Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/etiología , Terapia Antirretroviral Altamente Activa/efectos adversos , Herpes Zóster/etiología , Meningitis Criptocócica/etiología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adulto , Antifúngicos/uso terapéutico , Linfocitos T CD8-positivos/inmunología , Susceptibilidad a Enfermedades , Fluconazol/uso terapéutico , Herpesvirus Humano 3/fisiología , Humanos , Masculino , Meningitis Criptocócica/tratamiento farmacológico , Riesgo , Activación Viral/efectos de los fármacosAsunto(s)
Miositis/tratamiento farmacológico , Miositis/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Adulto , Antibacterianos/uso terapéutico , Humanos , Masculino , Miositis/etiología , Infecciones Estafilocócicas/etiología , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
OBJECTIVES: To compare the incidence, mortality, clinical characteristics and outcome between bacteraemias in diabetic and non-diabetic patients. METHODS: A prospective study of all adult patients with bacteraemia admitted to a large Spanish teaching hospital during six consecutive years (1984-1990); 152 were diabetics and 1488 non-diabetics. RESULTS: Rates per 1000 admissions when bacteraemic diabetic patients were compared with non-diabetics (p < 0.001) were respectively as follows: incidence 26.8/15.5, acquisition in the community 18.4/6.2, urinary tract source 8.7/2.2, and E. coli aetiology 8.9/3.4. Diabetes mellitus type II was found in 138 episodes. Glycosylated haemoglobin levels were 13 +/- 3%. Bacteraemia developed in association with hyperosmolar status in 14.5% of patients and with ketoacidosis in 5%. Patients in the diabetic group developed septic shock in 22% of the episodes, acute renal failure in 40%, superinfections in 22% and had an inappropriate empirical antibiotic treatment in 6%, vs 15.6%, 20%, 11% and 25% respectively of the non-diabetic bacteraemic patients (p < 0.05 for all comparisons). Overall mortality and bacteraemia-related mortality were similar in both groups. Multivariate analysis showed that the association with fatal diseases, shock and renal insufficiency negatively influenced the outcome of diabetic patients, while the nephro-urologic source and an appropriate therapy were accompanied by a better prognosis. CONCLUSIONS: A higher incidence of bacteraemia, mainly of urinary source, community-acquired, and due to E. coli was found in the diabetic patients compared to non-diabetics. The common use of rapidly effective drugs for this predominant bacteraemia conditioned similar outcome and prognosis factors in both populations, in spite of the higher incidence of septic shock and acute renal failure in the diabetic population.
Asunto(s)
Bacteriemia/complicaciones , Complicaciones de la Diabetes , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/mortalidad , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Cetoacidosis Diabética/complicaciones , Infecciones por Escherichia coli/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Infecciones Urinarias/complicacionesRESUMEN
OBJECTIVES: We prospectively investigated 274 consecutive Staphylococcus aureus septicaemias in adult patients between January 1983 and December 1989 to evaluate outcome in hospital acquired and community acquired episodes. METHODS: Epidemiologic, clinical, laboratory and therapeutic parameters were analyzed with univariate and multivariate statistical tests. RESULTS AND CONCLUSIONS: Ninety episodes of Staphylococcus aureus bacteraemia were acquired in the community and 184 in hospital. Diabetes mellitus and renal failure were accompanied by a clear increase in bacteraemia related death in the community-acquired category. Correct antibiotic therapy showed a better response in the community-acquired group. Bacteraemia related death was 22.6% for episodes acquired in the hospital and 18.8% for those originating in the community.