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1. Pseudomonas aeruginosa Community-Onset Bloodstream Infections: Characterization, Diagnostic Predictors, and Predictive Score Development—Results from the PRO-BAC Cohort

Author

Pedro María Martínez Pérez-Crespo, Álvaro Rojas, Joaquín Felipe Lanz-García, Pilar Retamar-Gentil, José María Reguera-Iglesias, Olalla Lima-Rodríguez, Alfonso del Arco Jiménez, Jonathan Fernández Suárez, Alfredo Jover-Saenz, Josune Goikoetxea Aguirre, Eva León Jiménez, María Luisa Cantón-Bulnes, Pilar Ortega Lafont, Carlos Armiñanzas Castillo, Juan Sevilla Blanco, Jordi Cuquet Pedragosa, Lucía Boix-Palop, Berta Becerril Carral, Alberto Bahamonde-Carrasco, Teresa Marrodan Ciordia, Clara Natera Kindelán, Isabel María Reche Molina, Carmen Herrero Rodríguez, Inés Pérez Camacho, David Vinuesa García, Fátima Galán-Sánchez, Alejandro Smithson Amat, Esperanza Merino de Lucas, Antonio Sánchez-Porto, Marcos Guzmán García, Inmaculada López-Hernández, Jesús Rodríguez-Baño, Luis Eduardo López-Cortés, and on behalf of the PROBAC REIPI/GEIH-SEIMC/SAEI Group

Subjects
Pseudomonas aeruginosa, bacteraemia, bloodstream infection, community-onset, epidemiology, Therapeutics. Pharmacology, RM1-950
Abstract

Community-onset bloodstream infections (CO-BSI) caused by gram-negative bacilli are common and associated with significant mortality; those caused by Pseudomonas aeruginosa are associated with worse prognosis and higher rates of inadequateempirical antibiotic treatment. The aims of this study were to describe the characteristics of patients with CO-BSI caused by P. aeruginosa, to identify predictors, and to develop a predictive score for P. aeruginosa CO-BSI. Materials/methods: PROBAC is a prospective cohort including patients >14 years with BSI from 26 Spanish hospitals between October 2016 and May 2017. Patients with monomicrobial P. aeruginosa CO-BSI and monomicrobial Enterobacterales CO-BSI were included. Variables of interest were collected. Independent predictors of Pseudomonas aeruginosa CO-BSI were identified by logistic regression and a prediction score was developed. Results: A total of 78patients with P. aeruginosa CO-BSI and 2572 with Enterobacterales CO-BSI were included. Patients with P. aeruginosa had a median age of 70 years (IQR 60–79), 68.8% were male, median Charlson score was 5 (IQR 3–7), and 30-daymortality was 18.5%. Multivariate analysis identified the following predictors of CO-BSI-PA [adjusted OR (95% CI)]: male gender [1.89 (1.14–3.12)], haematological malignancy [2.45 (1.20–4.99)], obstructive uropathy [2.86 (1.13–3.02)], source of infection other than urinary tract, biliary tract or intra-abdominal [6.69 (4.10–10.92)] and healthcare-associated BSI [1.85 (1.13–3.02)]. Anindex predictive of CO-BSI-PA was developed; scores ≥ 3.5 showed a negative predictive value of 89% and an area under the receiver operator curve (ROC) of 0.66. Conclusions: We did not find a good predictive score of P. aeruginosa CO-BSI due to its relatively low incidence in the overall population. Our model includes variables that are easy to collect in real clinical practice and could be useful to detect patients with very low risk of P. aeruginosa CO-BSI.

