Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 38
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 377-384, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185134

RESUMO

Objetivo. Analizar la evolución de las características epidemiológicas de las visitas atendidas de forma consecutiva en una unidad de dolor torácico (UDT) de un servicio de urgencias hospitalario (SUH) durante un periodo de 10 años. Método. Se incluyeron todas las visitas por dolor torácico no traumático (DTNT), analizándose la evolución temporal de las características epidemiológicas, de la clasificación diagnóstica inicial (evaluación clínica inicial y electrocardiograma) y final (al alta de la UDT), y los tiempos necesarios para alcanzar las mismas. Resultados. Se incluyeron 34.552 pacientes consecutivos con una edad media 59 (DE: 13) años, el 42% mujeres. Se observó un incrementó en el número anual de visitas a la UDT (p < 0,001), menor afluencia los meses de verano (p < 0,001), y mayor los días laborables (p < 0,001) y de 8-16 horas (p < 0,001). Se comprobó que progresivamente más pacientes eran mujeres (+0,29% anual, p < 0,05), menores de 50 años (+0,92%, p < 0,001), con más factores de riesgo cardiovascular, menos antecedentes de cardiopatía isquémica y con DTNT menos sugestivo de síndrome coronario agudo (SCA). La clasificación diagnóstica inicial y final descartó SCA en un 52,2% y un 80,4% de pacientes, respectivamente, hecho que aumentó progresivamente durante el periodo evaluado (+1,86%, p < 0,001; y +0,56%, p = 0,04; respectivamente). El tiempo de clasificación inicial no se modificó, pero se incrementó el necesario para la clasificación final (p < 0,001), que resultó superior en pacientes con diagnostico final de SCA (p < 0,001). Conclusión. Se observa un mayor uso de la UDT tras su creación, causado por un incremento de pacientes con DTNT de características no típicamente coronarias, disminuyendo el porcentaje de clasificados inicial y finalmente como debidos a SCA


Objective. To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. Methods. All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. Results. A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). Conclusions. The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dor no Peito/epidemiologia , Serviços Médicos de Emergência , Síndrome Coronariana Aguda/epidemiologia , Métodos Epidemiológicos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Infarto do Miocárdio sem Supradesnível do Segmento ST , Infarto do Miocárdio com Supradesnível do Segmento ST , Estudos Retrospectivos , Fatores de Risco , Análise de Variância
2.
Emergencias ; 31(6): 377-384, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31777208

RESUMO

OBJECTIVES: To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. MATERIAL AND METHODS: All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. RESULTS: A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). CONCLUSION: The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time.

3.
Ocul Immunol Inflamm ; : 1-12, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31710514

RESUMO

Purpose: To estimate the incidence rate (IR) and identify risk factors associated to inflammatory relapse after immunosuppressive drug (ISD) discontinuation in noninfectious uveitis patients.Methods: Multicenter longitudinal retrospective study, including patients from four uveitis clinics followed-up until December 2018. Hazard ratios for different variables were estimated using multivariable Cox models.Results: 32 patients (34 episodes of ISD discontinuation) were analyzed (median and maximum follow-up time: 2.4 and 19.2 years, respectively). Fourteen patients presented at least one relapse: anterior (8 patients), intermediate (5) and posterior (8). IR (95% confidence interval) of the first relapse was 14.3 (8.6-23.8) episodes per 100 patient-years (median survival time: 4.8 years). Early use of ISDs, panuveitis, and higher oral corticosteroid dosage at discontinuation were associated with higher hazards of relapse in multivariable analysis.Conclusions: Relapse is a frequent and early event after ISD discontinuation. Identifying relapse risk factors could support the physician's decision regarding ISD discontinuation.

