RESUMEN
During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. We aimed to describe the characteristics, outcome and tolerance of PSAT in elderly patients with PJI. We performed a national cross-sectional cohort study of patients >75 years old and treated with PSAT for PJI. We evaluated the occurrence of events, which were defined as: (i) local or systemic progression of the infection (failure), (ii) death and (iii) discontinuation or switch of PSAT. A total of 136 patients were included, with a median age of 83 years [interquartile range (IQR) 81-88]. The predominant pathogen involved was Staphylococcus (62.1%) (Staphylococcus aureus in 41.7%). A single antimicrobial drug was prescribed in 96 cases (70.6%). There were 46 (33.8%) patients with an event: 25 (18%) with an adverse drug reaction leading to definitive discontinuation or switch of PSAT, 8 (5.9%) with progression of sepsis and 13 died (9.6%). Among patients under follow-up, the survival rate without an event at 2 years was 61% [95% confidence interval (CI): 51;74]. In the multivariate Cox analysis, patients with higher World Health Organization (WHO) score had an increased risk of an event [hazard ratio (HR) = 1.5, p = 0.014], whereas patients treated with beta-lactams are associated with less risk of events occurring (HR = 0.5, p = 0.048). In our cohort, PSAT could be an effective and safe option for PJI in the elderly.
Asunto(s)
Antibacterianos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/epidemiología , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/epidemiología , Factores de Edad , Anciano de 80 o más Años , Artritis Infecciosa/microbiología , Artritis Infecciosa/mortalidad , Femenino , Humanos , Masculino , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: Antiphospholipid antibodies (aPL) can be associated with numerous infectious and particularly Q fever. Data on the pathogenicity of aPL in the course of acute Q fever are scarce. CASE REPORT: We report the case an acute Coxiella burnetii infection associated with clinical and biological manifestations of the aPL syndrome, including a renal infarction. Along with antibiotic treatment, anticoagulation and intravenous immunoglobulins, the clinical outcome was favourable. Antiphospholipid antibodies and Q fever antibody titers had a closely related evolution. CONCLUSION: Arterial thrombosis associated with Q fever and aPL is exceptional. The nosology and potential mechanisms are discussed.
Asunto(s)
Síndrome Antifosfolípido/complicaciones , Fiebre Q/complicaciones , Obstrucción de la Arteria Renal/complicaciones , Trombosis/complicaciones , Enfermedad Aguda , Adulto , Anticuerpos Anticardiolipina , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Estudios de Seguimiento , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Fiebre Q/diagnóstico , Fiebre Q/tratamiento farmacológico , Obstrucción de la Arteria Renal/diagnóstico por imagen , Obstrucción de la Arteria Renal/tratamiento farmacológico , Trombosis/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: Antiplatelet agents (APA), statins and angiotensin converting enzyme inhibitors (ACEI) are effective to reduce the risk of cardio-vascular events in patients with peripheral arterial disease (PAD). Few data are available on the actual prescription of these drugs in outpatients and on the effect of hospital care on the level of prescription. METHODS: Retrospective study of patients hospitalized with a confirmed diagnosis of PAD over a one-year period. Comparison of medical treatments on admission and on discharge. RESULTS: 262 patients were included. Mean age was 73 +/- 11 years, and 29% of the patients were women. APA were present in 64% on admission and in 83% when discharged (P < 0.0001). A statin was present in 29% on admission and in 38% when discharged (P = 0.001). ACEI were present in 27% on admission and in 32% when discharged (P= 0.02). A vasodilator was present in 47% on admission and 52% when discharged (P = 0.1). 35% of the patients had isolated PAD. Compared to the patients with associated clinical coronary or cerebro-vascular disease, they were less frequently discharged on statins (respectively 26 and 45%, p = 0.003) and on ACEI (respectively 23 et 38%, P = 0.016) whereas APA were equally prescribed (respectively 82 and 84%, P= 0.7). CONCLUSION: APA were prescribed to a majority of outpatients and the level of prescription was further improved when patients were discharged from the hospital. Statins and ACEI were insufficiently prescribed. On the other hand, vasodilator therapy remained still largely prescribed, despite the lack of any strong effect on morbidity and survival.