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Ferré Losa C, Llopis Roca F, Jacob Rodríguez J, Giol Amich J, Palom Rico X, Bardés Robles I. [Characteristics of acute bacterial prostatitis in elderly patients attended in the Emergency Department]. Rev Esp Geriatr Gerontol 2019; 54:143-146. [PMID: 30606500 DOI: 10.1016/j.regg.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the characteristics of acute bacterial prostatitis between patients ≥75 years old with those <75 years old attended in the Emergency Department. MATERIAL AND METHODS A descriptive and observational study was conducted with a prospective follow-up including all consecutive patients with acute bacterial prostatitis that were admitted during one year to the Emergency Department of a tertiary-care hospital. Data were collected for demographic variables, comorbidities, clinical and microbiological findings, treatment, outcome, and re-consultation at 30 days follow-up. Patients were compared depending on age. RESULTS A total of 241 episodes of acute bacterial prostatitis were included. The mean age was 62.9±16 years, and 64 patients (26.5%) were ≥75 years old. In the microbiology findings, 104 out of 215 (48.4%) of urine cultures and 25 out of 136 (18.4%) blood cultures were positive. Escherichia coli was the most frequent isolation, with resistance rates in elderly patients above 30% for ciprofloxacin, amoxicillin-clavulanic, and cotrimoxazole, and 15.4% of extended spectrum beta-lactamase producing strains. In the univariate analysis, previous manipulation of the urinary tract, history of cancer, previous antibiotic treatment, resistant E. coli strains, renal impairment, and admission to the hospital were more frequent among patients ≥75 years. Nonetheless, in the multivariate analysis only inadequate empirical antibiotic treatment was found to be significantly more frequent in elderly patients (P=.004). CONCLUSIONS Drug-resistance patterns to commonly used antibiotics should be considered when choosing empirical treatment for acute bacterial prostatitis in the Emergency Department setting, especially for patients ≥75 years.
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Affiliation(s)
- Carles Ferré Losa
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - Ferran Llopis Roca
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Javier Jacob Rodríguez
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Jordi Giol Amich
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Xavier Palom Rico
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Ignasi Bardés Robles
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Martín-Sánchez FJ, Perdigones J, Ferré Losa C, Llopis F, Navarro Bustos C, Borraz Ordas C, Llorens Soriano P, Sempere Montes G, Fernández Alonso C, Fuentes Ferrer M, Juan Pastor A. 180-day risk of mortality in older patients admitted to short-stay units: the 6-Month Short-Stay Unit (6M UCE) Score. Emergencias 2018; 30:315-320. [PMID: 30260115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To develop a multidimensional score to assess risk of death for patients of advanced age 180 days after their admission to short-stay units (SSUs). MATERIAL AND METHODS Prospective, multicenter, observational and analytical study of a cohort of patients aged 75 years or older who were admitted to 5 Spanish SSUs between February 1 and April 30, 2014. We recorded demographic and clinical data as well as geriatric assessment scores. A multilevel logistic regression model was developed to identify independent factors associated with 180-day mortality. The model was used to construct a scale for scoring risk. RESULTS Data for 593 patients with a mean (SD) age of 83.4 (5.9) years entered the model; 359 (60.7%) were women. Ninety-two patients (15.5%) died within 180 days of SSU admission. Factors included in the final risk score were age over 85 years (1 point), male sex (1), loss of appetite or weight loss in the 3 months before admission (1), acute confusional state (2), functional dependence for basic activities of daily living at admission (2), and pressure ulcers (2). Low risk was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 9 points. Mortality rates at 180 days in these 3 risk groups were 5%, 18%, and 54%, respectively. The area under the receiver operating characteristic curve for the model after boots trapping was 0.72 (95% CI, 0.65-0.78). CONCLUSION The SSU score could be useful for stratifying risk of death within 6 months of SSU admission of older patients, so that type of care can be tailored to risk.
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Affiliation(s)
- F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria del Hospital San Carlos. Facultad de Medicina, Universidad Complutense de Madrid, España
| | - Javier Perdigones
- Servicio de Urgencias, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria del Hospital San Carlos. Facultad de Medicina, Universidad Complutense de Madrid, España
| | - Carles Ferré Losa
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital Universitario de Bellvitge, Barcelona, España
| | - Ferrán Llopis
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital Universitario de Bellvitge, Barcelona, España
| | | | - Carmen Borraz Ordas
- Unidad de Corta Estancia, Hospital Universitario Dr. Peset, Valencia, España
| | - Pere Llorens Soriano
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital General Universitario de Alicante, España
| | | | - Cesáreo Fernández Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria del Hospital San Carlos. Facultad de Medicina, Universidad Complutense de Madrid, España
| | - Manuel Fuentes Ferrer
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria del Hospital San Carlos. Facultad de Ciencias de la Salud, Universidad Alfonso X el Sabio, Madrid, España
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Ferré Losa C, Llopis Roca F, Jacob Rodríguez J, Cabello Zamora I, Martínez Muñoz C, Bardés Robles I. [Factors associated with emergency department revisits for acute bacterial prostatitis]. Emergencias 2018; 29:105-108. [PMID: 28825252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To analyze factors associated with revisits by patients with acute bacterial prostatitis treated in a hospital emergency department. MATERIAL AND METHODS Descriptive analysis and prospective follow-up of a cohort of patients with acute bacterial prostatitis treated in an emergency department. RESULTS We included 241 episodes of acute bacterial prostatitis. The mean (SD) age was 63 (16) years. Seventy-three percent reported dysuria, 64% had fever, and between 15.4% and 22.4% had medical histories of cancer, urethral/bladder catheterization, or prostate adenoma. Positive urine cultures were obtained for 48.1% and positive blood cultures for 17.6%. Escherichia coli was the bacterium isolated most often, and 27.7% of the cultures showed resistance to ciprofloxacin and amoxicillin-clavulanic acid. Twenty-nine patients (12%) revisited within 30 days. The only factors associated with revisiting were performance of a rectal examination (odds ratio [OR], 9.23; 95% CI, 1.12-75.82) and bacteremia (OR, 3.81; 95% CI, 1.31-11.04) (P<.05). CONCLUSION Factors associated with revisiting for acute bacterial prostatitis were bacteremia and performance of a rectal examination.
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Affiliation(s)
- Carles Ferré Losa
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Ferran Llopis Roca
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Javier Jacob Rodríguez
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Irene Cabello Zamora
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Concepción Martínez Muñoz
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Ignasi Bardés Robles
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
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Llopis Roca F, Ferré Losa C, Juan Pastor A, Martín Sánchez FJ, Sempere Montes G, Jacob Rodríguez J, Llorens Soriano P, Navarro Bustos C, Martínez Ortiz de Zárate M. [Spanish short-stay-units: results according to department designated to manage the unit]. Emergencias 2015; 27:109-112. [PMID: 29077352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare the efficiency of short-stay units (SSUs) managed by different departments within hospitals. MATERIAL AND METHODS Cross-sectional study in 40 hospitals with SSUs. From June 1 to December 31, 2012,we gathered data on clinical caseloads and management. Variables directly related to efficiency were mean length of stay, bed rotation index, and weekend discharge rate. RESULTS Forty SSUs were studied; 25 (62.5%) were managed by the hospital's emergency department (ED), 9 (22.5%) were managed by the internal medicine department (IMD), 5 (12.5%) were independent, and 1 was jointly managed by the hospital's ED and the IMD. A total of 45 140 patients were discharged from the SSUs. The most common diagnoses were exacerbation of chronic heart or respiratory disease, urinary tract infection, and respiratory infection. Age was the only variable that was related to the hospital department designated to manage these SSUs. The mean ages by management type were as follows: independent SSUs (75.6 years) vs ED-managed SSUs (67.2 years) vs IMD-managed SSUs (57.8 years) (P=.02). Group-by-group comparisons showed that the mean length of stay was shorter in ED-managed SSUs than in IMD-managed units (2.65 vs 3.73 respectively; P=.047), and overall mortality was lower in IMD-managed SSUs than in ED-managed SSUs (0.64% vs 3%; P=.033). However, unforeseen mortality (after excluding patients under palliative care or judged to be in the final hours of life) did not differ significantly between groups. CONCLUSION We did not detect important differences between SSUs managed by different departments in the hospitals in this series. However, mean length of stay was found to be shorter in ED-managed SSUs than in IMD-managed units.
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Affiliation(s)
- Ferrán Llopis Roca
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Carles Ferré Losa
- Unidad de Corta Estancia de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Gonzalo Sempere Montes
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitario Dr. Peset, Valencia, España
| | - Javier Jacob Rodríguez
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Pere Llorens Soriano
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital Universitario de Alicante, España
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Juan Pastor A, Ferré Losa C, Llopis Roca F, Jacob Rodríguez J, Bardés Robles I, Salazar Soler A. [The short stay unit as an alternative to conventional hospitalisation in the treatment of community acquired pneumonia in the over 75 year-old population]. Rev Esp Geriatr Gerontol 2011; 46:213-6. [PMID: 21719153 DOI: 10.1016/j.regg.2011.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 02/07/2011] [Accepted: 02/14/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients. The short stay units can be an alternative for patients who need admission with acute illness. MATERIAL AND METHODS Descriptive and retrospective study in an Short-Stay Unit (SSU) of a 900-bed tertiary-care teaching hospital in the metropolitan area of Barcelona, Spain. PERIOD a total of 22 months from January 2004 to December 2006. PATIENTS all patients ≥ 75 years admitted to EDSSU with a diagnosis of CAP. Data were collected for demographic variables, Pneumonia Severity Index score (PSI), microbiological findings, antibiotic treatment, length of stay, mortality rates and new admissions during the 30 days following discharge. RESULTS 175 consecutive patients ≥ 75 years with pneumonia were admitted to the EDSSU. Mean age was 84.31 years (range 75-100, SD ± 5.76), 92 (52,5%) were men, with 24 being nursing home residents. According to the PSI, 64 cases (36.6%) were scored as III, 97 (55.4%) as IV and 14 (8%) as V. A positive microbiological result was obtained in 46 cases (26.2%). Length of stay on average was 3.29 days (range 1-10, SD ± 1.56) and 19 patients died (10.8%). Six (3.8%) attended the ED in the 30 days following discharge. CONCLUSIONS In view of our experience, the EDSSU can be an alternative to standard inpatient for elderly patients with pneumonia in PSI risk class III and IV.
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Affiliation(s)
- Antoni Juan Pastor
- Unidad de Corta Estancia, Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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