Repositori URV

Identificador: TDX:632

Handle: https://hdl.handle.net/20.500.11797/TDX632

Autors:
López Dupla, Jesus Miguel

Resum:
OF THE THESISThe thesis presented is a made up of two works that have as a common characteristic to be both a report about persistent bacteremia. The first study analyses aetiology, microbiological associations and prognosis of breakthrough bacteraemia. The second one states the characteristics of a series of infective endocarditis in a teaching hospital without cardiac surgery facilities and analyses the effect of a multidisciplinary group working at infective endocarditis. The objective of the first study is to determine the clinical significance and outcome of a large series of breakthrough bacteremia. It is a retrospective analysis of a prospectively collected database from two hospitals, hospital Clínic of Barcelona and hospital Universitari Joan XXIII of Tarragona. Patients higher than 14 years diagnosed of breakthrough bacteremia were included. Demographic characteristics, underlying diseases, origin of infection, sources of infection, microorganisms isolated, prognosis of underlying disease and mortality were analysed. Breakthrough bacteremia was detected in 392 of 6324 episodes (6,2%) of bacteremia. Eighty percent of them were nosocomial and the most frequent source of infection was endovascular. Coagulase-negative staphylococcus, S. aureus, and P. aeruginosa were the most significant microorganisms involved. The conditions independently associated with an increased risk for developing breakthrough bacteraemia were nosocomial acquisition, selected sources (central venous catheter, endocarditis and other endovascular foci), underlying conditions (neutropenia, polytraumatism, allogenic bone marrow and kidney transplantation), and some particular microbial aetiologies (S. aureus, P. aeruginosa and polymicrobial). Crude mortality rate was greater in patients with