4.
Graefes Arch Clin Exp Ophthalmol ; 257(11): 2505-2516, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31385033

RESUMO

PURPOSE: To compare the clinical prognosis among selected white dot syndromes (WDS) (birdshot chorioretinopathy (BRC), multifocal choroiditis, serpiginous choroidopathy (SC), and others) and to identify risk factors of poor visual prognosis. METHODS: Retrospective longitudinal cohort study including 84 patients (143 affected eyes) diagnosed with WDS between 1982 and July 2017, followed up until loss of follow-up or December 2017, and recruited from three Uveitis Clinics (Madrid Community, Spain). Our main outcome measures were temporary or permanent moderate (corrected visual acuity in the Snellen scale < 20/50) or severe (< 20/200) vision losses, and development of new ocular complications. Incidence rates (IR) of the main outcome measures were estimated per 100 eye-years. Bivariate and multivariate Cox robust regression models analyzed the association of demographic- and clinical-related variables with vision loss. RESULTS: SC exhibited the greatest IR of vision loss, even in the multivariate models. Previous events of vision loss, presence of choroidal neovascularization, and cataracts exhibited worse visual prognosis. Monotherapy with immunosuppressive drugs but not combine therapy was also associated with higher IR of visual loss. Regarding new ocular complications, BRC showed the highest IR of epiretinal membrane and macular edema. CONCLUSIONS: SC presents the worst visual prognosis. Some ocular manifestations can identify patients with WDS at risk of a worse clinical evolution.

5.
Eur J Emerg Med ; 26(4): 234-241, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29768299

RESUMO

BACKGROUND: The quick sequential organ failure assessment (qSOFA) score showed good prognostic performance in patients with suspicion of infection in the emergency department (ED). However, previous studies only assessed the performance of individual values of qSOFA during the ED stay. As this score may vary over short timeframes, the optimal time of measurement, and the prognostic value of its variation are unclear. The objective of the present study was to prospectively assess the prognostic value of the change in qSOFA over the first 3 h (ΔqSOFA = qSOFA at 3 h-qSOFA at inclusion). PATIENTS AND METHODS: This is an international prospective cohort study conducted in 17 EDs in France, Belgium, and Spain. From November 2016 to March 2017, patients with a suspected infection and a qSOFA score of 2 or higher were included and followed up until death or hospital discharge. qSOFA was measured at inclusion, 1 h and 3 h. Primary end point was in-hospital mortality, truncated at 28 days. RESULTS: Of 534 recruited patients, 512 were included in the analysis. The qSOFA was improved at 3 h (ΔqSOFA < 0) in 287 (55%) patients. Overall in-hospital mortality was 27%: 44% when ΔqSOFA greater than 0, 36% when ΔqSOFA = 0, and 18% when ΔqSOFA less than 0. A positive ΔqSOFA was independently associated with reduced in-hospital mortality (adjusted hazard ratio of 0.48, 95% confidence interval: 0.34-0.68). After modeling qSOFA kinetics in the first 3 h, there was a significant difference in adjusted slopes between patients who died and those who survived (0.15, 95% confidence interval: 0.09-0.22, P < 0.001). CONCLUSION: In patients with suspected infection presenting to the ED with a qSOFA of 2 or higher, the early change in qSOFA is a strong independent predictor of mortality.


Assuntos
Bacteriemia/diagnóstico , Bacteriemia/mortalidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade Hospitalar , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/terapia , Bélgica , Causas de Morte , Estudos de Coortes , Bases de Dados Factuais , Progressão da Doença , Feminino , França , Humanos , Internacionalidade , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Escores de Disfunção Orgânica , Valor Preditivo dos Testes , Prevalência , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Espanha
8.
JAMA ; 317(3): 301-308, 2017 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-28114554

