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Cernada M, De Alba Romero C, Fernández-Colomer B, González-Pacheco N, González M, Couce ML. Health care-associated infections in neonatology. An Pediatr (Barc) 2024; 100:46-56. [PMID: 38177038 DOI: 10.1016/j.anpede.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Health care-associated infections are common in neonatology, but there is no consensus on their definitions. This makes it difficult to compare their incidence or assess the effectiveness of prevention bundles. This is why we think it is very important to achieve a consensus on the definitions and diagnostic criteria for one of the most frequent causes of morbidity in hospitalised neonates. This document aims to standardise the definitions for the most frequent health care-associated infections, such as catheter-associated bloodstream infection, ventilator-associated pneumonia and surgical wound infection, as well as the approach to their diagnosis and treatment.
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Affiliation(s)
- María Cernada
- Servicio de Neonatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | - María González
- Servicio de Neonatología, Hospital Materno-Infantil Regional Málaga, Málaga, Spain
| | - María Luz Couce
- Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, Universidad de Santiago, Santiago de Compostela, Spain.
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Andrés M, García MC, Fajardo A, Grau L, Pagespetit L, Plasencia V, Martínez I, Abadía C, Sanahuja A, Bella F. Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission. Rev Clin Esp 2022; 222:578-583. [PMID: 35798645 PMCID: PMC9239913 DOI: 10.1016/j.rceng.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. METHODS This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. RESULTS From December 5 to December 17, 21 patients and 44 healthcare workers (HCWs) developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among HCWs, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%; p = 0.005). Three days before the first positive case was detected, two extractor fans were found to be defective, affecting the ventilation of three rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. CONCLUSION The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.
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Affiliation(s)
- M. Andrés
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain,Corresponding author
| | - M.-C. García
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - A. Fajardo
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - L. Grau
- Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - L. Pagespetit
- Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - V. Plasencia
- Laboratorio de Microbiología, CATLAB, Viladecavalls (Barcelona), Spain
| | - I. Martínez
- Servicio de Prevención de Riesgos Laborales, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - C. Abadía
- Servicio de Salud Laboral, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - A. Sanahuja
- Departamento de Recursos Físicos, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - F. Bella
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
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Galán MI, Velasco M, Casas ML, Goyanes MJ, Rodríguez-Caravaca G, Losa-García JE, Noguera C, Castilla V. Hospital-Wide SARS-CoV-2 seroprevalence in health care workers in a Spanish teaching hospital. Enferm Infecc Microbiol Clin 2020; 40:S0213-005X(20)30418-3. [PMID: 33485676 PMCID: PMC7833995 DOI: 10.1016/j.eimc.2020.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Hospital-wide SARS-CoV-2 seroprevalence is rarely explored and can identify areas of unexpected risk. We determined the seroprevalence against SARS-CoV-2 in all health care workers (HCW) at a hospital. METHODS Cross-sectional study (14-27/04/2020). We determined SARS-CoV-2 IgG by ELISA in all HCW including external workers of a teaching hospital in Madrid. They were classified by professional category, working area, and risk for SARS-CoV-2 exposure. RESULTS Among 2919 HCW, 2590 (88,7%) were evaluated. The mean age was 43.8 years (SD 11.1), and 73.9% were females. Globally, 818 (31.6%) workers were IgG positive with no differences for age, sex or previous diseases. Of these, 48.5% did not report previous symptoms. Seropositivity was more frequent in high- (33.1%) and medium- (33.8%) than in low-risk areas (25.8%, p=0.007), but not for hospitalization areas attending COVID-19 and non-COVID-19 patients (35.5 vs 38.3% p>0.05). HWC with a previous SARS-CoV2 PCR-positive test were IgG seropositive in 90.8%. By multivariate logistic regression analysis seropositivity was significantly associated with being physicians (OR 2.37, CI95% 1.61-3.49), nurses (OR 1.67, CI95% 1.14-2.46), nurse assistants (OR 1.84, CI95% 1.24-2.73), HCW working at COVID-19 hospitalization areas (OR 1.71, CI95% 1.22-2.40), non-COVID-19 hospitalization areas (OR 1.88, CI95% 1.30-2.73), and at the Emergency Room (OR 1.51, CI95% 1.01-2.27). CONCLUSIONS Seroprevalence uncovered a high rate of infection previously unnoticed among HCW. Patients not suspected of having COVID-19 as well as asymptomatic HCW may be a relevant source for nosocomial SARS-CoV-2 transmission.
