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]:2.32–3.34), CCI = 3 (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 <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

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.

The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. Prospective descriptive multicenter cohort study. 26 Intensive care units (ICU) from Andalusian region in Spain. Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. None. Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission 6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission 470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor

Anales de Edafología y Agrobiología Tomo 46 Número 1-6

l. Suelos-Química Análisis de los procesos de alteración y neoformación en sistemas edáficos a partir de consideraciones termodinámicas de equilibrios solución-mineral. Por M. L. Fernández Marcos y F. Macías.-- Estudio de la materia orgánica y naturaleza de los compuestos hllmicos en suelos afectados por sales. Por P. Gómez, J. Gumuzzio y A. Polo.-- Factores formadores y características mineralógicas de suelos desarrollados sobre el Karst de Larra (Pirineo Occidental). Por J. López Martínez, J. Casas y J. L. Martín Vidales.-- Variación estacional de la composición de la disolución de suelos de Galicia en relación con el tipo de horizonte y material original. Por M. L. Fernández Marcos y F. Macías.-- Génesis, Clasificación y Cartografía Reconocimiento y evaluación de suelos del Valle del Guadalquivir: Zona Marmolejo-Menjibar (Jaén). l. Relaciones geomorfología-suelos. Por J. Gil, L. Corral y G. Paneque.-- Fertilidad Influencia del pH del suelo sobre el desarrollo y producción de la Piña tropical en Canarias, l.-Fertilidad del suelo y nutrición mineral. Por A. E. Carracedo Torres, C. E. Alvarez González, V. García García y C. García Corujo.-- Absorción de P por Rye-grass y el fósforo asimilable de suelos aluviales y autoctonos del Valle del Ebro. Por B. Eleizalde t y V. Hernando.-- ll. Biología Vegetal-Nutrición Evolución de los contenidos minerales de raíz, tallo y hoja de plantas de tomate como índices de nutrición. Por O. Carpena Artes, A. Masaguer Rodríguez y M. J. Sarro Casillas.-- Quelación por Dtpa de oligoelementos en suelos calizos. Ecuación modificada de Freundlich. Por J. Sánchez-Andréu, E. A. Gadea, M. Juárez y A. Gárate.-- Fisiología. Efecto de diversas concentraciones de nitratos y pH sobre el crecimiento de plántulas de capsicum annuum L. Var. acuminatum Fingerh H. Por l. Iglesias, T. Díaz, E. González y C. Rodríguez Bujan.-- Vitis Vinifera en el campo de Cartagena. II. Evolución de azllcares (Glucosa, fructosa y sacarosa), sustancias pécticas, ácidos orgánicos (Tartárico, málico y cítrico) y contenido catiónico. Por G. Navarro, M. Romero, C. Zuñel, C. Méndez y S. Navarro.-- Presencia de pigmentos antocianicos en el reino vegetal con referencia especial al género vitis. Por M. L. González-San José y C. Díez de Bethencourt.-- Protección Vegetal. Ensayos de lucha contra Globodera Rotochiensis en España. l. Tendencias de las poblaciones, Por L. M. Paz-Vivas, L. Franco, M. P. Gutiérrez y M. L. Martínez-Beringola.-- Ensayos de lucha contra Globodera Rostochiensis en España. II. Las variedades resistentes al patotipo rol. Por L. Franco, L. M. Paz-Vivas, A. Aguirre, M. P. Gutiérrez y M. L. Martínez-Beringola.--Agrobiología Comparación de métodos de evaluación del fosfato asimilable procedente de la solubilización de fosfato bicálcico por cepas de B. cereus. Por M. Fernández Herrera, N. Blat Martín y l. Gómez de Mingo.