RESUMO

Importance: An international task force recently redefined the concept of sepsis. This task force recommended the use of the quick Sequential Organ Failure Assessment (qSOFA) score instead of systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk of mortality. However, these new criteria have not been prospectively validated in some settings, and their added value in the emergency department remains unknown. Objective: To prospectively validate qSOFA as a mortality predictor and compare the performances of the new sepsis criteria to the previous ones. Design, Settings, and Participants: International prospective cohort study, conducted in France, Spain, Belgium, and Switzerland between May and June 2016. In the 30 participating emergency departments, for a 4-week period, consecutive patients who visited the emergency departments with suspected infection were included. All variables from previous and new definitions of sepsis were collected. Patients were followed up until hospital discharge or death. Exposures: Measurement of qSOFA, SOFA, and SIRS. Main Outcomes and Measures: In-hospital mortality. Results: Of 1088 patients screened, 879 were included in the analysis. Median age was 67 years (interquartile range, 47-81 years), 414 (47%) were women, and 379 (43%) had respiratory tract infection. Overall in-hospital mortality was 8%: 3% for patients with a qSOFA score lower than 2 vs 24% for those with qSOFA score of 2 or higher (absolute difference, 21%; 95% CI, 15%-26%). The qSOFA performed better than both SIRS and severe sepsis in predicting in-hospital mortality, with an area under the receiver operating curve (AUROC) of 0.80 (95% CI, 0.74-0.85) vs 0.65 (95% CI, 0.59-0.70) for both SIRS and severe sepsis (P < .001; incremental AUROC, 0.15; 95% CI, 0.09-0.22). The hazard ratio of qSOFA score for death was 6.2 (95% CI, 3.8-10.3) vs 3.5 (95% CI, 2.2-5.5) for severe sepsis. Conclusions and Relevance: Among patients presenting to the emergency department with suspected infection, the use of qSOFA resulted in greater prognostic accuracy for in-hospital mortality than did either SIRS or severe sepsis. These findings provide support for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in the emergency department setting. Trial Registration: clinicaltrials.gov Identifier: NCT02738164.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade Hospitalar , Escores de Disfunção Orgânica , Sepse/mortalidade , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Bélgica , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Normal , Prognóstico , Estudos Prospectivos , Curva ROC , Infecções Respiratórias/mortalidade , Distribuição por Sexo , Espanha , Suíça
9.
Emergencias (Sant Vicenç dels Horts) ; 26(5): 367-370, oct. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-181353

RESUMO

Objetivos: Analizar la prescripción de antibióticos en un servicio de urgencias hospitalario (SUH) mediante la evaluación del tiempo hasta la primera dosis, el ajuste a función renal, la adecuación según resultados microbiológicos y el paso precoz a vía oral. Método: Se identificaron los pacientes que recibieron una primera dosis de antibiótico por vía intravenosa con intención terapéutica en el SUH. Los pacientes fueron seguidos de manera prospectiva mientras duró el tratamiento antibiótico. Resultados: Se incluyeron 98 pacientes. La mediana del tiempo hasta la primera dosis de antibiótico fue de 180 minutos (media 215 min, DE: 127 min) desde la llegada a urgencias y de 120 minutos (media 132 min, DE: 80 min) desde la visita médica. Doce pacientes cumplieron criterios de sepsis grave y 7 de shock séptico, y en ellos la mediana entre la valoración médica y la primera dosis de antibiótico fue de 93 y 60 minutos respectivamente. El ajuste a la función renal fue realizado en el 95% de pacientes, y en el 97% se ajustó el tratamiento a los aislamientos microbiológicos. El paso a vía oral fue realizado en el 98% de los casos elegibles, con un retraso medio de 1,7 días. Conclusiones: El tiempo hasta la administración de la primera dosis de antibiótico en el SUH es mayor a lo recomendado incluso en los pacientes con sepsis grave y shock séptico


Objectives: To analyze the prescription of antibiotics in a hospital emergency department (ED) by assessing time elapsed until the first antibiotic dose, adjustment of renal function, adjustment according to the findings for microbiology, and early switch to oral route of administration. Methods: Patients were included consecutively on receiving a first intravenous dose of an antibiotic in the ED. The patients were followed prospectively while they were on antibiotic treatment. Results: We included 98 patients. The median time until the first dose was 180 minutes from the time of arrival in the department; the mean (SD) time was 215 (127) minutes. The median time from first medical evaluation until the first dose was 120 minutes; the mean time was 132 (80) minutes. Twelve of the 98 patients had severe sepsis and 7 were in septic shock. In these patients the median time between physician evaluation and first antibiotic dose was 93 minutes (severe sepsis) and 60 minutes (septic shock). In 95% of the patients, the dosage was adjusted based on renal function; in 97% treatment was adjusted based on results of microbiology. Ninety-eight percent of patients were switched to oral antibiotics after a mean of 1.7 days. Conclusions: Time elapsed until the first antibiotic dose administered in the ED is longer than recommended even for patients with severe sepsis or in septic shock


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Universitários , Estudos Prospectivos , Espanha
10.
Eur Respir J ; 43(6): 1698-708, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24525448

RESUMO

We describe the aetiology of community-acquired pneumonia (CAP) in HIV-infected patients, risk factors for bacterial or Pneumocystis jirovecii CAP and prognostic factors of 30-day mortality. This was a prospective observational study of 331 consecutive adult CAP cases in HIV-infected patients (January 2007 to July 2012). 128 (39%) patients had CD4(+) cell counts <200 per mm(3) and 99 (43%) ha HIV RNA levels <200 copies per mL on antiretroviral therapy. Streptococcus pneumoniae was the most frequent microorganism in the group with CD4(+) cell counts ≥ 200 per mm(3); P. jirovecii was the most frequent microorganism in the group with CD4(+) cell counts <200 per mm(3) and in patients with HIV RNA ≥ 200 copies per mL. Predictors of bacterial CAP were: time with symptoms ≤ 5 days (OR 2.6, 95% CI 1.5-4.4), C-reactive protein level ≥ 22 mg·dL(-1) (OR 4.3, 95% CI 2.3-8.2) and hepatitis C virus co-infection (OR 2.3, 95% CI 1.4-3.9). White blood cell count ≤ 4 × 10(12) per L (OR 3.7, 95% CI 1.2-11.5), lactate dehydrogenase (LDH) level ≥ 598 U·L(-1) (OR 12.9, 95% CI 4.2-39.7) and multilobar infiltration (OR 5.8, 95% CI 1.9-19.5) were predictors of P. jirovecii. Overall 30-day mortality was 7%. Appropriate antibiotic treatment (OR 0.1, 95% CI 0.03-0.4), LDH ≥ 598 U·L(-1) (OR 6.2, 95% CI 1.8-21.8) and mechanical ventilation (OR 22.0, 95% CI 6.2-78.6) were the variables independently associated with 30-day mortality. The described predictors may help clinicians to distinguish between bacterial and P. jirovecii pneumonia in patients with suspected or confirmed HIV infection.


Assuntos
Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/mortalidade , Infecções por HIV/complicações , Infecções por HIV/microbiologia , Pneumopatias/complicações , Pneumopatias/microbiologia , Adulto , Antibacterianos/química , Contagem de Linfócito CD4 , Feminino , HIV-1 , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii , Prognóstico , Estudos Prospectivos , Fatores de Risco , Streptococcus pneumoniae , Fatores de Tempo , Resultado do Tratamento
11.
Eur Respir J ; 40(4): 931-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22267760

RESUMO

The purpose of this study was to establish the microbial aetiology and outcomes of patients with community-acquired pneumonia (CAP) treated as outpatients after presenting to a hospital emergency care unit. A prospective observational study was carried out in the Hospital Clinic of Barcelona (Barcelona, Spain). All consecutive cases of CAP treated as outpatients were included. 568 adult outpatients with CAP were studied (mean ± SD age 47.2 ± 17.6 yrs; 110 (19.4%) were aged ≥ 65 yrs). Aetiological diagnoses were established in 188 (33.1%) cases. Streptococcus pneumoniae was the most frequent pathogen followed by Mycoplasma pneumoniae and respiratory viruses. Legionella was detected in 13 (2.3%) cases. More than one causative agent was found in 17 (9.0%) patients. Mortality was low (three (0.5%) patients died) and other adverse events were rare (30 (5.2%) patients had complications, 13 (2.3%) were re-admitted and treatment failed in 13 (2.3%)). Complications were mostly related to pleural effusion and empyema, and re-admissions and treatment failures to comorbidities. Outpatients with CAP have a characteristic microbial pattern. Regular antipneumococcal coverage remains mandatory. Treatment failures and re-admissions are rare and may be reduced by increased attention to patients requiring short-term observation in the emergency care unit and in the presence of pleural effusion and comorbidities.


