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

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

Colonización gastrointestinal por enterobacterias en niños sanos: influencia del tipo de alimentación / María Jesús del Amor Espín; directores, Genoveva Yagüe Guirao, Carmen Martínez Graciá.

Texto en español, resumen en inglés.Tesis-Universidad de Murcia.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. TM 4321

Colonización gastrointestinal por enterobacterias en niños sanos: influencia del tipo de alimentación

La microbiota presente en el tracto gastrointestinal, es un complejo ecosistema compuesto por varios cientos de especies de microorganismos, la mayoría de ellos bacterias. El establecimiento y diversidad de la microbiota intestinal en el neonato es un complejo proceso influenciado tanto por factores internos como factores externos tales como la edad gestacional, el tipo de parto, la hospitalización, diferencias geográficas, la administración de antibióticos, y fundamentalmente, el tipo de alimentación infantil (Fanaro y col., 2003). Esta microbiota, aunque tiene importantes beneficios sobre la salud humana puede comportarse, bajo determinadas circunstancias, como potencialmente patógena dada la capacidad de estos microorganismos de invadir al huésped y originar diferentes infecciones y enfermedades (Guarner y Malagelada, 2003). En la flora fecal de neonatos sanos, entre los bacilos gramnegativos que colonizan el tracto intestinal, y concretamente entre los perteneciente a la familia Enterobacteriaceae, E. coli suele ser la especie predominante, aunque se pueden aislar otras especies como Klebsiella , Enterobacter, Citrobacter, y Proteus spp. etc, (Adlerberth y col., 1991). Este estudio se llevó a cabo con el objetivo de conocer el patrón de colonización por Enterobacterias desde el nacimiento hasta un periodo aproximado de tres meses, y observar la posible influencia de la alimentación (lactancia materna, y dos fórmulas infantiles del mercado, una de ellas enriquecida)The microbiota in the gastrointestinal tract is a complex ecosystem comprising several hundred species of microorganisms, including bacteria most. The establishment and diversity of the intestinal microbiota in the newborn is a complex process influenced by both internal factors and external factors such as gestational age, mode of delivery, hospitalization, geographical differences, antibiotics, and fundamentally, type infant feeding (Fanaro et al., 2003). This microbiota, although it has significant benefits for human health can behave under certain circumstances, as potentially pathogenic given the ability of these microorganisms to invade the host and cause different infections and diseases (Guarner and Malagelada, 2003). On fecal flora of healthy infants, including gram negative bacilli colonizing the intestinal tract, and specifically between belonging to the family Enterobacteriaceae, E. coli is usually the predominant species, although other species may be isolated as Klebsiella, Enterobacter, Citrobacter, and Proteus spp. etc. (Adlerberth et al., 1991). This study was conducted in order to know the pattern of colonization by Enterobacteriaceae from birth to approximately three months, and observe the possible influence of diet (breastfeeding, and two infant formula market, one enriched)

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. 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 th

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective