RESUMO
Enterococcal bloodstream infections (EBSI) caused by vancomycin-resistant enterococci (VRE) are associated with a significant rate of unfavorable outcomes. No definitive data have been reported about the association between delayed antibiotic therapy and mortality. In this prospective observational study in three large hospitals in Italy (from August 2016 to April 2021), all consecutive hospitalized patients with a confirmed diagnosis of hospital-acquired monomicrobial BSI caused by VREwith no evidence of endocarditiswere analyzed. Cox regression analysis showed that risk factors independently associated with 30-day mortality were age (HR 2.98, CI95% 1.44−6.81, p = 0.002), chronic kidney disease (HR 5.21, CI95% 1.48−22.23, p = 0.001), oncologic disease (HR 2.81, CI95% 1.45−19.8, p = 0.005), and intensive care unit admission (HR 3.71, CI95% 2.23−7.99, p < 0.001). Conversely, early effective therapy was associated with survival (HR 0.32, CI95% 0.38−0.76, p < 0.001). The administration of early effective antibiotic therapy within 48 h from blood culture collection was associated with 30-day mortality rates lower than 33%. Time from blood culture collection to appropriate therapy was an independent predictor of 30-day mortality in patients with EBSI caused by VRE. Based on these data, clinicians should start effective antibiotic therapy as soon as possible, preferably within the first 48 h from blood culture collection. Treatment strategies allowing the early delivery of in vitro active antibiotics are urgently needed, especially in critically ill patients at risk of VRE bacteremia.
Assuntos
Bacteriemia , Infecções por Bactérias Gram-Positivas , Enterococos Resistentes à Vancomicina , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Estudos Retrospectivos , Vancomicina/farmacologia , Vancomicina/uso terapêutico , Resistência a VancomicinaRESUMO
BACKGROUND: nursing home-acquired pneumonia (NHAP), is among the main causes of hospitalization and mortality of frail elderly patients. Aim of this study was analysis of patients residing in long-term care facilities (LTCF) and developing pneumonia to reach a better knowledge of criteria for hospitalization and outcomes. MATERIALS/METHODS: this is a prospective, observational study in which patients residing in 3 LTCFs (metropolitan area of Rome, Italy) and developing pneumonia, hospitalized or treated in LTCF, were recruited and followed up from January 2017 to June 2019. Primary endpoint was 30-day mortality, secondary endpoint was analysis of risk factors associated with hospitalization. RESULTS: Overall, 146 episodes of NHAP were enrolled in the study: 57 patients were treated in LTCF, while 89 patients were hospitalized. Overall incidence rates of NHAP varied from 2.6 to 7.5 per 1000 residents. Methicillin-resistant Staphylococcus aureus was the most frequently isolated pathogen (25%), and in 28 (55%) patients was documented a MDR pathogen. For hospitalized patients was reported a higher 30-day mortality (43.8% Vs 7%, p < 0.001). Multivariate analysis showed that severe pneumonia, neoplasm, chronic hepatitis, antibiotic monotherapy, and malnutrition were independent risk factors for hospitalization from LTCF. MDR pathogen, severe pneumonia, COPD, and moderate to severe renal disease were independently associated with death at 30 days. CONCLUSION: frail elderly patients in LTCF have a high risk of MDR etiology with a higher risk to receive an inadequate antibiotic therapy and a fatal outcome. These results point to the need for increased provision of acute care and strategies in LTCF.
Assuntos
Infecção Hospitalar/epidemiologia , Casas de Saúde/estatística & dados numéricos , Pneumonia Bacteriana/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Farmacorresistência Bacteriana Múltipla , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Assistência de Longa Duração , Masculino , Desnutrição/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/mortalidade , Estudos Prospectivos , Fatores de Risco , Streptococcus pneumoniae/isolamento & purificação , Resultado do TratamentoAssuntos
Infecções , Unidades de Terapia Intensiva , Humanos , Infecções/diagnóstico , Infecções/terapiaRESUMO
We observe, in patients with type 2 diabetes of recent onset, the activity of the autonomic nervous system and glucose metabolic impairment. The data indicate the hyperactivity of the sympathetic and minimal changes in glucose values. The role played by glycemia appeared to be less important than that represented by insulin resistance.
Assuntos
Sistema Nervoso Autônomo/metabolismo , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Monitorização Fisiológica/métodos , Adulto , Sistema Nervoso Autônomo/efeitos dos fármacos , Sistema Nervoso Autônomo/fisiopatologia , Automonitorização da Glicemia , Estudos Transversais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Eletrocardiografia , Feminino , Hemoglobinas Glicadas/metabolismo , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipoglicemiantes/uso terapêutico , Resistência à Insulina , Itália/epidemiologia , Masculino , Metformina/uso terapêutico , Pessoa de Meia-IdadeRESUMO
Despite schistosomiasis is one of the most prevalent tropical diseases in developing countries and and large flows of migrants come from countries where the disease is endemic, imported urinary schistosomiasis is still not easily recognized in non-endemic areas, especially if not subjected to specific investigations. Moreover schistosomiasis is currently not reportable in any European public health system. The data presented in this report were collected were collected between asylum seekers by a simple screening method based on a prior or actual history of a macroscopic hematauria. In case of a history of gross hematuria, the patient underwent to specific exams standardized for the diagnosis of urinary schistosomiasis. Our data show that the prevalence of the disease has been largely underestimated by European Surveillance Systems; in fact in a small population of young asylum seekers coming from endemic areas for schistosomiasis, we found a significant number of individuals with symptomatic disease. Given that the disease typically has an insidious course, it is highly probable that a screening procedure is able to identify early asymptomatic or mildly symptomatic subjects and avoid the serious complications that are present in advanced stages of disease. Given the limits and the costs of a late diagnosis and that an effective treatment is available, subjects from endemic areas should be actively screened for urinary schistosomiasis.