Introduction
This study was aimed to identify risk factors associated with unfavorable outcomes (composite outcome variable: mortality and need for mechanical ventilation) in patients hospitalized in ...Galicia with COVID-19 pneumonia.
Methods
Retrospective, multicenter, observational study carried out in the 8 Galician tertiary hospitals. All Patients admitted with confirmed COVID-19 pneumonia from 1st of March to April 24th, 2020 were included. A multivariable logistic regression analysis was performed in order to identify the relationship between risk factors, therapeutic interventions and the composite outcome variable.
Results
A total of 1292 patients (56.1% male) were included. Two hundred and twenty-five (17.4%) died and 327 (25.3%) reached the main outcome variable. Age odds ratio (OR) = 1.03 (95% confidence interval (CI): 1.01–1.04), CRP quartiles 3 and 4 OR = 2.24 (95% CI: 1.39–3.63) and OR = 3.04 (95% CI: 1.88–4.92), respectively, Charlson index OR = 1.16 (95%CI: 1.06–1.26), SaO2 upon admission OR = 0.93 (95% CI: 0.91–0.95), hydroxychloroquine prescription OR = 0.22 (95%CI: 0.12–0.37), systemic corticosteroids prescription OR = 1.99 (95%CI: 1.45–2.75), and tocilizumab prescription OR = 3.39 (95%CI: 2.15–5.36), significantly impacted the outcome. Sensitivity analysis using different alternative logistic regression models identified consistently the ratio admissions/hospital beds as a predictor of the outcome OR = 1.06 (95% CI: 1.02–1.11).
Conclusion
These findings may help to identify patients at hospital admission with a higher risk of death and may urge healthcare authorities to implement policies aimed at reducing deaths by increasing the availability of hospital beds.
Streptococcus suis (S. suis) infection is poorly described zoonosis in our country, which is related with exposure to pigs or their meat. The most common clinical presentation is meningitis, while ...spinés involvement is rare.
We report 2 cases of S. suis infection and perform a systematic review of the articles published on S. suis spondylodiscitis between January 1994 and May 2020 with the aim of defining the clinical characteristics, predisposing factors and evolution.
17 cases are described, 76.5% males with a mean age of 57.6 years, generally without associated underlying disease. Enolism was a factor present in 17.6%. 70.6% had exposure to pigs or their meat and 20% hand injuries. The mean duration of symptoms was 10.2 days and the most affected segment was the lumbar level. 70.6% had meningitis. All were treated with beta-lactams with an average duration of 53.2 days. There was a recurrence and none died.
There are few cases of S. suis spondylodiscitis in the literature. When occurs, it is associated with another type of infection in most cases. They present a good response to medical treatment and a good prognosis.
To analyse the characteristics and predictors of death in hospitalized patients with coronavirus disease 2019 (COVID-19) in Spain.
A retrospective observational study was performed of the first ...consecutive patients hospitalized with COVID-19 confirmed by real-time PCR assay in 127 Spanish centres until 17 March 2020. The follow-up censoring date was 17 April 2020. We collected demographic, clinical, laboratory, treatment and complications data. The primary endpoint was all-cause mortality. Univariable and multivariable Cox regression analyses were performed to identify factors associated with death.
Of the 4035 patients, male subjects accounted for 2433 (61.0%) of 3987, the median age was 70 years and 2539 (73.8%) of 3439 had one or more comorbidity. The most common symptoms were a history of fever, cough, malaise and dyspnoea. During hospitalization, 1255 (31.5%) of 3979 patients developed acute respiratory distress syndrome, 736 (18.5%) of 3988 were admitted to intensive care units and 619 (15.5%) of 3992 underwent mechanical ventilation. Virus- or host-targeted medications included lopinavir/ritonavir (2820/4005, 70.4%), hydroxychloroquine (2618/3995, 65.5%), interferon beta (1153/3950, 29.2%), corticosteroids (1109/3965, 28.0%) and tocilizumab (373/3951, 9.4%). Overall, 1131 (28%) of 4035 patients died. Mortality increased with age (85.6% occurring in older than 65 years). Seventeen factors were independently associated with an increased hazard of death, the strongest among them including advanced age, liver cirrhosis, low age-adjusted oxygen saturation, higher concentrations of C-reactive protein and lower estimated glomerular filtration rate.
Our findings provide comprehensive information about characteristics and complications of severe COVID-19, and may help clinicians identify patients at a higher risk of death.
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To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalisation Unit of a tertiary hospital for 3 years ...and to analyse clinical evolution and mortality.
Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received, and clinical evolution. Statistical analysis was performed using SPSS® 19 software.
81 patients were included, 61.7% men, with a mean age of 73.5±17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9±8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p=.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p=.04) were associated with worse clinical outcome.
