[Viral pneumonia. COVID-19 pneumonia]

Viruses are becoming more and more important as etiological agents of pneumonia, mainly due to improvements in diagnostic techniques. At present, they account for approximately one-third of community-acquired pneumonia cases. They tend to occur in children and elderly patients, causing anything from mild cases to severe cases which require intubation and intensive care. The main causative agents include rhinovirus, influenza virus A or B, metapneumovirus, respiratory syncytial virus, parainfluenza virus, coronavirus, or adenovirus. Infection produced by SARS-CoV-2, the cause of the current COVID-19 pandemic, which has had devastating consequences, is proof of the vital importance of viral pneumonia. This is the main subject of this update. Drawing on the abundant information available, which has been continuously evolving since the beginning of the pandemic, this section will review the main characteristics of the virus, its pathophysiology, and its clinical manifestations as well as the main diagnostic and treatment methods.

[Relevance of empirical antibiotic treatment in the evolution of prosthetic joint infection treated with implant retention]

Introducción

Numerosos factores se han relacionado con el pronóstico de la infección de prótesis articular (IPA) tratada con desbridamiento quirúrgico, antibioterapia y retención del implante (DAIR). No existe evidencia sólida sobre cuál es el tratamiento antibiótico empírico que debe emplearse antes de conocerse el/los microorganismo/s causal/es de la misma.

Material y métodos

Realizamos un estudio observacional retrospectivo de pacientes con IPA tratados con DAIR entre 2009 y 2018 en nuestro centro, analizando los factores de riesgo conocidos que se han relacionado con su pronóstico y, además, si el que la antibioterapia empírica sea activa o no contra los microorganismos causales influye también en el resultado final.

Resultados

Se incluyeron un total de 80 casos de IPA tratados con DAIR en el periodo del estudio, en 79 pacientes (58,7% mujeres, edad media 76,3 años). Entre los 65 casos en los que la antibioterapia empírica era activa contra los microorganismos causales se consiguió la curación en 45 (69,2%), mientras que en los 15 restantes en que no lo era se logró tan solo en 1 (6,7%, OR 31,5, p=0,001). Al analizar los factores relacionados con el éxito del DAIR mediante análisis multivariante, el tratamiento antibiótico empírico activo se mantuvo estadísticamente significativo como factor de buen pronóstico (OR 0,004, p<0,01).

Conclusiones

El tratamiento antibiótico empírico podría ser un factor importante en el pronóstico de la IPA tratada con DAIR. Identificar los casos con riesgo de infección por microrganismos multirresistentes podría ser útil para guiar la antibioterapia empírica.

Effect of co-management with Internal Medicine on hospital stay in Ophthalmology

OBJECTIVE

Patients admitted to the Department of Ophthalmology (OPH) are of increasing age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. The effect of co-management on length of hospital stay was studied in patients admitted to OPH.

METHODS

Retrospective observational study was performed that included patients ≥14 years old discharged from OPH between 1 January 2009 and 30 June 2013, who were co-managed from May 2011. An analysis was made including age, sex, type of admission, whether it was operated on, administrative weight associated with GRD, total number of discharge diagnoses, Charlson comorbidity index (CCI), mortality, readmissions, and LoS.

RESULTS

There were statistically significant differences between the groups in operated patients (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.5 to 3.6), administrative weight (0.1160; 95% CI 0.0738 to 0.1583), and number of diagnoses (0.9, 95% CI 0.5 to 1.3). On adjustment, co-management reduced LoS in OPH by 27.8%, 0.5 days (95% CI 0.1 to 1).

CONCLUSIONS

Patients admitted to OPH have increasing comorbidity and complexity. Co-management is associated with a reduced LoS and costs in OPH, similar to that observed in other surgical services.