Published
2022
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3. Causes of death in hospitalized patients in internal medicine departments with heart failure according to ejection fraction. RICA registry

Author

María Esther Guisado-Espartero, Prado Salamanca-Bautista, Óscar Aramburu-Bodas, Luis Manzano, M. Angustias Quesada Simón, Gabriela Ormaechea, Sara Carrascosa García, Marcos Guzmán García, José María Cepeda Rodrigo, Manuel Montero-Pérez-Barquero, P. Álvarez Rocha, Ó. Aramburu-Bodas, J.L. Arias Jiménez, S. Carrascosa, J.M. Cepeda, A. García Campos, A. González Franco, M.E. Guisado Espartero, M. Guzmán García, A. León Acuña, G. López Castellanos, O. Lorente Furió, L. Manzano, M. Montero-Pérez-Barquero, G. Ormaechea, M.A. Quesada Simón, R. Ruiz Ortega, M.P. Salamanca Bautista, G. Silvera, and J.C. Trullàs

Published
2022
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4. Palliative Sedation in Patients Hospitalized in Internal Medicine Departments

Author

Jesús Díez-Manglano, Soledad Isasi de Isasmendi Pérez, Rosa García Fenoll, Luis Ángel Sánchez, Françesc Formiga, Vicente Giner Galvañ, Carlos Dueñas, Bernardino Roca, Cristina Estrada Díaz, Emilio Casariego Vales, Marta Rubio Gómez, Magdalena Martín Pérez, Luis Felipe Díez García, Ignacio Vallejo Maroto, Cristina Ocaña Losada, Susana Moya Roldán, Catalina Díaz Pérez, Javier Caballero Granado, Resfa María García Font, Francisco J. Jódar Lorente, Gloria Pérez Vázquez, Ana belén Ferro Expósito, María Luisa Amaya González, Fernando Gamboa Antiñolo, Álvaro González Molina, Mercedes Gómez Hernández, Marcos Guzmán García, Lola Benítez León, Lorena Montero Rivas, María Ruiz Mariscal, Noelia Gómez Aguirre, María Pilar González García, Isabel Martín Algora, María Carmen Bueno Castel, Fernando Ruiz Laiglesia, Esperanza Bejarano Tello, José Luis Cabrerizo García, Nuria Guiral Fernández, Luis Camera, Carla Gauna, Pedro Abad Requejo, Rocío Martínez Gutiérrez, Rebeca Fernández Regueiro, María Teresa Sánchez Vidal, Joaquín Alfonso Mejido, Enrique García Carús, Carmen Elena Calvo Rodríguez, Paula Martínez García, Sixto Ruiz Olivares, María Isabel Fullana Barcelo, Carmen González Arencibia, Rosa Ros Vilamajó, María José Monedero Prieto, Concepción González Becerra, Sofía Pérez, Andrea Martín Plata, Raquel Portilla Chocarro, Carlos Dueñas Gutiérrez, Francisco Estrada Álvarez, Sonia Peña Balbuena, Raúl Rodríguez Galindo, Marta María Cobos Siles, Luis Ángel Sánchez Muñoz, Ana Castañón López, Celia Sanz Lobo, María Montserrat Chimeno Viñas, María Ángeles Contreras Uriel, Judit Gil Domínguez, Francisco Medrano González, José Manuel Machín Lázaro, Jeffrey Magallanes Gamboa, Mónica Rodríguez Galdeano, Joaquín Castro Giménez, José Ramón Barberá Farré, Raquel Núñez Aragón, Ferrán Masanés Torán, José Barbé, Elena Güell Farré, Olga Torres Bonafonte, Ana lozano Miñana, Desirée Moras Sarabia, Rosa Pérez, Dolors Arnau i Fernández, Francesc Formiga, Javier Fernández Fernández, Antoni Castro Salomó, Rami Qanneta, María Victoria Pardo Ortega, Yasmina Monterroso Pintado, Montserrat García Cors, María Cruz Almendros Rivas, Dolors Domingo Albin, Jaume Roig Morera, Nuria Galofré Álvaro, Aythami Toro Parodi, Mario Loureiro Sánchez, Carla de la Guerra Acebal, Javier Zubizarreta García, Iasone Benavente Claveras, Juan Martí Cabanes, Ignacio Sanz Lázaro, José Barquero Romero, Leticia Nevado López-Alegría, José Carlos Arévalo Lorido, Ana María Lorenzo Vizcaya, Cristina Macía Rodríguez, Silvia Pérez Fernández, Pascual Sesma Sánchez, María Dolores Jiménez-Beatty, Laura González Vázquez, Ángel Brea Hernando, Jesús Castiella Herrero, María Isabel González Anglada, Virginia M. Gracia Lorenzo, Alejandro Pérez Martín, Gerardo García Melcón, María Gómez Antúnez, María Angustias Quesada Simón, Fuensanta Gil Gil, María Asenjo Martínez, Lourdes Mancebo Aragoneses, Jorge Calderón Parra, María del Carmen Romero Pérez, José Curbelo García, Fernando Laguna Cuesta, María Eugenia Segovia Abad, María Fontecha Ortega, Guillermina Lara Martínez, Ana Pinos Blanco, Raquel Rodil Fraile, Elisabel Martínez Litago, Aitziber Echeverría Echeverría, Manuel Priego Valladares, Carlos Trescoli Serrano, Josep Vicente Mas, Óscar Torregrosa Suau, Eva Gil Tomás, Rafael Castillo Rubio, José Manuel Murcia Zaragoza, Pilar Román Sánchez, Ana García Herola, Pedro Pablo Tenllado Doblas, Julio César Blázquez Encinar, Enrique Castellano Vela, Néstor Carrizo, Bernardino Manuel Roca Villanueva, Francisco Pasquau Liaño, and José María Pascual Izuel

