Revisión sistemática con metodología de meta-análisis determinar factores predictores de falla terapeútica a la antibioticoterapia oral ambulatoria, en pacientes con infección de piel y tejidos blandos, diagnosticados en el Servicio de Emergencias
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2019
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Las infecciones de piel y tejidos blandos corresponden del 1% al 5% de los diagnósticos en pacientes admitidos en las unidades de observación de los servicios de emergencias. Las consultas por esta patología han venido en aumento, por lo que es importante lograr identificar de manera temprana, a los pacientes con alto riesgo de falla terapéutica ambulatoria y que van a requerir de un manejo intrahospitalario. Objetivo: Determinar que factores predicen falla terapéutica a una estrategia de antibioticoterapia oral ambulatoria, en pacientes con diagnóstico de infección de piel y tejidos blandos en el servicio de emergencias. Métodos: Se realizó una búsqueda en bases de datos PubMed, Cochrane, y SCIELO en las fechas comprendidas del 1 de enero del 2012 al 1 de diciembre del 2018. Se identificaron 5 estudios que se incluyeron para el meta análisis. Se tomaron en cuenta variables clínicas y de laboratorio para lograr determinar si alguna era estadísticamente significativa. La extracción de datos de los estudios seleccionados sigue las recomendaciones de acuerdo a los elementos sugeridos para revisiones sistemáticas y metanálisis (PRISMA) para un informe adecuado. Resultados: Se incluyeron 5 estudios que cumplieron los criterios de inclusión, para una muestra total de 2811 pacientes. Se determinaron 4 variables que fueron las que se incluyeron en el meta análisis. La localización anatómica de la infección en mano, 146 pacientes en total tuvieron falla terapéutica, correspondiente a un OR 1,168 bajo IC del 95% (0,905-1,508), p 0,23. La presencia de fiebre, en total 139 pacientes tuvieron falla terapéutica asociada, correspondiente a OR 2,80, con un IC del 95% (2,006-3,92) y p 0,001. La asociación entre la colonización por SAMR y falla terapéutica, estuvo presente en 81 pacientes, correspondiente a OR 1,164, con un IC del 95% (0,876-1,546) y p 0,296. Por último, el uso reciente...
Inglés: Skin and soft tissue infections correspond from 1% to 5% of the diagnoses in patients admitted in observation units of the Emergency Departments. Medical consultations for this pathology have been on the rise, so it is important to identify early the patients with a high risk of failure to ambulatory therapy, and who will require in-hospital management. Objective: To determine the factors that predict therapeutic failure to an outpatient oral antibiotic therapy strategy, in patients with a diagnosis of skin and soft tissue infections in the Emergency Departments. Methods: A search was conducted in different databases including PubMed, Cochrane, and SCIELO in the dates from January 1, 2012 to January 1, 2019. This search was carried out between the months of February and May of the 2019. We identified 5 studies that were included for the meta-analysis. Clinical and laboratory variables were taken into account to determine if any were statistically significant. The extraction of data from the selected studies follows the recommendations according to the suggested elements for systematic reviews and meta-analyzes (PRISMA) for an adequate report. Results: Five studies that met the inclusion criteria were included for a total sample of 2811 patients. Four variables were determined, which were included in the meta analysis. The anatomical location of the infection in hand, 146 patients in total had therapeutic failure, corresponding to an OR 1,168 under 95% CI (0.905-1.508), p 0.23. The presence of fever, in total 139 patients had associated therapeutic failure, corresponding to OR 2.80, with a 95% CI (2,006-3.92) and p 0.001. The association between MRSA colonization and therapeutic failure was present in 81 patients, corresponding to OR 1,164, with a 95% CI (0.876-1.546) and p 0.296. Finally, the use of recent antibiotics associated with therapeutic failure was presented by 198 patients, which...
Inglés: Skin and soft tissue infections correspond from 1% to 5% of the diagnoses in patients admitted in observation units of the Emergency Departments. Medical consultations for this pathology have been on the rise, so it is important to identify early the patients with a high risk of failure to ambulatory therapy, and who will require in-hospital management. Objective: To determine the factors that predict therapeutic failure to an outpatient oral antibiotic therapy strategy, in patients with a diagnosis of skin and soft tissue infections in the Emergency Departments. Methods: A search was conducted in different databases including PubMed, Cochrane, and SCIELO in the dates from January 1, 2012 to January 1, 2019. This search was carried out between the months of February and May of the 2019. We identified 5 studies that were included for the meta-analysis. Clinical and laboratory variables were taken into account to determine if any were statistically significant. The extraction of data from the selected studies follows the recommendations according to the suggested elements for systematic reviews and meta-analyzes (PRISMA) for an adequate report. Results: Five studies that met the inclusion criteria were included for a total sample of 2811 patients. Four variables were determined, which were included in the meta analysis. The anatomical location of the infection in hand, 146 patients in total had therapeutic failure, corresponding to an OR 1,168 under 95% CI (0.905-1.508), p 0.23. The presence of fever, in total 139 patients had associated therapeutic failure, corresponding to OR 2.80, with a 95% CI (2,006-3.92) and p 0.001. The association between MRSA colonization and therapeutic failure was present in 81 patients, corresponding to OR 1,164, with a 95% CI (0.876-1.546) and p 0.296. Finally, the use of recent antibiotics associated with therapeutic failure was presented by 198 patients, which...
Descripción
Tesis (especialista en medicina de emergencias)--Universida de Costa Rica. Sistema de Estudios de Posgrado. Programa de Estudios de Posgrado de Medicina de Emergencias, 2019
Palabras clave
ANTIBIOTICOS - USO TERAPEUTICO, MEDICINA DE URGENCIAS, PIEL - INFECCIONES - PACIENTES, PIEL - INFECCIONES - TRATAMIENTO, SERVICIOS MEDICOS DE URGENCIAS - CASOS, HISTORIAS CLÍNICAS, ESTADISTICAS, ETC. - COSTA RICA, TEJIDO CONJUNTIVO - INFECCIONES - FACTORES DE RIESGO, TEJIDO CONJUNTIVO - INFECCIONES - PACIENTES