Assuntos
Infecções Comunitárias Adquiridas/microbiologia , Pneumonia/microbiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/tratamento farmacológico , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Legionella pneumophila/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Mycoplasma pneumoniae/isolamento & purificação , Orthomyxoviridae/isolamento & purificação , Pacientes Ambulatoriais , Paramyxovirinae/isolamento & purificação , Derrame Pleural/etiologia , Pneumonia/complicações , Pneumonia/tratamento farmacológico , Estudos Prospectivos , Vírus Sinciciais Respiratórios/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Falha de Tratamento , Resultado do Tratamento
12.
Emerg Med J ; 28(10): 841-6, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20961935

RESUMO

OBJECTIVE: To validate a triage flowchart to rule out acute coronary syndrome (ACS) in chest pain patients attending the emergency department (ED). METHODS: An observational cohort study of consecutive patients. In all cases, a previously derived five-step triage flowchart (age ≤ 40 years, absence of diabetes, not previously known coronary artery disease, non-oppressive and non-retrosternal pain) was applied. Patients meeting all five discriminators were grouped as 'five-step triage non-ACS', the rest as 'five-step triage ACS'. The same strategy was used with a four-step model (without age ≤ 40 years). After ED study and 1-month follow-up, patients were definitively classified as 'true ACS' or 'true non-ACS'. Validity indexes and receiver operating characteristics curves were calculated. RESULTS: 4231 patients were included: 918 (21.7%) were 'true ACS', 3303 (78.1%) 'true non-ACS'; 10 (0.2%) were lost to follow-up. The five-step triage flowchart classified 4000 (94.8%) as 'triage ACS' and 221 (5.2%) as 'triage non-ACS'; none of the latter was 'true ACS'. The four-step model classified 3194 (75.6%) as 'triage ACS' and 1027 (24.4%) as 'triage non-ACS'. A 'true ACS' was seen in 26 patients from the latter group. Accordingly, five-step triage flowchart specificity and positive predictive value (PPV) to rule out ACS were 100% (95% CI 100% to 100%). For the four-step model specificity and PPV were 97% (95% CI 96% to 98%). CONCLUSION: The five-step triage flowchart identifies chest pain patients without an ACS. However, only 5% of these patients meet these five criteria. A simpler model allows greater patient inclusion but a higher risk of misclassification of true ACS.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/diagnóstico , Árvores de Decisões , Triagem/métodos , Adulto , Idoso , Estudos de Coortes , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
13.
Rev. esp. quimioter ; 23(2): 93-99, jun. 2010. tab
Artigo em Espanhol | IBECS | ID: ibc-79906

RESUMO

Introducción: El objetivo de nuestro estudio fue revisar laepidemiología y forma de presentación clínica de lasinfecciones producidas por Staphylococcus aureus resistente ameticilina productor de leucocidina de Panton-Valentine(SARM-LPV).Material y métodos: Se revisaron las historias de lospacientes con infección por una cepa de SARM-LPV atendidosentre Enero de 2007 y Julio de 2009. Se determinó mediantePCR la presencia de LPV y el tipo de cassette cromosómico entodos los aislados de SARM durante el periodo del estudio.Resultados: Se incluyeron en el estudio 37 casos. El 70%de los pacientes eran varones con una mediana de edad de 39años. El 62,1% eran españoles, 14 (37,8%) tenían infección porel VIH y 11 (29,7%) eran homosexuales. El foco fue unainfección de piel y partes blandas en 36 casos y neumonía en 1caso. 16 pacientes requirieron ingreso hospitalario, 5 casoscursaron con bacteriemia y en 5 se produjeron metástasissépticas. La tasa de recidiva fue de 24% (9 casos). Laprevalencia durante el periodo de Octubre 2007 a Julio 2009fue del 11,2 % de los SARM aislados (37 de 329). Todas lascepas tenían el cassette cromosómico tipo IV y eran sensibles acotrimoxazol, rifampicina, vancomicina, daptomicina ylinezolid. La CMI de vancomicina, medida por E-test fue ≥1,5mg/L en 28 de 34 casos (82,3%).Conclusiones: El 11,2% de las cepas de SARM aisladas ennuestro hospital son productoras de LPV. En general produceninfección de piel y partes blandas y a menudo cursan conbacteriemia y metástasis sépticas, pero respecto adescripciones previas, con mayor frecuencia se aislan enpersonas nacidas en España y se asocian a infecciones graves(AU)


