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Rodriguez-Bano J.,Hospital Universitario Virgen Macarena | Rodriguez-Bano J.,University of Seville | Picon E.,Hospital Universitario Virgen Macarena | Gijon P.,Hospital Universitario Gregorio Maranon | And 16 more authors.
Journal of Clinical Microbiology | Year: 2010

Extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs) caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.4 to 15.7), the previous use of oxyimino-β-lactams (OR = 6.0; 95% CI = 3.0 to 11.8), and unknown BSI source (protective; OR = 0.4; 95% CI = 0.2 to 0.9), and duration of hospital stay (OR = 1.02; 95% CI = 1.00 to 1.03). The variables independently associated with mortality were a Pitt score of >1 (OR = 3.9; 95% CI = 1.2 to 12.9), a high-risk source (OR = 5.5; 95% CI = 1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR = 6.5; 95% CI = 1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-β-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality. Copyright © 2010, American Society for Microbiology. All Rights Reserved. Source

Rodriguez-Bano J.,Hospital Universitario Virgen Macarena | Picon E.,Hospital Universitario Virgen Macarena | Gijon P.,Hospital Universitario Gregorio Maranon | Hernandez J.R.,Hospital Universitario Virgen Macarena | And 12 more authors.
Clinical Infectious Diseases | Year: 2010

Background. There is little clinical information about community-onset bloodstream infections (COBSIs) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBLEC). We investigated the prevalence and risk factors for COBSI due to ESBLEC, and described their clinical features and the impact of COBSI caused by ESBLEC on 14-day mortality. Methods. Risk factors were assessed using a multicenter case-control-control study. Influence of ESBL production on mortality was studied in all patients with COBSI due to E. coli. Isolates and ESBLs were microbiologically characterized. Statistical analysis was performed using multivariate logistic regression. Thirteen tertiary care Spanish hospitals participated in the study. Results. We included 95 case patients with COBSI due to ESBLEC, which accounted for 7.3% of all COBSI due to E. coli. The ESBL in 83 of these (87%) belonged to the CTX-M family of ESBL, and most were clonally unrelated. Comparison with both control groups disclosed association with health care (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.8), urinary catheter use (OR, 3.1; 95% CI, 1.5-6.5), and previous antimicrobial use (OR, 2.7; 95% CI, 1.5-4.9) as independent risk factors for COBSI due to ESBLEC. Mortality among patients with COBSI due to ESBLEC was lower among patients who received empirical therapy with β-lactam/β-lactam inhibitor combinations or carbapenems (8%-12%) than among those receiving cephalosporins or fluoroquinolones (24% and 29%, respectively). Mortality among patients with COBSI due to E. coli was associated with inappropriate empirical therapy irrespective of ESBL production. Conclusions. ESBLEC is an important cause of COBSI due to E. coli. Clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors. © 2009 by the Infectious Diseases Society of America. All rights reserved. Source

Valdesuso R.,Hospital Universitario Virgen Of La Arrixaca | Karjalainen P.,Satakunta Central Hospital | Garcia J.,Hospital de Sant Pau | Diaz J.,Hospital Juan Ramon Jimenez | And 9 more authors.
Catheterization and Cardiovascular Interventions | Year: 2010

Objectives: We sought to explore the immediate results of Titan2® stent implantation in small coronary arteries, as well as the incidence of major adverse cardiac events (MACE) at six months follow-up. Background: The safety of Titan2® stent has been confirmed in several studies in real-life unselected populations. Methods: We enrolled 311 consecutive patients admitted for percutaneous intervention for at least one significant (50%) de novo lesion in a native small coronary artery (2.0-2.75 mm). All lesions were treated with Titan2® stent implantation. Patients were prospectively followed up for at least six months. The primary endpoint was MACE at six months follow-up [death, myocardial infarction (MI), or target vessel revascularization (TVR)]. Secondary endpoints included angiographic and clinical procedural success, in-hospital MACE, target lesion revascularization (TLR) during follow-up, and stent thrombosis. Results: The mean age was 67.3 ± 10.9 years (65.9% males). A total of 356 Titan2® stents were implanted in 353 lesions. Angiographic and clinical procedural success was achieved in 344 (97.5%) patients. No case of in-hospital MACE or acute stent thrombosis was reported. Clinical follow-up was completed for an average of 8 ± 2 months. Two patients (0.7%) died, and 6 (2.1%) developed MI. TLR was performed in 12 (4.2%) and TVR in 16 (5.5%) patients, all were clinically driven. Cumulative MACE occurred in 20 (6.9%) patients. One patient suffered subacute stent thrombosis, but no late stent thrombosis. Conclusions: Titan2® stent implantation in small coronary arteries achieves excellent immediate outcome, with a low incidence of MACE at mid-term follow-up. © 2010 Wiley-Liss, Inc. Source

