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Background and objective To analyse factors related to mortality and influence of antibiotic treatment on outcome in patients with nosocomial infection due to multidrug and carbapenem-resistant Acinetobacter baumannii (MDR-C AB). Patients and methods Observational and prospective study of a cohort of adult patients with MDR-C AB infection. Data collection from clinical records was done according to a standard protocol (January 2007 through June 2008). Patients with MDR-C AB infection were identified by review of results of microbiology cultures from the hospital microbiology laboratory. Epidemiological and clinical variables and predictors of mortality were analysed. Results 24 out of 101 cases were considered colonizations and 77 infections (27 bacteraemia); global mortality in infected patients was 49% (18 cases with bacteraemia and 20 with no bacteraemia). In the multivariate analysis, including the 77 cases of infection, the prognosis factors associated with mortality were age (OR 1.09; 95% CI 1.02–1.2), McCabe 1 (OR 33.98; 95% CI 4.33–266.85), bacteraemia (OR 9.89; 95% CI 1.13–86.13), inadequate empiric treatment (OR 16.7; 95% CI 2.15–129.79), and inadequate definitive treatment (OR 26.29; 95% CI 1.45–478.19). In the multivariate analysis including the 57 cases of infection with adequate definitive treatment, the prognosis factors associated with mortality were McCabe 1 (OR 24.08; 95% CI 3.67–157.96) and monotherapy versus combined treatment (OR 7.11; 95% CI 1.63–30.99). Conclusions Our cohort of patients with MDR-C AB infection is characterised by a very high mortality (49%); the severity of patients and inadequate treatment or monotherapy are statistically associated with mortality.

Resumen Fundamento y objetivo Analizar los factores predictivos de bacteriemia por E. coli productor de betalactamasa de espectro extendido (BLEE) frente a E. coli no productor de BLEE y su repercusion en la mortalidad. Pacientes y metodo Estudio observacional de una cohorte de pacientes adultos ingresados con bacteriemia por E. coli . Resultados Se incluyeron 153 bacteriemia por E. coli (22% eran BLEE). Los factores de riesgo para BLEE fueron: consumo previo de antibioticos (odds ratio [OR] 2,61; intervalo de confianza del 95% [IC 95%] 1,1–6,19), indice de Winston ≤2 (OR 9,83, IC 95% 3,42–28,26) y adquisicion asociada a cuidados sanitarios (OR 5,35; IC 95% 1,57–18,27). La mortalidad relacionada fue del 21%, siendo factores de riesgo: neoplasia de base (OR 4,02; IC 95% 1,08–14,82), gravedad de enfermedad de base (segun indice de McCabe) (OR 7,69; IC 95% 1,96–30,09) y gravedad al diagnostico (segun indice de Winston) (OR 48,89; IC 95% 11,58–206,97). El tratamiento empirico inadecuado era mas frecuente en pacientes con bacteriemia por E. coli BLEE (67%, p Conclusiones El tratamiento antibiotico previo, el indice de Winston ≤2 y la adquisicion relacionada con cuidados sanitarios se asocian a bacteriemia por E. coli productor de BLEE comparado con no productor. Ni la produccion de BLEE ni el tratamiento empirico inadecuado se asociaban a mayor mortalidad, pero si la existencia de neoplasia de base y la gravedad clinica al diagnostico.

