Drug treatment of multidrug-resistant osteoarticular tuberculosis: a systematic literature review.

OBJECTIVE: To review the literature in order to determine the best treatment options for multidrug-resistant tuberculosis (MDR-TB) of the skeletal system. METHODS: We searched the PubMed database for all case reports of osteoarticular MDR-TB that provided information on drug treatment and clinical outcome. RESULTS: We identified six cases with spinal MDR-TB and seven with extraspinal MDR-TB and reviewed their susceptibility tests, treatments administered, surgical treatments, and clinical outcomes. All patients had a successful clinical outcome (either cured or improved) except one who died due to septicemia. One patient with spinal MDR-TB and four patients with extraspinal MDR-TB had a successful outcome with medical treatment alone. Two patients who received treatment for a shorter time or with fewer drugs than recommended were cured with the addition of surgery. CONCLUSIONS: Osteoarticular MDR-TB is very infrequently reported in the literature. The few cases reviewed suggest that it is possible to achieve a good outcome with second-line anti-tuberculous drugs, and that surgery might be useful for cases in which an optimized medical treatment is not possible.

Modelo clínico predictivo y validación de bacteriemias por anaerobios (incluidas las bacteriemias polimicrobianas) / Clinic predictive model and validation of anaerobic bacteremias (including polymicrobial bacteremias)

Introducción Las bacteriemias por microorganismos anaerobios son poco frecuentes, no existiendo consenso sobre su predictibilidad clínica y la utilidad rutinaria de los medios de cultivo para anaerobios. El objetivo del estudio es crear y validar un modelo predictivo de bacteriemia por anaerobios. Métodos El modelo predictivo se realizó con 984 bacteriemias (45 anaerobios estrictos) durante 1985–86 y 1996–97. La validación durante 2005–06 con 320 bacteriemias. Resultados Los factores predictores de bacteriemia por anaerobios calculados en el análisis multivariante para la creación de un modelo estratificado con puntuaciones de 0–13 puntos (p) fueron: origen desconocido (OR: 3,46; IC 95%: 1,13–10,54) 3 p; origen abdominal y cutáneo (OR: 14,85; IC 95%: 6,37–34,62) 6 p; hipotensión (OR: 1,99; IC 95%: 0,98–4,04) 2 p; ausencia de manipulaciones vasculares (OR: 2,62; IC 95%: 1,04–6,60) 2 p y edad >60 años (OR: 3,21; IC 95%: 1,19–8,67) 3 p. Con >7 p el modelo tiene S:77,8%, E:78,3%, VPP: 14,7% y un VPN del 98,6%, área bajo curva ROC=0,84 (EE=0,011). IC 95%: 0,82–0,86 con prevalencia de bacteriemia por anaerobios estimada 4,6%. La validación del modelo se realizó con 320 bacteremias (55 de ellas por anaerobios estrictos). El 83,6% (IC 95%: 71,19–92,23) de las bacteriemias por anaerobios tienen >7 p, y el 72,7% tienen 9 p o más. El 26,4% (IC 95%: 21,2–32,15) de las bacteriemias por aerobios y aerobios-anaerobios facultativos tienen >7 p, y solo el 11,7% tienen 9 p o más.Área bajo curva ROC=0,82 (EE=0,02). IC 95%: 0,78–0,86. Prevalencia estimada 2%.ConclusionesEl origen abdominal y cutáneo OR 14,85; origen desconocido OR 3,46; hipotensión OR 1,99; ausencia de manipulaciones vasculares OR 2,62 y edad >60 años OR 3,21 permiten crear un modelo clínico predictivo de bacteriemia por anaerobios con alta S y E. Por su baja prevalencia la importancia del modelo radica en su altísimo valor predictivo negativo (AU)

Introduction Anaerobic bacteremias are uncommon. There is no agreement on their clinical predictability and the usefulness of anaerobic blood cultures. The objective of this study was to develop and validate a model for the prediction of anaerobic bacteremias. Method The developing model was created with 984 bacteremias (45 anaerobic bacteremias) during 1985–1986 and 1996–1997. The validation model was made with 320 bacteremias during 2005–2006.ResultsIndependent multivariate predictors of true anaerobic bacteremia were used to develop a model stratifying patients with scores of 0 to 13 points(p), which were: unknown focus OR 3.46 (CI: 1.13–10.54) 3 p; abdominal and skin focus OR 14.85 (CI: 6.37–34.62) 6p; hypotension OR 1.99 (CI: 0.98–4.04) 2p; absence of vascular manipulations OR 2.62 (CI: 1.04–6.60) 2p and age over 60 years OR 3.21 (CI: 1.19–8.67) 3p. In the derivation sets group with more than 7p the model had Sensitivity: 77.8%, Specificity: 78.3%, PPV:14.7%, and a NPV of 98.6%. The area under curve was ROC=0.84 (SE=0.011), 95% CI: 0.82–0.86 (..) (AU)

[Clinic predictive model and validation of anaerobic bacteremias (including polymicrobial bacteremias)]. / Modelo clínico predictivo y validación de bacteriemias por anaerobios (incluidas las bacteriemias polimicrobianas).

