A Large Multicenter Prospective Study of Community-Onset Healthcare Associated Bacteremic Urinary Tract Infections in the Era of Multidrug Resistance: Even Worse than Hospital Acquired Infections?

Introduction: Healthcare-associated (HCA) infections represent a growing public health problem. The aim of this study was to compare community-onset healthcare associated (CO-HCA) bacteremic urinary tract infections (BUTI) and hospital-acquired (HA)-BUTI with special focus on multidrug resistances (MDR) and outcomes. Methods: ITUBRAS-project is a prospective multicenter cohort study of patients with HCA-BUTI. All consecutive hospitalized adult patients with CO-HCA-BUTI or HA-BUTI episode were included in the study. Exclusion criteria were: patients < 18 years old, non-hospitalized patients, bacteremia from another source or primary bacteremia, non-healthcare-related infections and infections caused by unusual pathogens of the urinary tract. The main outcome variable was 30-day all-cause mortality with day 1 as the first day of positive blood culture. Logistic regression was used to analyze factors associated with clinical cure at hospital discharge and with receiving inappropriate initial antibiotic treatment. Cox regression was used to evaluate 30-day all-cause mortality. Results: Four hundred forty-three episodes were included, 223 CO-HCA-BUTI. Patients with CO-HCA-BUTI were older (p < 0.001) and had more underlying diseases (p = 0.029) than those with HA-BUTI. The severity of the acute illness (Pitt score) was also higher in CO-HCA-BUTI (p = 0.026). Overall, a very high rate of MDR profiles (271/443, 61.2%) was observed, with no statistical differences between groups. In multivariable analysis, inadequate empirical treatment was associated with MDR profile (aOR 3.35; 95% CI 1.77–6.35), Pseudomonas aeruginosa (aOR 2.86; 95% CI 1.27–6.44) and Charlson index (aOR 1.11; 95% CI 1.01–1.23). Mortality was not associated with the site of acquisition of the infection or the presence of MDR profile. However, in the logistic regression analyses patients with CO-HCA-BUTI (aOR 0.61; 95% CI 0.40–0.93) were less likely to present clinical cure. Conclusion: The rate of MDR infections was worryingly high in our study. No differences in MDR rates were found between CO-HCA-BUTI and HA-BUTI, in the probability of receiving inappropriate empirical treatment or in 30-day mortality. However, CO-HCA-BUTIs were associated with worse clinical cure. © 2021, The Author(s)

Dietary knowledge: a comparative study between health professionals and the general population

Fundamento: determinar el grado de conocimiento de los profesionales sanitarios en formación en relación al contenido en sal y colesterol de diversos alimentos, comparándolos con un grupo perteneciente a la población general. Métodos: estudio transversal realizado en la Ciudad Sanitaria y Universitaria de Bellvitge (Barcelona). Se entrevistaron 106 médicos residentes (66% del total de los sujetos potencialmente elegibles) y 71 estudiantes de Medicina (42%), que colaboraron voluntariamente en el estudio. Para el grupo perteneciente a la población general se escogieron 53 pacientes, que acudieron a consultas externas del hospital mediante muestreo aleatorio sistemático. Resultados: el estudio consistió en la autocumplimentación de un cuestionario sobre el contenido (alto o bajo) en sal y colesterol de una serie de variables alimentarias. Se encontraron diferencias estadísticamente significativas (p<O.OOl) cuando se compararon las medias de aciertos totales entre los profesionales sanitarios y la población general, aunque en muchos casos el porcentaje de aciertos no superó el 60%. Conclusiones: si bien el conocimiento sobre el contenido en colesterol y sal de la dieta entre los profesionales sanitarios es superior al de la población general, es necesaria una mejor y más continua formación en esta materia

Guia per a l'abordatge de la insuficiència cardíaca

Insuficiència cardíaca; Tractament; RecomanacionsInsuficiencia cardíaca; Tratamiento; RecomendacionesHeart failure; Treatment; RecommendationsAquest document aporta una revisió acurada del coneixement científic actualment disponible sobre la insuficiència cardíaca, i el tradueix en recomanacions per a la pràctica diària. Pel seu contingut docent, la Guia constitueix també un valuós document per facilitar l’adquisició de competències clíniques que ha de caracteritzar el desenvolupament dels professionals de l’Institut Català de la Salut