Clinical profiles of patients colonized or infected with extended-spectrum beta-lactamase producing Enterobacteriaceae isolates: a 20 month retrospective study at a Belgian University Hospital

<p>Abstract</p> <p>Background</p> <p>Description of the clinical pictures of patients colonized or infected by ESBL-producing <it>Enterobacteriaceae </it>isolates and admitted to hospital are rather scarce in Europe. However, a better delineation of the clinical patterns associated with the carriage of ESBL-producing isolates may allow healthcare providers to identify more rapidly at risk patients. This matter is of particular concern because of the growing proportion of ESBL-producing <it>Enterobacteriaceae </it>species isolates worldwide.</p> <p>Methods</p> <p>We undertook a descriptive analysis of 114 consecutive patients in whom ESBL-producing <it>Enterobacteriaceae </it>isolates were collected from clinical specimens over a 20-month period. Clinical data were obtained through retrospective analysis of medical record charts. Microbiological cultures were carried out by standard laboratory methods.</p> <p>Results</p> <p>The proportion of ESBL-producing <it>Enterobacteriaceae </it>strains after exclusion of duplicate isolates was 4.5% and the incidence rate was 4.3 cases/1000 patients admitted. Healthcare-associated acquisition was important (n = 104) while community-acquisition was less frequently found (n = 10). Among the former group, two-thirds of the patients were aged over 65 years and 24% of these were living in nursing homes. Sixty-eight (65%) of the patients with healthcare-associated ESBL, were considered clinically infected. In this group, the number and severity of co-morbidities was high, particularly including diabetes mellitus and chronic renal insufficiency. Other known risk factors for ESBL colonization or infection such as prior antibiotic exposure, urinary catheter or previous hospitalisation were also often found. The four main diagnostic categories were: urinary tract infections, lower respiratory tract infections, septicaemia and intra-abdominal infections. For hospitalized patients, the median hospital length of stay was 23 days and the average mortality rate during hospitalization was 13% (Confidence Interval 95%: 7-19). <it>Escherichia coli</it>, by far, accounted as the most common ESBL-producing <it>Enterobacteriaceae </it>species (77/114; [68%]) while CTX-M-1 group was by far the most prevalent ESBL enzyme (n = 56).</p> <p>Conclusion</p> <p>In this retrospective study, the clinical profiles of patients carrying healthcare-associated ESBL-producing <it>Enterobacteriacae </it>is characterized by a high prevalence rate of several major co-morbidities and potential known risk factors. Both, the length of hospital stay and overall hospital mortality rates were particularly high. A prospective case-control matched study should be designed and performed in order to control for possible inclusion bias.</p

Soins palliatifs en MRS: fin de vie normale ou fin de vie en soins palliatifs, quelle différence?

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Vieillissement de la fonction cardiaque chez l'homme.

In normal subjects at rest neither heart rate nor ejection volume are influenced by age. The loss of elasticity of the great arteries, and in particular the aorta which becomes tortuous and wider, results in an increase of impedance at ejection. At systole time pressure rises in the whole cardiovascular system, so that the left ventricle is subjected to an increase of parietal tension to which it adapts itself by hypertrophy which normalizes this tension. Ejection fraction and end-systolic volume are thus preserved, and the systolic function at rest globally remains unmodified by age. The delay and slowing down of relaxation due to hypertrophy of the left ventricle, to the reflection waves and to other changes in cardiac muscle physical properties during senescence reduce the importance of the initial phase of left ventricular filling. This major modification of diastolic dynamics at rest is compensated, at the end of diastole, by a more vigorous contraction of the left atrium, which increases its contribution to left ventricular filling. The global filling volume is thus preserved and the end-diastolic volume remains appropriate, these two conditions being necessary to start off a normal ejection. In normal subjects at exercise the cardiac function is also modified by age. Maximum heart rate is reduced in the elderly, whereas the ejection volume increases more than in younger subjects, which maintains the appropriate cardiac output. This adaptation takes place owing to an increase of cardiac volume and through Starling's mechanism which ensures a greater ejection volume. Only the maximum exercise level (VO2 max) decreases with age, mainly because of the decrease of skeletal muscle mass. Filling of the left ventricle seems to continue to rely, at rest as at exercise, on atrial compensation. Cardiac output therefore is globally maintained with age during a dynamic effort. During isometric exercise, which in the elderly results in a higher rise in blood pressure, the ejection fraction decreases, the end-systolic volume increases and the initial filling decreases but is compensated by a greater contribution of the atrium. Thus, cardiac work at rest and during exercise is well preserved in the ageing man, due to secondary homeostatic adaptations which counterbalance the primary age-related changes. The principal primary changes are loss of elasticity of the great vessels and reduction of efficacy in response to adrenergic stimulation. The principal secondary adaptations are left ventricular hypertrophy, increased atrial contribution and, during exercise, intervention of Starling's mechanism

Évaluation globale et interdisciplinarité

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La santé fonctionnelle des aînés est-elle influencée par la structure et le fonctionnement de leur réseau social : étude exploratoire

Dans cet article, nous nous intéressons à la structure et au fonctionnement du réseau social des aînés en rapport avec leur santé et leur bien-être. À l’aide d’un inventaire original dit « générateur de noms », nous avons conduit une enquête auprès d’aînés vivant à leur domicile, dans la région de Bruxelles-Capitale, afin d’explorer la structure de leur réseau social, les types de relations (enfants, amis, voisins, etc.) composant celui-ci et ses différentes fonctions de soutien (instrumental, émotionnel, social). Nos résultats soulignent le rôle de la participation sociale et du réseau d’amis du même âge, ainsi que l’importance de la réciprocité dans les échanges sociaux pour le maintien de la santé fonctionnelle des aînés. Ces résultats sont discutés à la lumière des principales typologies de réseaux mises en évidence dans la population âgée, avec, pour objectif, une meilleure identification des « ingrédients actifs » des relations sociales susceptibles de promouvoir la santé fonctionnelle et le bien-être dans le grand âge.[Do the structure and functioning of the elderly’s social network influence functional health: a preliminary study] We examined structural and functional characteristics of social networks related to health and well-being among community-dwelling older adults. A survey was performed in Brussels, using an original name-generating network inventory, to explore the structure and types of social ties (e.g. children, friends, neighbors) which forms the elderly's network. Different kinds of support (instrumental, emotional, social) were assessed due to the multiple contents of social exchanges between the elderly and their network's members. Our results highlighted some important social network resources. Especially, social participation, contacts with friends of the same age and reciprocity of social relationships are likely to promote functional health and well-being in later life. We discuss our findings in relation to major social network's typologies referring to older adults

Elderly heart failure patients with drug-induced serious hyperkalemia.

We report four cases of hyperkalemia induced by the association of spironolactone with ACE inhibitor in geriatric patients. Over a period of one year, four elderly patients treated for congestive heart failure with this association were admitted to the Geriatric Ward with serious hyperkalemia. These occurrences represented one third of all-cause severe hyperkalemia cases admitted during this one-year period. A common observation in our cases was that the dose of spironolactone employed far exceeded the recommended dosages. These cases illustrate that spironolactone dosage must be kept low in the setting of chronic congestive heart failure treatment, as well as the need for close monitoring of frail elderly patients who are given this combination