Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project

Biliary-tract bloodstream infections (BT-BSI) caused by Enterococcus faecalis and E. faecium are associated with inappropriate empirical treatment and worse outcomes compared to other etiologies. The objective of this study was to investigate the risk factors for enterococcal BT-BSI. Patients with BT-BSI from the PROBAC cohort, including consecutive patients with BSI in 26 Spanish hospitals between October 2016 and March 2017, were selected; episodes caused by E. faecalis or E. faecium and other causes were compared. Independent predictors for enterococci were identified by logistic regression, and a predictive score was developed. Eight hundred fifty episodes of BT-BSI were included; 73 (8.5%) were due to target Enterococcus spp. (48 [66%] were E. faecium and 25 [34%] E. faecalis). By multivariate analysis, the variables independently associated with Enterococcus spp. were (OR; 95% confidence interval): cholangiocarcinoma (4.48;1.32 to 15.25), hospital acquisition (3.58;2.11 to 6.07), use of carbapenems in the previous month (3.35;1.45 to 7.78), biliary prosthesis (2.19;1.24 to 3.90), and moderate or severe chronic kidney disease (1.55;1.07 to 2.26). The AUC of the model was 0.74 [95% CI0.67 to 0.80]. A score was developed, with 7, 6, 5, 4, and 2 points for these variables, respectively, with a negative predictive value of 95% for a score # 6. A model, including cholangiocarcinoma, biliary prosthesis, hospital acquisition, previous carbapenems, and chronic kidney disease showed moderate prediction ability for enterococcal BT-BSI. Although the score will need to be validated, this information may be useful for deciding empirical therapy in biliary tract infections when bacteremia is suspected. IMPORTANCE Biliary tract infections are frequent, and a significant cause of morbidity and mortality. Bacteremia is common in these infections, particularly in the elderly and patients with cancer. Inappropriate empirical treatment has been associated with increased risk of mortality in bacteremic cholangitis, and the probability of receiving inactive empirical treatment is higher in episodes caused by enterococci. This is because many of the antimicrobial agents recommended in guidelines for biliary tract infections lack activity against these organisms. To the best of our knowledge, this is the first study analyzing the predictive factors for enterococcal BT-BSI and deriving a predictive score.8 página

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Geopaca folk rustic performance

El trabajo obtuvo un Premio Tomás García Verdejo a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso 2018/2019, Modalidad ASe presenta un proyecto llevado a cabo en el CRA La Jara (Villar del Pedroso, Cáceres) articulado a través del área de Música, en el que alrededor de una mascota (Geopaca, una cabra del Geoparque Villuercas Ibores Jara) se forma un grupo que creó un espectáculo de música, teatro, baile y artes plásticas con el alumnado, el profesorado y las familias, con la música del cancionero tradicional extremeño adaptándola a la actualidad. Los objetivos de la experiencia fueron: abrir la escuela a la comunidad; conocer, valorar y respetar el Geoparque a través de la música y el arte; favorecer el aprendizaje colaborativo e intercambio de conocimientos y competencias clave a través de grupos intergeneracionales y promover el desarrollo emocional de los participantesExtremaduraES

Pseudomonas aeruginosa Community-Onset Bloodstream Infections: Characterization, Diagnostic Predictors, and Predictive Score Development&mdash;Results from the PRO-BAC Cohort

Community-onset bloodstream infections (CO-BSI) caused by gram-negative bacilli are common and associated with significant mortality; those caused by Pseudomonas aeruginosa are associated with worse prognosis and higher rates of inadequateempirical antibiotic treatment. The aims of this study were to describe the characteristics of patients with CO-BSI caused by P. aeruginosa, to identify predictors, and to develop a predictive score for P. aeruginosa CO-BSI. Materials/methods: PROBAC is a prospective cohort including patients &gt;14 years with BSI from 26 Spanish hospitals between October 2016 and May 2017. Patients with monomicrobial P. aeruginosa CO-BSI and monomicrobial Enterobacterales CO-BSI were included. Variables of interest were collected. Independent predictors of Pseudomonas aeruginosa CO-BSI were identified by logistic regression and a prediction score was developed. Results: A total of 78patients with P. aeruginosa CO-BSI and 2572 with Enterobacterales CO-BSI were included. Patients with P. aeruginosa had a median age of 70 years (IQR 60&ndash;79), 68.8% were male, median Charlson score was 5 (IQR 3&ndash;7), and 30-daymortality was 18.5%. Multivariate analysis identified the following predictors of CO-BSI-PA [adjusted OR (95% CI)]: male gender [1.89 (1.14&ndash;3.12)], haematological malignancy [2.45 (1.20&ndash;4.99)], obstructive uropathy [2.86 (1.13&ndash;3.02)], source of infection other than urinary tract, biliary tract or intra-abdominal [6.69 (4.10&ndash;10.92)] and healthcare-associated BSI [1.85 (1.13&ndash;3.02)]. Anindex predictive of CO-BSI-PA was developed; scores &ge; 3.5 showed a negative predictive value of 89% and an area under the receiver operator curve (ROC) of 0.66. Conclusions: We did not find a good predictive score of P. aeruginosa CO-BSI due to its relatively low incidence in the overall population. Our model includes variables that are easy to collect in real clinical practice and could be useful to detect patients with very low risk of P. aeruginosa CO-BSI

