lon N. The pathogenesis and treatment of optic disc swelling in neurosarcoidosis: a unique therap... more lon N. The pathogenesis and treatment of optic disc swelling in neurosarcoidosis: a unique therapeutic response to infliximab.
To evaluate the effectiveness and safety of ertapenem in patients hospitalized at home. Retrospec... more To evaluate the effectiveness and safety of ertapenem in patients hospitalized at home. Retrospective analysis of data from Spanish Outpatient Parenteral Antimicrobial Therapy (OPAT) registry. Data from 1428 patients (median age 70 years; 5.4% institutionalized) and 1547 infectious processes (24% self-administration) were analyzed. Clinical cure or improvement was achieved in 93.8% of cases. Rate of related readmissions was 4.2%, of clinically important complications -3.9%, and of adverse drug reactions -3.2%. High comorbidity burden, contagion in nursing home and certain types of infection were associated with worse prognosis. Self-administration was effective and safe, except in case of nursing home-acquired infections. Ertapenem OPAT was effective and safe. Caregivers in nursing homes should be better trained in OPAT-related procedures.
Daptomycin is an optimal choice for outpatient parenteral antibiotic therapy (OPAT) because of it... more Daptomycin is an optimal choice for outpatient parenteral antibiotic therapy (OPAT) because of its safety, once-daily administration and its activity against Gram-positive bacteria. Although daptomycin is increasingly being used in OPAT, limited information about its safety in this scenario is available. We performed a prospective multicentre pilot study to evaluate the safety of daptomycin in outpatients with proved or suspected Gram-positive infections (DAPTODOM). The primary objective was to evaluate the safety and the secondary objective to evaluate the efficacy in OPAT. We also looked at the development of daptomycin resistance in those cases with microbiological failure. We included 54 patients from 12 Spanish hospitals, 67% male with a mean age of 67.1 years. Most patients (87%) had chronic underlying diseases. The main reason for inclusion was skin and soft-tissue infections in 52%, followed by bacteremia or endocarditis in 34%. Staphylococcus aureus accounted for 44% of the isolates (24% were methicillin-resistant), coagulase-negative staphylococci 15% and enterococci 7%. Two patients (4%) had to be readmitted because of complications; only one patient had an adverse effect related to daptomycin (increase in serum creatine kinase levels), which disappeared after discontinuation (2%). At the end of follow-up, 96% of patients had good outcome and only 4% of patients did not have a clinical or microbiological cure. The use of a 2-minute bolus in 18 cases was not associated with adverse effects. Daptomycin was safe and efficacious in outpatients with Gram-positive bacterial infections and can be administered in 2-minute bolus infusion.
Objetivo: Describir las características epidemiológicas, clínicas y microbiológicas de una cohort... more Objetivo: Describir las características epidemiológicas, clínicas y microbiológicas de una cohorte de pacientes con diagnostico de Endocarditis infecciosa en una unidad de Hospitalización a Domicilio, analizando la seguridad y eficacia en el tratamiento antibiótico parenteral en estos pacientes. Método: Estudio d e cohortes r etrospectivo en el que se in cluyó a todos los pacientes diagnosticados de EI según los criterios de Duke modificados, ingresados en nuestra unidad de Hospitalización a Domicilio desde el 1 de enero del año 1998 al 30 de diciembre de 2011 en el Hospital Universitario Marques Valdecilla. Todos los pacientes cumplieron los criterios generales y específicos de inclusión para ingresar en nuestra unidad Hospitalización a domicilio. Para la evaluación de la seguridad se recogieron los retornos inesperado al hospital y/o muerte no esperada. Y para el análisis de eficacia; se evaluó datos de curación microbiológica, y reingresos por recurrencia de EI, durante el seguim...
La neutropenia se define como una cifra absoluta de neutrófilos < 1.500/µl. Su gravedad se gradúa... more La neutropenia se define como una cifra absoluta de neutrófilos < 1.500/µl. Su gravedad se gradúa de la siguiente manera: leve entre 1.000 y 1.500 neutrófilos/µl; moderada entre 500 y 1.000 neutrófilos/µl; grave menos de 500 neutrófilos/µl y muy grave si es inferior a 100 neutrófilos/µl. La fiebre se define como la elevación de la temperatura corporal en una toma superior a 38,3 ºC o una temperatura mantenida superior a 38º C durante más de una hora.
Introducción/Objetivos: La EI es un proceso infeccioso con alto de riesgo de complicaciones, por ... more Introducción/Objetivos: La EI es un proceso infeccioso con alto de riesgo de complicaciones, por lo que habitualmente se maneja mediante el ingreso del paciente en una planta de hospitalización tradicional. Muchas unidades de HaD de nuestro país ofrecen en su cartera de servicios el tratamiento antibiótico domiciliario endovenoso (TADE) para procesos infecciosos de diversa complejidad, siendo la EI uno de los que más reticencias ha suscitado hasta el momento. Determinar la seguridad y la eficacia de un programa de HaD específico para el tratamiento de la EI. Material y Métodos: Estudio de 57 episodios de EI, ocurridos en 54 pacientes, que ingresaron en nuestra unidad de HaD (UHD) para recibir TADE entre los años 1998 y 2014. Los pacientes recibieron tratamiento antibiótico endovenoso intrahospitalario hasta lograr su estabilidad clínica, siendo posteriormente derivados a la UHD dentro de un programa diseñado al efecto (criterios de selección estrictos, protocolos de seguimiento, tra...
ABSTRACT : Two cases of digitalis poisoning are described. Case 1, a man, aged 40 years, swallowe... more ABSTRACT : Two cases of digitalis poisoning are described. Case 1, a man, aged 40 years, swallowed for suicidal purposes about 50 digitalis tablets, each containing 50 mg standardized digitalis leaf, digitalis purpurea (0.5 i.u.). Death occured about 8 hours after the intake. A quantitative determination of digitalis glycoside in the gastric contents, and in the contents of the small intestine, blood and heart was performed with xanthydrol. Case 2, a child, 11 days old, because of a congenital heart disease was treated with digoxin. 1/2-1 hour before death the child was given 0.7 mg digoxin intravenously. A quantitative determination of digoxin was performed with xanthydrol in the liver, heart and lung and by the fluorometric method in the liver, heart, kidney, urine and blood.
The safety and efficacy of treatment of infectious endocarditis (IE) was evaluated within a progr... more The safety and efficacy of treatment of infectious endocarditis (IE) was evaluated within a program of hospital-in-home (HIH) based on self-administered outpatient parenteral antimicrobial therapy (S-OPAT). IE episodes (n=48 in 45 patients; 71% middle-aged males) were recruited into the HIH program between 1998 and 2012. Following treatment stabilization at the hospital they returned home for HIH in which a physician and/or a nurse supervised the S-OPAT. Safety and efficacy were evaluated as mortality, re-occurrence, and unexpected re-admission to hospital. Of the episodes of IE, 83.3% had comorbidities with a mean score of 2.3 on the Charlson index and 1.5 on the Profund index; 60.4% had pre-existing valve disease (58.6% having had surgical intervention); 8.3% of patients had suffered a previous IE episode; 62.5% of all episodes affected a native valve; 45.8% being mitral; 70.8% of infection derived from the community. In 75% of the episodes there was micro-organism growth, of which 83.3% were Gram positive. Overall duration of antibiotic treatment was 4.8weeks; 60.4% of this time corresponding to HIH. Re-admission occurred in 12.5% of episodes of which 33.3% returned to HIH to complete the S-OPAT. No deaths occurred during HIH. One year after discharge, 2 patients had recurrence and 5 patients died, in 2 of whom previous IE as cause-of-death could not be excluded. In conclusion, the S-OPAT schedule of hospital-in-home is safe and efficacious in selected patients with IE.
Spain lacks detailed data on hip fracture trends despite being the country with the greatest incr... more Spain lacks detailed data on hip fracture trends despite being the country with the greatest increase in the pensioner-to-provider ratio in Europe. We reproduced a study on hip fracture incidence in a region of northern Spain (Cantabria) carried out 14 years ago to determine whether a secular trend to change is taking place. If such a trend could be found, our objective was to determine whether the effect is solely due to ageing or whether additional variables are involved. We assessed the incidence of hip fracture in patients aged ≥50 years through clinical records from Emergency Units and Orthopedic Surgical Units of all hospitals in the region of Cantabria in 1988 and 2002. A total of 318 new cases of hip fracture were recorded in 1988 and 490 in 2002 (54% increase; p<0.001). No significant changes were noticed following an adjustment for age. Women accounted for the increase in crude hip fracture incidence [246 women and 72 men suffered a hip fracture in 1988 compared to 404 women and 86 men in 2002 (64% increase in women and 19% increase in men; p<0.005 and not significant, respectively)]. The female:male ratio was 3.4 in 1988 versus 4.7 in 2002; following age-adjustment, no significant changes were found (1.8 in 1988 and 1.9 in 2002). The increase in crude hip fracture incidence was greater at cervical (versus trochanteric) sites. Patient residence, time of the year, site of fracture, kind of injury, previous contralateral hip fracture, length of stay, and peri-operative mortality did not differ significantly. In conclusion, a crude hip fracture incidence increase of about 50% in the northern Spanish region of Cantabria has taken place over the last 14 years. This effect does not persist after adjustments have been made for age. The crude rate increase occurred mainly at the expense of women, with a more noticeable rise in cervical fractures as opposed to trochanteric lesions.
Spain lacks detailed data on hip fracture trends despite being the country with the greatest incr... more Spain lacks detailed data on hip fracture trends despite being the country with the greatest increase in the pensioner-to-provider ratio in Europe. We reproduced a study on hip fracture incidence in a region of northern Spain (Cantabria) carried out 14 years ago to determine whether a secular trend to change is taking place. If such a trend could be found,
lon N. The pathogenesis and treatment of optic disc swelling in neurosarcoidosis: a unique therap... more lon N. The pathogenesis and treatment of optic disc swelling in neurosarcoidosis: a unique therapeutic response to infliximab.
To evaluate the effectiveness and safety of ertapenem in patients hospitalized at home. Retrospec... more To evaluate the effectiveness and safety of ertapenem in patients hospitalized at home. Retrospective analysis of data from Spanish Outpatient Parenteral Antimicrobial Therapy (OPAT) registry. Data from 1428 patients (median age 70 years; 5.4% institutionalized) and 1547 infectious processes (24% self-administration) were analyzed. Clinical cure or improvement was achieved in 93.8% of cases. Rate of related readmissions was 4.2%, of clinically important complications -3.9%, and of adverse drug reactions -3.2%. High comorbidity burden, contagion in nursing home and certain types of infection were associated with worse prognosis. Self-administration was effective and safe, except in case of nursing home-acquired infections. Ertapenem OPAT was effective and safe. Caregivers in nursing homes should be better trained in OPAT-related procedures.
Daptomycin is an optimal choice for outpatient parenteral antibiotic therapy (OPAT) because of it... more Daptomycin is an optimal choice for outpatient parenteral antibiotic therapy (OPAT) because of its safety, once-daily administration and its activity against Gram-positive bacteria. Although daptomycin is increasingly being used in OPAT, limited information about its safety in this scenario is available. We performed a prospective multicentre pilot study to evaluate the safety of daptomycin in outpatients with proved or suspected Gram-positive infections (DAPTODOM). The primary objective was to evaluate the safety and the secondary objective to evaluate the efficacy in OPAT. We also looked at the development of daptomycin resistance in those cases with microbiological failure. We included 54 patients from 12 Spanish hospitals, 67% male with a mean age of 67.1 years. Most patients (87%) had chronic underlying diseases. The main reason for inclusion was skin and soft-tissue infections in 52%, followed by bacteremia or endocarditis in 34%. Staphylococcus aureus accounted for 44% of the isolates (24% were methicillin-resistant), coagulase-negative staphylococci 15% and enterococci 7%. Two patients (4%) had to be readmitted because of complications; only one patient had an adverse effect related to daptomycin (increase in serum creatine kinase levels), which disappeared after discontinuation (2%). At the end of follow-up, 96% of patients had good outcome and only 4% of patients did not have a clinical or microbiological cure. The use of a 2-minute bolus in 18 cases was not associated with adverse effects. Daptomycin was safe and efficacious in outpatients with Gram-positive bacterial infections and can be administered in 2-minute bolus infusion.
Objetivo: Describir las características epidemiológicas, clínicas y microbiológicas de una cohort... more Objetivo: Describir las características epidemiológicas, clínicas y microbiológicas de una cohorte de pacientes con diagnostico de Endocarditis infecciosa en una unidad de Hospitalización a Domicilio, analizando la seguridad y eficacia en el tratamiento antibiótico parenteral en estos pacientes. Método: Estudio d e cohortes r etrospectivo en el que se in cluyó a todos los pacientes diagnosticados de EI según los criterios de Duke modificados, ingresados en nuestra unidad de Hospitalización a Domicilio desde el 1 de enero del año 1998 al 30 de diciembre de 2011 en el Hospital Universitario Marques Valdecilla. Todos los pacientes cumplieron los criterios generales y específicos de inclusión para ingresar en nuestra unidad Hospitalización a domicilio. Para la evaluación de la seguridad se recogieron los retornos inesperado al hospital y/o muerte no esperada. Y para el análisis de eficacia; se evaluó datos de curación microbiológica, y reingresos por recurrencia de EI, durante el seguim...
La neutropenia se define como una cifra absoluta de neutrófilos < 1.500/µl. Su gravedad se gradúa... more La neutropenia se define como una cifra absoluta de neutrófilos < 1.500/µl. Su gravedad se gradúa de la siguiente manera: leve entre 1.000 y 1.500 neutrófilos/µl; moderada entre 500 y 1.000 neutrófilos/µl; grave menos de 500 neutrófilos/µl y muy grave si es inferior a 100 neutrófilos/µl. La fiebre se define como la elevación de la temperatura corporal en una toma superior a 38,3 ºC o una temperatura mantenida superior a 38º C durante más de una hora.
Introducción/Objetivos: La EI es un proceso infeccioso con alto de riesgo de complicaciones, por ... more Introducción/Objetivos: La EI es un proceso infeccioso con alto de riesgo de complicaciones, por lo que habitualmente se maneja mediante el ingreso del paciente en una planta de hospitalización tradicional. Muchas unidades de HaD de nuestro país ofrecen en su cartera de servicios el tratamiento antibiótico domiciliario endovenoso (TADE) para procesos infecciosos de diversa complejidad, siendo la EI uno de los que más reticencias ha suscitado hasta el momento. Determinar la seguridad y la eficacia de un programa de HaD específico para el tratamiento de la EI. Material y Métodos: Estudio de 57 episodios de EI, ocurridos en 54 pacientes, que ingresaron en nuestra unidad de HaD (UHD) para recibir TADE entre los años 1998 y 2014. Los pacientes recibieron tratamiento antibiótico endovenoso intrahospitalario hasta lograr su estabilidad clínica, siendo posteriormente derivados a la UHD dentro de un programa diseñado al efecto (criterios de selección estrictos, protocolos de seguimiento, tra...
ABSTRACT : Two cases of digitalis poisoning are described. Case 1, a man, aged 40 years, swallowe... more ABSTRACT : Two cases of digitalis poisoning are described. Case 1, a man, aged 40 years, swallowed for suicidal purposes about 50 digitalis tablets, each containing 50 mg standardized digitalis leaf, digitalis purpurea (0.5 i.u.). Death occured about 8 hours after the intake. A quantitative determination of digitalis glycoside in the gastric contents, and in the contents of the small intestine, blood and heart was performed with xanthydrol. Case 2, a child, 11 days old, because of a congenital heart disease was treated with digoxin. 1/2-1 hour before death the child was given 0.7 mg digoxin intravenously. A quantitative determination of digoxin was performed with xanthydrol in the liver, heart and lung and by the fluorometric method in the liver, heart, kidney, urine and blood.
The safety and efficacy of treatment of infectious endocarditis (IE) was evaluated within a progr... more The safety and efficacy of treatment of infectious endocarditis (IE) was evaluated within a program of hospital-in-home (HIH) based on self-administered outpatient parenteral antimicrobial therapy (S-OPAT). IE episodes (n=48 in 45 patients; 71% middle-aged males) were recruited into the HIH program between 1998 and 2012. Following treatment stabilization at the hospital they returned home for HIH in which a physician and/or a nurse supervised the S-OPAT. Safety and efficacy were evaluated as mortality, re-occurrence, and unexpected re-admission to hospital. Of the episodes of IE, 83.3% had comorbidities with a mean score of 2.3 on the Charlson index and 1.5 on the Profund index; 60.4% had pre-existing valve disease (58.6% having had surgical intervention); 8.3% of patients had suffered a previous IE episode; 62.5% of all episodes affected a native valve; 45.8% being mitral; 70.8% of infection derived from the community. In 75% of the episodes there was micro-organism growth, of which 83.3% were Gram positive. Overall duration of antibiotic treatment was 4.8weeks; 60.4% of this time corresponding to HIH. Re-admission occurred in 12.5% of episodes of which 33.3% returned to HIH to complete the S-OPAT. No deaths occurred during HIH. One year after discharge, 2 patients had recurrence and 5 patients died, in 2 of whom previous IE as cause-of-death could not be excluded. In conclusion, the S-OPAT schedule of hospital-in-home is safe and efficacious in selected patients with IE.
Spain lacks detailed data on hip fracture trends despite being the country with the greatest incr... more Spain lacks detailed data on hip fracture trends despite being the country with the greatest increase in the pensioner-to-provider ratio in Europe. We reproduced a study on hip fracture incidence in a region of northern Spain (Cantabria) carried out 14 years ago to determine whether a secular trend to change is taking place. If such a trend could be found, our objective was to determine whether the effect is solely due to ageing or whether additional variables are involved. We assessed the incidence of hip fracture in patients aged ≥50 years through clinical records from Emergency Units and Orthopedic Surgical Units of all hospitals in the region of Cantabria in 1988 and 2002. A total of 318 new cases of hip fracture were recorded in 1988 and 490 in 2002 (54% increase; p<0.001). No significant changes were noticed following an adjustment for age. Women accounted for the increase in crude hip fracture incidence [246 women and 72 men suffered a hip fracture in 1988 compared to 404 women and 86 men in 2002 (64% increase in women and 19% increase in men; p<0.005 and not significant, respectively)]. The female:male ratio was 3.4 in 1988 versus 4.7 in 2002; following age-adjustment, no significant changes were found (1.8 in 1988 and 1.9 in 2002). The increase in crude hip fracture incidence was greater at cervical (versus trochanteric) sites. Patient residence, time of the year, site of fracture, kind of injury, previous contralateral hip fracture, length of stay, and peri-operative mortality did not differ significantly. In conclusion, a crude hip fracture incidence increase of about 50% in the northern Spanish region of Cantabria has taken place over the last 14 years. This effect does not persist after adjustments have been made for age. The crude rate increase occurred mainly at the expense of women, with a more noticeable rise in cervical fractures as opposed to trochanteric lesions.
Spain lacks detailed data on hip fracture trends despite being the country with the greatest incr... more Spain lacks detailed data on hip fracture trends despite being the country with the greatest increase in the pensioner-to-provider ratio in Europe. We reproduced a study on hip fracture incidence in a region of northern Spain (Cantabria) carried out 14 years ago to determine whether a secular trend to change is taking place. If such a trend could be found,
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