Resumen Fundamento y objetivo Estudio de un brote de colonizacion/infeccion nosocomial por Acinetobacter baumannii multirresistente y resistente a carbapenemicos (ABMDR-C). Pacientes y metodo Estudio prospectivo de pacientes con aislamiento de ABMDR-C entre enero de 2007 y junio de 2008. Se analizaron las caracteristicas epidemiologicas y clinicas de los pacientes y los factores predictivos de infeccion frente a colonizacion. Resultados De 101 casos, 24 presentaban colonizacion y 77 presentaban infeccion (27 bacteriemia); la mortalidad global (colonizaciones e infecciones) fue del 42% (4 colonizaciones y 38 infecciones [18 bacteriemias]). La incidencia de colonizacion/infeccion fue de 3,2/1.000 ingresos/dia; un 29% tenia antecedente de ingreso previo y un 79% habia recibido antibioticos previos (carbapenemicos [29%], piperacilina-tazobactam [34%] y ambos [12,5%]). El 78% tenia enfermedades de base, un 81% ingreso en la unidad de cuidados intensivos/reanimacion, un 90% tuvo algun tipo de manipulacion y un 65% presentaba coinfeccion por otros microorganismos. En el analisis multivariante fueron factores predictivos de infeccion frente a colonizacion: aislamiento de ABMDR-C en las muestras respiratorias (odds ratio [OR]: 5,406; intervalo de confianza [IC] del 95%: 1,419–20,599); sexo masculino (OR: 8,842; IC del 95%: 1,988–39,325); ingreso previo (OR: 9,720; IC del 95%: 1,383–68,291) y gravedad clinica inicial (OR: 30,897; IC del 95%: 5,533–172,543). Conclusiones Nuestra cohorte de pacientes con colonizaciones/infecciones por ABMDR-C esta constituida por pacientes con enfermedad de base cronica, a los que se les realizo distintas manipulaciones instrumentales, con ingresos hospitalarios previos y uso previo de betalactamicos de amplio espectro, especialmente carbapenemicos. Los pacientes tienen una alta gravedad clinica al comienzo y el aislamiento respiratorio es un importante factor predictor de infeccion frente a colonizacion.

The Pneumonia Patient Outcomes Research Team (PORT) developed a prediction rule to identify patients with community-acquired pneumonia (CAP) who are at risk for death and other adverse outcomes. Simpler criteria are needed to evaluate risk of mortality in CAP.Observational study of patients with CAP admitted to a tertiary care university hospital. Epidemiological, clinical, radiological and laboratory data associated with mortality were analysed.A cohort of 211 patients with CAP was studied. Severity distribution according to PORT score was 12.3%, 15.6%, 19%, 35.5% and 17.5% in groups I, II, III, IV and V, respectively; mean age was 63 years (range, 13 to 100 years); in 43.6% age was65 years; 61.5% patients hador = 1 underlying disease (congestive heart failure in 33.6% and chronic lung disease in 29.9%). Mortality rate was 0% in groups I-II, 2.5% in group III, 5.3% in group IV and 27% in group V. All variables considered in PORT-score were included in a mortality predicting model; factors significantly associated with death were: altered mental status, respiratory rateor = 30/min, pH7.35, glucoseor = 250 mg/dl and age65 years; 99% of patients who had none of these abnormalities survived.Simpler criteria to assess mortality in CAP were identified. Non-existence of altered mental status, respiratory rateor = 30/min, pH7.35, glucoseor = 250 mg/dl and age65 years predicted a non-fatal outcome in 99% of patients. These clinical or laboratory findings should be considered as mortality predictors, can be used as severity adjustment measure and may help physicians make more rational decisions about hospitalization in CAP.