Age over 80 years was associated with better outcome (p=.03). The diagnosis of heart failure was associated with higher mortality (p=.026) and patients from surgical services, with lower mortality (p=.047). In the multivariate analysis, the presence of neoplasia was associated with unfavourable evolution (p=.012) and heart failure with higher mortality (p=.027).
Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.
Describir la experiencia de uso de la terapia de infusión domiciliaria de antibióticos mediante bombas de infusión elastoméricas, administrada a pacientes ingresados en la Unidad de Hospitalización a Domicilio de un hospital de tercer nivel durante tres años y analizar evolución clínica y mortalidad.
Estudio observacional retrospectivo mediante revisión de las historias clínicas de los pacientes incluidos. Se obtuvo información sobre antecedentes personales, terapia antimicrobiana recibida y evolución clínica. Análisis estadístico realizado mediante el software SPSS® 19.
Se incluyeron 81 pacientes, 61,7% hombres, con una media de edad de 73,5 ± 17,5 años. Las comorbilidades más frecuentes fueron diabetes mellitus (30,9%) y enfermedad renal crónica (28,4%). Los pacientes recibieron de media 11,9 ± 8,5 días de antibiótico en bombas de infusión elastoméricas. El principal foco infeccioso fue el respiratorio (27,2%), seguido de bacteriemia (16%) e infecciones de piel y partes blandas (12,3%). El 65,4% de las infecciones fueron monomicrobianas, siendo la Pseudomonas aeruginosa el principal microorganismo implicado (39,6%). El antimicrobiano más utilizado fue piperacilina/tazobactam (33,3%). El 85,2% de los pacientes presentó buena evolución clínica pero la tasa de mortalidad en los 30 días posteriores a la finalización del tratamiento fue de 24,7%. En el análisis univariante, se asociaron a peor evolución clínica los antecedentes de neoplasia en los últimos 5 años (p = 0,01) y haber recibido menos días de antibioterapia previo al inicio del tratamiento antibiótico domiciliario en infusor (p = 0,04). La edad mayor de 80 años se asoció a mejor evolución (p = 0,03). Se asoció a mayor mortalidad el diagnóstico de insuficiencia cardíaca (p = 0,026) y a menor mortalidad los pacientes procedentes de servicios quirúrgicos (p = 0,047). En el análisis multivariante, la presencia de neoplasia se asoció a evolución desfavorable (p = 0,012) y la insuficiencia cardíaca, a mayor mortalidad (p = 0,027).
La terapia antibiótica domiciliaria en bombas de infusión elastoméricas es una alternativa en pacientes que necesitan tratamiento intravenoso prolongado, sin ser condicionante para la inclusión en estos programas la edad. No obstante, la presencia de ciertas comorbilidades puede afectar negativamente a la evolución clínica y mortalidad de los pacientes.
describir la experiencia de uso de la terapia de infusión de antibióticos domiciliaria mediante bombas de infusión elastoméricas, administrada a pacientes ingresados en la unidad de hospitalización a ...domicilio de un hospital de tercer nivel durante 3 años y analizar la evolución clínica y la mortalidad.
estudio observacional retrospectivo mediante la revisión de las historias clínicas de los pacientes incluidos. Se obtuvo información sobre antecedentes personales, terapia antimicrobiana recibida y evolución clínica. Análisis estadístico realizado mediante el software SPSS® 19.
se incluyeron 81 pacientes, 61,7% hombres, con una media de edad de 73,5 ± 17,5 años. Las comorbilidades más frecuentes fueron diabetes mellitus (30,9%) y enfermedad renal crónica (28,4%). Los pacientes recibieron de media 11,9 ± 8,5 días de antibiótico en bombas de infusión elastoméricas. El principal foco infeccioso fue el respiratorio (27,2%), seguido de bacteriemia (16%) e infecciones de la piel y las partes blandas (12,3%). El 65,4% de las infecciones fueron monomicrobianas, siendo la Pseudomonas aeruginosa el principal microorganismo implicado (39,6%). El antimicrobiano más utilizado fue piperacilina/tazobactam (33,3%). El 85,2% de los pacientes presentó buena evolución clínica, pero la tasa de mortalidad en los 30 días posteriores a la finalización del tratamiento fue de 24,7%. En el análisis univariante, se asociaron a una peor evolución clínica los antecedentes de neoplasia en los últimos 5 años (p = 0,01) y haber recibido menos días de antiobioterapia previo al inicio del tratamiento antibiótico domiciliario en infusor (p = 0,04). La edad mayor de 80 años se asoció a mejor evolución (p = 0,03). Se asoció a mayor mortalidad el diagnóstico de insuficiencia cardiaca (p = 0,026) y a menor mortalidad los pacientes procedentes de servicios quirúrgicos (p = 0,047). En el análisis multivariante, la presencia de neoplasia se asoció a una evolución desfavorable (p = 0,012) y la insuficiencia cardiaca, a una mayor mortalidad (p = 0,027).
la terapia antibiótica domiciliaria en bombas de infusión elastoméricas es una alternativa en pacientes que necesitan tratamiento intravenoso prolongado, sin ser condicionante para la inclusión en estos programas la edad. No obstante, la presencia de ciertas comorbilidades puede afectar negativamente a la evolución clínica y mortalidad de los pacientes.