Subjects
Clinical audit, medicine.medical_specialty, Palliative care, Argentina, Context (language use), Palliative sedation, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Internal medicine, Terminal care, Humans, Hypnotics and Sedatives, Medicine, In patient, 030212 general & internal medicine, General Nursing, Retrospective Studies, Terminal Care, business.industry, Palliative Care, Odds ratio, Cross-Sectional Studies, Anesthesiology and Pain Medicine, Spain, 030220 oncology & carcinogenesis, Observational study, Neurology (clinical), business
Abstract

Palliative sedation is used to relieve end-of-life refractory symptoms.The objective of this study was to describe the use of palliative sedation in patients who die in internal medicine departments.An observational, cross-sectional, retrospective, and multicenter clinical audit study was conducted in 145 hospitals in Spain and Argentina. Each hospital included the first 10 patients who died in the internal medicine department, starting on December 1, 2015.We included 1447 patients, and palliative sedation was administered to 701 patients (48.4%). Having a terminal illness (odds ratio [OR] 2.469, 95% CI 1.971-3.093, P 0.001) and the length of hospital stay (OR 1.011, 95% CI 1.002-1.021, P = 0.017) were independently associated with the use of palliative sedation. Consent was granted by the families of 582 (83%) patients. The most common refractory symptom was dyspnea, and the most commonly used drugs for sedation were midazolam (77%) and morphine (89.7%). An induction dose was administered in 25.7% of the patients. Rescue doses were scheduled for 70% of the patients, and hydration was maintained in 49.5%. Pain was more common in patients with cancer, whereas dyspnea was more common in those without cancer. Rescue doses were used more often for the patients with cancer (77.8% vs. 67.7%, P = 0.015). Monitoring the palliative sedation with a scale was more frequent in the patients with cancer (23.7% vs. 14.3%, P = 0.008).Palliative sedation is used more often for terminal patients. There are differences in the administration of palliative sedation between patients with and without cancer.

Published
2020
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5. Complejidad en el paciente frágil joven: dificultad para la asistencia y la atención

Author

Esmeralda Ramiro-Ortega, María Luisa Fernández-Ávila, Marcos Guzmán-García, and Mirian Moreno-Conde

Subjects
business.industry, Medicine, business
Abstract

Paciente de 63 años con mieloma múltiple, insuficiencia renal crónica y miastenia gravis que presentaba infección respiratoria aguda. Se objetivó la evolución desfavorable, asociándose con hepatitis aguda de origen medicamentoso. Tras valoración integral del paciente, se llegó al hallazgo de posible demencia frontotemporal, enmascarada de forma previa como trastorno depresivo. La utilización de fármacos en esta paciente implica condicionamientos relevantes, por lo que se debe realizar una conciliación para evitar complicacio- nes relacionadas con las comorbilidades.

Published
2020
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6. Association of Hypertension with All-Cause Mortality among Hospitalized Patients with COVID-19

Author

Andrea Mendizabal, Marcos Guzmán-García, Elisa Rabadán-Pejenaute, Jose D Torres-Peña, Marta Nataya Solís-Marquínez, María Dolores Martín-Escalante, Araceli Pineda-Cantero, Maria Del Pilar Fidalgo-Montero, Francisco Javier Carrasco-Sánchez, Enrique Rodilla, Joaquín Fernandez López-Cuervo, María Esther Guisado-Espartero, Ricardo Gil-Sánchez, Lucy Abella-Vázquez, Ángel Luis Martínez-González, Ricardo Gómez-Huelgas, José Manuel Casas-Rojo, Elizabeth Lorenzo-Hernández, Joaquín Escobar-Sevilla, Julio González-Moraleja, Andrés de la Peña-Fernández, Vicente Giner-Galvañ, Alberto Saura, Ramon Boixeda, Iratxe Jimenez, UCH. Departamento de Medicina y Cirugía, Producción Científica UCH 2020, [Rodilla,E, Saura,A, Jiménez,I, Mendizábal,A] Internal Medicine Department, University Hospital of Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Sagunto, Spain. [Pineda-Cantero,A, Lorenzo-Hernández,E, and Gómez-Huelgas,R] Internal Medicine Department, Regional University Hospital of Málaga, Málaga, Spain. [Fidalgo-Montero,MP] Internal Medicine Department, Henares Hospital, Coslada (Madrid), Spain. [Fernandez López-Cuervo,J] Internal Medicine Department, Torrevieja University Hospital, Torrevieja (Alicante), Spain. [Gil-Sánchez,R] Internal Medicine Department, La Fe University Hospital, Valencia, Spain. [Rabadán-Pejenaute,E] Internal Medicine Department, San Pedro Hospital, Logroño (La Rioja), Spain. [Abella-Vázquez,L] Internal Medicine Department, Ntra Sra Candelaria University Hospital, Santa Cruz de Tenerife, Spain. [Giner-Galvañ,V] Internal Medicine Department, Hypertension and Cardiometabolic Risk Unit, San Juan de Alicante University Hospital, Miguel Hernández University, San Juan de Alicante (Alicante), Spain. [Solís-Marquínez,MN] Internal Medicine Department, San Agustin University Hospital, Avilés (Asturias), Spain. [Boixeda,R] Internal Medicine Department, Mataró Hospital, Mataró, Barcelona, Spain. [de la Peña-Fernández,A] Internal Medicine Department, Son Llàtzer University Hospital, Palma de Mallorca, Spain. [Carrasco-Sánchez,FJ] Internal Medicine Department, Juan Ramón Jiménez Hospital, Huelva, Spain. [González-Moraleja,J] Internal Medicine Department, Virgen de la Salud Hospital, Toledo, Spain. [Torres-Peña,JD] Internal Medicine Department, Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Spain, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain. [Guisado-Espartero,ME] Internal Medicine Department, Infanta Margarita Hospital, Cabra (Córdoba), Spain. [Escobar-Sevilla,J] Internal Medicine Department, Virgen de las Nieves University Hospital, Granada, Spain. [Guzmán-García,M] Internal Medicine Department, San Juan de la Cruz Hospital, Úbeda (Jaén), Spain. [Martín-Escalante,MD] Internal Medicine Department, Costa del Sol Hospital, Marbella (Málaga), Spain. [Martínez-González,AL] Internal Medicine Department, León University Hospital Complex, León, Spain. [Casas-Rojo,JM] Internal Medicine Department, Infanta Cristina University Hospital, Parla (Madrid), Spain.

Subjects
Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Cardiovascular Agents::Antihypertensive Agents [Medical Subject Headings], Hipertensión, Multivariate analysis, Physiology, lcsh:Medicine, Disease, 030204 cardiovascular system & hematology, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 0302 clinical medicine, SARS-CoV-2 (Virus) - Pacientes - Mortalidad, 030212 general & internal medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Cause of Death [Medical Subject Headings], Health Care::Environment and Public Health::Public Health::Epidemiologic Measurements::Demography::Vital Statistics::Mortality [Medical Subject Headings], Atrial fibrillation, General Medicine, Health Care::Environment and Public Health::Public Health::Epidemiologic Factors::Comorbidity [Medical Subject Headings], humanities, Population study, all-cause mortality, Inhibidores de la enzima convertidora de angiotensina, Cardiology and Cardiovascular Medicine, angiotensin-converting enzyme inhibitors (ACEIs), medicine.medical_specialty, angiotensin II receptor blockers (ARBs), hypertension, Infecciones por coronavirus, Antagonistas de receptores de angiotensina, COVID-19 (Disease) - Patients - Mortality, Lower risk, Article, Diseases::Cardiovascular Diseases::Vascular Diseases::Hypertension [Medical Subject Headings], 03 medical and health sciences, Internal medicine, Diabetes mellitus, Hypertension, Internal Medicine, medicine, Risk factor, COVID-19, all-cause mortality, angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs), hypertension, COVID-19 - Pacientes - Mortalidad, Geographical Locations::Geographic Locations::Europe::Spain [Medical Subject Headings], business.industry, lcsh:R, COVID-19, medicine.disease, Comorbidity, Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [Medical Subject Headings], SARS-CoV-2 (Virus) - Patients - Mortality, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Hospital Mortality [Medical Subject Headings], Observational study, business, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Enzyme Inhibitors::Protease Inhibitors::Angiotensin-Converting Enzyme Inhibitors [Medical Subject Headings]
Abstract

It is unclear to which extent the higher mortality associated with hypertension in the coronavirus disease (COVID-19) is due to its increased prevalence among older patients or to specific mechanisms. Cross-sectional, observational, retrospective multicenter study, analyzing 12226 patients who required hospital admission in 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics of survivors versus non-survivors. The mean age of the study population was 67.5 &plusmn, 16.1 years, 42.6% were women. Overall, 2630 (21.5%) subjects died. The most common comorbidity was hypertension (50.9%) followed by diabetes (19.1%), and atrial fibrillation (11.2%). Multivariate analysis showed that after adjusting for gender (males, OR: 1.5, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), and Charlson Comorbidity Index scores (second and third tertiles, OR: 4.7 and 8.1, p = 0.0001), hypertension was significantly predictive of all-cause mortality when this comorbidity was treated with angiotensin-converting enzyme inhibitors (ACEIs) (OR: 1.6, p = 0.002) or other than renin-angiotensin-aldosterone blockers (OR: 1.3, p = 0.001) or angiotensin II receptor blockers (ARBs) (OR: 1.2, p = 0.035). The preexisting condition of hypertension had an independent prognostic value for all-cause mortality in patients with COVID-19 who required hospitalization. ARBs showed a lower risk of lethality in hypertensive patients than other antihypertensive drugs.

Published
2020

7. Causes of death in hospitalized patients in internal medicine departments with heart failure according to ejection fraction. RICA registry

Author

María Esther, Guisado-Espartero, Prado, Salamanca-Bautista, Óscar, Aramburu-Bodas, Luis, Manzano, M Angustias, Quesada Simón, Gabriela, Ormaechea, Sara, Carrascosa García, Marcos, Guzmán García, José María, Cepeda Rodrigo, Manuel, Montero-Pérez-Barquero, and J C, Trullàs

Subjects
Cohort Studies, Heart Failure, Cause of Death, Internal Medicine, Humans, Stroke Volume, Prospective Studies, Registries, Prognosis, Ventricular Function, Left
Abstract

There are few data in the Spanish population about the causes of death in patients admitted to internal medicine departments for heart failure. Their study according to left ventricular ejection fraction (reduced: rEF, mid-range: mEF, and preserved: pEF) could improve the knowledge of patients and their prognosis.Prospective multicentre cohort study of 4144 patients admitted with heart failure to internal medicine departments. Their clinical characteristics, mortality rate and causes were classified according to pEF (≥ 50%), mEF (40%-49%) and rEF (40%). Patients were followed-up for a median of one year.There were 1198 deaths (29%). The cause of death was cardiovascular (CV) in 833 patients (69.5%), mainly heart failure (50%) and sudden cardiac death (7.5%). Non-cardiovascular (NoCV) causes were responsible for 365 deaths (30.5%). The most common NoCV causes were infections (13%). The most frequent and early cause in all groups was heart failure. Patients with pEF, compared to the other groups, had lower risk of sudden cardiac death and higher risk of infections (P .05). The causes of death in patients with mrEF were closer to those with pEF.The causes of death in patients with heart failure were different depending on ejection fraction strata. Patients with mEF and pEF, due to their high comorbidity and higher frequency of NoCV death, would require comprehensive management by internal medicine.

Published
2020

8. Revisiting the epidemiology of bloodstream infections and healthcare-associated episodes: results from a multicentre prospective cohort in Spain (PRO-BAC Study)

Author

Carmen Herrero Rodríguez, Clara Natera Kindelán, Teresa Marrodan Ciordia, Marcos Guzmán García, Juan Sevilla Blanco, Lucía Boix-Palop, Carlos Armiñanzas Castillo, Adrian Sousa Domínguez, Luis Eduardo López-Cortés, Alfredo Jover Saenz, Alberto Bahamonde-Carrasco, María Ángeles Mantecon Vallejo, Isabel María Reche Molina, María Luisa Cantón-Bulnes, José María Reguera-Iglesias, Eva León Jiménez, Berta Becerril Carral, Inmaculada López-Hernández, Jesús Rodríguez-Baño, Alfonso Del Arco Jiménez, José Bravo-Ferrer, Joaquín Felipe Lanz-García, Esperanza Merino de Lucas, Antonio Sánchez-Porto, Josune Goikoetxea Aguirre, David Garcia, Inés Pérez Camacho, Fátima Galán-Sánchez, Jonathan Fernández Suárez, Pedro María Martínez Pérez-Crespo, Alejandro Smithson Amat, Jordi Cuquet Pedragosa, Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, and European Commission

Subjects
Adult, Male, 0301 basic medicine, Microbiology (medical), Staphylococcus aureus, medicine.medical_specialty, Multivariate analysis, Adolescent, Epidemiology, 030106 microbiology, Bacteremia, Bloodstream infection, Healthcare-associated, Logistic regression, Severity of Illness Index, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Interquartile range, Klebsiella, Internal medicine, Escherichia coli, medicine, Humans, Pharmacology (medical), Prospective Studies, 030212 general & internal medicine, Aetiology, Prospective cohort study, Aged, Aged, 80 and over, Cross Infection, business.industry, Mortality rate, General Medicine, Middle Aged, Confidence interval, Community-Acquired Infections, Infectious Diseases, Spain, Etiology, Bacteraemia, Female, business
Abstract

PROBAC REIPI/GEIH-SEIMC/SAEI Group., The epidemiology of bloodstream infections (BSIs) is dynamic as it depends on microbiological, host and healthcare system factors. The aim of this study was to update the information regarding the epidemiology of BSIs in Spain considering the type of acquisition. An observational, prospective cohort study in 26 Spanish hospitals from October 2016 through March 2017 including all episodes of BSI in adults was performed. Bivariate analyses stratified by type of acquisition were performed. Multivariate analyses were performed by logistic regression. Overall, 6345 BSI episodes were included; 2510 (39.8%) were community-acquired (CA), 1661 (26.3%) were healthcare-associated (HCA) and 2056 (32.6%) hospital-acquired (HA). The 30-day mortality rates were 11.6%, 19.5% and 22.0%, respectively. The median age of patients was 71 years (interquartile range 60–81 years) and 3656 (58.3%; 95% confidence interval 57.1–59.6%) occurred in males. The proportions according to patient sex varied according to age strata. Escherichia coli (43.8%), Klebsiella spp. (8.9%), Staphylococcus aureus (8.9%) and coagulase-negative staphylococci (7.4%) were the most frequent pathogens. Multivariate analyses confirmed important differences between CA and HCA episodes, but also between HCA and HA episodes, in demographics, underlying conditions and aetiology. In conclusion, we have updated the epidemiological information regarding patients’ profiles, underlying conditions, frequency of acquisition types and aetiological agents of BSI in Spain. HCA is confirmed as a distinct type of acquisition., This work was financed by grants from Plan Nacional de I+D+i 2013–2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades [PI16/01432] and the Spanish Network for Research in Infectious Diseases (REIPI) [RD16/0016/0001; RD16/0016/0008], co‐financed by the European Development Regional Fund ‘A way to achieve Europe’, Operative program Intelligent Growth 2014–2020.

Published
2021
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9. Mortality and other adverse outcomes in patients with type 2 diabetes mellitus admitted for COVID-19 in association with glucose-lowering drugs: a nationwide cohort study

Author

Luis M. Pérez-Belmonte, José David Torres-Peña, María D. López-Carmona, M. Mar. Ayala-Gutiérrez, Francisco Fuentes-Jiménez, Lucía Jorge Huerta, Jaime Alonso Muñoz, Manuel Rubio-Rivas, Manel Madrazo, Marcos Guzmán Garcia, Beatriz Vicente Montes, Joaquim Fernández Sola, Javier Ena, Ruth Gonzalez Ferrer, Carmen Mella Pérez, Carlos Jorge Ripper, Jose Javier Napal Lecumberri, Iris El Attar Acedo, Susana Plaza Canteli, Sara Fuente Cosío, Francisco Amorós Martínez, Begoña Cortés Rodríguez, Pablo Pérez-Martínez, José Manuel Ramos-Rincón, Ricardo Gómez-Huelgas, and for the SEMI-COVID-19 Network

Subjects
Type 2 diabetes mellitus, Glucose-lowering drug, Coronavirus disease 2019, Medicine
Abstract

Abstract Background Limited evidence exists on the role of glucose-lowering drugs in patients with COVID-19. Our main objective was to examine the association between in-hospital death and each routine at-home glucose-lowering drug both individually and in combination with metformin in patients with type 2 diabetes mellitus admitted for COVID-19. We also evaluated their association with the composite outcome of the need for ICU admission, invasive and non-invasive mechanical ventilation, or in-hospital death as well as on the development of in-hospital complications and a long-time hospital stay. Methods We selected all patients with type 2 diabetes mellitus in the Spanish Society of Internal Medicine’s registry of COVID-19 patients (SEMI-COVID-19 Registry). It is an ongoing, observational, multicenter, nationwide cohort of patients admitted for COVID-19 in Spain from March 1, 2020. Each glucose-lowering drug user was matched with a user of other glucose-lowering drugs in a 1:1 manner by propensity scores. In order to assess the adequacy of propensity score matching, we used the standardized mean difference found in patient characteristics after matching. There was considered to be a significant imbalance in the group if a standardized mean difference > 10% was found. To evaluate the association between treatment and study outcomes, both conditional logit and mixed effect logistic regressions were used when the sample size was ≥ 100. Results A total of 2666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in monotherapy and 465 in combination with metformin. After propensity matching, 249 patients on metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 inhibitor, and 67 on metformin/insulin were selected. No at-home glucose-lowering drugs showed a significant association with in-hospital death; the composite outcome of the need of intensive care unit admission, mechanical ventilation, or in-hospital death; in-hospital complications; or long-time hospital stays. Conclusions In patients with type 2 diabetes mellitus admitted for COVID-19, at-home glucose-lowering drugs showed no significant association with mortality and adverse outcomes. Given the close relationship between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, prospective studies are needed.

Published
2020
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10. Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry.

Author

Jesús Díez-Manglano, Marta Nataya Solís-Marquínez, Andrea Álvarez García, Nicolás Alcalá-Rivera, Irene Maderuelo Riesco, Martín Gericó Aseguinolaza, José Luis Beato Pérez, Manuel Méndez Bailón, Ane-Elbire Labirua-Iturburu Ruiz, Miriam García Gómez, Carmen Martínez Cilleros, Paula María Pesqueira Fontan, Lucy Abella Vázquez, Julio César Blázquez Encinar, Ramon Boixeda, Ricardo Gil Sánchez, Andrés de la Peña Fernández, José Loureiro Amigo, Joaquín Escobar Sevilla, Marcos Guzmán Garcia, María Dolores Martín Escalante, Jeffrey Oskar Magallanes Gamboa, Ángel Luis Martínez González, Carlos Lumbreras Bermejo, Juan Miguel Antón Santos, and SEMI-COVID-19 Network

Subjects
Medicine, Science
Abstract

AimTo determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW).MethodsObservational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality.ResultsAs of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; pConclusionsHospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality.

Published
2021
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