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Enfermedades Vasculares Periféricas/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Anciano , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Quimioterapia Combinada , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Masculino , Registros Médicos , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/complicaciones , Pautas de la Práctica en Medicina , Pravastatina , Estudios Retrospectivos , Accidente Cerebrovascular/tratamiento farmacológicoAsunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus/terapia , Hipoglucemiantes/uso terapéutico , Tiazolidinedionas/uso terapéutico , Anciano , Albuminuria/tratamiento farmacológico , Antihipertensivos/administración & dosificación , Antihipertensivos/uso terapéutico , Conservadores de la Densidad Ósea/administración & dosificación , Conservadores de la Densidad Ósea/uso terapéutico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus/fisiopatología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/prevención & control , Diuréticos/administración & dosificación , Diuréticos/uso terapéutico , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Hipoglucemiantes/administración & dosificación , Masculino , Persona de Mediana Edad , Antagonistas de Receptores de Mineralocorticoides/administración & dosificación , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Estudios Multicéntricos como Asunto , Pioglitazona , Estudios Prospectivos , Clorhidrato de Raloxifeno/administración & dosificación , Clorhidrato de Raloxifeno/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Riesgo , Espironolactona/administración & dosificación , Espironolactona/uso terapéutico , Tiazolidinedionas/administración & dosificación , Factores de TiempoRESUMEN
INTRODUCTION: Polyarteritis nodosa is a systemic necrotizing vasculitis that may become serious, even with no usual poor prognosis factors. EXEGESIS: We report two cases of polyarteritis nodosa with negative histology, starting only with an extensive necrosis of the extremities. The treatment, associating corticosteroids and, secondarily, immunosuppressors, did not prevent a bilateral half-leg amputation for the two patients. In the first case the disease stabilized, but in the second one, it worsened, leading to death within 2 years. CONCLUSION: This clinical aspect of the disease is unusual and should be identified because of its bad prognosis. It might benefit from a treatment from the outset associating corticosteroids and immunosuppressors, even with no usual bad prognosis factors.
Asunto(s)
Poliarteritis Nudosa/patología , Corticoesteroides/uso terapéutico , Anciano , Amputación Quirúrgica , Resultado Fatal , Femenino , Humanos , Inmunosupresores/uso terapéutico , Pierna/patología , Masculino , Necrosis , Poliarteritis Nudosa/tratamiento farmacológico , Poliarteritis Nudosa/cirugía , PronósticoRESUMEN
PURPOSE: Arterial or venous thromboses are frequent in patients with homocystinuria. Because severe homocystinuria is rare, prevalence of thrombosis, especially in France, is still unknown. METHODS: Review of the clinical outcome of 37 patients with homocystinuria due to cystathionine-cystathionine beta-synthase deficiency (34) and 5,10-methylenetetrahydrofolate reductase (three) lead us to describe vascular complications occurring in 12 (32%) of them. RESULTS: Venous thromboembolism is the earlier and the most frequent one and is mainly found in untreated late-diagnosed cases. Under specific treatment of homocystinuria, thromboses are rare and always a complication of surgery associated with high thromboembolic risk. Association with factor V Leiden increased the risk of venous thrombosis.
Asunto(s)
Homocistinuria/complicaciones , Trombosis/etiología , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , Interpretación Estadística de Datos , Factor V/genética , Femenino , Homocistinuria/genética , Homocistinuria/terapia , Humanos , Masculino , Persona de Mediana Edad , Mutación , Polimorfismo Genético , Estudios Retrospectivos , Factores Sexuales , Tromboembolia/etiología , Trombosis de la Vena/etiologíaRESUMEN
Homocystinuria is a genetically determined inborn error of the methionine amino acid pathway characterized by increased plasma homocysteine. In its major form, homocystinuria, is due to cystathionine beta synthase deficiency. Treatment of these adulthood patients lead physicians to call up on the skilled advices of pediatricians. But prevention and treatment of age related vascular and osteoporotic complications are still to be evaluated.
Asunto(s)
Homocistinuria/terapia , Adulto , Cistationina betasintasa/deficiencia , Cistationina betasintasa/genética , Homocisteína/sangre , Homocistinuria/complicaciones , Homocistinuria/diagnóstico , Humanos , Metionina/genéticaRESUMEN
Cardiac amyloidosis is expressed as a restrictive myocardiopathy. Echocardiography suggests the diagnosis. There is a great difference between the prognosis of senile cardiac amyloidosis and "AL" amyloidosis. We illustrate this point with two case reports.