11 research outputs found
Linezolid for infective endocarditis. A structured approach based on a national database experience
Current data on the frequency and efficacy of linezolid (LNZ) in infective endocarditis (IE) are based on small retrospective series. We used a national database to evaluate the effectiveness of LNZ in IE. This is a retrospective study of IE patients in the Spanish GAMES database who received LNZ. We defined 3 levels of therapeutic impact: LNZ 50% of the total treatment, and > 50% of the LNZ doses prescribed in the first weeks of treatment), and LNZ ? 7 days not fulfilling the high-impact criteria (LNZ-NHI). Effectiveness of LNZ was assessed using propensity score matching and multivariate analysis of high-impact cases in comparison to patients not treated with LNZ from the GAMES database matched for age-adjusted comorbidity Charlson index, heart failure, renal failure, prosthetic and intracardiac IE device, left-sided IE, and Staphylococcus aureus. Primary outcomes were in-hospital mortality and one-year mortality. Secondary outcomes included IE complications and relapses
Role of age and comorbidities in mortality of patients with infective endocarditis
Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality.
Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk.
Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32â3.34), CCI = 3 (HR:1.62; 95% CI:1.39â1.88), and non-performed surgery (HR:1.64;95% CI:11.16â1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality.
Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group
Role of age and comorbidities in mortality of patients with infective endocarditis
[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality.
[Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65âŻyears,65 to 80âŻyears,andâŻâ„âŻ80âŻyears.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk.
[Results]: A total of 3120 patients with IE (1327âŻ<âŻ65âŻyears;1291 65-80âŻyears;502âŻâ„âŻ80âŻyears) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients â„80âŻyears who underwent surgery were significantly lower compared with other age groups (14.3%,65âŻyears; 20.5%,65-79âŻyears; 31.3%,â„80âŻyears). In-hospital mortality was lower in the <65-year group (20.3%,<65âŻyears;30.1%,65-79âŻyears;34.7%,â„80âŻyears;pâŻ<âŻ0.001) as well as 1-year mortality (3.2%, <65âŻyears; 5.5%, 65-80âŻyears;7.6%,â„80âŻyears; pâŻ=âŻ0.003).Independent predictors of mortality were ageâŻâ„âŻ80âŻyears (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32â3.34), CCIâŻâ„âŻ3 (HR:1.62; 95% CI:1.39â1.88),and non-performed surgery (HR:1.64;95% CI:11.16â1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65âŻyears(pâŻ<âŻ0.001) for both in-hospital and 1-year mortality.
[Conclusion]: There were no differences in the clinical presentation of IE between the groups. AgeâŻâ„âŻ80âŻyears, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group
Nosocomial meningitis caused by ESBL- and OXA-48-producing Klebsiella pneumoniae and treated with ceftazidime-avibactam. Report of one case and review of the literature.
Role of age and comorbidities in mortality of patients with infective endocarditis
[eng] Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65âŻyears,65 to 80âŻyears,andâŻâ„âŻ80âŻyears.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327âŻ<âŻ65âŻyears;1291 65-80âŻyears;502âŻâ„âŻ80âŻyears) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients â„80âŻyears who underwent surgery were significantly lower compared with other age groups (14.3%,65âŻyears; 20.5%,65-79âŻyears; 31.3%,â„80âŻyears). In-hospital mortality was lower in the <65-year group (20.3%,<65âŻyears;30.1%,65-79âŻyears;34.7%,â„80âŻyears;pâŻ<âŻ0.001) as well as 1-year mortality (3.2%, <65âŻyears; 5.5%, 65-80âŻyears;7.6%,â„80âŻyears; pâŻ=âŻ0.003).Independent predictors of mortality were ageâŻâ„âŻ80âŻyears (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCIâŻâ„âŻ3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65âŻyears(pâŻ<âŻ0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. AgeâŻâ„âŻ80âŻyears, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group
Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis: A Prospective Cohort Study From the GAMES Cohort
BACKGROUND: Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). METHODS: Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed. RESULTS: A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09-.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22-.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. CONCLUSIONS: OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded
Role of age and comorbidities in mortality of patients with infective endocarditis.
The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups: A total of 3120 patients with IE (1327⯠There were no differences in the clinical presentation of IE between the groups. AgeâŻâ„âŻ80âŻyears, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in th
The ATLAS Experiment at the CERN Large Hadron Collider
The ATLAS detector as installed in its experimental cavern at point 1 at CERN is
described in this paper. A brief overview of the expected performance of the detector when the
Large Hadron Collider begins operation is also presented