[Translated article] Retrospective study of home antibiotic infusion therapy using elastomeric infusion pumps

OBJECTIVES

To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalisation Unit of a tertiary hospital for 3 years and to analyse clinical evolution and mortality.

METHOD

Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received, and clinical evolution. Statistical analysis was performed using SPSS® 19 software.

RESULTS

81 patients were included, 61.7% men, with a mean age of 73.5±17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9±8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p=.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p=.04) were associated with worse clinical outcome. Age over 80 years was associated with better outcome (p=.03). The diagnosis of heart failure was associated with higher mortality (p=.026) and patients from surgical services, with lower mortality (p=.047). In the multivariate analysis, the presence of neoplasia was associated with unfavourable evolution (p=.012) and heart failure with higher mortality (p=.027).

CONCLUSIONS

Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.

BCGitis with aortoiliac aneurysm involvement: Report of two cases and review of the literature

BCGitis is a rare complication after intravesical administration of Bacillus Calmette-Guérin for high-grade superficial bladder cancer and carcinoma in situ. May cause vascular involvement. We present 2 cases and a review of the literature of the case reports pubished on the 10 years prior to April of 2022, when this proyect was finished, which described a case of aortoiliac mycotic aneurysm after receiving this treatment. Of the 51 cases included (49 revised and 2 original), 100% were men, 82% were older than 65 years. The median latency period was 15 months (IQR 18). The most frequent location was the abdominal aorta, rupture occurred in 45,1% of patients. The most frequent symptom was abdominal or lumbar pain (61%), followed by general syndrome (49%). In 39,2% cases, it was associated with retroperitoneal abscesess. Attributable mortality was 13,6%. BCGitis should be included in the differential diagnosis in patients who have received BCG therapy and present vascular involvement, even years after being treated.

Retrospective study of home antibiotic infusion therapy in elastomeric infusion pumps

OBJECTIVES

To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalization Unit of a tertiary hospital for three years and to analyse clinical evolution and mortality.

METHOD

Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received and clinical evolution. Statistical analysis was performed using SPSS® 19 software.

RESULTS

Eighty-one patients were included, 61.7% men, with a mean age of 73.5 ± 17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9 ± 8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p = 0.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p = 0.04) were associated with worse clinical outcome. Age over 80 years was associated with better outcome (p = 0.03). The diagnosis of heart failure was associated with higher mortality (p = 0.026) and patients from surgical services, with lower mortality (p = 0.047). In the multivariate analysis, the presence of neoplasia was associated with unfavorable evolution (p = 0.012) and heart failure with higher mortality (p = 0.027).

CONCLUSIONS

Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.

Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review

OBJECTIVES

To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections.

METHODS

Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted.

RESULTS

52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001).

CONCLUSIONS

CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.

SARS-COV-2 antibodies after booster vaccination. Identification of subgroups with poor response

OBJECTIVE

To determine which patients within the high-risk group are most likely to have insufficient post-vaccination immunity.

METHODS

Determination of IgG titers against SARS-CoV-2 after the booster dose. Vaccine response was categorized as negative (IgG titers < 34 BAU/ml), indeterminate (titers 34-259 BAU/ml) or positive (≥260 BAU/ml).

RESULTS

765 patients were included (31.25% of those vaccinated). 54 (7.1%) on treatment with biologics, 90 (11.8%) with hematologic disease, 299 (39.1%) with oncologic pathology, 304 (39.7%) with solid organ transplant and 18 (2.4%) with immunosuppression for other reasons. 74 patients (9.7%) had negative serology and 45 (5.9%) had indeterminate titers. By diagnostic group, the patients with the highest proportion of negative or indeterminate serology were patients with biologic treatment (55.6%, mainly at expense of antiCD20), hematologic (35.4%) and transplant patients (17.8%, mainly lung and kidney). Oncology and other immunosuppressed patients had a favorable response to vaccination.

CONCLUSION

Patients treated with antiCD20 drugs, hematologic patients and transplanted patients (mainly lung and kidney) have a higher risk of not achieving post-vaccination immunity. It is essential to identify them in order to individualize and optimize their management.

