RESUMO
OBJECTIVE: To describe and quantify resource use and direct health costs associated with skin and skin structure infections (SSSIs) caused by Gram-positive bacteria in adults receiving outpatient parenteral antimicrobial therapy (OPAT), administered by Hospital at Home units (HaH) in Spain. METHODS: Observational, multicenter, retrospective study. We included patients of both sexes included in the HaH-based OPAT Registry during 2011 to 2017 who were hospitalized due to SSSIs caused by Gram-positive bacteria. Resource use included home visits (nurses and physician), emergency room visits, conventional hospitalization stay, HaH stay and antibiotic treatment. Costs were quantified by multiplying the natural units of the resources by the corresponding unit cost. All costs were updated to 2019 euros. RESULTS: We included 194 episodes in 189 patients from 24 Spanish hospitals. The most frequent main diagnoses were cellulitis (26.8%) and surgical wound infection (24.2%), and 94% of episodes resulted in clinical improvement or cure after treatment. The median HaH stay was 13 days (interquartile range [IR]:8-22.7), and the conventional hospitalization stay was 5 days (IR: 1-10.7). The mean total cost attributable to the complete infectious process was 7,326 (95% confidence interval: 6,316-8,416). CONCLUSIONS: Our results suggest that OPAT administered by HaH is a safe and efficient alternative for the management of these infections and could lead to lower costs compared with hospital admission.
Assuntos
Antibacterianos , Pacientes Ambulatoriais , Adulto , Masculino , Feminino , Humanos , Estudos Retrospectivos , Estresse Financeiro , Hospitais , Bactérias Gram-Positivas , Assistência Ambulatorial/métodosRESUMO
The aim of this study was to assess the direct healthcare costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home (HaH) units in Spain. An observational, multicentre, economic evaluation of retrospective cohorts was conducted. Patients were treated at home by the HaH units of three Spanish hospitals between January 2012 and December 2013. From the cost accounting of HaH OPAT (staff, pharmacy, transportation, diagnostic tests and structural), the cost of each outpatient course was obtained following a top-down strategy based on the use of resources. Costs associated with inpatient stay, if any, were estimated based on length of stay and ICD-9-CM diagnosis. There were 1324 HaH episodes in 1190 patients (median age 70 years). The median (interquartile range) stay at home was 10 days (7-15 days). Of the OPAT episodes, 91.5% resulted in cure or improvement on completion of intravenous therapy. The mean total cost of each infectious episode was 6707 [95% confidence interval (CI) 6189-7406]. The mean cost per OPAT episode was 1356 (95% CI 1247-1560), mainly distributed between healthcare staff costs (46%) and pharmacy costs (39%). The mean cost of inpatient hospitalisation of an infectious episode was 4357 (95% CI 3947-4977). The cost per day of inpatient hospitalisation was 519, whilst the cost per day of OPAT was 98, meaning a saving of 81%. This study shows that OPAT administered by HaH units resulted in lower costs compared with inpatient care in Spain.
Assuntos
Administração Intravenosa/economia , Assistência Ambulatorial/economia , Assistência Ambulatorial/métodos , Anti-Infecciosos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Custos de Cuidados de Saúde , Serviços de Assistência Domiciliar , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Retrospectivos , EspanhaRESUMO
Hospital at Home units allows ambulatory treatment and monitoring of complex and serious infections. Nosocomial infections produce an extension of the stay in hospital often specifying long intravenous treatments without any effective oral alternatives. Daily dosing of antimicrobial are easier to administer at home. The use of portable programmable pump infusion and elastomeric devices allow efficient and safe infu-sions for most antimicrobials at home. Some antibiotics against multidrug-resistant organisms of recent introduction have a suitable profile for outpatient intravenous treatment.
Assuntos
Assistência Ambulatorial , Infecção Hospitalar/tratamento farmacológico , Serviços de Assistência Domiciliar , Anti-Infecciosos/uso terapêutico , Infecção Hospitalar/microbiologia , Hospitais , HumanosRESUMO
OBJECTIVE: To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. METHODS: Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. RESULTS: A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. CONCLUSIONS: Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
Assuntos
Endocardite Bacteriana/complicações , Endocardite Bacteriana/epidemiologia , Cirrose Hepática/complicações , Idoso , Procedimentos Cirúrgicos Cardíacos , Estudos de Coortes , Endocardite Bacteriana/mortalidade , Feminino , Humanos , Cirrose Hepática/microbiologia , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologiaRESUMO
The high prevalence of blood hypertension together with a deficient control, make this one of the frequent causes requiring urgent medical attention. The concepts are reviewed and the treatment of the hypertensive urgency and emergency are described. The term hypertensive emergency means a serious affliction of vital organs caused by the increased of blood pressure, this needing a very close control and parenteral treatment. Hypertensive urgency is a less severe situation, which requires a less aggressive via-oral or sublingual treatment.
Assuntos
Hipertensão/complicações , Anti-Hipertensivos/administração & dosagem , Contraindicações , Cuidados Críticos , Emergências , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologiaRESUMO
Cerebrovascular diseases (CVD) entail high costs associated to therapies, hospitalizations and disabilities. Arterial hypertension (AHT) is the major modifiable risk factor for the development of all types of CVDs (cerebrovascular accidents, vascular dementias, etc.). The increase of arterial pressure causes functional and anatomical changes in the cerebral circulation which facilitate the development of CVDs. The time of evolution and the severity of the AHT, as well as the associated vascular risk factors, will determine its impact on the central nervous system.
Assuntos
Encefalopatias/etiologia , Hipertensão/complicações , Hemorragia Cerebral/etiologia , Infarto Cerebral/etiologia , Circulação Cerebrovascular , Demência por Múltiplos Infartos/etiologia , Demência Vascular/etiologia , Encefalite/etiologia , Humanos , Hipertensão/fisiopatologia , Pseudotumor Cerebral/etiologiaRESUMO
A case of 54-year-old male who, during the development of a pulmonary fibrosis, showed extrapulmonary autoimmune symptoms (polyarthritis and hemolytic anemia), is presented. The antinuclear antibodies and rheumatoid factor positives have been described in up to 30% of the idiopathic pulmonary fibrosis, complicating the differential diagnosis with lung fibrosis caused by alterations of connective tissue. We discuss the prognosis and treatment of this difficult diagnosis.
Assuntos
Doenças Autoimunes/diagnóstico , Fibrose Pulmonar/diagnóstico , Anticorpos Antinucleares/sangue , Doenças Autoimunes/tratamento farmacológico , Biópsia , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Fibrose Pulmonar/tratamento farmacológico , Fator Reumatoide/sangueRESUMO
450 patients who arrived at the emergency department with abdominal pain were studied. 71% arrived without having previously consulted another doctor. The most frequent diagnosis was reno ureteral pain, non-specific pain, gastroenteritis and in geriatric patients (hernia, biliar pathology) other pathology. 69 patients with non-specific pain were followed-up during a period of one year. The symptoms returned in 40% of patients. Only 3% required urgent medical treatment.
Assuntos
Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Emergências , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Diabetic nephropathy is one of the most serious complications of diabetes mellitus because of the associated mortality and morbility. The proteinuria, together with hypertension and renal function, are the clinical features. It is linked with a major prevalence of the other late complications of the disease. In recent years progress has been made in the knowledge of the natural history of the disease, as well as, its predictive factors. We review the etiopathogenia, the actual therapeutic management with special emphasis on hypertension treatment and the controversial metabolic control.
Assuntos
Nefropatias Diabéticas , Nefropatias Diabéticas/classificação , Nefropatias Diabéticas/patologia , Nefropatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/terapia , HumanosRESUMO
We present 13 cases taken care at the Emergency Service, whose diagnosis was acute rhabdomyolysis related to consumption of illicit drugs. In all cases, the presence of cocaine in the urine was detected. Clinical features, other associated factors and complications are described, stressing the etiopathogenic mechanism of presentation of cocaine-related rhabdomyolysis.
Assuntos
Cocaína , Rabdomiólise/etiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Doença Aguda , Adulto , Feminino , Humanos , MasculinoRESUMO
Medical problems related to cocaine consumption are not rare in our environment; however, to this respect, descriptions in the spanish literature are scarce. We present three cases of intracerebral hemorrhage which occurred after cocaine consumption (intranasal route in two cases and intravenous route in one case). In the three cases, another associated risk factor was observed (alcohol in one case, hypertension in other case, arteriovenous malformation in the third case). We comment on the pathophysiological theories of the cause of bleeding, high-lighting the routine search of this association.
Assuntos
Hemorragia Cerebral/etiologia , Cocaína , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Hemorragia Cerebral/fisiopatologia , Humanos , MasculinoRESUMO
Cocaine intake growth is a well-known fact, and that involves the appearance of unknown or forgotten complications. We have wanted to make a checking of neurologic complications due to the intake of this drug, make a special point of the physiopathological mechanisms and stopping at those related to treatment. We also want to contribute with our experience with regard to these processes.
Assuntos
Cocaína/efeitos adversos , Doenças do Sistema Nervoso/induzido quimicamente , Anticonvulsivantes/uso terapêutico , Hemorragia Cerebral/induzido quimicamente , Infarto Cerebral/induzido quimicamente , Diazepam/uso terapêutico , Cefaleia/induzido quimicamente , Humanos , Ataque Isquêmico Transitório/induzido quimicamente , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico , Hemorragia Subaracnóidea/induzido quimicamenteRESUMO
The importance of atrial fibrillation (AF) as a risk factor (RF) for cerebral infarction (CI) is well-known. It is probably caused by cardiac embolism but other explanations can also justify this association. Our aim was to analyse the features of the patients with CI and AF and sinus rhythm (SR), as well as to form hypotheses as regards the pathogenesis. 250 patients with CI, 204 in RS and 46 in AF (31 non-valvular and 15 associated to a valvular disease) were studied, analysing the prevalence of RF and initial blood tests. The group of patients with valvular AF of probably embolic mechanism had a minor prevalence of RF (hypertension, diabetes, smoking, alcoholism) but higher mortality. The group with non-valvular AF, had a lower RF prevalence compared to the SR group (non-embolic mechanism), without statistical significance and with a similar mortality rate. We concluded that the atherothrombotic mechanism can be the cause of a considerable proportion of CI in patients with non-valvular AF.
Assuntos
Fibrilação Atrial/complicações , Infarto Cerebral/etiologia , Idoso , Fibrilação Atrial/sangue , Infarto Cerebral/sangue , Feminino , Humanos , Hipertensão/complicações , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The development of rhabdomyolysis is a complications of acute intoxications, although its actual incidences is unknown. We had studied the frequency and differential characteristics of the patients with such complications. A prospective study was conducted with 200 patients admitted to a General Hospital from an urban area due to acute intoxication, recording the etiology of the intoxication, motivation and analytical characteristics of the patients with rhabdomyolysis compared to their patients without rhabdomyolysis. The incidence of rhabdomyolysis was 7.7%. Among the patients with rhabdomyolysis, ludic motivation (59%) and etiology associated to drug abuse (heroin 30%, cocaine 24%) were more frequent compared to the patients without rhabdomyolysis. Twenty per cent of the patients consuming cocaine and 17% of the patients consuming heroin developed rhabdomyolysis. Acute rhabdomyolysis was, thus, a significant complication of acute intoxications, associated to the consumption of illegal drugs and, at least in our cases, with a good evolution regarding the renal function.
Assuntos
Rabdomiólise/etiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Doença Aguda , Adulto , Feminino , Humanos , Incidência , Masculino , Estudos Prospectivos , Rabdomiólise/epidemiologiaRESUMO
Cardiac tamponade (CT) and Carcinomatous lymphangitis (CL) association as an initial clinical presentation of a neoplasm is very uncommon, creating diagnosis difficulties in the patient first evaluation. This paper reports one case of a male who was admitted in Emergency Department with clinical and radiological findings of heart failure. Following studies showed CT and CL secondary to a bronchial adenocarcinoma. Differential diagnosis is really important for its associated therapeutic implications because of the CT hemodynamic worsening situation due to the diuretic and vasodilators used in the treatment of heart failure. An echocardiography should be done because it is very useful for the initial evaluation of a heart failure of obscure origin.
Assuntos
Adenocarcinoma/diagnóstico , Carcinoma Broncogênico/diagnóstico , Tamponamento Cardíaco/etiologia , Neoplasias Pulmonares/diagnóstico , Linfangite/etiologia , Líquido da Lavagem Broncoalveolar , Tamponamento Cardíaco/diagnóstico por imagem , Cardiomegalia/diagnóstico por imagem , Cardiomegalia/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
We studied the clinical characteristics and the initial supplementary test available in the emergency service, in aged patients with community-acquired pneumonia, as well as their mortality prognosis value. We assessed 190 patients attended consecutively during one year. Clinical, analytical and radiological data were registered. The parameters associated to a higher mortality were: age, absence of thoracic pain, reduction in the level of consciousness, leukocytosis, increased urea levels, aminotransferases, lactate dehydrogenase and reduction in prothrombin activity and pH. The data associated to a greater relative risk were: age above 80 years, absence of thoracic pain, prothrombin activity lower than 70% and ALT < 40 U/l. The presence of three to four of these variables had a sensitivity of 62% and a specificity of 94% in the prediction of mortality. In the multivariable analysis, the following variables remained significative: age, obnubilation and decrease of prothrombin. We stress the relevance of a high clinical suspicion, given the frequency of these cases with little symptomatology, in order to allow for an early treatment and the identification of right risk patients at the initial assessment.