Introduction: the aim of our study was to review theepidemiology and clinical manifestations of infections due toPanton-Valentine leukocidin-positive methicillin-resistantStaphylococcus aureus (PVL-MRSA)Material and methods: Medical history of patientsinfected by MRSA-PVL admitted to our hospital from January2007 to July 2009 was reviewed. PVL and the type ofcromosomic cassette were determined in all strains by PCR.Results: A total of 37 cases were included. Seventypercent were males and the median age was 39 years. Sixtytwopercent were Spanish, 14 (37.8%) were HIV-positive and11 (29.7%) were homosexual. The source of the infection wasthe skin and soft tissue in 36 cases and pneumonia in 1. Sixteenpatients were hospitalized, 5 had bacteremia and 5 developedseptic metastasis. The relapse rate was 24% (9 cases). Theprevalence during the study period was 11.2% of all MRSAisolated (37 out of 329). All the strains had a cromosomiccassette type IV and were susceptible to cotrimoxazole,rifampin, vancomyin, daptomycin and linezolid. The MIC ofvancomycin, measured by E-test, was ≥1.5 mg/L in 28 out of 34cases (82.3%).Conclusions: Eleven percent of the MRSA strains isolatedin our hospital are PVL positive. In general, skin and soft tissueinfections are the most common and bacteremia or septicmetastasis are frequent. In contrast to previous Spanishstudies, more cases are observed in patients born in Spain andthe infections are more severe(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Staphylococcus aureus , Staphylococcus aureus/isolamento & purificação , Meticilina/uso terapêutico , Resistência a Meticilina , Infecção/epidemiologia , Eletroforese/métodos , Eletroforese , Controle de Infecções/normas
14.
Am J Emerg Med ; 27(6): 660-7, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19751622

RESUMO

AIM: To determine predictors of frequent chest pain unit (CPU) users and to identify characteristics and outcomes of their CPU visits. PATIENTS AND METHODS: Observational prospective case-control study. Frequent CPU user was defined by 3 or more CPU visits within the study year. A control patient and a control visit were randomly selected for each case patient and case visit. Demographic, clinical, and outcome variables were collected from medical record and phone interview performed in a 30-day interval. A multivariate logistic regression analysis was used to identify frequent CPU users' predictors. RESULTS: Of 1934 patients presenting during the year, 80 (4.1%) met the definition for case patient. They accounted for 352 (13%) of 2709 CPU visits. Sixty-seven (83.7%) case patients and 71 (88.7%) control patients were contacted. The final predictors were the following: Karnofsky Performance Scale of 70 or lesser (odds ratio [OR], 5.24 [95% confidence interval {CI}, 1.71-16.06]), previous hospitalization (OR, 3.76 [95% CI, 1.49-9.49]), previously known coronary artery disease (OR, 3.72 [95% CI, 1.32-10.52]), and symptoms of depression (OR, 2.98 [95% CI, 1.14-7.78]). Case visits were more likely at night (OR, 2.41 [95% CI, 1.64- 3.52]), generated more diagnostic uncertainty (OR, 2.39 [95% CI, 1.71-3.35]), but did not increase the need of hospital admission. CONCLUSIONS: Frequent CPU user is associated with previously known coronary artery disease, previous hospitalization, impaired performance status, and presence of symptoms of depression. They are more likely to arrive on CPU at night and generate more diagnostic uncertainty.