Assessment of Post-COVID Symptoms Using the C19-YRS Tool in a Cohort of Patients from the First Pandemic Wave in Northwestern Spain

Introduction: The emergence or persistence of symptoms after acute SARS-CoV-2 infection has made it necessary to develop tools to detect them and assess their impact on patients' quality of life. One of these tools is the COVID-19 Yorkshire Rehabilitation Screening (C19-YRS) scale. We present the results of this tool in a cohort of first pandemic wave patients. Methods: A cross-sectional study of patients with confirmed SARS-CoV-2 infection from March to May 2020 in Lugo (northwestern Spain). C19-YRS was administered via phone 10 months after the acute infection to both former inpatients and outpatients. Electronic medical records were reviewed and relevant data from the acute episode were collected. The main outcome was the presence of impairment in different areas measured by the C19-YRS scale. Results: The answer rate was 63.2%. The mean age was 54 ± 16 years, 38.4% were male and 190 (42.9%) had some comorbidity. Eighty-seven patients (19.6%) required hospitalization and 10 (2.3%) required intensive care unit admission. Ten (3.5%) patients lost their job due to the pandemic. Two hundred seventy-six patients (62.3%) related any symptoms; fatigue (37.2%) and exertional dyspnea (33.4%) were the most common with significant worsening in both cases compared with the situation before the infection. Subgroup analysis showed that more symptom domains were impaired in women than men. Older patients, those with comorbidity and those who needed hospital admission, demanded more health resources after the acute infection. Discussion: C19-YRS is useful for the detection and quantification of symptoms after COVID-19 and provides relevant social, health, and occupational information.

In-hospital incidence of and risk factors for influenza-associated respiratory failure

BACKGROUND

Respiratory failure (RF) is the most important complication of influenza virus infection. Its definition and incidence are heterogeneous in the literature.

METHODS

This systematic review and meta-analysis aim to determine the incidence of and risk factors for RF in patients hospitalized with influenza. Electronic databases were searched for articles on RF in patients hospitalized for influenza infection up to December 2021 regardless of their geographical location. Observational and experimental studies were considered for inclusion, excluding case series. The Newcastle-Ottawa and Johanna Briggs scales were used for quality assessment. A random-effects meta-analysis was performed, followed by subgroup analyses according to, among others, presence/absence of pneumonia, RF definition, serotype and time period. PRISMA guidelines were followed for this review.

RESULTS

Thirty-six studies were finally included in the meta-analysis. Overall, RF incidence was 24% (range 5%-85%, 95% confidence interval [95CI] 19%-31%). Significantly higher incidences of RF were found in patients with pneumonia (42%, 95CI 28%-57%, p = .006), when RF was defined as hypoxemia (58%, 95CI 31%-81%, p < .001), and during the 2009 pandemic (25%, 95CI 16%-36%) and postpandemic period (23%, 95CI 15%-34%, p = .01). No differences were found between human influenza serotypes. Assessment of risk factors associated with the development of RF was not possible due to their inconsistent and heterogeneous reporting.

CONCLUSION

Respiratory failure is frequent in hospitalized influenza patients, especially in patients with pneumonia and since the 2009 pandemic, although its definition and reporting widely vary in the literature. This complicates its characterization and comparison between cohorts and with other respiratory viruses.

Influence of smoking history on the evolution of hospitalized in COVID-19 positive patients: results from the SEMI-COVID-19 registry

INTRODUCTION

Smoking can play a key role in SARS-CoV-2 infection and in the course of the disease. Previous studies have conflicting or inconclusive results on the prevalence of smoking and the severity of the coronavirus disease (COVID-19).

METHODS

Observational, multicenter, retrospective cohort study of 14,260 patients admitted for COVID-19 in Spanish hospitals between February and September 2020. Their clinical characteristics were recorded and the patients were classified into a smoking group (active or former smokers) or a non-smoking group (never smokers). The patients were followed up to one month after discharge. Differences between groups were analyzed. A multivariate logistic regression and Kapplan Meier curves analyzed the relationship between smoking and in-hospital mortality.

