RESUMO
DENOVA-score is useful to stratify the risk of infective endocarditis (IE) in Enterococcus faecalis bacteremia. Recently, time to positive (TTP) of blood cultures has also been related with a higher risk of IE. The objective was to evaluate DENOVA- score with TTP to improve its specificity. We performed a retrospective, case-control study in adult patients with E. faecalis bacteremia. Thirty-nine patients with definite E. faecalis IE and 82 with E. faecalis bacteremia were included. The addition of a TTP ≤ 8 h to DENOVA-score did not improve the diagnostic accuracy of this score.
Assuntos
Bacteriemia , Hemocultura , Endocardite Bacteriana , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas , Humanos , Enterococcus faecalis/isolamento & purificação , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Estudos Retrospectivos , Hemocultura/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Estudos de Casos e Controles , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/sangue , Fatores de Tempo , Adulto , Idoso de 80 Anos ou mais , Sensibilidade e Especificidade , Valor Preditivo dos TestesRESUMO
Clostridium difficile infection (CDI) is characterized by a high delayed and unrelated mortality. Predicting delayed mortality in CDI patients could allow the implementation of interventions that could reduce these events. A prospective multicentric study was carried out to investigate prognostic factors associated with mortality. It was based on a cohort (July 2015 to February 2016) of 295 patients presenting with CDI. Logistic regression was used and the model was calibrated using the Hosmer-Lemeshow test. The mortality rate at 75 days in our series was 18%. Age (>65 years), comorbidity (defined by heart failure, diabetes mellitus with any organ lesion, renal failure, active neoplasia or immunosuppression) and fecal incontinence at clinical presentation were associated with delayed (75-day) mortality. When present, each of the aforementioned variables added one point to the score. Mortalities with 0, 1, 2 and 3 points were 0%, 9.4%, 18.5% and 38.2%, respectively. The area under the ROC curve was 0.743, and the Hosmer-Lemeshow goodness-of-fit test p value was 0.875. Therefore, the prediction of high delayed mortality in CDI patients by our scoring system could promote measures for increasing survival in suitable cases.
Assuntos
Infecções por Clostridium/mortalidade , Idoso , Infecções por Clostridium/complicações , Comorbidade , Feminino , Humanos , Masculino , Estudos Prospectivos , Análise de Sobrevida , Fatores de TempoAssuntos
Endocardite , Infecções por Pseudomonas , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Compostos Azabicíclicos/farmacologia , Compostos Azabicíclicos/uso terapêutico , Ceftazidima/farmacologia , Ceftazidima/uso terapêutico , Combinação de Medicamentos , Farmacorresistência Bacteriana Múltipla , Endocardite/tratamento farmacológico , Humanos , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosaRESUMO
Positron emission tomography (18FDG PET-CT) is a widely used method to help in the diagnosis of infective endocarditis (IE). Lipomatous hypertrophy of the interatrial septum (LHIS) is an uncommon fat deposition in the region of the interatrial septum. PET-CT images of LHIS may be indistinguishable from changes associated with IE.
Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Cefalosporinas/uso terapêutico , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Ácido Penicilânico/análogos & derivados , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Dermatopatias Bacterianas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Penicilânico/uso terapêutico , Infecções por Pseudomonas/microbiologia , Dermatopatias Bacterianas/microbiologia , Infecções dos Tecidos Moles/microbiologia , TazobactamRESUMO
BACKGROUND: Treatment optimization for serious infections, such as Staphylococcus aureus bacteremia (SAB), is a challenge for antimicrobial stewardship teams. Currently, SAB guidelines recommend a completely intravenous therapy (CIT). OBJECTIVES: The objective of the study was to analyze the usefulness and safety of oral sequential therapy (OST) in SAB. PATIENTS AND METHODS: We conducted a retrospective, observational study in a tertiary teaching hospital in Spain. The inclusion criteria were complicated and non-complicated monomicrobial SAB and an adequate duration of therapy, with patients classified into OST or CIT. The primary endpoint was the 90-day recurrence of S. aureus infection. We also analyzed the mortality, the length of the hospital stay, and the duration of the intravenous antibiotic administration. RESULTS: Of a total of 201 patients with SAB, 125 (62%) underwent OST. The most commonly administered oral antibiotic was trimethoprim-sulfamethoxazole (66% of patients). Of those administered OST, 43% had complicated bacteremia (most with an osteoarticular source of infection), and 6% had an intravascular device. The 90-day recurrence rate was 4%, with no differences between the two groups. The duration of the therapy (22 [16-28] vs. 13 days [8-17] for CIT and OST, respectively; p < 0.001) and the hospital stay (36 [27-71] vs. 18 days [13-29] for CIT and OST, respectively; p < 0.001) were shorter for OST. MRSA was related with mortality (OR 4.4, 95% CI [1.67-11.37]; p = 0.003). CONCLUSIONS: OST for properly selected patients with SAB could be a safe therapeutic option and can reduce their use of CIT and their hospital stay.
Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos , Bacteriemia/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Administração Intravenosa , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Centros de Atenção TerciáriaRESUMO
Recurrence of Clostridium difficile infection (CDI) has major consequences for both patients and the health system. The ability to predict which patients are at increased risk of recurrent CDI makes it possible to select candidates for treatment with new drugs and therapies (including fecal microbiota transplantation) that have proven to reduce the incidence of recurrence of CDI. Our objective was to develop a clinical prediction tool, the GEIH-CDI score, to determine the risk of recurrence of CDI. Predictors of recurrence of CDI were investigated using logistic regression in a prospective cohort of 274 patients diagnosed with CDI. The model was calibrated using the Hosmer-Lemeshow test. The tool comprises four factors: age (70-79 years and ≥80 years), history of CDI during the previous year, direct detection of toxin in stool, and persistence of diarrhea on the fifth day of treatment. The functioning of the GEIH-CDI score was validated in a prospective cohort of 183 patients. The area under the ROC curve was 0.72 (0.65-0.79). Application of the tool makes it possible to select patients at high risk (>50%) of recurrence and patients at low risk (<10%) of recurrence. GEIH-CDI score may be useful for clinicians treating patients with CDI.
Assuntos
Infecções por Clostridium/diagnóstico , Técnicas de Apoio para a Decisão , Recidiva , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Candida/isolamento & purificação , Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora/microbiologia , Contaminação de Equipamentos , Medição de Risco , Adulto , Idoso , Bacteriemia/epidemiologia , Candidíase/diagnóstico , Candidíase/epidemiologia , Candidíase/etiologia , Candidíase/transmissão , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/transmissão , Cateteres Venosos Centrais/microbiologia , Coinfecção , Feminino , Fungemia/epidemiologia , Fungemia/etiologia , Fungemia/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Although there is a great concern regarding rational use of drugs, the available evidence for the most appropriate strategies to improve prescribing is scarce. GOAL: The goal of this study was to evaluate the effectiveness of the combination of feedback of individualized prescribing data and educational recommendations for improving the quality of prescribing in general practice. METHOD: A quasiexperimental intervention study was conducted in which prescribing rates of 282 family physicians before and after the intervention were compared. Physicians assigned to the individualized feedback group (n = 195) received individual instruction with specific recommendations for improvement according to their baseline prescribing quality levels, whereas physicians in the minimal intervention group (n = 87) only received standard nonindividualized prescribing data for the practice group as a whole. RESULTS: A trend toward increasing high pharmacologic intrinsic value in both groups was observed. Overprescription of antibiotics showed a decrease in the individualized feedback group (P = 0.006) and it did not change in the minimal intervention group. A different trend in the values in each group was observed with nonsteroidal antiinflammatory drugs, although it was not statistically significant. Overprescription of antiulcerative agents decreased among physicians in the individualized feedback group (P = 0.003); however, there were not statistically significant differences as compared with the minimal intervention group. Changes in indicators of drug selection were more favorable for the group with individualized feedback, although no statistically significant differences were observed. Pharmaceutical expenditure increased significantly in the minimal intervention group as compared with the individualized feedback group, with an approximate difference of dollars 7.87 per inhabitant and trimester (P = 0.003). CONCLUSION: The intervention showed that improving the quality of prescribing was feasible, particularly in overprescribing, and was associated with considerable savings in pharmaceutical costs.