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OBJECTIVE: The aim of the study was to analyze predictive factors of bacteraemia in patients seen in the emergency department (ED) for an episode of infectious disease. METHODS: Observational, retrospective and descriptive analytical study of all blood cultures extracted in an ED in adult patients (≥ 18 years) seen in ED due to infec-tious disease from 1-1-2019 to 1-7-2019. The follow-up was carried out during 30 days. Thirty-eight variables for predicting bacteraemia were assessed. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Univariate and multivariate logistic regression analysis was performed. RESULTS: A total of 1,425 blood cultures were finally enrolled in the study. Of those were considered true bacteremia 179 (12.6 %) and as negative blood cultures 1,246 (87.4 %). Amongst negatives, 1,130 (79.3%) without growth and 116 (8.1%) as contaminants blood cultures. Five variables were significantly associated with true bacteraemia: serum procalcitonin (PCT) ≥ 0.51 ng/ml [odds ratio (OR): 4.52; 95% confidence interval (CI): 4.20-4.84, P <.001], temperature > 38.3°C [OR:1.60; 95% CI:1.29-1.90, P <.001], systolic blood pressure (SBP) < 100 mmHg [OR:3.68; 95% CI:2.78-4.58, P <.001], septic shock [OR:2.96; 95% CI:1.78-4.13, P <.001] and malignancy [OR:1.73; 95% CI:1.27-2.20, P <.001]. CONCLUSIONS: Several factors evaluated in an initial assessment in the ED, including serum PCT, temperature, hypotension (with/without septic shock) and being malignancy, were found to predict true bacteraemia.

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Introducción: El objetivo del estudio fue analizar y comparar la capacidad de la procalcitonina (PCT) y proteína C reactiva (PCR) para detectar meningitis bacteriana (MB) y para predecir la existencia de bacteriemia. Métodos: Estudio observacional, prospectivo, descriptivo y analítico de pacientes adultos (≥ 15 años) diagnosticados de meningitis aguda (MA) en un servicio de urgencias (SU) desde agosto de 2009 hasta julio de 2013. Resultados: Se incluyeron 98 casos diagnosticados de MA con una edad media de 44 ± 21 años, el 67% varones (66). De ellos 38 fueron MB (20 con bacteriemia), 33 meningitis virales (MV), 15 probable MV y 12 posibles MA decapitadas. La PCT obtiene la mayor área bajo la curva ROC (ABC-ROC), de 0,996 (IC 95%:0,987-1, p < 0,001) y con un punto de corte ≥ 0,74 ng/ml se consigue una sensibilidad del 94,7%, especificidad del 100%, un VPN de 93,9% y un VPP del 100%. Los valores medios al comparar la PCT en MB y MV fueron 11,47 ± 7,76 vs. 0,10 ± 0,15 ng/ml, p < 0,001. La PCR consigue un ABC-ROC de 0,916 y con punto de corte ≥ 90 mg/L una sensibilidad de 67,5%, especificidad de 86,3%, VPP 89,2% y VPN: 90,4%. Para la predicción de bacteriemia en las MB solo la PCT consigue diferencias significativas (14,7 ± 7,1vs. 4,68 ± 3,54 ng/ml, p < 0,001) y con un PC de 1,1 ng/ml una sensibilidad de 94,6%, especificidad 72,4%, VPN 95,4% y VPP 69,2% y un ABC de 0,965 (IC 95%: 0,921-1, p < 0,001). Conclusiones: En los pacientes con MA en SU la PCT consigue un gran rendimiento diagnóstico para sospechar la etiología bacteriana, mayor que la PCR, y para predecir la existencia de bacteriemia en las MB