RESULTS

The median age was 68.6 (55.8-79.1) years, with 57.7% of males. Smoking patients were older (69.9 [59.6-78.0 years]), more frequently male (80.3%) and with higher Charlson index (4 [2-6]) than non-smoking patients. Smoking patients presented a worse evolution, with a higher rate of admission to the intensive care unit (ICU) (10.4 vs 8.1%), higher in-hospital mortality (22.5 vs. 16.4%) and readmission at one month (5.8 vs. 4.0%) than in non-smoking patients. After multivariate analysis, smoking remained associated with these events.

CONCLUSIONS

Active or past smoking is an independent predictor of poor prognosis in patients with COVID-19. It is associated with higher ICU admissions and in-hospital mortality.

Influence of smoking history on the evolution of hospitalized in COVID-19 positive patients: Results from the SEMI-COVID-19 registry

Introduction

Methods

Results

Conclusions

Calidad De Vida Relacionada Con La Salud En Pacientes Recuperados De Covid-19

Introducción

La presencia de síntomas tras la infección aguda por SARS-CoV-2 es frecuente y tiene impacto en la calidad de vida de los pacientes. El objetivo del estudio fue evaluar su calidad de vida después de la COVID-19 y determinar los factores de riesgo para una peor percepción de esta.

Métodos

Estudio observacional de corte transversal mediante encuesta telefónica efectuada a todos los pacientes con infección por el SARS-CoV-2 durante la primera onda epidémica tras 10 meses de seguimiento. Se excluyó a pacientes con deterioro cognitivo e institucionalizados. La principal variable evaluada fue la calidad de vida relacionada con la salud mediante la escala EQ-5D y sus índices, el EQ-EVA y el EQ-Health Index.

Resultados

Se obtuvieron un total de 443 respuestas. La media de edad de los pacientes incluidos fue 54 ± 16 años y el 38,4% de ellos fueron varones. El área más afectada fue la ansiedad/depresión (23,9%) y la movilidad (16,5%). La escala EQ-EVA global fue de 75,8 ± 18,7 y el EQ-Health Index global fue 0,884 ± 0,174. La puntuación EVA y el EQ-Health Index fueron significativamente menores en mujeres, mayores de 65 años, pacientes con comorbilidad y los que necesitaron ingreso hospitalario; estos grupos además tenían más esferas de la salud afectadas. La puntuación EVA fue más baja en la muestra que la media nacional, pero similar a la de la misma comunidad autónoma antes de la pandemia. Fueron factores de riesgo independientes para una puntuación EQ-Health Index menor el sexo femenino, haber estado ingresado y el nivel de estudios (estudios básicos).

Conclusión

Aunque la percepción de la salud tras la COVID-19 esté afectada, puede que no esté directamente relacionada con la pandemia. Existen perfiles de pacientes más susceptibles a tener una peor calidad de vida sobre los que podrían plantearse intervenciones.

Hypophonia as a sign of thalamus lesion: a case report

Hypophonia is a neurological sign usually seen after brainstem or peripheral damage, either at the recurrent laryngeal nerve or vocal cord level. However, it has been described as a sign of supratentorial strokes in a few studies, specifically when anterior and ventral thalamic involvement is reported. In addition, it is a prominent sign of other neurological disorders such as Parkinson disease and other extrapyramidal conditions. We describe a case of hypophonia secondary to a left thalamic hemorrhage, after a careful search of other potential causes of this deficit, and we discuss the underlying neuroanatomical circuits.

Mitochondrial 16S DNA variation in populations of Triatoma infestans from Argentina

