Colecistitis aguda perforada con bacteriemia por Actinomyces naeslundii

Actinomycosis of the gallbladder is a very rare condition: only 25 cases have been reported in the medical literature to date. We report a case of a 68-year-old man presented with short term fever and no obvious source of infection. Complementary tests revealed perforated acute cholecystitis along with bacteremia due to Actinomyces naeslundii. The patient was treated with amoxicillin-clavulanate for 3 weeks, significantly lower than the usual course. Subsequently, he underwent elective cholecystectomy. Histopathological study of the surgical specimen confirmed complete resolution of the infection.La infección de la vesícula biliar por bacterias del género Actinomyces es extremadamente rara, habiéndose descrito hasta la fecha 25 casos en la literatura. Presentamos el caso de un hombre de 68 años que ingresó por un cuadro de fiebre de corta evolución sin focalidad infecciosa aparente. Las pruebas complementarias revelaron la existencia de colecistitis aguda perforada junto con bacteriemia por A. naeslundii. El paciente realizó tratamiento antibiótico con amoxicilina-clavulanato durante 3 semanas, sensiblemente inferior a las pautas habituales. Posteriormente se sometió a una colecistectomía electiva. El estudio histopatológico de la pieza quirúrgica confirmó la resolución completa de la infección

Prognostic factors of Infective Endocarditis in Patients on Hemodialysis: A Case Series from a National Multicenter Registry.

Background: Infective endocarditis (IE) is a severe complication associated with high mortality. Objectives: To examine the clinical characteristics of IE in hemodialysis (HD) patients and to determine prognostic factors related to HD. Methods: From January 2008 to April 2015, 2,488 consecutive patients with definite IE were included. Clinical characteristics of IE patients on HD were compared with those of IE patients who were not on HD. Results: A total of 126 patients (63% male, median age: 66 years; IQR: 54-74 years) with IE (5.1%) were on HD. Fifty-two patients died during hospitalization (41%) and 17 additional patients (14%) died during the first year. The rate of patients who underwent surgery during hospitalization was lower in HD patients (38 patients, 30%) than in non-HD patients (1,177 patients, 50%; p 70 years (OR: 4.1, 95% CI: 1.7-10), heart failure (OR: 3.3, 95% CI: 1.4-7-6), central nervous system (CNS) vascular events (OR: 6.7, 95% CI: 2.1-22) and septic shock (OR: 4.1, 95% CI: 1.4-12.1) were independently associated with fatal outcome in HD patients. Of the 38 patients who underwent surgery, 15 (39.5%) died during hospitalization. Conclusions. HD patients with IE present a high mortality. Advanced age and complications, such as heart failure, CNS stroke or septic shock, are associated with mortality.pre-print714 K

Factors associated with severe sepsis or septic shock in complicated pyelonephritis.

Severe sepsis or septic shock are the main factors influencing the prognosis of acute pyelonephritis (APN). Our aim was to analyze factors associated with the development of severe sepsis or septic shock in a large sample of patients with acute complicated pyelonephritis (ACPN).This prospective observational study comprised 1507 consecutive patients aged 14 years or older who were admitted to a tertiary care hospital because of ACPN between 1997 and 2015. Covariates associated in univariate analysis with severe sepsis or septic shock were then analyzed by multivariate logistic regression.Of the 1507 patients, 423 (28.1%) fulfilled the criteria for severe sepsis or septic shock at the time of admission. Crude and attributable mortality at 30 days were 17.7% and 11.7% in patients with severe sepsis or septic shock versus 1.7% and 0.6% in patients without severe sepsis or septic shock, P  65 years, urinary instrumentation in the previous 2 weeks, the lack of mictional syndrome or costovertebral tenderness, an ectasia ≥ grade II, and bacteremia were independent risk factors associated with severe sepsis or septic shock.The prevalence of severe sepsis and septic shock in patients with ACPN is high. Some factors associated with severe sepsis are easy to identify in any emergency department. The information provided here could be useful when deciding which patients should be admitted to receive immediate treatment