C. Canha

Epidemiology of Clostridium difficile infection in Portugal: Experience at a tertiary care hospital

BACKGROUND Clostridium difficile is the main cause of healthcare-associated diarrhoea. Its incidence, severity and relapse rates increased over the past two decades. AIM To study epidemiologic characteristics and treatment of Clostridium difficile infection (CDI) and compare with a previous cohort from the same hospital. METHOD Retrospective analysis of clinical records of CDI diagnosed from 2010 to 2015 and comparison with data from 2004 to 2009. RESULTS 259 cases were diagnosed, compared to 83 in 2004-2009. There was no difference in mean annual incidence (8.66 versus 7.11 per 1000 patients; p = .116), but a dramatic increase was observed in 2009/2010 (peak incidence: 21.63 cases per 1000 admissions). Females were more affected (61.4% versus 69.9%; p = .177). Median age was 80 and 83 (p = .097). We observed an increase in median number of antibiotics previously used (2 versus 3; p = .147) and in community-associated CDI (6% versus 19.7%; p = .003). There was a continued increase in the use of carbapenems and quinolones until 2010 and a high percentage of refractory cases in 2010. Female gender (p = .043), long-term care facility (LTCF) residency (p = .022) and a higher number of previous antibiotics (median of 3; p = .025) were independent predictors for refractory and recurrent CDI. CONCLUSIONS CDI incidence achieved a peak in 2009/2010 coinciding with the introduction of alcohol-based hand products, increase in quinolone and carbapenem prescription and a possible outbreak of an epidemic strain. Female gender, LTCF residency and exposure to three or more antibiotics are risk factors for refractory and recurrent CDI. We emphasize the need to restrict use of large spectrum antibiotics.

Influence of different antithrombotic drugs in acute upper gastrointestinal bleeding: A cross-sectional study

also indicating good agreement. When stratified based on whether scores were concordant or discordant, patients discharged home (as opposed to nursing/other care facility) and patients with suspected cardiac etiology of arrest were statistically more likely to have concordant scores. For the in-house database, patients with discordant scores had a statistically higher median CPC score than those with concordant scores (p<0.01 for statistical significance). Conclusions: CPC scores are not always reliably assessed. This reliability is reduced in patients who have worse outcomes, have a non-cardiac etiology of arrest, and are discharged to a location other than home. This is an important limitation to note when interpreting and powering studies using CPC scores as an outcome.

Um caso excepcional de miopericardite por Corynebacterium amycolatum

As corinebacterias nao difteroides tem uma prevalencia crescente nos doentes hospitalizados, particularmente em doentes imunodeprimidos ou portadores de proteses artificiais ou dispositivos intravasculares. Sao responsaveis essencialmente pela infeccao da pele cirurgica e das estruturas cardiacas, provocando endocardite, miocardite e/ou pericardite, que necessitam de diagnostico atempado e tratamento adequado. Apresentamos um caso clinico notavel de miopericardite por Corynebacterium amycolatum, como sendo o primeiro caso relatado desta rara associacao.

Syphilitic vasculitis: Diagnostic challenge

the absence of an infectious focus, normal cervical and dorsal column X-ray, a thoracic abdominal and pelvic CT scan was done which revealed a collection at the left psoas muscle level, as well as other infectious lesions of bronchogenic dissemination versus septic embolus. Transthoracic echocardiogram excluded infectious endocarditis. Due to elevated sedimentation rate (91 mm), normocytic normochromic anemia (Hb 8.7 g/dL, VGM 76 fL), and monoclonal IgG protein spike on protein electrophoresis, a bone biopsy was performed and confirmed multiple myeloma (IgG k). Blood cultures were positive for MRSA. Results: She completed 21 days of Vancomycin, became apyretic, blood cultures were negative and abdominal CT scan control showed resolution of the abscess and of the pulmonary lesions. The patient was sent for hematology–oncology follow-up but declined chemotherapy for multiple myeloma. Conclusions: The primary psoas abscess is a rare entity, with challenging diagnosis and therapy. This is an unusual presentation because of the patients age and the absence of clinical symptoms. The coexistence of an immunocompromised state, the multiple myeloma, favored the abscess formation. Systemic antibiotherapy was effective in the complete resolution of the lesion.

In-hospital mortality in centenarians admitted to an internal medicine ward

Introduction.– The increase of centenarians requiring hospitalization is a reality. The main purpose of the study was to analyze the determinants of in-hospital mortality among centenarians admitted to an Internal Medicine ward. Methods.–A cohort of 63patients, 100years of age andolder, admitted to Internal Medicine, from 2008 to 2012, were retrospectively studied. Demographic information, comorbidities, recent admissions (past 90 days), clinical and laboratory data were recorded from each patient. Results.– Of these 63 patients, with a mean age of 101.1 years, 57 (90.5%)werewomen. Themain reasons for admissionwere respiratory infection (68,3%), especially healthcare-associated pneumonia (38.1%), and urinary infection (12.7%). The most commonly identified comorbiditieswere hypertension (58.7%), heart failure (54.0%), atrial fibrillation (33.3%), renal disease (28.6%) and respiratory disease (28.6%). Diabetes was present in 10 patients. The overall mortality was 36.5%, respiratory infections were responsible for most deaths (69.6%). Patients coming from nursing homes had higher mortality (52.9%). 17 patients had at least one hospitalization in the last 90 days, with a mortality of 58.8% (versus 28.26% in patients without recent hospitalizations). 8 patients had pressure ulcers, of which 5 died. 55.6% of patients with renal disease also died. Laboratory tests associated with mortality were: leukocytes, C-reactive protein, creatinine, BUN and lactates. Conclusions.– The leading cause of hospitalization was respiratory infections. Most comorbidities identified were referred to the cardiovascular system, however diabetes percentage was relatively low. Mortality among hospitalized centenarians was very high, particularly in patients in nursing homes and with recent hospitalizations.