Variation in the mtDNA 16S ribosomal RNA gene in populations of Triatoma infestans (Klug) was surveyed. DNA sequence comparisons yielded 18 haplotypes among 130 individuals from 16 localities that represent a large proportion of the range of T. infestans in Argentina. The most common genotype in all populations was found in 76.9% of individuals and two other haplotypes were shared among different populations. The remaining 15 haplotypes were present exclusively in one of the populations, suggesting currently low levels of genetic exchange. Analysis of mtDNA 16S sequences uncovered substantial genetic variation among T. infestans populations. Haplotype and nucleotide diversities varied among populations, from 0% to 0.84% and 0% to 0.29%, respectively. It appears that this locus has a low mutation rate. Uncorrected pairwise differences of T. infestans haplotypes ranged from 0% to 1.2%. The molecular phylogeny supported the monophyly of T. infestans haplotypes and clustered two different pairs of haplotypes with a moderate degree of bootstrap support (approximately 60%). Mitochondrial DNA phylogeographic differentiation was not evident, suggesting a recent rapid spread of the species. Analysis of molecular variance showed hierarchical structure in the data. Considerably less variation was found among T. infestans populations from the northwest and northeast regions than among those belonging to the central area. Such a lack of variation may be indicative of one or more past population bottlenecks.

Mitochondrial DNA sequences of triatomines (Hemiptera: Reduviidae): phylogenetic relationships

The phylogenetic relationships among 18 species of Triatominae were inferred based on mitochondrial DNA (mtDNA) sequences. The species of Triatoma included 11 belonging to the infestans complex [T. infestans (Klug), T. guasayana Wygodzinsky & Abalos, T. sordida (Stål), T. platensis Neiva, T. brasiliensis Neiva, T. rubrovaria (Blanchard), T. vitticeps (Stål), T. delpontei Romaña & Abalos, T. maculata (Erichson), T. patagonica Del Ponte, and T. matogrossensis Leite & Barbosa] and four others of the same genus but of different complexes [T. circummaculata (Stål), T. protracta (Uhler), T. dimidiata (Latreille), and T. mazzottii Usinger]. As possible outgroups we used Mepraia spinolai Mazza, Panstrongylus megistus (Burmeister), and Rhodnius prolixus Stål. We analyzed mtDNA fragments of the 12S and 16S ribosomal RNA genes from each of the 18 species, as well as of the cytochrome oxidase I (COI) gene from nine. The 12S, 16S, and COI gene sequences were analyzed individually and combined. All of the phylogenetic analyses unambiguously supported two clusters: one including T. infestans, T. platensis, and T. delpontei, and the other T. sordida and T. mutagrossensis. Inclusion of T. circummaculata into the infestans complex was confirmed, although this is in disagreement with the morphological classification. On the other hand, our analyses showed that T. dimidiata is closely related to a phylosoma complex species, T. mazzottii. This is consistent with the tentative classification previously made based on morphological characters. The issue of the monophyly of the genus Triatoma remains unresolved.

Characterization of the soluble guanylyl cyclase beta-subunit gene in the mosquito Anopheles gambiae

Genomic DNA corresponding to the soluble guanylyl cyclase beta-subunit (GCSbeta) gene was cloned and sequenced from Anopheles gambiae. The sequence was 8103 bp long and presumably included the entire coding region. The deduced amino acid sequence was 71% and 62% similar to previously known Drosophila and vertebrate GCSbeta, while the C-terminus of A. gambiae GCSbeta was shorter. Because of the conserved characteristics in each functional domain, the high G+C% in the third codon positions compared to the introns, the lack of internal stop codons, and the fact that we identified the gene from a cDNA, we conclude that this A. gambiae gene is functional. This is the first detailed description of a guanylyl cyclase gene structure (e.g. intron-exon boundaries). Interestingly, within the fifth intron we found high similarity to the flanking regions of the Pegasus-27 transposable element and other noncoding regions of the A. gambiae genome.

Phylogeny of species of Triatoma (Hemiptera: Reduviidae) based on mitochondrial DNA sequences

DNA sequence comparisons of 12S, 16S, and COI mitochondrial DNA (mtDNA) genes were used to infer phylogenetic relationships among 8 species of Triatoma [7 belonging to the infestans complex and T. circummaculata (Stål), a member of a different complex based on morphology]. There was remarkable mtDNA similarity between T. infestans (Klug) and T. platensis Neiva that can be explained by mtDNA introgression. Evolutionary trees were constructed using Panstrongylus megistus (Burmeister) as the outgroup. This outgroup gave evidence that the root of the group would be between T. vitticeps (Stål) and the rest of the species. The placement of T. circummaculata into the middle of the infestans complex is not consistent with the morphological classification, suggesting that the current systematics of this group does not reflect phylogenetic affinities.

