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The aim of this study was to assess changes in antibiotic resistance, epidemiology and outcome among patients with Enterococcus faecalis infective endocarditis ( EFIE) and to compare the efficacy and safety of the combination of ampicillin and gentamicin (A+G) with that of ampicillin plus ceftriaxone (A+C). The study was a retrospective analysis of a prospective cohort of EFIE patients treated in our centre from 1997 to 2011. Thirty patients were initially treated with A+G (ampicillin 2 g/4 h and gentamicin 3 mg/kg/day) and 39 with A+C (ampicillin 2 g/4 h and ceftriaxone 2 g/12 h) for 4-6 weeks. Increased rates of high-level aminoglycoside resistance ( HLAR; gentamicin MIC ≥512 mg/L, streptomycin MIC ≥1024 mg/L or both) were observed in recent years (24% in 1997-2006 and 49% in 2007-2011; p 0.03). The use of A+C increased over time: 1997-2001, 4/18 (22%); 2002-2006, 5/16 (31%); 2007-2011, 30/35 (86%) (p <0.001). Renal failure developed in 65% of the A+G group and in 34% of the A+C group (p 0.014). Thirteen patients (43%) in the A+G group had to discontinue treatment, whereas only one patient (3%) treated with A+C had to discontinue treatment (p <0.001). Only development of heart failure and previous chronic renal failure were independently associated with 1-year mortality, while the individual antibiotic regimen (A+C vs. A+G) did not affect outcome ( OR, 0.7; 95% CI, 0.2-2.2; p 0.549). Our study shows that the prevalence of HLAR EFIE has increased significantly in recent years and that alternative treatment with A+C is safer than A+G, with similar clinical outcomes, although the sample size is too small to draw firm conclusions. Randomized controlled studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI) is a major infectious complication that increases mortality, morbidity, and healthcare costs. There are scores attempting to classify patients for calculating SSI risk. Our objectives were to validate the Australian Clinical Risk Index (ACRI) in a European population after cardiac surgery, comparing it against the National Nosocomial Infections Surveillance-derived risk index (NNIS) and analyzing the predictive power of ACRI for SSI in valvular patients. All the patients that who underwent cardiac surgery in a tertiary university hospital between 2011 and 2015 were analyzed. The patients were divided into valvular and coronary groups, excluding mixed patients. The ACRI score was validated in both groups and its ability to predict SSI was compared to the NNIS risk index. We analyzed 1,657 procedures. In the valvular patient group (n: 1119), a correlation between the ACRI score and SSI development (p < 0.05) was found; there was no such correlation with the NNIS index. The area under the receiver-operating characteristic curve (AUC) was 0.64 (confidence interval [CI] 95%, 0.5-0.7) for ACRI and 0.62 (95% CI, 0.5-0.7) for NNIS. In the coronary group (n: 281), there was a correlation between ACRI and SSI but no between NNIS and SSI. The ACRI AUC was 0.70 (95% CI, 0.5-0.8) and the NNIS AUC was 0.60 (95% CI, 0.4-0.7). The ACRI score has insufficient predictive power, although it predicts SSI development better than the NNIS index, fundamentally in coronary artery bypass grafting (CABG). Further studies analyzing determining factors are needed.

Background and Aim of the Study: Today, transplantation of cardiovascular tissues is common practice, and tissue banking has become routine. Consequently, many institutions exist which carry out high-quality tissue banking., Methods: The Hospital Clinico of the University of Barcelona established its cardiovascular tissue bank in 1989. The bank follows international and national regulations, and functions as a non-profit-making organization. Organ and tissue donors are recruited by the Transplant Coordination unit, which works closely with the Catalonian Organ Transplant Network (OCAT) and the Spanish National Organ Transplantation Network (ONT). The hearts are removed during multi-organ donation and processed using aseptic techniques in a laminar flow hood. Hearts are only accepted from brain-dead multiorgan and non-beating-heart donors. The heart valves are dissected, decontaminated, cryopreserved in specific media and stored in liquid nitrogen at -196 degrees C under strict bacteriological and serological control., Results: Between 1989 and 1999, a series of 1,005 cardiovascular donors from within Spain was identified, from which 840 hearts were processed. After evaluation, 1,099 (65.4%) valves were cryopreserved, and 1,023 (61.5%) given clearance for implantation. In total, 534 aortic, 530 pulmonary, 33 mitral and two tricuspid valves were processed; ultimately 92.8% of aortic and 93.9% of pulmonary valves were accepted for clinical implantation. The rejection rate was 39.1%. Homografts were transported to their destination in dry ice in a cryogenic container. Overall, 608 valves were implanted at our own institution and at hospitals in Barcelona and Europe. Only two cases of complaint were received from implanting surgeons., Conclusion: After ten years' experience, the degree of satisfaction of implanting surgeons appears to be adequate. Strict control of the entire tissue banking process has permitted the availability of high-quality homografts for clinical implantation.

Patients in cardiogenic shock refractory to basic medical therapy may require specialised assistance in a multispeciality environment distant to the institution where they are first admitted. In such situations, transportation of these critical patients may be difficult and involve many risks. Here we describe the case histories of two patients who underwent implantation of a paracorporeal left ventricular assist device and were transferred to specialised institutions for extended treatment. The distance of transportation was 400 km and the patients were transported by ambulance and helicopter. Some aspects of logistics and complexity of long-distance transportation are also commented on.

Behavior of transitional cell carcinoma of the bladder during the third decade of life remains a controversial subject. During the period 1980-1988, we treated 7 patients (4 male and 3 female), 25 years of age or less (mean age 19.3, range 14-25), with transitional cell carcinoma of the bladder. Until now, all patients are alive and without disease during 12-50 months after surgery. In 6 of the 7 patients, endoscopic resection was the choice treatment for superficial stage A/O. The seventh patient underwent a partial cystectomy for a B1 Jewet stage cell carcinoma. We conclude that transitional cell carcinoma of the bladder in patients under 25 years of age has a less aggressive biological behavior. Therefore, ultrasonographic examinations and serial urine cytology represent the elective test for follow-up. Cystoscopy would only be performed in doubtful cases.