Introduction: The aim of this study was to analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis and predicting bacteraemia. Methods: Prospective, observational, and descriptive analytical study of 98 consecutive patients aged ≥ 15 years and diagnosed with acute meningitis in an emergency department between August 2009 and July 2013. Results: We analysed 98 patients with AM (66 males [67%]); mean age was 44 ± 21 years. The diagnosis was bacterial meningitis in 38 patients (20 with bacteraemia); viral meningitis in 33; probable viral meningitis in 15; and presumptively diagnosed partially treated acute meningitis in 12. PCT had the highest area under the ROC curve (AUC) (0.996; 95% CI, 0.987-1; p < 0 .001). With a cutoff of ≥ 0.74 ng/ml, PCT achieved 94.7% sensitivity, 100% specificity, negative predictive value (NPV) of 93.9%, and positive predictive value (PPV) of 100%. The mean levels for PCT were11.47 ± 7.76 ng/ml in bacterial meningitis vs. 0.10 ± 0.15 ng/ml in viral meningitis (p <0.001). The AUC for CRP was 0.916 and a cutoff of ≥ 90 mg/L achieved 67.5% sensitivity, 86.3% specificity, PPV of 89.2%, and NPV of 90.4%. As a predictor of bacteraemia in bacterial meningitis, only PCT delivered a significant difference (14.7 ± 7.1 ng/mL vs. 4.68 ± 3.54 ng/mL, p < 0 .001). A cutoff of ≥ 1.1 ng/mL achieved 94.6% sensitivity, 72.4% specificity, NPV of 95.4%, and PPV of 69.2%; the AUC was 0.965 (95% CI, 0.921-1; p < 0 .001). Conclusions: PCT has a high diagnostic power for acute meningitis in emergency department patients. PCT outperforms CRP in the detection of bacterial aetiology and is a good predictor of bacteraemia in bacterial meningitis

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INTRODUCTION: The aim of this study was to analyse and compare procalcitonin (PCT) and C-reactive protein (CRP) as tools for detecting bacterial meningitis and predicting bacteraemia. METHODS: Prospective, observational, and descriptive analytical study of 98 consecutive patients aged ≥15 years and diagnosed with acute meningitis in an emergency department between August 2009 and July 2013. RESULTS: We analysed 98 patients with AM (66 males [67%]); mean age was 44±21 years. The diagnosis was bacterial meningitis in 38 patients (20 with bacteraemia); viral meningitis in 33; probable viral meningitis in 15; and presumptively diagnosed partially treated acute meningitis in 12. PCT had the highest area under the ROC curve (AUC) (0.996; 95% CI, 0.987-1; p<0.001). With a cutoff of ≥ 0.74 ng/ml, PCT achieved 94.7% sensitivity, 100% specificity, negative predictive value (NPV) of 93.9%, and positive predictive value (PPV) of 100%. The mean levels for PCT were11.47±7.76 ng/ml in bacterial meningitis vs. 0.10±0.15 ng/ml in viral meningitis (p <0.001). The AUC for CRP was 0.916 and a cutoff of ≥ 90 mg/L achieved 67.5% sensitivity, 86.3% specificity, PPV of 89.2%, and NPV of 90.4%. As a predictor of bacteraemia in bacterial meningitis, only PCT delivered a significant difference (14.7±7.1 ng/mL vs. 4.68±3.54 ng/mL, p<0.001). A cutoff of ≥ 1.1 ng/mL achieved 94.6% sensitivity, 72.4% specificity, NPV of 95.4%, and PPV of 69.2%; the AUC was 0.965 (95% CI, 0.921-1; p<0.001). CONCLUSIONS: PCT has a high diagnostic power for acute meningitis in emergency department patients. PCT outperforms CRP in the detection of bacterial aetiology and is a good predictor of bacteraemia in bacterial meningitis.