Assuntos
Dor no Peito/diagnóstico , Unidades Hospitalares/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Dor no Peito/psicologia , Doença da Artéria Coronariana/diagnóstico , Depressão/epidemiologia , Feminino , Hospitais com mais de 500 Leitos , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva , Espanha
15.
Emergencias (St. Vicenç dels Horts) ; 21(1): 36-41, feb. 2009. tab
Artigo em Espanhol | IBECS | ID: ibc-60100

RESUMO

Por término medio, el tiempo de espera desde que el paciente llega al servicio de urgencias hospitalario (SUH) hasta que es visitado no es inferior a 1 ó 2 horas, y en el periodo invernal o ante cualquier brote epidémico de infección respiratoria, la demora en la visita se puede alargar hasta 4 ó 6 horas. En el área de espera de un SUH saturado, los pacientes ancianos, con inmunodepresión o con co-morbilidad significativa permanecen, durante varias horas, cerca de otros pacientes que quizás sufran infecciones víricas de vías respiratorias, o pueden ser portadores de S. aureus resistente a meticilina ode P. aeruginosa multirresistente. En el presente trabajo analizamos las precauciones de aislamiento en tres situaciones concretas de la consulta del paciente en un SUH: 1/ durante el tiempo de espera hasta ser atendido; 2/ mientras se le visita en el box de urgencias; y 3/ en el tiempo de espera hasta su hospitalización cuando ésta es necesaria (AU)


Patients wait at least 1 to 2 hours on the average before being attended in a hospital emergency department. In winter, or during a respiratory infection epidemic, wait times can be 4 to 6 hours. Patients who are elderly orimmunocompromised or who have significant comorbidity may spend several hours in an overcrowded emergency waiting area, alongside others who may have respiratory tract viral infections or be carriers of methicillin-resistant Staphylococcus aureus or multidrug resistant Pseudomonas aeruginosa. We analyze precautionary measures for isolating hospital emergency patients in 3 situations: 1) while they wait to see a doctor, 2) while they are in the emergency room cubicle, and 3) while they wait for a hospital bed (AU)


Assuntos
Humanos , Serviço Hospitalar de Emergência/normas , Isolamento de Pacientes/estatística & dados numéricos , Isolamento de Pacientes/normas , Doenças Transmissíveis , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Período de Transmissibilidade
18.
Clin Infect Dis ; 46(2): 193-200, 2008 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-18171250

RESUMO

BACKGROUND: Vancomycin treatment failure in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is not uncommon, even when MRSA is susceptible to vancomycin. The aim of our study was to evaluate whether vancomycin minimum inhibitory concentration has any influence on the mortality associated with MRSA bacteremia. METHODS: A total of 414 episodes of MRSA bacteremia were prospectively followed-up from 1991 through 2005. MIC of vancomycin for the first isolate was determined by E-test. Clinical variables recorded were age, comorbidity, prior administration of vancomycin, use of corticosteroids, prognosis of underlying disease, source of bacteremia, the need for mechanical ventilation, shock, and mortality. A "treatment group" variable was created and defined as follows: (1) receipt of empirical vancomycin and an isolate with a vancomycin MIC of 1 microg/mL (38 episodes), (2) receipt of empirical vancomycin and an isolate with a vancomycin MIC of 1.5 microg/mL (90 episodes), (3) receipt of empirical vancomycin and an isolate with a vancomycin MIC of 2 microg/mL (40 episodes), and (4) receipt of inappropriate empirical therapy (246 episodes). Univariate and multivariate analyses were performed. RESULTS: Episodes caused by strains with a vancomycin MIC of 2 microg/mL were independently associated with a lower risk of shock (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.15-0.75). Multivariate analysis selected receipt of empirical vancomycin and an isolate with a vancomycin MIC of 2 microg/mL (OR, 6.39; 95% CI, 1.68-24.3), receipt of inappropriate empirical therapy (OR, 3.62; 95% CI, 1.20-10.9), increasing age (OR, 1.02; 95% CI, 1.00-1.04), use of corticosteroids (OR, 1.85; 95% CI, 1.04-3.29), an ultimately (OR, 10.2; 95% CI, 2.85-36.8) or rapidly (OR, 1.81; 95% CI, 1.06-3.10) fatal underlying disease, high-risk (OR, 3.60; 95% CI, 1.89-6.88) and intermediate-risk (OR, 2.18; 95% CI, 1.17-4.04) sources of bacteremia, and shock (OR, 7.38; 95% CI, 4.11-13.3) as the best predictors of mortality. CONCLUSIONS: Mortality associated with MRSA bacteremia was significantly higher when the empirical antibiotic was inappropriate and when vancomycin was empirically used for treatment of infection with strains with a high vancomycin MIC (>1 microg/mL).


