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Resumen Objetivo Describir la experiencia clinica con dalbavancina en el tratamiento de la infeccion de pie diabetico en una unidad multidisciplinar de un hospital de segundo nivel. Metodos Estudio descriptivo retrospectivo de pacientes con infeccion de pie diabetico tratados con dalbavancina en la Unidad de Pie Diabetico del Hospital Universitario Fundacion Alcorcon de septiembre de 2016 a diciembre de 2019. Se recogieron parametros demograficos y comorbilidades, caracteristicas de la infeccion y del tratamiento con dalbavancina. Se estimo la tasa de curacion a los 90 dias tras finalizar el tratamiento. Resultados Un total de 23 pacientes con infeccion de pie diabetico (osteomielitis) fueron tratados con dalbavancina; 19 eran hombres con una edad media de 65 anos. Los microorganismos mas frecuentemente aislados fueron Staphylococcus aureus (11) y Corynebacterium striatum (7). En 22 casos se uso dalbavancina como terapia de segunda eleccion, en 11 debido a toxicidad de otros antibioticos. La mediana de duracion del tratamiento fue de 5 (4-7) semanas; la dosis mas frecuente de dalbavancina (8 pacientes) fue de 1.000 mg seguido de 500 mg semanales durante 5 semanas. Tres pacientes presentaron efectos secundarios leves (nauseas y molestias gastrointestinales). A los 90 dias de finalizar el tratamiento, el 87% (20) de los pacientes se curaron (IC95%: 65,2-94,52%). Conclusion Los pacientes con osteomielitis por microorganismos grampositivos que recibieron como parte del tratamiento multidisciplinar antibioterapia con dalbavancina tuvieron una elevada tasa de curacion, con una adecuada tolerancia y escasos efectos secundarios. Dalbavancina ofrece una alternativa segura en el tratamiento de la infeccion profunda de pie diabetico.

To describe the clinical experience with dalbavancin in the treatment of diabetic foot infection in a multidisciplinary unit of a second level hospital.A retrospective, descriptive study was made with all patients with diabetic foot infection treated with dalbavancin in the Diabetic Foot Unit of Hospital Universitario Fundación Alcorcón, covering the period from September 2016 to December 2019. Demographic parameters and comorbidities, characteristics of the infection and treatment with dalbavancin were recorded. The cure rate is estimated at 90 days after finishing the treatment.A total of 23 patients with diabetic foot infection (osteomyelitis) started treatment with dalbavancin, 19 were men and the mean age was 65 years. The microorganisms most frequently isolated for the indication of treatment with dalbavancin were Staphylococcus aureus (11) and Corynebacterium striatum (7). Dalbavancin was used as a second choice therapy in 22 cases, in 11 due to toxicity from other antibiotics. The median duration of treatment was 5 (4-7) weeks; the most frequent dose of dalbavancin (8 patients) was 1000 mg followed by 500 mg weekly for 5 weeks. 3 patients presented mild side effects (nausea and gastrointestinal discomfort). At 90 days after completion of dalbavancin therapy, 87% (20) of the patients were cured (95% CI: 65.2%-94.52%).Patients with osteomyelitis due to gram-positive microorganisms who received as part of the multidisciplinary antibiotic treatment with dalbavancin, had a high rate of cure with adequate tolerance and few side effects. Dalbavancin offers a safe alternative in treating deep diabetic foot infection.

Objective To estimate the incidence of falls and to know their characteristics in terms of location, temporality and injuries produced, and to analyse the sociodemographic and clinical characteristics of the patients who suffer falls. Methodology A retrospective observational cohort study was carried out in a level 2 hospital of the Madrid Health Service. Falls in hospitalized patients between July 1, 2018 and June 30, 2019 were studied. The incidence rate of falls per 1000 days of stay was estimated considering a Poisson distribution. The characteristics of the falls are described: temporality, injuries produced, location of the injuries and prescribed drugs. Sociodemographic and clinical characteristics of patients who suffered a fall were registered. A univariate analysis was performed to compare the results by gender. All data were obtained from the electronic medical record. Results One hundred and thirty-two falls were studied, which represent a rate of 1.61 falls per 1,000 days of stay. Men, older age, and admission to a medical specialty showed a significantly higher fall rate. The patients who suffered a fall had a mean age of 77.5 years (SD: 11.7), and had a median of 12.5 drugs prescribed (IQR: 9.25-15). Of the falls, 63.6% did not present any injury. Difference in gender was only found in the situation in which the fall occurred. Conclusions Our data report an incidence of falls similar to other institutions in our environment. The profile of the patient who suffers a fall is an older man, admitted under the charge of a medical specialty, with longer hospital stay, with associated comorbidity and polymedicated, without an obvious temporal feature.

Resumen Objetivo Estimar la incidencia de caidas y conocer sus caracteristicas en cuanto a localizacion, temporalidad y lesiones producidas, y analizar las caracteristicas sociodemograficas y clinicas de los pacientes que sufren caidas. Metodo Se llevo a cabo un estudio observacional de cohortes retrospectivo, en un hospital de nivel 2 del Servicio Madrileno de Salud. Se estudiaron las caidas de pacientes hospitalizados entre el 1 de julio de 2018 y el 30 de junio de 2019. Se estimo la tasa de incidencia de caidas por 1.000 dias de estancia considerando una distribucion de Poisson. Se describen las caracteristicas de las caidas: temporalidad, lesiones producidas, localizacion de las lesiones y pauta de farmacos. Se registraron caracteristicas sociodemograficas y clinicas de los pacientes que sufrieron una caida. Se realizo un analisis univariante para comparar los resultados por sexos. Todos los datos se han obtenido de registros de la historia clinica electronica. Resultados Se estudiaron 132 caidas, que suponen una tasa de 1,61 caidas por 1.000 dias de estancia. Hombres, edad avanzada e ingreso a cargo de una especialidad medica presentaron una tasa de caida significativamente mayor. Los pacientes que sufrieron una caida tienen una edad media de 77,5 anos (DE 11,7), y tuvieron pautados una mediana de 12,5 farmacos (RIC 9,25-15). El 63,6% de las caidas no presentan lesion alguna. Solo se encontro diferencia en cuanto al genero en la situacion en la que se produce la caida. Conclusiones Nuestros datos notifican una incidencia de caidas similar a la de centros de nuestro entorno. El perfil del paciente que sufre una caida es el de un hombre mayor, ingresado a cargo de una especialidad medica, con estancias hospitalarias mas largas, con alguna comorbilidad y polimedicado, sin una asociacion temporal evidente.

One of the most important strategies of PROA in the Emergency Department (ED) is the accurate diagnosis of infection to avoid inappropriate prescription. Our objective is to evaluate patients who receive antibiotics despite not having objective data of infection.We carried out a cross-sectional study of patients admitted to the ED of the Hospital Universitario Fundación Alcorcón in which it was recommended to suspend the antibiotic through the PROA. Clinical and epidemiological characteristics and 30-day follow-up were analyzed to assess readmissions and mortality.145 patients were analyzed. It was recommended to suspend the antibiotic in 25. 44% of them had a diagnosis of urinary infection. The suspension recommendation was accepted by 88%. No patient died and one was readmitted.An important percentage of patients are prescribed antibiotics despite not having infection criteria, the clinical evolution after suspension of antibiotics was favorable.