Association between antibiotic pressure and the risk of colonization/infection by multidrug-resistant Acinetobacter baumannii complex: a time series analysis.

OBJECTIVE: To analyze the association between antibiotic pressure and the risk of colonization/infection by Acinetobacter baumannii complex (AB), evaluating both the individual and general prescriptions of antibiotics. METHODS: This is an analytical, observational, case-control study on patients admitted to an Intensive Care Unit (ICU) during an AB outbreak (14 months). A five-year time series was constructed with the monthly incidence of cases of infection/colonization with strains of AB resistant to each antibiotic administered and with the monthly consumption of these antibiotics in the ICU. RESULTS: We identified 40 patients either infected (23) or colonized (17) by AB and 73 controls. We found an epidemic multidrug-resistant clone of AB in 75% of cases. Risk factors associated with the development of AB infection/colonization were: greater use of medical instruments, the presence of a tracheostomy, cutaneous ulcers, surgical lesions and prior antibiotic therapies. The regression analysis of individual use of antibiotics showed that prior treatment with ceftazidime, ceftriaxone, amoxicillin/clavulanate, imipenem, levofloxacin, linezolid, and vancomycin was a risk factor for acquiring AB. ARIMA models showed that the relationship were greatest and statistically significant when the treatment occurred between 6 months (ceftazidime) and 9 months (imipenem and levofloxacin) prior. CONCLUSIONS: The dynamic and aggregate relationship between the incidence of infection/colonization by multidrug-resistant strains of AB and prior antibiotic treatment was statistically significant for intervals of 6 to 9 months.

Neumatoceles en una neumonía extrahospitalaria por Staphylococcus aureus sensible a meticilina / Pneumoceles in out-hospital methicillin-sensitive Staphylococcus aureus pneumonia

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[Clinical significance and risk factors for multidrug resistant Enterobacteriaceae colonization]. / Factores de riesgo de colonización por enterobacterias multirresistentes e impacto clínico.

OBJECTIVE: To identify the main risk factors of rectal colonization by multidrug resistant Enterobacteriaceae (MRE), and their clinical impact. METHODS: An observational, prospective cohort study was carried out, between April 2016 and June 2017, where every Monday of each week rectal samples were taken from all the patients admitted at that moment in the Intensive Care Unit. We performed a descriptive analysis of all the variables collected during the study and a multivariate logistic regression analysis to determine the independent association of carriers of MRE against non-carriers and several possible risk factors. RESULTS: During the study period, rectal samples were collected from 208 patients. Of the 208, 30 were carriers of MRE, with a mean age of 64.3 years and a mean score of APACHE II (Acute Physiology and Chronic Health Evaluation II) of 20.6 points. 70% of the patients with MRE had a positive result in the first rectal sample. The variables that were associated with an increased risk of rectal colonization by EMR in the regression analysis were the administration of antibiotics in the previous month (OR 5.2, 95% CI 1.71-15.79) and post-surgical patients (OR 3.8; IC95% 1.51 - 9.51). Although patients with EMR had more frequent infections by these bacteria, no differences were observed in mortality between the two groups. CONCLUSIONS: Post-surgical patients admitted to the ICU and those who received antibiotic treatment in the previous month have a higher probability of colonization due to MRE. The colonized patients presented more frequent infections by MRE although it was not associated to a higher mortality.

Una complicación rara asociada a la inserción de un catéter de estimulación cardiaca transitoria / A rare complication associated to a temporary cardiac pacing electrode

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A case of massive hemoptysis related to a smoking-history: an acquired form of the Dieulafoy's disease?

The hypervascularization of the bronquial wall, secondary to chronic bronchopulmonary inflammation is a bleeding etiology in smokers, but insufficient to explain certain massive recurrent cases. We report a case of a woman with a smoking history who presented a recurrent and massive hemoptysis. A diagnostic study with laboratory tests, bronchoscopy, computed tomography and echocardiogram did not identify the etiological cause. However, bronchial arteriography showed right and left bronchial tortuous and dilated arteries and demonstrated that a bronchovascular fistula was the origin of the hemoptysis. An acquired form of the Dieulafoy's disease in this context of a smoking history might justify such findings. Bronchial arteriography as a diagnostic method should be the preferred choice rather than bronchoscopy in these cases.

Marcadores para la detección precoz de las alteraciones del metabolismo hidrocarbonado tras un infarto agudo de miocardio / Markers for early detection of alterations in carbohydrate metabolism after acute myocardial infarction

OBJETIVO: Las alteraciones del metabolismo hidrocarbonado no conocidas son frecuentes en los pacientes con infarto agudo de miocardio, sin que exista un consenso en que pacientes estudiar para su identificación precoz. Nuestro objetivo es evaluar qué variables al ingreso se asocian al diagnóstico posterior de una alteración de dicho metabolismo. DISEÑO: Estudio de cohortes prospectivo. Ámbito: Servicio de Medicina Intensiva del Hospital Universitario Virgen de la Arrixaca (Murcia), España. PACIENTES: Un total de 138 pacientes ingresados en la UCI con infarto agudo de miocardio sin diabetes conocida ni de novo fueron, transcurrido un año, estudiados mediante un test de sobrecarga oral de glucosa. Variables principales: Se recogieron variables clínicas y parámetros analíticos al ingreso y trascurrido un año. Además, al año, se realizó una sobrecarga oral de glucosa y se estudió la capacidad diagnóstica para la diabetes de las variables al ingreso mediante las curvas ROC y análisis multivariable. RESULTADOS: Entre 138 pacientes estudiados, 112 (72,5%) presentaron una alteración del metabolismo hidrocarbonado, incluido un 16,7% de diabetes. La HbA1c se asoció independientemente con el diagnóstico de diabetes (RR: 7,28, IC 95%: 1,65-32,05, p = 0,009) y presentó la mejor área bajo la curva ROC para diabetes (0,81, IC 95%: 0,69-0,92, p < 0,001). CONCLUSIONES: En los pacientes con infarto agudo de miocardio, la HbA1c ayuda a identificar aquellos con alteración del metabolismo hidrocarbonado transcurrido un año. De esta forma, su determinación en este grupo de pacientes puede ser utilizada para identificar a aquellos que precisan un estudio mas detallado para establecer un diagnóstico precoz

OBJECTIVES: Undiagnosed abnormal glucose metabolism is often seen in patients admitted with acute myocardial infarction, although there is no consensus on which patients should be studied with a view to establishing an early diagnosis. The present study examines the potential of certain variables obtained upon admission to diagnose abnormal glucose metabolism. DESIGN: A prospective cohort study was carried out. SETTING: The Intensive Care Unit of Arrixaca University Hospital (Murcia), Spain. PATIENTS: A total of 138 patients admitted to the Intensive Care Unit with acute myocardial infarction and without known or de novo diabetes mellitus. After one year, oral glucose tolerance testing was performed. Main outcomes: Clinical and laboratory test parameters were recorded upon admission and one year after discharge. Additionally, after one year, oral glucose tolerance tests were made, and a study was made of the capacity of the variables obtained at admission to diagnose diabetes, based on the ROC curves and multivariate analysis. RESULTS: Of the 138 patients, 112 (72.5%) had glucose metabolic alteration, including 16.7% with diabetes. HbA1c was independently associated with a diagnosis of diabetes (RR: 7.28, 95% CI 1.65 to 32.05, P = .009), and showed the largest area under the ROC curve for diabetes (0.81, 95% CI 0.69 to 0.92, P = .001). CONCLUSIONS: In patients with acute myocardial infarction, HbA1c helps identify those individuals with abnormal glucose metabolism after one year. Thus, its determination in this group of patients could be used to identify those subjects requiring a more exhaustive study in order to establish an early diagnosis

[Markers for early detection of alterations in carbohydrate metabolism after acute myocardial infarction]. / Marcadores para la detección precoz de las alteraciones del metabolismo hidrocarbonado tras un infarto agudo de miocardio.

OBJECTIVES: Undiagnosed abnormal glucose metabolism is often seen in patients admitted with acute myocardial infarction, although there is no consensus on which patients should be studied with a view to establishing an early diagnosis. The present study examines the potential of certain variables obtained upon admission to diagnose abnormal glucose metabolism. DESIGN: A prospective cohort study was carried out. SETTING: The Intensive Care Unit of Arrixaca University Hospital (Murcia), Spain. PATIENTS: A total of 138 patients admitted to the Intensive Care Unit with acute myocardial infarction and without known or de novo diabetes mellitus. After one year, oral glucose tolerance testing was performed. MAIN OUTCOMES: Clinical and laboratory test parameters were recorded upon admission and one year after discharge. Additionally, after one year, oral glucose tolerance tests were made, and a study was made of the capacity of the variables obtained at admission to diagnose diabetes, based on the ROC curves and multivariate analysis. RESULTS: Of the 138 patients, 112 (72.5%) had glucose metabolic alteration, including 16.7% with diabetes. HbA1c was independently associated with a diagnosis of diabetes (RR: 7.28, 95%CI 1.65 to 32.05, P = .009), and showed the largest area under the ROC curve for diabetes (0.81, 95%CI 0.69 to 0.92, P = .001). CONCLUSIONS: In patients with acute myocardial infarction, HbA1c helps identify those individuals with abnormal glucose metabolism after one year. Thus, its determination in this group of patients could be used to identify those subjects requiring a more exhaustive study in order to establish an early diagnosis.