To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalization Unit of a tertiary hospital for three years and to analyse clinical evolution and mortality.
Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received and clinical evolution. Statistical analysis was performed using SPSS® 19 software.
Eighty-one patients were included, 61.7% men, with a mean age of 73.5 ± 17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9 ± 8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p = 0.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p = 0.04) were associated with worse clinical outcome.
Age over 80 years was associated with better outcome (p = 0.03). The diagnosis of heart failure was associated with higher mortality (p = 0.026) and patients from surgical services, with lower mortality (p = 0.047). In the multivariate analysis, the presence of neoplasia was associated with unfavorable evolution (p = 0.012) and heart failure with higher mortality (p = 0.027).
Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.
COVID-19 pneumonia in Galicia Pérez-de-Llano, Luis; Romay-Lema, Eva María; Baloira-Villar, Adolfo ...
PloS one,
06/2021, Volume:
16, Issue:
6
Journal Article
Peer reviewed
This study was aimed to identify risk factors associated with unfavorable outcomes (composite outcome variable: mortality and need for mechanical ventilation) in patients hospitalized in Galicia with ...COVID-19 pneumonia. Retrospective, multicenter, observational study carried out in the 8 Galician tertiary hospitals. All Patients admitted with confirmed COVID-19 pneumonia from 1st of March to April 24th, 2020 were included. A multivariable logistic regression analysis was performed in order to identify the relationship between risk factors, therapeutic interventions and the composite outcome variable. A total of 1292 patients (56.1% male) were included. Two hundred and twenty-five (17.4%) died and 327 (25.3%) reached the main outcome variable. Age odds ratio (OR) = 1.03 (95% confidence interval (CI): 1.01-1.04), CRP quartiles 3 and 4 OR = 2.24 (95% CI: 1.39-3.63) and OR = 3.04 (95% CI: 1.88-4.92), respectively, Charlson index OR = 1.16 (95%CI: 1.06-1.26), SaO2 upon admission OR = 0.93 (95% CI: 0.91-0.95), hydroxychloroquine prescription OR = 0.22 (95%CI: 0.12-0.37), systemic corticosteroids prescription OR = 1.99 (95%CI: 1.45-2.75), and tocilizumab prescription OR = 3.39 (95%CI: 2.15-5.36), significantly impacted the outcome. Sensitivity analysis using different alternative logistic regression models identified consistently the ratio admissions/hospital beds as a predictor of the outcome OR = 1.06 (95% CI: 1.02-1.11). These findings may help to identify patients at hospital admission with a higher risk of death and may urge healthcare authorities to implement policies aimed at reducing deaths by increasing the availability of hospital beds.
The positive-intraoperative-cultures-type prosthetic joint infection (PIOC-PJI) is considered when surgical cultures yield microorganisms in presumed aseptic arthroplasty revisions. Herein we assess ...the risk factors for failure in the largest cohort of PIOC-PJI patients reported to date.
A retrospective, observational, multicenter study was performed during 2007–2017. Surgeries leading to diagnose PIOC-PJI included only one-stage procedures with either complete or partial prosthesis revision. Failure was defined as recurrence caused by the same microorganism.
203 cases were included (age 72 years, 52% females). Coagulase-negative staphylococci (n = 125, 62%) was the main etiology, but some episodes were caused by virulent bacteria (n = 51, 25%). Prosthesis complete and partial revision was performed in 93 (46%) and 110 (54%) cases, respectively. After a median of 3.4 years, failure occurred in 17 episodes (8.4%, 95%CI 5.3–13.1). Partial revision was an independent predictor of failure (HR 3.63; 95%CI 1.03–12.8), adjusted for gram-negative bacilli (GNB) infection (HR 2.68; 95%CI 0.91–7.89) and chronic renal impairment (HR 2.40; 95%CI 0.90–6.44). Treatment with biofilm-active antibiotics (rifampin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and GNB.
Overall prognosis of PIOC-PJI is good, but close follow-up is required in cases of partial revision and in infections caused by GNB.
•The overall prognosis of unsuspected positive intraoperative cultures (PIOC) is good.•Partial revision of the orthopedic device is the main risk factor for failure in PIOC.•Gram-negative bacilli infection worsens the prognosis in PIOC.•Biofilm-active antibiotics (rifampin and fluoroquinolones) may improve the prognosis.•This is the largest cohort of patients with PIOC reported to date.
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