INTRODUCTION: Anaerobic bacteremias are uncommon. There is no agreement on their clinical predictability and the usefulness of anaerobic blood cultures. The objective of this study was to develop and validate a model for the prediction of anaerobic bacteremias. METHOD: The developing model was created with 984 bacteremias (45 anaerobic bacteremias) during 1985-1986 and 1996-1997. The validation model was made with 320 bacteremias during 2005-2006. RESULTS: Independent multivariate predictors of true anaerobic bacteremia were used to develop a model stratifying patients with scores of 0 to 13 points(p), which were: unknown focus OR 3.46 (CI: 1.13-10.54) 3 p; abdominal and skin focus OR 14.85 (CI: 6.37-34.62) 6p; hypotension OR 1.99 (CI: 0.98-4.04) 2p; absence of vascular manipulations OR 2.62 (CI: 1.04-6.60) 2p and age over 60 years OR 3.21 (CI: 1.19-8.67) 3p. In the derivation sets group with more than 7p the model had Sensitivity: 77.8%, Specificity: 78.3%, PPV:14.7%, and a NPV of 98.6%. The area under curve was ROC=0.84 (SE=0.011), 95% CI: 0.82-0.86 with an anaerobic bacteremia prevalence of 4.6%. The validation set was studied analysing 320 bacteremias. Of these, 83.6% (95% CI: 71.19%-92.23%) of anaerobic bacteremias had more than 7 points, and 72.7% had more than 9 points. There was 26.4% (95% CI: 21.2%-32.15%) aerobic and facultative anaerobic bacteremias with more than 7 points, and only the 11.7% with 9 or more points. The area under the curve was, ROC=0.82 (SE=0.02), 95% CI:0.78-0.86, and estimated prevalence, 2%. CONCLUSIONS: Abdominal and skin focus OR 14,85; unknown focus OR 3,46; hypotension OR 1,99; absence of vascular manipulations OR 2,62 and age over 60 years enable us to make a predictive clinical model of probability of anaerobic bacteremia with a high sensitivity and specificity. The model particularly has a significant predictive negative value due to the low prevalence of anaerobic bacteremia.

[Treatment of latent tuberculosis among homeless population. Comparison between wo therapeutic approaches]. / Infección tuberculosa latente en población indigente. Comparación de dos pautas terapéuticas.

BACKGROUND AND OBJECTIVE: We aimed to compare treatment adherence and toxicity of isoniazide (H) (6 months) compared with rifampicine (R) + pirazinamide (Z) (2 months) in homeless patients in latent tuberculous infection (LTBI). PATIENTS AND METHOD: Randomized and controlled prospective study. RESULTS: We included 172 patients (116 males and 56 females) with an age average of 42.3 (12.8) years; 31 (18%) had recent conversion and 72 (41.8%) had some risk factor of hepatotoxicity. Both bivariate and multivariate analysis (p < 0.001; OR = 5.15 [2.34-11.35]) showed that the treatment was completed by 61.5% of patients administered the R+Z regimen, while it was completed only by 28.2% of those administered H for 6 months. Moreover, treatment was completed by 48.4% of Spanish or foreign patients with legal residence, while it was completed only by 28.6% of immigrant patients with no legal residence (p = 0.044 in bivariate analysis). CONCLUSIONS: The R+Z regimen for 2 months as treatment of LTBI in homeless patients displays a higher adherence than H for 6 months. There were no differences in toxicity.

Infección tuberculosa latente en población indigente. Comparación de dos pautas terapéuticas / Treatment of latent tuberculosis among homeless population. Comparison between two therapeutic approaches

FUNDAMENTO Y OBJETIVO: Evaluar si los pacientes con fibrilación auricular crónica atendidos en un centro de salud siguen un tratamiento antitrombótico correcto. PACIENTES Y MÉTODO: Estudio descriptivo transversal, en el que se incluyó a 416 pacientes diagnosticados de fibrilación auricular crónica, de una población de 28.847 pacientes. Se recogieron las siguientes variables: edad, sexo, factores de riesgo embolígeno, tratamiento antitrombótico pautado, condicionantes y contraindicaciones para la anticoagulación, tratamiento antitrombótico correcto o no y estratificación del riesgo. Tras un análisis bivariante, realizamos un modelo de regresión logística para analizar las variables asociadas a un riesgo de mal tratamiento. RESULTADOS: El 81 por ciento recibía tratamiento antitrombótico correcto, un 96,8 por ciento se hallaba en fibrilación auricular valvular y un 78,2 por ciento, en no valvular. A mayor edad, el porcentaje de pacientes con mal tratamiento antitrombótico fue mayor (t = 3,184; p = 0,002). Un mayor riesgo embolígeno se asoció a mejor tratamiento antitrombótico (p < 0,001). La existencia de al menos un factor de riesgo se asoció a un tratamiento correcto (p < 0,001). Entre los factores de riesgo, sólo la hipertensión arterial, la valvulopatía mitral y la presencia de prótesis valvular tenían significación estadística. En el análisis multivariante, la calidad de vida limitada (odds ratio [OR] = 0,13; intervalo de confianza [IC] del 95 por ciento, 0,02-0,59), la existencia de valvulopatía mitral (OR = 0,13; IC del 95 por ciento, 0,03-0,57), la hipertensión arterial (OR = 0,36; IC del 95 por ciento, 0,20-0,63) y el antecedente de embolia sistémica (OR = 0,41; IC del 95 por ciento, 0,17-0,99) se comportaron como factores protectores de un mal tratamiento. La edad superior a 80 años se asoció a un riesgo de mal tratamiento 2,89 veces mayor que el de las personas de esa edad o menores (OR = 2,89; IC del 95 por ciento, 1,68-4,95). CONCLUSIONES: En nuestro centro, la mayoría de los pacientes con fibrilación auricular crónica, valvular y no valvular, reciben un tratamiento antitrombótico correcto, y la edad es el factor que más se asocia a un mal tratamiento (AU)