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

About blood products

La transfusión es una necesidad permanente, y la amplitud con la que es utilizada exige que deba garantizarse su calidad y seguridad para evitar, en particular, la transmisión de enfermedades. Ha de ser un tratamiento personalizado. Las funciones de enfermería son de especial importancia así como los cuidados que se requieren. El objetivo del presente estudio es conocer la variabilidad práctica de los profesionales de enfermería del centro hospitalario, sobre la extracción de muestras pretransfusionales y la administración de hemoderivados. Para lo cual se realizó el envío de un cuestionario para su posterior cumplimentación en formato online, que garantizaba el total anonimato. Han contestado a la encuesta 180 profesionales. El 74.4% de los enfermeros dice que la transfusión de hemoderivados sólo se puede administrar de forma simultánea con suero fisiológico. Un 56.1% refiere que cada concentrado transfundido de hematíes aumenta la hemoglobina en 1gr/dl. Hemos encontrado un consenso entre las recomendaciones científicas y las contestaciones realizadas por los diferentes profesionales, hecho que se reafirma con el escaso índice de notificaciones adversas que se han registrado en nuestro trabajo. La elaboración e implantación de una guía de actuación en cuanto a la administración de hemoderivados se hace imprescindibleABSTRACT Transfusion is an ongoing need, and as widely used it requires that quality and safety should be ensured to avoid, in particular, the transmission of diseases. It must be a custom treatment. Nursing roles are particularly important as the care required. The aim of this study is to determine the variability of nursing skills on the extraction of pre-transfusion samples and administration of blood products. Anonymous questionnaires were sent out on-line for subsequent filling and 180 nursing professionals participated. 74.4% of nurses said that blood transfusion can only be administered simultaneously with normal saline, 56.1% reported that each transfused packed red blood cells increases hemoglobin 1 g / dl. We found a consensus among the scientific recommendations and the responses made by different professionals, a fact that is confirmed by the low rate of adverse notifications registered in our study. The development and implementation of policy guidance regarding the administration of blood products is essential

Blood cultures ... What they tell you and what you do

Objetivo: Objetivo principal: Conocer la variabilidad práctica de los enfermeros/as (DUE´s) del Hospital General Nuestra Señora del Prado, sobre la técnica para la extracción de hemocultivo. Objetivos específicos: Determinar las condiciones de asepsia/ esterilidad de la técnica. Establecer la utilización (desinfección, orden de llenado, volumen, cambio de aguja) de los frascos de hemocultivos. Método: Estudio descriptivo transversal realizado en el Hospital General Nuestra Señora del Prado. Ha consistido en la entrega de un cuestionario para autocumplimentación a los profesionales de enfermería, donde se han incluido variantes tanto cuantitativas como cualitativas. Resultados: Se han recogido 52,9% encuestas de los 363 DUE´s del centro hospitalario, con una experiencia profesional media de 12,9 años [DE±7,9]. El 57,8% cree que no es necesario técnica estéril para el procedimiento. 94,7% utiliza un único antiséptico. 78,6% afirman que en la extracción de acceso venoso central desecha los primeros 10cc que extrae. Conclusiones: Consideramos un alto índice de respuesta, ya que es superior al 40% para cuestionarios autocumplimentados. Hemos observado que la mayoría de DUE´s utilizan técnica aséptica y en los protocolos estudiados no existe un consenso entre la utilización de técnica estéril y aséptica. Este estudio nos revela que la mayoría de los Enfermería Global Nº 26 Abril 2012 Página 147 DUE´s utilizan un único antiséptico, sin embargo la mayoría de los protocolos recomiendan la utilización primero de alcohol y luego povidona yodada para la desinfección de la piel.ABSTRACT Aims: Main aim: To ascertain differences in nurses at the Hospital General Nuestra Señora del Prado, in blood extraction and blood culture techniques. Specific aims: To determine the asepsis/sterility conditions of the technique; to establish the use (disinfection, filling order, volume, needle change) of the blood culture vials. Method: Transversal descriptive study made at the Hospital General Nuestra Señora del Prado. A self-completion questionnaire including quantitative and qualitative variants was delivered to nursing professionals. Results: 52.9% of the questionnaires were collected from the 363 DUE´s at the hospital. Mena working experience was 12.9 years [DE±7,9]. 57,8% believe sterile technique for the procedure was not necessary. 94.7% use a single antiseptic. 78.6% stated that they discard the first 10 cc extracted from the central vein. Conclusions: We consider that the response is high, with over 40% of the questionnaires being completed. We observed that most DUE´s use aseptic techniques and in the protocols studied there was no consensus about the use of sterilization and septic techniques. The study reveals that the majority of the DUE´s use a single antiseptic, even though most protocols recommend the use of alcohol, followed by povidone.iodine to disinfect the skin

Low-temperature, shallow-water hydrothermal vent mineralization following the recent submarine eruption of Tagoro volcano (El Hierro, Canary Islands)

Hydrothermal iron (Fe)-rich sediments were recovered from the Tagoro underwater volcano (Central Atlantic) that formed during the 2011–2012 volcanic event. Cruises in 2012 and 2014 enabled the monitoring and sampling of the early-stage establishment of a hydrothermal system. Degassing vents produced acoustic flares imaged on echo-sounders in June 2012, four months after the eruption. A novel hydrothermal vent system was discovered and sampled in 2014 during a ROV dive. The system is characterized by hornito-like structures and chimneys showing active CO2 degassing and anomalous temperatures at 120–89 m water depth, and along the SE flank at 215-185 m water depth associated with secondary cones. Iron- and silica-rich gelatinous deposits pooled over and between basanite in the hornitos, brecciated lavas, and lapilli. The low temperature, shallow-water hydrothermal system was discovered by the venting of Fe-rich fluids that produced a seafloor draped by extensive Fe-flocculate deposits precipitated from the neutrally buoyant plumes located along the oxic/photic zone at 50-70 m water depths. The basanite is capped by mm- to cm-thick hydrothermally derived Fe-oxyhydroxide sediment, and contains micro-cracks and degasification vesicles filled by sulfides (mostly pyrite). Mineralogically, the Fe-oxyhydroxide sediment consists of proto-ferrihydrite and ferrihydrite with scarce pyrite at their base. The Fe-rich endmember contains low concentrations of most trace elements in comparison with hydrogenetic ferromanganese deposits, and the sediments show some dilution of the Fe oxyhydroxide by volcanic ash. The Fe-oxyhydroxide phase, with a mean particle size of 3–4 nm, low average La/Fe ratios of the mineralized deposits from the various sampling sites, and the positive Eu anomalies indicate rapid deposition of the Fe oxyhydroxide near the hydrothermal vents. Electron microprobe studies show the presence of various organomineral structures, mainly twisted stalks and sheaths covered by iron-silica deposits within the mineralized samples, reflecting microbial iron-oxidation from the hydrothermal fluids. Sequencing of 16 s rRNA genes also reveals the presence of other microorganisms involved in sulfur and methane cycles. Samples collected from hornito chimneys contain silicified microorganisms coated by Fe-rich precipitates. The rapid silicification may have been indirectly promoted by microorganisms acting as nucleation sites. We suggest that this type of hydrothermal deposit might be more frequent than presently reported to occur in submarine volcanoes. On a geological scale, these volcanic eruptions and low-temperature hydrothermal vents might contribute to increased dissolved metals in seawater, and generate considerable Fe-oxyhydroxide deposits as identified in older hot-spot seamounts

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients