José Pardos-Gea

Antibioterapia intravenosa domiciliaria en una unidad de hospitalización a domicilio : factores pronósticos de reingreso hospitalario

BACKGROUND AND OBJECTIVE: Intravenous antibiotic therapy at home has showed its efficacy as an alternative to hospitalization care in many infectious pathologies. The objectives of this study are: a) to expose our experience, as hospital at home unit (HHU) integrated within a service of internal medicine, in the antibiotic treatment, and b) to define those parameters that can predict hospital readmissions. PATIENTS AND METHOD: This study included all patients with infectious pathology and intravenous antibiotic therapy who were admitted in our HHU from March 2006 to March 2007. RESULTS: 145 patients were included in this study. Successful treatment was observed in 92% of patients. Eleven patients were re-admitted at hospital during the episode by infectious disease, and only 2 of them showed adverse effects to treatment. Twenty-two patients were re-admitted at hospital 3 months after due to chronic pathology. CONCLUSIONS: Intravenous antibiotic therapy at home is a good alternative in many infectious pathologies. Infectious pathology and baseline state can be predictors of hospital readmissions.

Cardiac manifestations other than valvulopathy in antiphospholipid syndrome: long-time echocardiography follow-up study.

Non‐valvular cardiac disease in the antiphospholipid syndrome (APS) has been scanty studied. We wanted to assess the prevalence and evolution of left myocardial disease, pulmonary hypertension and intracardiac thrombi in a cohort of APS patients.

Acquired haemophilia A: Successful treatment with immunosuppression, methylprednisolone pulses and oral cyclosporin

Acquired haemophilia A: Successful treatment with immunosuppression, methylprednisolone pulses and oral cyclosporin -

Acquired haemophilia A. First line treatment with calcineurin inhibitors and steroid pulses: a 10-year follow-up study.

Summary.  Acquired haemophilia A (AH) is defined as the presence of autoantibodies or inhibitors against factor VIII (FVIII) with a clinical bleeding onset that can be life‐threatening. Immunosuppressant therapy must be initiated rapidly to eradicate the inhibitor. Current treatments based on steroids plus cyclophosphamide or rituximab are quite effective, but with significant side‐effects. Based on previous described AH cases treated with cyclosporine, with a good side‐effect profile, we aimed at assessing prospectively a first‐line calcineurin inhibitor based immunosuppressive therapy. We included a total of 11 patients affected with AH. Once diagnosed, pulse steroids and calcineurin inhibitors were started. Time to achieve sustained response (SR), defined as testing negative for inhibitor and with stable FVIII level >50%, immunosuppressant side‐effects, and relapse of AH were evaluated. Eight patients received cyclosporine and three patients received tacrolimus. SR was achieved in 10 of 11 patients (90.9%) in a median time of 3 weeks (range 2–8 weeks), and none of them relapsed during a median follow‐up time of 14 months (range 4–120). One major side‐effect appeared (posterior encephalopathy) that forced to discontinue cyclosporine. Overall 5‐year survival rate was 54.5%, with a total of five patients dying during the follow‐up (mortality rate of 45.5%). These five patients had achieved SR and died because of complications of basal morbidities and/or senescence, not related to AH (bleeding) or to immunosuppressant’s (infection) side‐effects. Combination therapy of calcineurin inhibitors and pulse steroids seems clinically effective as a first‐line treatment of AH.

Antibioticoterapia intravenosa domiciliaria en el tratamiento de las infecciones causadas por microorganismos multirresistentes

BACKGROUND Although home intravenous antimicrobial infusion therapy (HIVAIT) has proved its safety and efficacy in a great number of common infections, there are few published studies about its role in the treatment of infections caused by multi-drug resistant microorganisms. Our objectives are to study clinical and epidemiological characteristics of patients with multi-drug resistant microorganism infections treated with HIVAIT, and its usefulness in this type of infections. METHODS We analyzed all patients diagnosed of infections requiring HIVAIT and admitted to our Hospital at Home Unit (HHU) from March 2007 to February 2010. Subjects were divided into two groups: patients with multi-drug resistant microorganism infections as a study group, and the remaining patients as a control group. RESULTS A total of 487 patients were included, 82 in the study group. Comorbidity and physical dependence were higher in this group than in the control group (p=0.000 and p=0.002 respectively). The majority of patients were discharged because of a satisfactory clinical evolution. However, 17 (20.7%) patients in the study group required readmission to hospital during treatment and another 22 (26.8%) were re-admitted to hospital 3 months after discharge from HHU. There were significant differences between the results from the control group in clinical readmissions. CONCLUSIONS Patients with multi-drug resistant microorganism infections and HIVAIT have higher comorbidity, physical dependence, and frequency of hospital readmissions. However, HIVAIT is useful in this kind of infections if the patients are appropriately selected.