremia score, and the McCabe and Jackson classification

[Does the system of prescription issuance influence the therapeutic compliance of hypertensive patients?]. / Influye el sistema de entrega de recetas en el cumplimiento terapéutico de los pacientes hipertensos?

OBJECTIVES: To find out whether the system for issuing prescriptions is linked to the therapeutic compliance and control of the blood pressure of a group of hypertense patients, and to quantify compliance with hypertension treatment through an indirect measurement method (counting pills). DESIGN: Crossover, descriptive study. SETTING: Torrelodones Health District (Madrid). PATIENTS: 54 patients known to be hypertense, of which 27 collected their prescriptions over the counter with no need for a doctor's appointment and 27 received them at a consultation with their doctor. MEASUREMENTS AND MAIN RESULTS: To measure the therapeutic compliance, first a phone call and then a surprise visit to the patient's home were made. At this visit, all the hypertension drugs prescribed were counted. It was specified that patients would be considered compliant if they had a compliance rate of 80-110%. 53.7% of the patients were considered good compliers and 46.3% bad compliers (of whom 37% were under-compliers and 9.3% over-compliers). The statistical analysis found that 59.3% of the patients who collected their prescriptions over the counter were good compliers, whereas 48.1% of those who did so at a medical consultation were (p = 0.41). 7.4% of patients who collected their prescriptions over the counter controlled their blood pressure well, whereas 22% of those who collected them at a consultation did so (p = 0.12). CONCLUSIONS: No statistically significant association was found between compliance and blood pressure figures, and systems of issuing prescriptions. The percentage of good compliers is high in comparison with other studies, but still insufficient.

[Factors related to mortality of aged patients hospitalized with community-acquired pneumonia]. / Factores relacionados con la mortalidad de ancianos hospitalizados por neumonía adquirida en la comunidad.

BACKGROUND: Community-acquired pneumonia (CAP) frequently determines inpatient treatment and has a high mortality. It is desirable to know which factors predicts a favorable outcome of elderly patients with CAP. This fact could allow that a growing number of patients could be treated in their home. OBJECTIVE: To investigate the variables related with the survival of hospitalized elderly patients for with CAP. METHODS: We carried out a retrospective study of 158 patients aged more than 65 years, that were admitted to our hospital for CAP. RESULTS: Mean age was 80.3 +/- 8.2 years (66-98 years). Eighty nine (56%) patients were men and 69 (44%) were women. Twenty seven patients (17%) died during their stay in the hospital. By multivariate analysis, independent variables associated with survival were: confusion (p = 0.0001), treatment with H2 receptor antagonists (p = 0.01), respiratory frequency (above 30 per minute, p = 0.01) and arterial pH (below 7.40, p = 0.03). Sensibility and specificity about prediction of survival in elderly patients with PAC who hadn't any variables above pointed out were 0.89 and 0.64, respectively. CONCLUSIONS: Application of this results could help physicians make decisions about hospitalization for elderly patients with PAC.

[Usefulness of the guide of standards for the duration of processes of transient work disability published by Insalud for the attending physician]. / Utilidad de la guía de estándares de duración de procesos de incapacidad laboral transitoria publicada por el Insalud para el médico de cabecera.

OBJECTIVE: To compare the duration average of the ten most frequent causes of unfitness for work (ILT) observed in a services company's staff, with the duration standards registered in the guide published by the Insalud. Besides, some of the factors that could influence these ten diseases duration will be analyzed. DESIGN: An observational, retrospective, population-based study. SETTING: Sanitary district in Madrid area. POPULATION: Hospital Universitario de la Princesa's staff. From 1-1-93 to 31-12-94, a total of 1835 ILTs have been registered among the 2147 workers. MEASURES AND RESULTS: Among the ten most frequent causes of ILT analysed, influenza, acute gastroenteritis, lumbalgia, anide sprain, lumbociatica, contusions, tonsillitis and bronchitis have a duration median included within the Insalud's references. Acute respiratory infection duration is situated out of the intervals. Depressive syndrome does not appear in the guide. It has been proved that all the previous causes have a greater incidence on women except for contusions, tonsillitis and bronchitis. Ankle sprain has a longer duration in workers over fifty years old. CONCLUSIONS: We consider that Insalud's standards guide should be promoted and improved in order to be used as a reference handbook by general practitioners.