Todos muy capaces

El trabajo obtuvo un Premio Tomás García Verdejo a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso académico 2015/2016. Modalidad BSe describe un proyecto llevado a cabo con alumnos de 4º de diversificación y 2º de Formación Profesional Básica del IES Bioclimático de Badajoz, que consistió en realizar diversas actividades con la asociación Aspaceba (Asociación de Parálisis Cerebral de Badajoz) y que tuvo como objetivos principales que los alumnos se informase sobre la discapacidad en general y sobre la parálisis cerebral en particular, que se acercaran al mundo de la discapacidad superarando las barreras físicas y psicológicas, que conociesen los aspectos positivos y las necesidades de apoyo y recursos de las personas con discapacidad, que trabajasen la empatía y el respeto como mecanismo para entender sentimientos y vivencias de los demás y que rechazaran situciones de injusticia hacia personas con alguna discapacidadAndalucíaES

Microrelatario

Basta/Prou es el resultado de El desafío por la erradicación de la violencia contra las mujeres que el Instituto Universitario de Estudios Feministas y de Género Purificación Escribano de la Universitat Jaume I lanzó en los Diez días contra la violencia de género 2012

Políticas públicas

Amputaci&oacute;n de extremidades superiores: caracterizaci&oacute;n epidemiol&oacute;gicaAn&aacute;lisis comparado de las pol&iacute;ticas de promoci&oacute;n de la salud entre Chile y Catalu&ntilde;aAn&aacute;lisis de los Avisa para la toma de decisiones en pol&iacute;ticas de saludAntecedentes de colelitiasis en pacientes que presentaron colecistitis aguda. &iquest;Se puede prevenir la urgencia?Asociaci&oacute;n entre alcoholemia y traumatismos en Copiap&oacute;, 2009Automedicaci&oacute;n en la poblaci&oacute;n asistente al Cesfam de Puerto NatalesAutotoma vaginal para detecci&oacute;n de VPH para la prevenci&oacute;n de c&aacute;ncer cervicouterino, ChileCalidad de atenci&oacute;n programa Auge- c&aacute;ncer cervicouterino: la perspectiva de los profesionalesCaracterizaci&oacute;n de los casos de traumatismo enc&eacute;falo craneano en la comuna de Til-TilConocimiento de conductores universitarios sobre la alcoholemia permitida para conducir y su equivalencia en bebidas alcoh&oacute;licasDescripci&oacute;n de la consulta dermatol&oacute;gica pedi&aacute;trica en el Hospital Roberto del R&iacute;o (2007-2008)Elementos para un abordaje metodol&oacute;gico de la salud intercultural en la Regi&oacute;n Metropolitana de SantiagoEstudio descriptivo de consultas Sapu Cesfam Angachilla, visi&oacute;n tras dos a&ntilde;os de registro cl&iacute;nico-electr&oacute;nicoEstudio descriptivo de ingresos a Conin Valdivia, una revisi&oacute;n de 10 a&ntilde;os (1998-2008)Estudio descriptivo de pacientes hospitalizados por absceso y celulitis peritonsilar en el hospital de PurranqueEvaluaci&oacute;n de la aceptabilidad y consumo de alimentos del Pacam inscritos en el Cesfam Dr. V.M.FEvaluaci&oacute;n de la interacci&oacute;n de medicinas alternativas o complementarias (MAC) en dos centros APSExposici&oacute;n a humo de tabaco ambiental. Signos y s&iacute;ntomas respiratorios bajos: estudio de prevalenciaFactores relacionados con la rotaci&oacute;n laboral de m&eacute;dicos en consultorios del Gran SantiagoFibrosis qu&iacute;stica como patolog&iacute;a GES: una mirada cr&iacute;ticaHipersensibilidad dentinaria: comparaci&oacute;n de diferentes alternativas terap&eacute;uticasImpacto del GES en c&aacute;ncer mamario: seguimiento a 5 a&ntilde;os en un hospital del SSMSImplementaci&oacute;n de la pol&iacute;tica nacional de medicamentos: percepci&oacute;n del profesional qu&iacute;mico farmac&eacute;uticoLa implementaci&oacute;n de pol&iacute;ticas p&uacute;blicas cambi&oacute; mortalidad de los pacientes gran quemado en Chile&iquest;La infertilidad deber&iacute;a ser considerada un problema de salud p&uacute;blica en el Per&uacute;?Modelo de monitoreo de una pol&iacute;tica de protecci&oacute;n a la infanciaMortalidad materna en el Hospital Dr. Alfredo van Grieken Coro, Estado Falc&oacute;n, Venezuela 2005-2009Objetivos de desarrollo del milenio. Modelaci&oacute;n de la mortalidad infantil Nicaragua - Costa Rica 1978-2008Percepci&oacute;n de riesgo y beneficio respecto del cigarrillo y su relaci&oacute;n con el tabaquismo adolescentePol&iacute;ticas p&uacute;blicas y salud intercultural: la experiencia de la organizaci&oacute;n ind&iacute;gena Tai&ntilde; adkimnPrevalencia de atipias celulares del cuello uterino en mujeres entre 18 y 24 a&ntilde;osProceso de ser histerectomizada: relatos de experiencias de mujeres en un hospital p&uacute;blico de SantiagoProceso de ser histerectomizada: relatos de experiencias de mujeres en un hospital p&uacute;blico de SantiagoPrograma Auge y c&aacute;ncer cervicouterino: calidad de atenci&oacute;n percibida por las usuarias del programaResoluci&oacute;n quir&uacute;rgica por patolog&iacute;a adenoamigdalina: &iquest;Es la poblaci&oacute;n mapuche un grupo de riesgo?Resultados de alcoholemias tanatol&oacute;gicas del Servicio M&eacute;dico Legal de Copiap&oacute; 1999-2009Resultados de la evaluaci&oacute;n de los objetivos sanitarios de la d&eacute;cada 2000-2010Una mirada a los servicios de salud para adolescentes en Puente Alt