Fundamento y objetivo: Se ha realizado un estudio de las caracteristicas epidemiologicas y clini-cas de los pacientes con absceso cerebral (AC), y de los cambios que han tenido en los ultimos 30 anos. Pacientes y metodo: Estudio observacional de una cohorte de pacientes adultos con AC ingresados en un hospital de 944 camas. Los pacientes se evaluaron segun protocolo de estudio. Analizamos las caracteristicas epidemiologicas, clinicas y microbiologicas de los pacientes con AC, la localizacion y evolucion de los AC, en un periodo de 30 anos dividido en 2 mitades: 1976-1989 (P1) y 1990-2005 (P2). Resultados: Se valoro a 108 pacientes con AC (66 en P1 y 42 en P2), con una edad media de 45 anos (extremos: 12-86). Tenian mas de 40 anos de edad el 42,4% de los pacientes en P1 y el 71,4% en P2 (p < 0,05). La incidencia anual fue de 4-5 y 2-3 casos por 106 habitantes/ano en P1 y P2, respectivamente. El origen primario del AC se identifico en un 86% de los casos, con diferencias estadisticamente significativas entre ambos periodos en el foco (otitis media: el 18,2 frente al 2,4%; infeccion dental: el 3 frente al 16,7%; traumatismo craneoencefalico: el 16,7 frente al 0%; tras neurocirugia: el 15,1 frente al 21,4%, en P1 y P2, respectivamente). Hubo confirmacion microbiologica en un 76% (sin diferencias significativas entre P1 y P2). En cuanto a las caracteristicas clinicas, hubo diferencias significativas entre P1 y P2 en la alteracion del nivel de conciencia (el 10,6 frente al 0%), vomitos (el 37,9 frente al 21,4%) y deficits neurologicos focales (el 37,9 frente al 71,4%). No hubo diferencias en otras variables epidemiologicas, clinicas, radiologicas, microbiologicas o en el pronostico (mortalidad) de los pacientes entre P1 y P2. Conclusiones: A pesar de la menor incidencia de AC en P2 y de ciertas diferencias epidemiologicas y clinicas entre ambos periodos, la mortalidad y el porcentaje de recidivas en pacientes con AC no ha cambiado significativamente en los ultimos 30 anos.

Fundamento y Objetivo Hay controversia sobre la influencia de la resistencia a la meticilina en el pronostico de los pacientes con bacteriemia por Staphylococcus aureus. En este trabajo, analizamos los patrones clinicos y los factores pronosticos que se relacionan con el desarrollo de complicaciones y la mortalidad en pacientes con bacteriemia por S. aureus y valoramos la influencia de la resistencia a la meticilina (S. aureus sensible a la meticlina [SASM] frente a S. aureus resistente a la meticilina [SARM]). Pacientes y metodo Estudio prospectivo y comparativo de 213 pacientes con bacteriemia por S. aureus. Resultados Del total de pacientes con bacteriemia, 131 (61,5%) correspondian a SASM y 82 (38,5%) a SAMR. Se asociaron a SARM la adquisicion nosocomial de la infeccion, la presencia de una enfermedad de base rapidamente fatal y ciertos factores predisponentes (diabetes mellitus, utilizacion de cateteres vasculares, estancia previa en unidades de cuidados intensivos y uso previo de antibioticos). Los pacientes con bacteriemia por SARM presentaron mayor gravedad clinica y desarrollaron complicaciones con mas frecuencia que los pacientes con bacteriemia por SASM. La mortalidad de los casos con bacteriemia por SARM fue del 42,6%, mientras que en la de SASM fue del 16% (p Conclusiones En los pacientes con bacteriemia por S. aureus, la resistencia a la meticilina no se asocia a una mayor mortalidad cuando se hace un analisis ajustado por otros factores clinicos/ pronosticos. La gravedad de la enfermedad de base, la situacion clinica inicial critica-mala y el tratamiento empirico no adecuado son los factores pronosticos relacionados con el fracaso terapeutico en los pacientes con bacteriemia por S. aureus.

To analyze predictor factors of extended-spectrum betalactamasa (ESBL)-producing E. coli and its repercussion in mortality.Observational and comparative study of a cohort of non-paediatric admitted patients with E. coli bacteraemia (EB).153 EB (22% ESBL-producing strains). Risk factors associated with ESBLB: previous antibiotic treatment (OR 2.61; 95% CI 1.1-6.19), severity Winston score ≤2 (OR 9.83, 95% CI 3.42-28.26) and health-related acquired infection (OR 5.35; 95% CI 1.57-18.27). Related mortality rate was 21%, being independent risk factors: cancer (OR 4.02; 95% CI 1.08-14.82), high severity of underlying disease (McCabe) (OR 7.69; 95% CI 1.96-30.09) and critical severity of illness at onset (Winston) (OR 48.89; 95% CI 11.58-206.97). Inappropriate empirical therapy was more frequent in EBSL-producing group (67%, p0.05).Previous antibiotic treatment, severity Winston score ≤2 and health-related acquisition are factors associated to ESBL EB. EBSL-producing strains or inadequate treatment were not associated to higher mortality. Factors statistically associated to mortality were cancer, severity of underlying diseases and critical severity of illness at onset.

To study an outbreak of nosocomial colonisation/infection due to multidrug and carbapenem resistant A. baumannii (ABMDR-C).Prospective study of patients with ABMDR-C colonisation/infection (January 2007-June 2008). Epidemiological and clinical variables and predictors of infection versus colonization were analysed.24 out of 101 cases were considered colonisations and 77 infections (27 bacteraemia); global mortality (colonisations and infections) was 42% (4 colonisations and 38 infections -18 bacteraemia). All together, the incidence was 3.2/1000 admissions/day; 29% had been previously admitted and 79% had received previous antibiotic treatment (29% carbapenem; 34% piperacillin-tazobactam; 12.5% both); 78% had an underlying condition; 81% were UCI patients; 90% had gone through invasive procedures; 65% had another microorganism isolated. In multivariate analysis, infection predictor factors were isolation of ABMDR-C in respiratory samples (OR 5.406; 95% CI 1.419-20.599); male patients (OR 8.842; 95% CI 1.988-39.325); previous hospitalization (OR 9.720; 95% CI 1.383-68.291) and initial clinical severity (OR 30.897; 95% CI 5.533-172.543).Our cohort of patients with ABMDR-C colonisation/infection is characterised by their underlying comorbidity, the high rate of previous invasive procedures, previous hospitalisation and previous broad-spectrum betalactam treatments (especially carbapenem). Initial severity and respiratory samples with ABMDR-C isolates were predictors of infection versus colonisation.

To evaluate epidemiological and clinical prognosis factors related to mortality and impact of early empiric treatment on patients with nosocomial candidemia (NC).Observational study of a cohort of 107 adult patients with NC admitted at a tertiary hospital (2002-5).In bivariate analysis, risk factors significantly associated with mortality rate (49.5%) were: age65 years, previous steroid treatment, solid organ transplant, acute severity of illness, shock, renal failure and respiratory distress at onset, delayed or inadequate antifungal treatment, non-removal of central venous catheter and associated post-surgical bacterial sepsis or respiratory infection. In multivariate analysis, risk factor associated with mortality was acute severity of illness at onset (OR 76.9; CI 12.5-500) being early and adequate treatment (OR 11.8; CI 1.7-81.2) and early (48h) removing of central venous catheter (OR 12.2; CI 1.9-74.9) factors associated with cure; there was no statistically significant difference between fungistatic (azoles) or fungicidal (amphotericin or caspofungin) treatment.Acute severity of illness at onset is associated with mortality in patients with NC whereas early and adequate treatment and early removing of central venous catheter are associated with cure.

The influence of methicillin resistance in Staphylococcus aureus bacteremia (SAB) continues to be controversial. The aim of this study was to evaluate risk factors and mortality predictors in patients with SAB and the influence of methicillin resistance in mortality (SAMSB vs SAMRB).Prospective study including 213 in-patients with SAB.Of 213 episodes of SAB, 131 (61.5%) were due to SAMS and 82 (38.5%) to SAMR. Risk factors associated with SAMRB were: nosocomial infection, presence of an ultimately or rapidly fatal underlying disease, diabetes mellitus, intravenous catheters, previous ICU hospitalization and therapy with broad-spectrum antibiotics. Severity and complications were more frequent in patients with SAMRB. Mortality was 42.6% in SAMRB cases vs 16% in SAMSB cases (p0.05). Multivariate analysis showed as independent predictors of mortality in patients with SAB: presence of an ultimately or rapidly fatal underlying disease, acute severity of illness at onset and inappropriate empirical therapy; methicillin resistance was not an independent predictor of mortality.Methicillin resistance was not an independent predictor of mortality in patients with SAB. Presence of a fatal underlying disease, acute severity of illness at onset and inappropriate therapy were the main prognosis factors in patients with SAB.