0000000000140942
AUTHOR
Arturo Artero
Clinical characteristics of patients hospitalized with COVID-19 in Spain: results from the SEMI-COVID-19 Network
ABSTRACTBackgroundSpain has been one of the countries most affected by the COVID-19 pandemic.ObjectiveTo create a registry of patients with COVID-19 hospitalized in Spain in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease.MethodsA multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records.ResultsUp to April 30th 2020, 6,424 patients from 109 hospitals were included. …
COVID‐19 in older adults: What are the differences with younger patients?
Aim The present study aimed both to gain knowledge on the distinctive clinical characteristics of older adults with coronavirus disease 2019 (COVID‐19), in comparison with those of younger patients, and to identify risk factors for mortality. Methods A retrospective observational study was carried out of patients consecutively admitted to Doctor Peset University Hospital, Valencia (Spain) for COVID‐19 from 11 March to 28 April 2020. Every case was diagnosed by reverse transcription polymerase chain reaction or by serology test to detect antibodies. Demographic details, clinical characteristics, laboratory findings on admission and complications of each case were collected from electronic me…
Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections.
Abstract Background Inadequate empirical antimicrobial therapy (IEAT) in intensive care unit (ICU) is associated with adverse outcomes. However, the influence of IEAT on prognosis for elderly patients with urinary tract infection (UTI) in non-ICU settings is unknown. Methods A retrospective cross-sectional study of elderly patients admitted to a non-ICU ward in a university hospital with a primary diagnosis of UTI over a 3-year period was done. Data relating to age, sex, background comorbidities, severity of infection, bacteremia, microorganisms isolated in urine, treatment given, length of stay and prognosis were obtained using chart review. Cases were segregated according to the adequacy …
Virología: diagnóstico sindrómico de meningitis y encefalitis
Viral infections of the nervous system represent a major health problem. It is estimated that the incidence of viral meningitis in the general population ranges from 5-17 cases per 100,000 inhabitants per year in developed countries. This heading encompasses highly varied clinical pictures, ranging from meningitis to encephalitis. This article presents the agents involved in our environment and discusses their expressiveness. In immunocompetent patients, the course of these infections is usually benign. Nucleic acid amplification techniques are the gold standard for their etiological diagnosis. The introduction of polymerase chain reaction and serological diagnosis of the main arboviruses h…
The influence of inadequate empirical antimicrobial treatment on patients with bloodstream infections in an intensive care unit
Objective To determine the occurrence of inadequate antimicrobial therapy among critically ill patients with bacteremia and the factors associated with it, to identify the microorganisms that received inadequate antimicrobial treatment, and to determine the relationship between inadequate treatment and patients outcome. Methods From June 1995 to January 1999 we collected data on all clinically significant ICU-bacteremias in our teaching hospital. Clinical and microbiological characteristics were recorded and the adequacy of empirical antimicrobial treatment in each case was determined. We defined inappropriate empirical antimicrobial treatment as applying to infection that was not being eff…
Community-onset Pseudomonas aeruginosa urinary sepsis in elderly people: Predictive factors, adequacy of empirical therapy and outcomes.
Purpose To know the predictive factors for Pseudomonas aeruginosa (PA) urinary sepsis in hospitalised elderly patients coming from community, the adequacy of empirical antibiotic therapy and its outcomes. Methods Retrospective case-control study conducted between 2007 and 2017. Patients aged 65 years or older with PA urinary sepsis were included as cases. Three age-matched controls, with urinary sepsis caused by other microorganisms, were selected for each case. Predictors for PA urinary sepsis were determined by logistic regression analysis. Adequacy of empirical antibiotic therapy and outcomes were compared between both groups. Results A total of 332 patients, from which 83 were cases, we…
Effect of Bacteremia in Elderly Patients With Urinary Tract Infection.
The clinical effect of bacteremia on outcomes in urinary tract infection (UTI) is still debated. This study aims to examine the clinical effect of bacteremia in elderly patients with UTI requiring hospital admission.This retrospective observational study recorded the clinical features, microbiology and outcomes in a Spanish cohort of patients aged ≥65 years hospitalized for UTI in whom blood cultures were performed in the emergency department. The primary outcome of the study was in-hospital mortality.Of 333 patients, with a mean age of 81.6 years, 137 (41.1%) had positive blood cultures. Escherichia coli, with 223 (66.9%) cases, was the most common microorganism isolated. Independent risk …
The adverse effects of estrogen and selective estrogen receptor modulators on hemostasis and thrombosis.
Agonists of the estrogen receptor include estrogens and selective estrogen receptor modulators (SERMs). Both types of compounds increase the risk for thrombosis in the arterial and the venous tree. The magnitude of the effect is influenced by potency, which depends on the type of compound and the dose. The particulars of the process change in each territory. Atherosclerosis, which creates local inflammatory conditions, may favor thrombogenesis in arteries. A direct effect of estrogen agonists is also well endorsed at both arteries, as suggested from data with high-estrogenic contraceptives, and veins. Dose reduction has been proved to be an effective strategy, but there is debate on whether…
Prognostic accuracy of Quick SOFA in older adults hospitalised with community acquired urinary tract infection
Introduction Quick [Sepsis-related] Sequential Organ Failure Assessment (qSOFA) is a prognostic score based on sepsis-3 definition, easy to carry out, whose application has been studied in older adults with sepsis from different sources and respiratory sepsis. However, to date no study has analysed its prognostic accuracy in older adults admitted to hospital with community urinary tract infection. Methods In a prospective study of 282 older adults admitted to hospital with community acquired urinary tract infection, the application of qSOFA to predict hospital mortality was analysed. The predictive capacity of qSOFA for in-hospital mortality was compared with Systemic Inflammatory Response …
Re: The Clinical Impact of Bacteremia on Outcomes in Elderly Patients with Pyelonephritis or Urinary Sepsis: A Prospective Multicenter Study
Background Bacteremia is common in severe urinary infections, but its influence on the outcomes is not well established. The aim of this study was to assess the association of bacteremia with outcomes in elderly patients admitted to hospital with pyelonephritis or urinary sepsis. Methods This prospective muticenter observational study was conducted at 5 Spanish hospitals. All patients aged >65 years with pyelonephritis or urinary sepsis admitted to the departments of internal medicine and with urine and blood cultures obtained at admission to hospital were eligible. Transfer to ICU, length of hospital stay, hospital mortality and all cause 30-day mortality in bacteremic and non-bacteremic g…
Inadequate empirical antimicrobial treatment in older people with bacteremic urinary tract infection who reside in nursing homes: A multicenter prospective observational study.
AIM The aim of the study was to determine the rate of inadequate empirical antimicrobial treatment in older nursing home residents with bacteremic urinary tract infection and its influence on prognosis. METHODS We carried out a multicentric prospective observational study in five Spanish hospitals. Patients aged >65 years with pyelonephritis or urinary sepsis with bacteremia were included. Clinical characteristics, the percentage of inadequate empirical antibiotic treatment, length of hospital stay and mortality were evaluated. RESULTS A total of 181 patients, 54.7% women, were included in the study, and 35.9% of the patients came from nursing homes. These patients had higher percentages of…
Predictive factors for Enterococcus faecalis in complicated community‐acquired urinary tract infections in older patients
AIM Risk factors for complicated community acquired Enterococcus faecalis urinary tract infection (UTI) in older patients are not well known. METHODS We identified the predictive factors for E. faecalis on a cohort of 659 older patients admitted to hospital with complicated UTI. We also examined the adequacy of empirical antimicrobial therapy and outcomes in E. faecalis UTI. Multivariable logistic regression was used to identify predictors of E. faecalis UTI. RESULTS A total of 87 (13.2%) patients had E. faecalis UTI; of these 63.2% were men, their mean age was 82.3 years and they had a great number of comorbidities. Severe sepsis or septic shock was present in 50.5%, and bacteremia was pre…