RESUMEN
BACKGROUND: The first wave of the COVID-19 pandemic confronted healthcare systems around the world with unprecedented organizational challenges, particularly regarding the availability of intensive care unit (ICU) beds. One strategy implemented in France to alleviate healthcare pressure during the first COVID-19 wave was inter-hospital transfers of selected ICU patients from overwhelmed areas towards less saturated ones. At the time, the impact of this transfer strategy on patient mortality was unknown. We aimed to compare in-hospital mortality rates among ICU patients with COVID-19 who were transferred to another healthcare facility and those who remained in the hospital where they were initially admitted to. METHOD: A prospective observational study was performed from 1 March to 21 June 2020. Data regarding hospitalized patients with COVID-19 were collected from the Ministry of Health-affiliated national SI-VIC registry. The primary endpoint was in-hospital mortality. RESULTS: In total, 93,351 hospital admissions of COVID-19 patients were registered, of which 18,348 (19.6%) were ICU admissions. Transferred patients (n = 2228) had a lower mortality rate than their non-transferred counterparts (n = 15,303), and the risk decreased with increasing transfer distance (odds ratio (OR) 0.7, 95% CI: 0.6-0.9, p = 0.001 for transfers between 10 and 50 km, and OR 0.3, 95% CI: 0.2-0.4, p < 0.0001 for transfer distance > 200 km). Mortality decreased overall over the 3-month study period. CONCLUSIONS: Our study shows that the mortality rates were lower for patients with severe COVID-19 who were transferred between ICUs across regions, or internationally, during the first pandemic wave in France. However, the global mortality rate declined overall during the study. Transferring selected patients with COVID-19 from overwhelmed regions to areas with greater capacity may have improved patient access to ICU care, without compounding the short-term mortality risk of transferred patients.
RESUMEN
Scedosporium apiospermum is a ubiquitous filamentous fungus, commonly found in soil, sewage and polluted waters. It is rarely pathogenic but can cause a broad spectrum of clinical diseases, which can be localised or disseminate to distant organs. The disseminated form of the disease is mostly seen among immunocompromised patients. However, some rare cases of disseminated disease have been reported in immunocompetent individuals. Treatment of these infections is challenging because of their natural resistance to many antifungal agents. Here, we report the case of a 57-year-old immunocompetent patient diagnosed with femoral pseudarthrosis due to S. apiospermum, despite having no obvious clinical sign of infection. Previously, the patient had undergone four iterative femoral surgeries following a road traffic accident which occurred 20 years before. During its last surgery for pseudarthrosis, no clinical or biological signs of infection were present. Per operative samples tested positive for S. apiospermum. The patient was successfully treated with oral voriconazole during 6 months with an excellent tolerance. We also provide a review of literature on bone and joint infections due to Scedosporium spp. (S. apiospermum, Scedosporium boydii and Scedosporium aurantiacum), discussing the evolution of their management and outcome which seems to improve since the use of voriconazole.
Asunto(s)
Fémur/microbiología , Inmunocompetencia , Seudoartrosis/diagnóstico , Seudoartrosis/tratamiento farmacológico , Scedosporium/aislamiento & purificación , Antifúngicos/uso terapéutico , Tratamiento Conservador/métodos , Manejo de la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Seudoartrosis/microbiología , Scedosporium/patogenicidad , Resultado del Tratamiento , Triazoles/uso terapéutico , Voriconazol/uso terapéuticoRESUMEN
Pyoderma gangrenosum, severe acne, and suppurative hidradenitis (PASH) syndrome can prove refractory to treatment and is characterized by relapses and recurrences. The combination of antibiotic therapy and surgery can produce success in the management of the syndrome. Acute treatment is required, but maintenance therapy is also necessary to prevent disease relapse. The response to antibiotic therapy is hypothesis generating, raising the issue of a modified host response. To date, anecdotal reports support the use of surgery and medical therapy, but controlled investigations with extended follow-up are necessary to substantiate preliminary data observed with individual cases.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Antibacterianos/uso terapéutico , Sistemas de Liberación de Medicamentos/métodos , Hidradenitis Supurativa/tratamiento farmacológico , Piodermia Gangrenosa/tratamiento farmacológico , Acné Vulgar/complicaciones , Acné Vulgar/diagnóstico , Acné Vulgar/cirugía , Adulto , Terapia Combinada , Femenino , Estudios de Seguimiento , Hidradenitis Supurativa/complicaciones , Hidradenitis Supurativa/diagnóstico , Hidradenitis Supurativa/cirugía , Humanos , Masculino , Microbiota/efectos de los fármacos , Piodermia Gangrenosa/complicaciones , Piodermia Gangrenosa/diagnóstico , Piodermia Gangrenosa/cirugía , Muestreo , Índice de Severidad de la Enfermedad , Piel/efectos de los fármacos , Piel/microbiología , Síndrome , Resultado del Tratamiento , Adulto JovenAsunto(s)
Aspergilosis/patología , Enfermedades Óseas Infecciosas/patología , Inmunocompetencia , Anciano , Aspergilosis/inmunología , Aspergilosis/microbiología , Aspergillus/aislamiento & purificación , Enfermedades Óseas Infecciosas/inmunología , Enfermedades Óseas Infecciosas/microbiología , Humanos , MasculinoRESUMEN
We report two cases of invasive infections due to Geosmithia argillacea, an emerging mold, in patients with chronic granulomatous disease receiving prolonged azole antifungal prophylaxis. One patient died despite receiving a combination of four antifungals, and the other developed cerebral and medullary lesions under a combination of caspofungin, posaconazole, terbinafine, and gamma interferon.
Asunto(s)
Antifúngicos/administración & dosificación , Azoles/administración & dosificación , Quimioprevención/métodos , Eurotiales/aislamiento & purificación , Enfermedad Granulomatosa Crónica/tratamiento farmacológico , Micosis/diagnóstico , Absceso/microbiología , Adolescente , Adulto , Caspofungina , ADN de Hongos/química , ADN de Hongos/genética , ADN Espaciador Ribosómico/química , ADN Espaciador Ribosómico/genética , Equinocandinas/administración & dosificación , Eurotiales/clasificación , Resultado Fatal , Femenino , Enfermedad Granulomatosa Crónica/complicaciones , Histocitoquímica , Humanos , Interferón gamma/administración & dosificación , Lipopéptidos , Masculino , Microscopía , Datos de Secuencia Molecular , Micosis/microbiología , Naftalenos/administración & dosificación , Análisis de Secuencia de ADN , Terbinafina , Triazoles/administración & dosificaciónRESUMEN
BACKGROUND: Antibiotics have been shown to improve hidradenitis suppurativa (HS) patients but complete remission is rare using these treatments. OBJECTIVE: To assess the efficacy and safety of a combination of oral rifampin, moxifloxacin and metronidazole in long-lasting refractory HS. METHODS: We retrospectively studied 28 consecutive HS patients including 6, 10 and 12 Hurley stage 1, 2 and 3 patients, respectively. Complete remission, defined as a clearance of all inflammatory lesions including hypertrophic scars, was the main outcome criterion of the study. RESULTS: Complete remission was obtained in 16 patients, including 6/6, 8/10 and 2/12 patients with Hurley stage 1, 2 and 3, respectively (p=0.0004). The median duration of treatment to obtain complete remission was 2.4 (range 0.9-6.5) and 3.8 months (range 1.6-7.4) in stage 1 and 2 patients, respectively, and 6.2 and 12 months in the 2 stage 3 patients. Main adverse events of the treatments were gastrointestinal disorders (64% of patients) and vaginal candidiasis (35% of females). Reversible tendinopathy and hepatitis occurred in 4 and 1 patient, respectively. CONCLUSIONS: Complete remission of refractory HS can be obtained using broad-spectrum antibiotics and Hurley staging is a prognostic factor of response to the treatment.