Ajuste del tratamiento farmacológico a las guías de práctica clínica en pacientes octogenarios con infarto agudo de miocardio / Drug treatment adjustment to the clinical guidelines in octagenarians with acute myocardial infarction

Objetivo: Determinar si existe una asociación lineal de la edad y la administración de aspirina ,betabloque antes, inhibidores de la enzima convertidora de la angiotensina y estatinas, en qué medida los pacientes de edad avanzada reciben estos tratamientos y si la edad se asocia de forma independiente a estos tratamientos. Diseño: Estudio de cohortes prospectivo. Ámbito: Unidades Coronarias de 2 hospitales de la Región de Murcia Pacientes: Pacientes consecutivos ingresados con el diagnóstico de infarto agudo de miocardio entre enero de 1998 y enero de 2008.Intervenciones: Ninguna. Variables principales: Las relacionadas con la administración de aspirina, betabloqueantes, inhibidores de la enzima convertidora de la angiotensina y estatinas durante la estancia en la Unidad Coronaria. Resultados: Respecto al resto de pacientes, los octogenarios recibieron en similar proporción inhibidores de la enzima convertidora de la angiotensina (70,8 vs 69,3%, p=0,41) y con menor frecuencia aspirina (90,4 vs 94,6%, p<0,001), betabloqueantes (44,4 vs 69,4%, p<0,001) y estatinas(47,6 vs 64,7%, p<0,001). Solo pudo demostrarse una disminución brusca y significativa en la administración de estatinas a partir de los 80 años. La edad se asoció independientemente con la administración de betabloqueantes (OR 0,59; IC95% 0,47 - 0,73) y estatinas (OR 0,78;IC95% 0,65 - 0,95). La menor administración de estos fármacos también se asoció a una mayor (..) (AU)

Objectives: To determine whether there is a linear association of age and aspirin, beta-blockers, angiotensin-converting enzyme inhibitors and statins; the extent to which elderly patients receive these treatments; and whether age is independently associated with these treatments. Design: A prospective cohort study. Setting: Coronary Unit of two hospitals in the Region of Murcia (Spain).Patients: Consecutive patients admitted with the diagnosis of acute myocardial infarction between January 1998 and January 2008.Interventions: None. Main outcomes: Those related to the administration of aspirin, beta-blockers, angiotens nconverting enzyme inhibitors and statins during stay in the Coronary Care Unit. Results: Regarding the remaining patients, octogenarians received a similar proportion of angiotensin-converting enzyme inhibitors (70.8% vs. 69.3%, p=0.41) and less often aspirin (90.4%vs. 94.6%, p<0.001), beta-blockers (44.4% vs. 69.4%, p<0,001) and statins (47.6% vs. 64.7%,p<0.001). We were only able to demonstrate an abrupt and significant decrease in the use of statins after 80 years of age. Patient age was independently associated with the use of beta blockers (OR 0.59; 95%CI 0.47 - 0.73) and statins (OR 0.78; 95%CI 0.65 - 0.95). The lesser administration of these drugs was also associated with early mortality (OR 0.17, 95%CI 0.09 to0.33 and OR 0.14; 95%CI 0.08 to 0.23, respectively).Conclusions: Octogenarians less often receive aspirin, beta-blockers and statins, though old age was not an independent factor associated with lesser aspirin use (AU)

[Drug treatment adjustment to the clinical guidelines in octagenarians with acute myocardial infarction]. / Ajuste del tratamiento farmacológico a las guías de práctica clínica en pacientes octogenarios con infarto agudo de miocardio.

OBJECTIVES: To determine whether there is a linear association of age and aspirin, betablockers, angiotensin-converting enzyme inhibitors and statins; the extent to which elderly patients receive these treatments; and whether age is independently associated with these treatments. DESIGN: A prospective cohort study. SETTING: Coronary Unit of two hospitals in the Region of Murcia (Spain). PATIENTS: Consecutive patients admitted with the diagnosis of acute myocardial infarction between January 1998 and January 2008. INTERVENTIONS: None. MAIN OUTCOMES: Those related to the administration of aspirin, betablockers, angiotensin-converting enzyme inhibitors and statins during stay in the Coronary Care Unit. RESULTS: Regarding the remaining patients, octogenarians received a similar proportion of angiotensin-converting enzyme inhibitors (70.8% vs. 69.3%, p=0.41) and less often aspirin (90.4% vs. 94.6%, p<0.001), betablockers (44.4% vs. 69.4%, p<0,001) and statins (47.6% vs. 64.7%, p<0.001). We were only able to demonstrate an abrupt and significant decrease in the use of statins after 80 years of age. Patient age was independently associated with the use of betablockers (OR 0.59; 95%CI 0.47 - 0.73) and statins (OR 0.78; 95%CI 0.65 - 0.95). The lesser administration of these drugs was also associated with early mortality (OR 0.17, 95%CI 0.09 to 0.33 and OR 0.14; 95%CI 0.08 to 0.23, respectively). CONCLUSIONS: Octogenarians less often receive aspirin, betablockers and statins, though old age was not an independent factor associated with lesser aspirin use.