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Introducción: El objetivo del estudio fue analizar y comparar la capacidad de la procalcitonina (PCT), proteína C reactiva (PCR), lactato y leucocitos para predecir la existencia de bacteriemia en los pacientes con infección del tracto urinario (ITU). Métodos: Estudio observacional, retroprospectivo y analítico de pacientes adultos (≥ 15 años) diagnosticados de ITU en un servicio de urgencias desde agosto de 2012 hasta enero de 2013. Resultados: Se incluyeron 328 casos diagnosticados de ITU con una edad media de 52 ± 22 años, el 74% mujeres. De ellos 43 (13,1%) con bacteriemia. Para predecir bacteriemia la PCT obtiene la mayor área bajo la curva ROC (ABC-ROC), de 0,993 (IC 95%: 0,987-1, p < 0,001) y con un punto de corte ≥ 1,16 ng/ml se consigue una sensibilidad del 100%, especificidad del 97%, un valor predictivo positivo de 84% y un valor predictivo negativo del 100%. El lactato consigue un ABC-ROC de 0,844 y la PCR solo de 0,534. Los valores medios al comparar la PCT en pacientes con ITU con/sin bacteriemia fueron 8,08 ± 16,37 vs 0,34 ± 0,37 ng/ml, p < 0,001. Conclusiones: En los pacientes con ITU en el servicio de urgencias la PCT consigue un gran rendimiento diagnóstico para sospechar bacteriemia, mayor que el lactato, la PCR y los leucocitos

Introduction: The aim of this study was to analyze and compare the capacity of procalcitonin (PCT), C-reactive protein (CRP), lactate and leukocytes to predict the presence of bacteremia in patients with urinary tract infections (UTIs). Methods: Observational, retro-prospective analytical study of adult patients (≥15 years) diagnosed with UTI in an emergency department from August 2012 to January 2013. Results: The study included 328 patients diagnosed with UTI, with a mean age of 52 ± 22 years, 74% of whom were women. Of these, 43 (13.1%) had bacteremia. For predicting bacteremia, PCT achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at .993 (95% CI .987-1; P < .001). A cutoff ≥ 1.16 ng/mL achieves a sensitivity of 100%, a specificity of 97%, a positive predictive value of 84% and a negative predictive value of 100%. Lactate achieved an ROC-AUC of .844, and CRP achieved only .534. The mean values when comparing PCT levels in patients with UTIs with and without bacteremia were 8.08 ± 16.37 and .34 ± .37 ng/mL, respectively (P < .001). Conclusions: For patients with UTIs in the emergency department, PCT achieves considerable diagnostic performance for suspecting bacteremia, a performance greater than that of lactate, CRP and leukocytes

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INTRODUCTION: The aim of this study was to analyze and compare the capacity of procalcitonin (PCT), C-reactive protein (CRP), lactate and leukocytes to predict the presence of bacteremia in patients with urinary tract infections (UTIs). METHODS: Observational, retro-prospective analytical study of adult patients (≥15 years) diagnosed with UTI in an emergency department from August 2012 to January 2013. RESULTS: The study included 328 patients diagnosed with UTI, with a mean age of 52±22 years, 74% of whom were women. Of these, 43 (13.1%) had bacteremia. For predicting bacteremia, PCT achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at .993 (95% CI .987-1; P<.001). A cutoff≥1.16ng/mL achieves a sensitivity of 100%, a specificity of 97%, a positive predictive value of 84% and a negative predictive value of 100%. Lactate achieved an ROC-AUC of .844, and CRP achieved only .534. The mean values when comparing PCT levels in patients with UTIs with and without bacteremia were 8.08±16.37 and .34±.37ng/mL, respectively (P<.001). CONCLUSIONS: For patients with UTIs in the emergency department, PCT achieves considerable diagnostic performance for suspecting bacteremia, a performance greater than that of lactate, CRP and leukocytes.