-- Vitis vinífera en el campo de Cartagena. l. Aspectos edafoclimáticos y del desarrollo del fruto. Por G. Navarro, C. Méndez, C. Zuñel y S. Navarro.--III. Trabajos recapitulativos. Interés agrícola de lodos de depuradoras de aguas residuales. Por M. Juárez, J. Sánchez-Andréu y J. Mataix.-- Micorrizas VA en árboles y arbustos. Por B. E. Roldán-Fajardo y J. M. Barea.-- l. Suelos.-Física Balance hfdrico y regímenes- de humedad para suelos de elevada reserva en la provincia de Pontevedra. Por A . M. Martínez Cortizas.-- El balance hfdrico y su efecto sobre los cultivos en la provincia de Pontevedra. Por A. M. Martínez.-- Biología Contribución al conociniiento de las relaciones suelo-agua-vegetación en un sector de las salinas de Santa Pola (Alicante, España). Por F. Alcaraz, R. Ortiz y S. Hernández.-- Distribución y variación estacional de la población microbiana de. un suelo humffero atlántico. Por M. J. Acea y T. Carballas.-- Génesis, OasifJcación y Cartografía Suelos desarrollados sobre peridotitas de Sierra Nevada (Granada). Por l. García Fernández, C. Gil de Carrasco, M. Ortega Huertas y M. Simón Torres.-- Reconocimiento y evaluación de suelos del valle del Guadalquivir : zona Marmolejo-Menjibar (Jaén). II. Unidad geomorfológica 1 (Vegas y terrazas). Por L. Corral, J. Gil y G. Paneque.-- Reconocimiento y evaluación de suelos del valle del Guadalquivir: zona Marmolejo-Menjibar. (Jaén). III. Unidad Geomorfológoca 2 (Campiña baja). Por L. Corral, J. Gil y G. Paneque.-- Clasificación morfogenética de las acumulaciones calizas. Por V. Gómez-Miguel.-- Influencia de la granulometrfa en la morfología y génesis de las acumulaciones calizas. Por V. Gómez-Miguel.-- Contribución al estudio de suelos sobre calizas en la región de Cantabria. Por l. He mando Massanet, C. García Paz y M. L. Palomar García-Villamil.—Fertilidad. Mineralización "In vitro" de Inisitol-hexafosfato por dos estirpes de Bacillus cereus. Por M. Fernández Herrera, l. Gómez de Mingo y N. Blat Martín.-- Limitaciones a la fertilidad en áreas serpentinizadas de Galicia. Por R. Calvo de Anta y V. Tovar Caballero.-- II. Biología Vegetal.-- Nutrición Respuesta a la fertilización nitrogenada de trigo sometido a la competencia de Auena sterilis L . en dos suelos diferentes. Por R . González Ponce.-- Efecto de distintas dosis y formas de fertilización nitrogenada sobre producción de Cynodon dactylon en la región mediterránea. Por M. C. Bergareche y E. Simón.-- Fisiologla Estudio de la actividad citoquinina en flores de platanera. Efecto de L-Dopamina sobre el bioensayo del callo de soja. Por J. R . Lorenzo Martín, A. Jorge Cannona, J. F. Pérez Francés y A. C. Blesa.-- Producción de ácido 3-lndolacético en cultivos de Azotobacter uinilandii suplemetados con triptofano, triptamina y otros índoles. Por J. L. García Bilbao, M. G. Curiel, M. V. Celaa y Castro y F. Amat-Guerri.-- Agrobiologla Dinámica del P en el suelo afectada por la aplicación de düerentes fertilizantesorgánicos. Por J. A. Díez.-- Importancia de la capacidad tampon de fosfato y de la relación P/Ca en la absorción de fósforo por la planta. Por J. A . Díez.-- l. Suelos.-Física Zonas agroecológicas de Galicia: Zonas climáticas F AO. Por A . Martínez Cortizas.-- Químicas Mineralogía y minerales de la arcilla de la capa de San Nicolás. Yacimiento de Almaden. (Ciudad Real). Por J. B. Alvarez Martfn, J. Monseur Lespagnard, A. Gutiérrez Maroto y A . Moreno Gutiérrez.-- Aplicación de modelos de regresión mültiple para evaluar la variabilidad estadística de contenidos de metales pesados en función de parámetros edáficos. Por J. Rodríguez Sanchidrián y V. Cala Rivero.—Biología. Cambios en la densidad de los microartropodos y de las bacterias en un suelo de la zona semiérida que contiene restos de Eragrostis curuula (Schrad.) Nees como agregado orgánico. Por M. T. Pérez, M. A. Gómez y M. A . Sagardoy.-- Génesis, Clasificación y Cartografía. Estudio edáfico de la Sierra de Cazarla (Jaén). Características litológicas y climátológicas. Cambisoles. Por J. González Parro, C. González Huecas y A . López Lafuente.-- Estudio edáfico de la Sierra de Cazorla (Jaén). (II). Características de luvisoIes. Por J. González Parra, A. López Lafuente y C. González Huecas.-- Reconocimiento y evaluación de suelos del Valle del Guadalquivir: Zona Marmolejo-Menjibar (Jaén). IV. Unidad geomorfológica III (Campiña Alta). Por J. Gil, L. Corral y G. Paneque.-- Composición de la solución del suelo en medios naturales de Galicia. Por R. Calvo de Anta, M. L. Fernández Marcos y M. A. Veiga Vila. --Estabilidad mineral de suelos desarrollados a partir de rocas básicas y ultrabásicas de Galicia. Por R . Calvo de Anta, M. L. Fernández Marcos y A. Veiga Vila.-- Contribución a la génesis de paleosoles (Almagres) en las Islas Canarias mediante el estudio de lámina delgada. Por J. Benayas, H. Carbajal y Ma J. Herrera.-- Fertilidad Reconocimiento y evaluación de suelos del Valle medio del Guadalquivir: Zona Marmolejo-Menjibar. (Jaén). V. Evaluación de la capacidad de uso. Por J. Gil, L. Corral y G. Paneque.-- Estudio de los suelos de la depresión Guadix-Baza (Granada). 1: Distribuciones de frecuencia y relaciones entre las propiedades de los horizontes superiores e inferiores. Por A. lriarte Mayo, J. L. García-Chicano Fernández y E. Barahona Fernández. II. Biología Vegetal-Nutrición Estudio comparado de la eficacia de G. mosseae y los endofitos V A autoctonos de dos suelos de Granada. Por l. García-Romera y J. A. Ocampo.-- Fisiología Localization of abscisic acid binding sites in epidemal tissue by the peroxidase antiperoxidase technique. Por N. Curvetto, S. Delmastro and R. Brevedan. Efecto combinado de la salinidad y de la fertilización nitrogenada sobre el contenido de micronutrientes en plantas de tomate y pepino. Por V. Martínez, A. Cerdá y M. Nieves.-- Factores que afectan la micropropagación del Abedul. Por A. Ballester y A. M. Vieitez.-- Estudio de las deficiencias de boro y manganeso en plantas de tomate. Por J. M. Peñalosa, P. Zomoza y O. Carpena.-- Agrobiología. Determinación de los niveles óptimos de los parámetros que definen la dinámica del K en el suelo en relación al cultivo de veza. Por J. A. DíezPeer reviewe

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58\ub75%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31\ub72%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10\ub72%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12\ub73%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9\ub74%] of 7339 patients), middle (549 [14\ub70%] of 3918 patients), and low (298 [23\ub72%] of 1282) HDI (p&lt;0\ub7001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17\ub78%] of 574 patients in high-HDI countries; 74 [31\ub74%] of 236 patients in middle-HDI countries; 72 [39\ub78%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1\ub760, 95% credible interval 1\ub705\u20132\ub737; p=0\ub7030). 132 (21\ub76%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16\ub76%) of 295 patients in high-HDI countries, in 37 (19\ub78%) of 187 patients in middle-HDI countries, and in 46 (35\ub79%) of 128 patients in low-HDI countries (p&lt;0\ub7001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this