Assuntos
Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Resistência a Meticilina , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Vancomicina/uso terapêutico , Idoso , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Falha de Tratamento , Vancomicina/farmacologia , Resistência a Vancomicina
19.
Am J Emerg Med ; 25(8): 865-72, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17920969

RESUMO

AIM: The aim of the study was to establish a triage flowchart to rule out acute coronary syndrome (ACS) among patients with chest pain (CP) arriving on an Emergency Department (ED). PATIENTS AND METHOD: This prospective observational study included 1000 consecutive patients with CP arriving on an ED CP unit. Demographic and clinical characteristics along with vital signs were recorded as independent variables. After CP unit protocol completion and 1-month follow-up, patients were classified as (dependent variable) (1) true non-ACS (all noncoronary patients at the first visit that kept this condition when called 1 month later) or (2) true ACS (all the remaining patients). Relationship among variables was assessed by multiple logistic regression analysis. A triage flowchart was obtained from significant variables and applied to patients with CP who were then grouped in "triage non-ACS" and "triage ACS." Validity indexes to exclude ACS for triage flowchart were measured. RESULTS: Variables significantly associated with non-ACS and included in the triage flowchart were age <40 years (odds ratio 3.61, 95% CI 1.63-7.99), absence of diabetes (2.74, 1.53-4.88), no previously known coronary artery disease (5.46, 3.42-8.71), nonoppressive pain (10.63, 6.04-18.70), and nonretrosternal pain (5.16, 2.82-9.42). For the triage flowchart, both specificity and positive predictive value to rule out ACS were 100%. CONCLUSIONS: The triage flowchart is able to accurately identify patients with CP not having an ACS. It may help triage nurses make quick decisions on who should be immediately seen and who could safely wait when delays in medical attention are unavoidable. Prospective validation is needed.


Assuntos
Angina Instável/diagnóstico , Dor no Peito/etiologia , Infarto do Miocárdio/diagnóstico , Triagem/métodos , Adulto , Fatores Etários , Idoso , Algoritmos , Análise de Variância , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade
20.
Antimicrob Agents Chemother ; 51(7): 2559-63, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17470658

RESUMO

Hematological disturbances that develop during linezolid treatment are a major concern when linezolid is administered for prolonged periods of time. The aim of this study was to evaluate the influences of pyridoxine, rifampin, and renal function on hematological adverse events. From January 2002 to April 2006, 52 patients received a long-term course of linezolid. Blood cell counts were monitored weekly. Thrombocytopenia was defined as a decrease to <75% of the baseline platelet count, and anemia was defined when the hemoglobin concentration decreased by > or =2 g/liter from the baseline value. Twenty-four patients received linezolid alone, and 28 patients received linezolid plus 200 mg of pyridoxine. The Kaplan-Meier survival method, followed by the log-rank test, was used to estimate the cumulative probability of adverse events, and Cox regression analysis was performed to evaluate the independent predictors of toxicity. The baseline characteristics of the patients in both groups were similar. The cumulative probability of thrombocytopenia and anemia in patients who received pyridoxine was not different from that in patients who did not receive it. Hematological adverse events were less frequent in patients taking rifampin and were more frequent in patients with renal failure. However; the Cox regression analysis showed that rifampin was the only independent predictor associated with a lower risk of thrombocytopenia (hazard ratio, 0.37; 95% confidence interval, 0.14 to 0.98; P = 0.045). In conclusion, pyridoxine did not prevent linezolid-related hematological adverse events, and the coadministration of rifampin was associated with a lower risk of thrombocytopenia.


Assuntos
Acetamidas/efeitos adversos , Anti-Infecciosos/efeitos adversos , Taxa de Filtração Glomerular/efeitos dos fármacos , Oxazolidinonas/efeitos adversos , Piridoxina/uso terapêutico , Rifampina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anemia/induzido quimicamente , Glicemia/análise , Estudos de Coortes , Creatinina/sangue , Quimioterapia Combinada , Feminino , Humanos , Linezolida , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos , Trombocitopenia/induzido quimicamente
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA