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The aim of this review is to synthesise the key aspects of the epidemiology, current microbiological diagnostic challenges, antibiotic resistance rates, optimal antimicrobial management, and most effective prevention strategies for Stenotrophomonas maltophilia (SM) in the intensive care unit (ICU) population. In recent years, resistance surveillance data indicate that SM accounts for less than 3% of all healthcare-associated infection strains, a percentage that doubles in the case of ventilator-associated pneumonia (VAP). Interestingly, SM ranks as the third most isolated non-glucose fermenter Gram-negative bacilli (NFGNB). Although this NFGNB genus has usually been considered a bystander and colonising strain, recently published data warn about its potential role as a causative pathogen of severe infections, particularly pneumonia and bloodstream infections (BSI), not only for the classical immunocompromised susceptible host patients but also for critically ill ones even without overt immunosuppression. Indeed, it has been associated with crude 28-day mortality as high as 54.8%, despite initial response following targeted therapy. Additionally, alongside its intrinsic resistance to a wide range of common antimicrobials, various worldwide and local surveillance studies raise concerns about an increase in ICU settings regarding resistance to first-line drugs such as cotrimoxazole or tigecycline. This scenario alerts ICU physicians to the need to reconsider the best stewardship approach when SM is isolated in obtained samples from critically ill patients. Despite the coverage of this multidrug-resistant bacterium (MDRB) provided by some traditional and a non-negligible number of current pipeline antimicrobials, an ecological and cost-effective strategy is needed in the present era.

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The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term "elderly" corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population.

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OBJECTIVES: To asses the prognostic value of diagnostic scales in mortality of community-adquired sepsis and added value of additional parameters. METHODS: Prospective observational study of patients with community-adquired sepsis in the Emergency Room of University Hospital. The study population were patients presented in the Emergency Room with confirmed infection and practicians sepsis diagnosis. Demographics, triage vital signs, inhaled oxygen fraction, inflammatory markers, biochemistry, all-cause mortality during hospitalization and three months after were recorded. Prognostic value of qSOFA, NEWS, SOFA, SIRS, and amplified scales were calculated by using logistic regression and ROC curves. RESULTS: 201 patients, 54% male, average age 77±11,2 years were included. Sixty-three (31.5%) died during hospitalization and 24 (12%) three months after discharge. At the time of admission vital signs related with in-hospital mortality were Glasgow Coma Scale <13, respiratory rate ≥22 bpm, temperature, oxygen desaturation, high flow oxygen therapy and heart rate. Patients dead in-hospital had lower PaCO2, higher lactate, glucose and creatinine. Greater predictive capacity of the scales, from higher to lower, was: qSOFA, NEWS2, SOFA and SIRS. Amplified scales with lactate >2mg/dl, glucose, blood level >190mg/dl and PaCO2 <35mmHg improved predictive value. CONCLUSION: Amplified-qSOFA and amplified-NEWS2 scales at Emergency Department may offer a better prognostic of septic patients mortality.

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Antimalarial drugs are used for the control of mild manifestations of autoimmune diseases due to their low toxicity. Hydroxychloroquine (HCQ), a alpha-hydroxylated derivative of chloroquine, is usually preferred because of its higher tolerability. Mild and unspecific gastrointestinal symptoms are the main secondary effects related to HCQ use. Less than 1% of subjects show liver enzyme increase, although the percentage can be as high as 50% in subjects with chronic liver disease. A woman with mixed connective tissue disease who developed a reversible acute hepatitis shortly after the initiation of low-dose HCQ is presented. Two previous cases of patients with acute liver failure have previously been published. All three cases have been reported in the absence of previous liver disease. It seems to be a dose-dependent, idiosyncratic, and molecule-specific toxic effect and must be considered, taking into account the potential bad prognosis.

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BACKGROUND AND OBJECTIVE: Measurement of blood pressure by using the auscultatory method coupled with mercury sphygmomanometer is rapidly being replaced for monitor using the oscillometric one. Discrepancies between the two methods and the factors related to them were analyzed in a large subset of adults. MATERIAL AND METHOD: Blood pressure values were obtained sequentially in the same arm by using a mercury sphygmomanometer and a Spacelabs monitor devices. The relationship between both kinds of measurements was assessed by the Pearson's correlation coefficients and the concordance by using the Bland and Altman method. Differences between the two methods were calculated and the factors related to the differences were sought by multiple regression models. RESULTS: A total of 1,742 adult subjects were analyzed. Pearson's correlation coefficients were 0.927, 0.922, 0.886, 0.962 for SBP, DBP, MBP and PR, respectively. Oscillometric method overestimate and infraestimate SBP values in the two extreme of SBP values, the lowest SBP the highest the values and vice versa. A similar trend was observed for DBP although the differences were minor. Pulse wave amplitude explains the 24% of the variance observed for SBP and arm circumference the 8% for DBP. CONCLUSIONS: Blood pressure values measured by oscillometric methods are influenced for pulse wave amplitude and by the arm circumference. These need to be taken in account when blood pressure assessment is obtained by using this method.

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Fundamento y objetivo: El método auscultatorio mediante esfigmomanómetro de mercurio está siendo sustituido por otros métodos de medida de presión arterial, de los que el más utilizado es el oscilométrico. Se analiza las posibles discrepancias de medida entre ambos métodos y los factores que influyen en ellas. Material y método: Se obtuvieron medidas de presión arterial (PA) mediante esfigmomanómetro de mercurio, con un monitor Spacelabs, en el mismo brazo y mediante un método secuencial. La relación entre ambas medidas se analizó mediante los coeficientes de correlación de Pearson y el método de Bland y Altman. Se calcularon las diferencias entre ambos métodos de medida. Se analizó los factores que influyen en las diferencias mediante regresión lineal múltiple. Resultados: Se incluyó a 1.742 sujetos adultos. El coeficiente de correlación intraclase entre los valores obtenidos por método auscultatorio y los del oscilométrico fue 0,927 para la PA sistólica (PAS), 0,922 para la PA diastólica (PAD), 0,886 para la presión de pulso (PP) y 0,962 para la frecuencia de pulso (FP). Con el método oscilométrico se sobrestimó los valores medios de PAS más bajos, tendencia que se invirtió para valores elevados de PAS. Aunque hubo una tendencia similar para la PAD, fue de menor magnitud. El factor que explicaba un 24% de la variancia de las diferencias de la PAS fue la PP obtenida por esfigmomanómetro, mientras que para las diferencias de la PAD fue el perímetro del brazo lo que explicaba el 8% de la variancia. Conclusiones: Al utilizar monitores oscilométricos, se debe considerar que los valores extremos de amplitud de pulso y perímetro del brazo pueden inducir discrepancias importantes en las medidas de PA

Background and objective: Measurement of blood pressure by using the auscultatory method coupled with mercury sphygmomanometer is rapidly being replaced for monitor using the oscillometric one. Discrepancies between the two methods and the factors related to them were analyzed in a large subset of adults. Material and method: Blood pressure values were obtained sequentially in the same arm by using a mercury sphygmomanometer and a Spacelabs monitor devices. The relationship between both kinds of measurements was assessed by the Pearson's correlation coefficients and the concordanceby using the Bland and Altman method. Differences between the two methods were calculated and the factors related to the differences were sought by multiple regression models. Results: A total of 1,742 adult subjects were analyzed. Pearson's correlation coefficients were 0.927, 0.922, 0.886, 0.962 for SBP, DBP, MBP and PR, respectively. Oscillometric method overestimate and infraestimate SBP values in the two extreme of SBP values, the lowest SBP the highest the values and viceversa. A similar trend was observed for DBP although the differences were minor. Pulse wave amplitud explains the 24% of the variance observed for SBP and arm circumference the 8% for DBP. Conclusions: Blood pressure values measured by oscillometric methods are influenced for pulse wave amplitud and by the arm circumference. These need to be taken in account when blood pressure assessment is obtained by using this method

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BACKGROUND AND OBJECTIVE: Although renal pathologies are becoming an emergent problem in the population infected by the human immunodeficiency virus (HIV), there is very scarce information about the natural course of this problem. The objective of the present study is to describe renal lesions in an autopsy series of HIV-infected patients never treated with antiretroviral therapies. PATIENTS AND METHOD: Autopsy information has been retrospectively retrieved from 61 HIV-infected subjects (mean age, 36,9 [8,4] years; 58,6% drug abusers, 84% males) died in our hospital between 1984 and 1997. None of the patients received antiretroviral therapy. All autopsy and clinical reports were considered, as well as basic analytical parameters about renal function. Renal autopsy samples were specifically reviewed. RESULTS: At the time of the last admission, 9.8% of patients had renal insufficiency, who made up 44.3% of patients having renal insufficiency anytime. Infections were the main cause of death (76%). The majority of patients (93.4%) showed histopathological renal abnormalities, which were highly heterogeneous. Renal lesions were mainly located on the tubules (96.7%) and the interstitium (60.7%). Moreover, glomeruli were affected in 55.7% of patients. Most frequent histopathological diagnosis was acute tubular necrosis (16.4%) and septic nephritic abscesses (16.4%), followed by tubulointerstitial nephritis (9%). HIV-associated nephropathy was present in two patients (3.3%). There were no significant differences when considering the existent of renal failure. CONCLUSIONS: Renal histological abnormalities are frequent in the natural evolution of HIV infection. There is an important heterogeneity of lesions, mainly involving tubules, interstitium and mesangium. The cause of renal lesions is predominantly septic, according to the chief systemic process. It does not exist any relationship between renal analytical parameters and the presence of renal damage.

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