Inversion monophyly in African anopheline malaria vectors

The African Anopheles gambiae complex of six sibling species has many polymorphic and fixed paracentric inversions detectable in polytene chromosomes. These have been used to infer phylogenetic relationships as classically done with Drosophila. Two species, A. gambiae and A. merus, were thought to be sister taxa based on a shared X inversion designated Xag. Recent DNA data have conflicted with this phylogenetic inference as they have supported a sister taxa relationship of A. gambiae and A. arabiensis. A possible explanation is that the Xag is not monophyletic. Here we present data from a gene (soluble guanylate cyclase) within the Xag that strongly supports the monophyly of the Xag. We conjecture that introgression may be occurring between the widely sympatric species A. gambiae and A. arabiensis and that the previous DNA phylogenies have been detecting the introgression. Evidently, introgression is not uniform across the genome, and species-specific regions, like the X-chromosome inversions, do not introgress probably due to selective elimination in hybrids and backcrosses.

Enzyme polymorphism among Triatoma infestans (Hemiptera: Reduviidae) colonies

Allozyme variability in populations of the Chagas's disease vector Triatoma infestans (Klug) was investigated by means of starch gel electrophoresis. Samples were taken from nine laboratory colonies established with individuals collected at different localities across the range of this insect in South America. Zymograms for proteins coded by a total of 17 loci were obtained. Allele frequencies, proportion of polymorphic loci (P), mean heterozygosity per locus (H), similarity (S), and identity (I) indices, genetic distance (D), and gene flow among populations were estimated. Mean values for P = 58.53% and for H = 0.095, indicating an important level of genetic variability. There was remarkable similarity among the colonies (mean I = 0.9946). Estimated gene flow among populations was high. However, on the basis of the known natural history of T. infestans, the uniformity of allele frequencies among populations may be interpreted as the result of the recent and rapid dispersal of the species from the site of origin in the Cochabamba Valley, Bolivia.

Genetic structure of four species of Triatoma (Hemiptera: Reduviidae) from Argentina

The genetic structure of Triatoma guasayana Wygodzinsky & Abalos, T. sordida (Stål), T. platensis Neiva, and T. infestans (Klug) was compared by starch gel electrophoresis. In total, 17 enzyme loci were analyzed in T. infestans and 14 loci in the other three species. Zymograms were useful in species identification. Icdh-2 and Hk-1 are diagnostic loci, and Icdh-1, Hk-2, Es-1, and Es-2 are helpful in distinguishing these species. The proportion of polymorphic loci for the four species (range, 52.9 to 58.3%) was somewhat higher than that expected from reports for other insects. Mean heterozygosity per locus (range, 0.062 to 0.156) was within the range reported for insects in the literature. The level of heterozygosity was highest for T. guasayana and lowest for T. sordida. Values of genetic distance (Nei's D), identity (Nei's I), and similarity (Rogers's S) indices indicate that the four species are well-defined taxa. T. infestans and T. platensis are the closest (D = 0.45, S = 0.62). T. guasayana and T. sordida (D = 0.77, S = 0.46) form another pair of related species.

Protein polymorphism and genetic distance in South American cricetid rodents of the genus Calomys

Allozymic variation in population samples of Calomys laucha, C. musculinus and C. venustus collected simultaneously from the province of Córdoba, Argentina, was analyzed by gel electrophoresis. These three species showed high levels of polymorphism: for C. laucha, the P value was 72.7% and the H value was 0.147 (19 loci); for C. musculinus, P = 61.9% and H = 0.149 (20 loci); for C. venustus, P = 66.7% and H = 0.146 (18 loci). These species are non-fossorial generalists, have a high reproductive rate and live in disturbed habitats. The similarity indices (S) range between 0.613 and 0.681. On the basis of genetic distance, D (between 0.354 and 0.476), divergence time was estimated to be from 6.3 to 8.5 million years (late Miocene). Even admitting some imprecision for this estimate, the remarkable differences at the structural gene level shown by the species analyzed, suggest they had an early origin.