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The case is presented of a 62-year-old patient who required lipid-lowering therapy with proprotein convertase subtilisin/kexin type9 (PCSK9). It was empirically decided to change one drug to another of the two currently available, obtaining a different response. Our objective is to present our experience and to consider a possible therapeutic option in patients in whom, exceptionally, this could happen.

The case is presented of a 62-year-old patient who required lipid-lowering therapy with proprotein convertase subtilisin/kexin type9 (PCSK9). It was empirically decided to change one drug to another of the two currently available, obtaining a different response. Our objective is to present our experience and to consider a possible therapeutic option in patients in whom, exceptionally, this could happen.

Resumen Fundamento y objectivos Pocos trabajos han valorado el riesgo especifico de infeccion urinaria bacteriemica por Escherichia coli productor de betalactamasas de espectro extendido (BLEE). Pacientes y metodos Serie de casos retrospectiva de todos los pacientes con infeccion urinaria bacteriemica por E. coli atendidos en nuestro centro durante el 2006. Resultados Se aislo BLEE en 19 casos (17,9%) de 106 bacteriemias de foco urinario. Los pacientes con bacteriemia por BLEE eran predominantemente varones, de mayor edad, procedentes de residencia de ancianos, con enfermedad urologica previa y manipulacion urologica mas frecuente, con mayor uso de antibiotico previo, con porcentaje mas alto de infecciones urinarias previas, mayor frecuencia de infeccion nosocomial e ingreso en el mes previo. En la regresion logistica, resultaron variables independientes predictoras de infeccion urinaria bacteriemica por BLEE la enfermedad urologica previa (odds ratio [OR]: 13,9, intervalo de confianza [IC] del 95%: 2,5–8,2) y estar institucionalizado en residencia (OR: 6,5, IC del 95%: 1,4–30,9). Conclusiones La enfermedad urologica previa y estar institucionalizado en residencia son factores de riesgo independientes para presentar infeccion urinaria bacteriemica por BLEE.

Although risk factors for extended spectrum beta lactamase E. coli (EBLE) infection have been explored, specific risk factors for bacteremic urinary tract infection by EBLE have been hardly analyzed.We collected data from all patients with bacteremic urinary tract infection by E. coli attended in our hospital during 2006. Logistic regression was performed to explore predictors for EBLE bloodstream infection in this group of patients.EBLE was present in 19 cases (17,9%) out of 106 bacteraemia from urinary origin. Patients with bloodstream infection by EBLE were male, older, demented, living in a nursing home, with previous urologic diseases and urologic manipulation, with a higher percentage of previous urinary tract infection, previous antibiotic use, more frequent nosocomial infection, and hospital admission in the previous month. In the logistic regression analysis, only previous urologic diseases (OR 13,9; IC95% 2,5-78,2) and living in a nursing home (OR 6,5; IC95% 1,4-0,9) were associated with EBLE bacteremic urinary tract infection.Previous urologic disease and living in a nursing home are independent risk factors for EBLE bacteremic urinary tract infection.