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INTRODUCTION: The creation of a Nutrition Unit (NU), with a specialized professional establishing homogenous criteria and standardized proceedings for the use of parenteral nutrition (PN) may improve the clinical course of the patients and decrease the number of technique-related complications. OBJECTIVES: To describe the clinical characteristics of the patients submitted to PN at our Center. To assess the effect that the implementation of a NU has on the patients clinical course, and to know the frequency of mortality and hospital stay duration after the implementation of the NU at the University Hospital Complex of Albacete. MATERIAL AND METHODS: We reviewed the clinical charts of the patients receiving PN during the two years before and the two years after the creation of the NU by means of a two-period cohort study. RESULTS: Of the 390 patients, 100 belonged to the cohort before the NU and 290 to the following cohort. 61.3% of the patients were admitted at the surgery department. 25% of the patients had a personal history of digestive pathology. Among the reasons for ordering PN to the NU, surgical complications were the most common (66.7%). Oncologic abdominal surgery was the most common category (39.3%) out of the six in which the patients have been categorized. The mortality rate for the first cohort was 29% and for the second cohort 12.8% (p < 0,00). The average of stay days for the first cohort was 29.53 days and 27.67 days for the second one (p = 0.41). CONCLUSIONS: The implementation of a NU has a positive impact on the clinical course of hospitalized patients submitted to PN.

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Introducción: La creación de una Unidad de Nutrición (UN), con un especialista en la materia que establezca criterios homogéneos y procedimientos estandarizados de uso de la nutrición parenteral (NP) puede mejorar el curso clínico de los pacientes y disminuir las complicaciones relacionadas con la técnica. Objetivos: Describir las características clínicas de los pacientes sometidos a NP en nuestro centro. Evaluar el efecto que la introducción de una UN tiene en el curso clínico de los pacientes y conocer la frecuencia de mortalidad y duración la estancia tras la introducción de una UN en el Complejo Hospitalario Universitario de Albacete. Material y métodos: Se estudiaron las historias clínicas de los pacientes que recibieron NP durante los dos años previos y los dos años posteriores a la creación de la UN mediante un estudio de cohortes con doble temporalidad. Resultados: De 390 pacientes, 100 pertenecen a la cohorte previa a la UN y 290 a la posterior. Un 61,3% de los pacientes estaban ingresados en cirugía. Un 25% de los pacientes presentaba antecedentes de patología digestiva. Respecto a los motivos por los que se solicitó la NP a la UN, las complicaciones quirúrgicas fueron los más frecuentes (66,7%). La cirugía abdominal tumoral fue la categoría más frecuente (39,3%) de las seis en las que se han clasificado a los pacientes. La mortalidad en la primera cohorte fue 29% y en la segunda 12.8% (p < 0,00). 29,53 días fue la media de los días de estancia en la primera cohorte y 27,67 días en la segunda (p = 0,41). Conclusiones: La introducción de una UN tiene un impacto positivo en la evolución de los pacientes hospitalizados sometidos a NP (AU)

Introduction: The creation of a Nutrition Unit (NU), with a specialized professional establishing homogenous criteria and standardized proceedings for the use of parenteral nutrition (PN) may improve the clinical course of the patients and decrease the number of technique-related complications. Objectives: To describe the clinical characteristics of the patients submitted to PN at our Center. To assess the effect that the implementation of a NU has on the patients clinical course, and to know the frequency of mortality and hospital stay duration after the implementation of the NU at the University Hospital Complex of Albacete. Material and methods: We reviewed the clinical charts of the patients receiving PN during the two years before and the two years after the creation of the NU by means of a two-period cohort study. Results: Of the 390 patients, 100 belonged to the cohort before the NU and 290 to the following cohort. 61.3% of the patients were admitted at the surgery department. 25% of the patients had a personal history of digestive pathology. Among the reasons for ordering PN to the NU, surgical complications were the most common (66.7%). Oncologic abdominal surgery was the most common category (39.3%) out of the six in which the patients have been categorized. The mortality rate for the first cohort was 29% and for the second cohort 12.8% (p < 0,00). The average of stay days for the first cohort was 29.53 days and 27.67 days for the second one (p = 0.41). Conclusions: The implementation of a NU has a positive impact on the clinical course of hospitalized patients submitted to PN (AU)

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