RESUMO
INTRODUCTION: The main objective of the study was to determine the frequency of patients receiving inappropriate empiric antibiotic therapy and to assess the impact in terms of increase length of hospital stay, 30-day re-admissions, and 30-day mortality. METHODS: An observational retrospective cohort study was conducted over a one-month period that included all patients hospitalised from an Emergency Department (ED) due to infection. Demographic variables, comorbidity, multi-resistance risk factors, site of infection, microbiological findings, and antibiotic prescribed in ED were collected. Outcomes were length of hospital stay, 30-day re-admissions, and 30-day mortality. RESULTS: A total of 376 patients were included, with a mean age of 71.1 (SD 21) years. The most frequent causes were respiratory (45.7%) and urine (23.9%) infections. The number of patients with length of stay over the median (≥9 days) was 165 (46.1%), with re-admissions 74 (19.7%), and mortality at 30 days 44 (11.7%). There was inappropriate antibiotic treatment in 42 (11.2%) cases. After adjusting for demographic data, comorbidity, risk factors for multidrug resistant organism, presence of sepsis criteria in ED, and site of infection, inappropriate treatment was associated with an extended length of hospital stay (OR 2.22; 95% CI; 1.07-4.60; P=.032), but did not to an increase in mortality (P=.271) or re-admission (P=.784) at 30 days. CONCLUSION: The inappropriate empirical antibiotic therapy in patients admitted from the ED leads to an extended hospital stay, but did not increase mortality or readmission.
Assuntos
Antibacterianos/uso terapêutico , Prescrição Inadequada/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Idoso , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Masculino , Estudos Retrospectivos , Fatores de RiscoAssuntos
Bacteriemia , Pneumonia Pneumocócica , Pneumonia , Adulto , Hospitalização , Hospitais Gerais , HumanosAssuntos
Antibacterianos , Prescrições , Serviço Hospitalar de Emergência , Humanos , Tempo de Internação , PrognósticoRESUMO
OBJECTIVES: The rates of undiagnosed and late-diagnosed human immunodeficiency virus (HIV) infection are high. Screening for HIV infection in hospital emergency departments (EDs) could offer a way to increase the number of diagnoses. Our aim was to analyze whether universal hospital ED screening for HIV is efficient. MATERIAL AND METHODS: We followed the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, the Cochrane Library, LILACS, Scopus, EMBASE, and the Web of Science were searched using the following terms: "HIV infections/epidemiology," "AIDS serodiagnosis," "emergency service, hospital," "prevalence," and "mass screening/methods." The searches were limited to a 5-year time frame (2016-2020); only publications in English or Spanish were collected. We included studies of universal HIV screening among hospital ED patients and evaluated them using the Quality Assessment Tool for Quantitative Studies. RESULTS: A total of 273 articles were identified. Twelve met the inclusion criteria. The studies analyzed 103 731 patient samples and yielded 652 new HIV diagnoses. A random effects model estimated an overall new-diagnosis prevalence of 0.60% (95% CI, 0.39%-0.84%). The heterogeneity statistic I2 was high, at 90.02% (P .001). Estimates of prevalence based on studies carried out in Europe, the United States, and Africa were, respectively, 0.48% (95% CI, 0.13%-1.03%), 0.54% (95% CI, 0.33%-0.40%), and 5.6% (95% CI, 3.37%-9.2%). The studies received quality ratings of moderate or strong. CONCLUSION: Although the reviewed studies applied various screening strategies to identify new HIV diagnoses, our findings support the conclusion that universal screening is efficient.
OBJETIVO: Existe una elevada tasa de infección oculta y diagnóstico tardío en el virus de la inmunodeficiencia hu mana (VIH). La realización de pruebas diagnósticas de infección por VIH en los servicios de urgencias hospitalarios (SUH) puede representar una oportunidad para aumentar el número de diagnósticos. El objetivo de este trabajo es analizar si el cribado universal para el VIH realizado en los SUH es eficiente. METODO: Se realiza una revisión sistemática y metanálisis siguiendo la normativa PRISMA en la base de datos de Pubmed, Cochrane, LILACS, Scopus, EMBASE y WOS utilizando una combinación de términos MESH: "HIV Infections/ epidemiology", "AIDS Serodiagnosis", "Emergency Service, Hospital", "Prevalence", "Mass screening/methods". Los criterios de la búsqueda se centraron en los últimos 5 años (2016-2020) y en los artículos publicados en inglés y en español. Se incluyeron los estudios de pruebas de cribado universal mediante test de cribado de VIH realizadas en los SUH. Para evaluar la calidad de los artículos se utilizó el cuestionario "Quality assessment tool for quantitative studies". RESULTADOS: Se identificaron un total de 273 artículos de los cuales se analizaron finalmente 12 que cumplían los criterios de inclusión. Los estudios incluidos representan un total de 103.731 muestras analizadas obteniéndose un total de 652 nuevos diagnósticos de VIH. La prevalencia conjunta obtenida a través del modelo de efectos aleatorios fue de 0,60% (IC 95%: 0,39-0,84) y el valor del I2 revela una presencia elevada de heterogeneidad (I2 90,02%; p 0,001). La prevalencia conjunta en los estudios incluidos realizados en Europa, América y África fue de 0,48% (IC 95%: 0,13-1,03), 0,54% (IC 95%: 0,33-0,40) y 5,6% (IC 95%: 3,37-9,2), respectivamente. La evaluación de la calidad de los estudios fue de moderada a fuerte. CONCLUSIONES: Aunque las pruebas del VIH pueden realizarse utilizando diferentes estrategias, nuestros datos avalan que una estrategia de cribado universal es eficiente.
Assuntos
Infecções por HIV , Serviço Hospitalar de Emergência , Europa (Continente) , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Programas de Rastreamento/métodos , Prevalência , Estados UnidosRESUMO
Objetivo. Existe una elevada tasa de infección oculta y diagnóstico tardío en el virus de la inmunodeficiencia humana (VIH). La realización de pruebas diagnósticas de infección por VIH en los servicios de urgencias hospitalarios (SUH) puede representar una oportunidad para aumentar el número de diagnósticos. El objetivo de este trabajo es analizar si el cribado universal para el VIH realizado en los SUH es eficiente. Método. Se realiza una revisión sistemática y metanálisis siguiendo la normativa PRISMA en la base de datos de Pubmed, Cochrane, LILACS, Scopus, EMBASE y WOS utilizando una combinación de términos MESH: HIV Infections/ epidemiology, AIDS Serodiagnosis, Emergency Service, Hospital, Prevalence, Mass screening/methods. Los criterios de la búsqueda se centraron en los últimos 5 años (2016-2020) y en los artículos publicados en inglés y en español. Se incluyeron los estudios de pruebas de cribado universal mediante test de cribado de VIH realizadas en los SUH. Para evaluar la calidad de los artículos se utilizó el cuestionario Quality assessment tool for quantitative studies. Resultado. Se identificaron un total de 273 artículos de los cuales se analizaron finalmente 12 que cumplían los criterios de inclusión. Los estudios incluidos representan un total de 103.731 muestras analizadas obteniéndose un total de 652 nuevos diagnósticos de VIH. La prevalencia conjunta obtenida a través del modelo de efectos aleatorios fue de 0,60% (IC 95%: 0,39-0,84) y el valor del I2 revela una presencia elevada de heterogeneidad (I2 90,02%; p < 0,001). La prevalencia conjunta en los estudios incluidos realizados en Europa, América y África fue de 0,48% (IC 95%: 0,13- 1,03), 0,54% (IC 95%: 0,33-0,40) y 5,6% (IC 95%: 3,37-9,2), respectivamente. La evaluación de la calidad de los estudios fue de moderada a fuerte. [...]
Background and objective. The rates of undiagnosed and late-diagnosed human immunodeficiency virus (HIV) infection are high. Screening for HIV infection in hospital emergency departments (EDs) could offer a way to increase the number of diagnoses. Our aim was to analyze whether universal hospital ED screening for HIV is efficient. Methods. We followed the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, the Cochrane Library, LILACS, Scopus, EMBASE, and the Web of Science were searched using the following terms: HIV infections/epidemiology, AIDS serodiagnosis, emergency service, hospital, prevalence, and mass screening/methods. The searches were limited to a 5-year time frame (20162020); only publications in English or Spanish were collected. We included studies of universal HIV screening among hospital ED patients and evaluated them using the Quality Assessment Tool for Quantitative Studies. Results. A total of 273 articles were identified. Twelve met the inclusion criteria. The studies analyzed 103731 patient samples and yielded 652 new HIV diagnoses. A random effects model estimated an overall new-diagnosis prevalence of 0.60% (95% CI, 0.39%0.84%). The heterogeneity statistic I2 was high, at 90.02% (P < .001). Estimates of prevalence based on studies carried out in Europe, the United States, and Africa were, respectively, 0.48% (95% CI, 0.13%1.03%), 0.54% (95% CI, 0.33%0.40%), and 5.6% (95% CI, 3.37%9.2%). The studies received quality ratings of moderate or strong. Conclusion. Although the reviewed studies applied various screening strategies to identify new HIV diagnoses, our findings support the conclusion that universal screening is efficient.
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Humanos , Programas de Rastreamento , HIV , Serviços Médicos de Emergência , Infecções por HIV , Diagnóstico TardioRESUMO
No disponible
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Humanos , Síndrome da Imunodeficiência Adquirida/terapia , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Quimioterapia CombinadaRESUMO
No disponible
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Humanos , Infecções por HIV/epidemiologia , Terapia Antirretroviral de Alta Atividade/tendências , Antirretrovirais/uso terapêutico , Complicações Infecciosas na Gravidez/tratamento farmacológico , África/epidemiologia , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas , Segurança do PacienteAssuntos
Humanos , Masculino , Feminino , Pacientes Internados , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Fatores de Risco , Unidades de Terapia Intensiva , Mortalidade , Tempo de Internação , Pandemias , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , PrevisõesRESUMO
Sepsis is a complex entity where there are still many controversies regarding diagnosis and therapeutic management. The present article pretends to review the recently published in relation to these disagreements and contains a proposal of practical approach to the infected patient
La sepsis es una entidad compleja donde existen aún múltiples controversias en cuanto al diagnostico y el manejo terapéutico. El presente artículo pretende hace una revisión de lo publicado recientemente en relación con estas polémicas y ofrece una propuesta de aproximación práctica al paciente infectado