[P. aeruginosa bacteremias: analysis of prognostic factors. A prospective study, 1992-1998]. / Bacteriemias por P. aeruginosa: análisis de los factores pronóstico. Estudio prospectivo 1992-1998.

INTRODUCTION: P. aeruginosa causes serious infections with high mortality. OBJECTIVES: Identify the prognostic factors associated with higher mortality in P. aeruginosa bacteremias (PAB). METHODS: 211 consecutive cases of PAB were analyzed prospectively between 1992-1998. Blood cultures, isolation, and antimicrobial sensitivity were carried out according to microbiology standard methodology. The variables analyzed as prognostic factors were: sex, age, source of infection, background, main disease, initial clinical severity, foci, presence of complications, leukocyte count, type of antibiotic treatment and adaptation. Bivariate and multivariate statistical analyses were carried out by the method of logistic regression. RESULTS: Global mortality was 27.96%; factors associated with higher mortality in the bivariate study were main disease rapidly and eventually fatal, diabetes, a situation of critical initial clinical severity, lung focus, complications, neutropenia and inadequate antibiotic treatment. The logistic regression study, the critical initial clinical severity, and the presence of complications were the variables associated with worse prognosis. We did not find significant differences in the evolution among the patients who received monotherapy and those on combinations of antimicrobial drugs against pseudomonas. CONCLUSION: Higher mortality of PAB is statistically associated to the situation of critical initial clinical severity and to the presence of complications; therefore, an early diagnosis and adequate treatment to improve the morbidity and mortality are recommended.

[Classification of medication interactions in family medicine and effectiveness of an intervention to improve them]. / Tipificación de interacciones medicamentosas en medicina de familia y efectividad de una intervención para su mejora.

OBJECTIVE: a) To build a detection and evaluation tool of drug interactions (DI) in family practice prescribing; b) to elaborate and to offer a DI report, including appearance mechanism, clinical consequences and appropriate alternatives; c) to evaluate their effectiveness to diminish the DI incidence, and d) to check effectiveness of different diffusion methods. DESIGN: Previous phase: we will build the tool and will elaborate the report. Intervention phase: longitudinal, interventional, multicenter. SETTING: Primary care, Murcia Region. PARTICIPANTS: Family doctors (FD) with computerized clinical history frequently used to prescribe, with indefinite contract and who don't reject to participate. INTERVENTIONS: Randomly we will form 4 FD groups to carry out monthly (6 months): a) Minimal intervention: we mail DI reports; b) generic intervention: DI report is delivered in collective session managed by a trained doctor; c) personalized intervention: discussion peer-to-peer between FD and the trained doctor; d) control group: they won't receive DI information. MAIN MEASUREMENTS: We will measure the evolution of DI incidence and their classification according to relevance and repercussions. Different aspects related with FD and patient characteristics and with organizational environment are measured for subject's describing, inclusion-exclusion criteria assurance and conditioning and confusion factors analysis. DISCUSSION: Limitations. Using a new DI classification make difficult external comparisons, although it is useful because we use generalised and prestigious data sources. Applicability. The project produces a tool to avoid prescription errors. Checking the effectiveness in different corrective measures allows to take reasoned decisions for future interventions in quality care.

Evaluation of methods for isolation of Salmonella species using modified semisolid Rappaport-Vassiliadis medium and Salmonella-Shigella agar.

A total of 197 Salmonella strains were isolated from 1717 stool samples on salmonella-shigella agar and modified semisolid Rappaport-Vassiliadis medium before and after enrichment in selenite broth. Better sensitivity was obtained with salmonella-shigella agar than in direct plating (89.2% vs. 64.4%, P<0.0001) and after broth enrichment (96.4% vs. 88.1%, P<0.01). The incidence of false-positive results using modified semisolid Rappaport-Vassiliadis medium was higher than that obtained using salmonella-shigella agar combined with the oxidase and C8 esterase tests in direct plating (33 vs. 2 strains) and after enrichment (43 vs. 0 strains). Thus, based on its performance modified semisolid Rappaport-Vassiliadis medium could be a suitable option for isolation of salmonellae from stool samples in clinical microbiology laboratories.