[Hospital morbidity in HIV infected patients]. / Morbilidad hospitalaria en pacientes con infección por VIH.

BACKGROUND AND OBJECTIVE: With the increasing life expectancy in human immunodeficiency virus (HIV) infected patients since the highly active antiretroviral therapy (HAART), other underlying comorbilities such as chronic liver pathology, cardiovascular diseases or side effects of treatment may lead to hospitalization. The purpose of this study is to determine the clinical and epidemiological characteristics of these patients. MATERIAL AND METHODS: A descriptive-retrospective study. We reviewed the clinical records of patients with HIV infection admitted in our medical departments through a year. RESULTS: There were 125 hospitalizations of 82 patients. 77% were males and 71% had hepatitis C virus (HCV) infection. The median age was 42 years. 64% HIV infection had been acquired by sharing material for intravenous drug use. A 36% were receiving HAART and 51% had AIDS. The respiratory tract pathology (32%) and AIDS-defining illnesses (22%) were the most frequent causes of hospitalization, and the main opportunistic disease was tuberculosis (TBC). Ten per cent were admitted in the Intensive Care Unit. Mortality rate was 11% patients/year. CONCLUSIONS: Most of the patients were male, drug users and HCV positive, and the admissions to hospital were mostly due to respiratory patology and opportunistic diseases. TBC remains like the most frequent AIDS-defining illness.

[Hospital detoxification unit: 4-year experience. Treatment and infections]. / Unidad de desintoxicación hospitalaria: cuatro años de experiencia. Tratamiento e infecciones.

BACKGROUND: Analysis of the main infections complications in drug-dependents and their relation between the way of consumption and sexual activity; the detoxification treatments used are taken into consideration. MATERIAL AND METHODS: We studied the patients admitted to the HDU (Hospital Detoxification Unit) between 1991 and 1995 revising their Clinical Histories with a protocol made for the occasion; the statistical calculations were subjected to the SPSS program, applying the Fisher's and Chi-square tests. RESULTS: 458 patients were included (males = 365); drug were taken intravenously in 290 cases (distribution from 1991 to 1995: 61, 92, 72, 88-p = 0.05), smoked in 120 cases (distribution: 18, 57, 60, 67-p = 0.01), inhaled in 29 cases (2, 16, 4, 6-p = 0.01) and taken orally 176 cases (29, 50, 46, 50). The Hepatitis B Virus (HBV) was positive in 186 of 403; the Hepatitis C Virus (HCV) was positive in 259 of 374 (known = 115/discovered = 144) and incidence with respect to the human immunodeficiency virus (HIV) has p < 0.000001; HIV was positive in 85 (known = 69). Sexually Transmitted Diseases (STD) were present in 94 patients, 27 of whom were women (p = 0.03), HBV(+) = 38, HCV(+) = 49 and HIV(+) = 52 (p = 0.02). Candida infections is present in 31 HIV(+). Phlebitis antecedents are found in 79 (424), 48 of whom were HBV(+) (p = 0.00003), 60 were HCV(+) (p = 0.000008) and 29 HIV(+) (p = 0.00003). The patients were mainly treated with Clonidina (450) and tricyclic antidepressants (242). CONCLUSIONS: In our study, we observe the increase of intravenous drug users, being phlebitis the most frequent antecedent in HBV(+), HCV(+) and HIV(+); we have also detected a higher number of STD both in these groups and in women as well.

[Study of costs associated with catheter-related bacteremia]. / Estudio de los costes asociados a la bacteriemia relacionada con el catéter.

BACKGROUND: Nosocomial infection (NI) is associated with an increase in resource consumption. The estimation of extra costs attributable to NI in a group of patients with catheter-related bacteremia (CRB) was the objective of the present study. METHODS: A matched case-control, study was conducted in a cohort population. Individual matching was accomplished departing from the diagnosis related group (DRG) to which the case patient episode was ascribed and later searching in the hospital discharge data base using the following parameters: DRG, sex, age, admission date, department, comparison of hospital stays, main diagnosis, co-morbidity, number of secondary diagnoses and procedures. Matching was obtained for 22 cases (68.7%), upon which the cost estimations were performed. RESULTS: The mean hospital stay length for cases was 26.5 days (median: 24.5) and for controls 14.5 days (median: 13.5), p = 0.0002. The excess stay attributable to CRB was 11.5 days. The use of diagnostic resources was significantly higher for bacteriological tests and complete blood counts. The consumption of antibiotics and fluid therapy was higher in infected patients. Eighty-nine percent of 536,736 pesetas, the total excess of the estimated cost per episode, corresponded to the increase in hospital stay length. Seven patients (32%) were responsible for 64% of the total of extra costs. CONCLUSIONS: The method employed proved useful for estimating the costs associated with NI. The prolongation of hospital stay is responsible for most of the associated cost.