Slater L.A.,University of Toronto | Coutinho J.M.,University of Toronto | Gralla J.,University of Bern | Nogueira R.G.,Emory University | And 6 more authors.
American Journal of Neuroradiology | Year: 2016

BACKGROUND AND PURPOSE: Previous studies have suggested that advanced age predicts worse outcome following mechanical thrombectomy. We assessed outcomes from 2 recent large prospective studies to determine the association among TICI, age, and outcome. MATERIALS AND METHODS: Data from the Solitaire FR Thrombectomy for Acute Revascularization (STAR) trial, an international multicenter prospective single-arm thrombectomy study and the Solitaire arm of the Solitaire FR With the Intention For Thrombectomy (SWIFT) trial were pooled. TICI was determined by core laboratory review. Good outcome was defined as an mRS score of 0-2 at 90 days. We analyzed the association among clinical outcome, successful-versus-unsuccessful reperfusion (TICI 2b-3 versus TICI 0-2a), and age (dichotomized across the median). RESULTS: Two hundred sixty-nine of 291 patients treated with Solitaire in the STAR and SWIFT data bases for whom TICI and 90-day outcome data were available were included. The median age was 70 years (interquartile range, 60-76 years) with an age range of 25-88 years. The mean age of patients 70 years of age or younger was 59 years, and it was 77 years for patients older than 70 years. There was no significant difference between baseline NIHSS scores or procedure time metrics. Hemorrhage and device-related complications were more common in the younger age group but did not reach statistical significance. In absolute terms, the rate of good outcome was higher in the younger population (64% versus 44%, P < .001). However, the magnitude of benefit from successful reperfusion was higher in the 70 years of age and older group (OR, 4.82; 95% CI, 1.32-17.63 versus OR 7.32; 95% CI, 1.73-30.99). CONCLUSIONS: Successful reperfusion is the strongest predictor of good outcome following mechanical thrombectomy, and the magnitude of benefit is highest in the patient population older than 70 years of age. Source

Montero Matamala A.,Hospital Universitario Arnau Of Vilanova | Samper Bernal D.,Hospital Universitario Germans Trias jol | Vidal Fuentes J.,Hospital Universitario Of Guadalajara | Rodriguez Dinten M.J.,Grupo del Dolor Musculoesqueletico de la Sociedad Espanola del Dolor | Jimenez Cosmes L.,Hospital Universitario Ramon jal
Revista de la Sociedad Espanola del Dolor | Year: 2011

Objective: to define the sociodemographic and clinical profile of patients attending the Pain Unit (PU) for the first time. Material and methods: this was an epidemiological, cross-sectional, multicenter study. Study variables were recorded on a Case Report Form. The investigators collected the sociodemographic and clinical variables of patients who attended the pain unit, complied with eligibility criteria, and gave their written informed consent to participate in the study. One hundred and sixty-five physicians from 107 Pain Units in Spanish hospitals took part in the study with a total of 823 patients. Results: mean age (SD) of patients was 59 (15.1) years; 66.4% were women. The referring specialists were orthopedics (35.1% of patients), followed by general practitioners (24.9% of patients). The mean (SD) pain intensity as measured by a numerical visual scale (NVS) was 7 (1.8). In 33.7% of patients the pain episode lasted from 3 to 12 months. 96.3% of patients presented non-oncologic pain with musculoskeletal pain predominated in 68.6%. The most common sites were the lumbar area in 55.3% of patients and the lower limbs in 40.8%. On their first visit to the Pain Unit, 7.8% of patients were receiving no analgesic treatment, while 55.2% were on non-steroid anti-inflammatory drugs (NSAIDs), 45.1% on acetaminophen, 31.6% on minor opioids, and 15.7% on major opioids. Conclusions: results show a predominance of musculoskeletal pain, which is located in the lumbar area, long-lasting, and more common in women. NSAIDs are the most common drugs prescribed by clinicians who refer patients to the Pain Unit, with opioids and antiepileptic drugs being used much less frequently. © 2011 Sociedad Española del Dolor: Published by Arán Ediciones, S.L. Source

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