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Affiliation(s)
- Mª Isabel Galán
- Occupational Health Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - María Velasco
- Infectious Diseases and Research Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
| | - Mª Luisa Casas
- Laboratory Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Mª José Goyanes
- Microbiology Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Juan E Losa-García
- Preventive Medicine Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Carmen Noguera
- Nurse Subdirector, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Virgilio Castilla
- Medical Director, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Laviano E, Sanchez M, González-Nicolás MT, Palacian MP, López J, Gilaberte Y, Calmarza P, Rezusta A, Serrablo A. Surgical site infection in hepatobiliary surgery patients and its relationship with serum vitamin D concentration. Cir Esp 2020; 98:456-464. [PMID: 32723503 DOI: 10.1016/j.ciresp.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION While several studies have examined the correlation between vitamin D concentrations and post-surgical nosocomial infections, this relationship has yet to be characterized in hepatobiliary surgery patients. We investigated the relationship between serum vitamin D concentration and the incidence of surgical site infection (SSI) in patients in our hepatobiliary surgery unit. METHODS Participants in this observational study were 321 successive patients who underwent the following types of interventions in the hepatobiliary surgery unit of our center over a 1-year period: cholecystectomy, pancreaticoduodenectomy, total pancreatectomy, segmentectomy, hepatectomy, hepaticojejunostomy and exploratory laparotomy. Serum vitamin D levels were measured upon admission and patients were followed up for 1 month. Mean group values were compared using a Student's T-test or Chi-squared test. Statistical analyses were performed using the Student's T-test, the Chi-squared test, or logistic regression models. RESULTS Serum concentrations >33.5 nmol/l reduced the risk of SSI by 50%. Out of the 321 patients analyzed, 25.8% developed SSI, mainly due to organ-cavity infections (incidence, 24.3%). Serum concentrations of over 33.5 nmol/l reduced the risk of SSI by 50%. CONCLUSIONS High serum levels of vitamin D are a protective factor against SSI (OR, 0.99). Our results suggest a direct relationship between serum vitamin D concentrations and SSI, underscoring the need for prospective studies to assess the potential benefits of vitamin D in SSI prevention.
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Affiliation(s)
- Estefania Laviano
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, España.
| | - María Sanchez
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, España
| | | | | | - Javier López
- Medicina Familiar y Comunitaria, Sector II, Zaragoza, España
| | | | - Pilar Calmarza
- Servicio de Bioquímica, Hospital Miguel Servet, Zaragoza, España
| | - Antonio Rezusta
- Servicio de Microbiología, Hospital Miguel Servet, Zaragoza, España
| | - Alejandro Serrablo
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, España
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Santana MMPD, Hoffmann-Santos HD, Dias LB, Tadano T, Karhawi ASK, Dutra V, Cândido SL, Hahn RC. Epidemiological profile of patients hospitalized with candiduria in the Central-Western region of Brazil. Rev Iberoam Micol 2019; 36:175-180. [PMID: 31699523 DOI: 10.1016/j.riam.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 03/07/2019] [Accepted: 04/15/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Candida yeasts are considered the main agents of nosocomial fungal infections. AIMS This study aimed to establish the epidemiological profile of patients with candiduria hospitalized in the capital of the State of Mato Grosso, in the Central-Western region of Brazil. METHODS Patients from three private hospitals and a public hospital participated in the study. This was an observational and cross-sectional study including analysis of patients mortality. It was carried out from March to August 2015. RESULTS A total of 93 patients with candiduria were evaluated. Candida tropicalis was found most commonly (37.6%; n=35), followed by Candida albicans (36.6%; n=34), Candida glabrata (19.3%; n=18), psilosis complex (4.3%; n=4), Candida lusitaniae (1.1%; n=1) and Candida krusei (1.1%; n=1). Antibiotic therapy (100%) and the use of an indwelling urinary catheter (89.2%; n=83) were the most frequent predisposing factors. Antifungal treatment was given to 65.6% of the patients, and anidulafungin was the most used antifungal. Mortality rates were 48% higher among patients with candiduria who had renal failure. Micafungin was the antifungal most prescribed among the patients who died. Candidemia concomitant with candiduria occurred in eight (8.6%; n=8) cases. Considering the species recovered in the blood and urine, only one patient had genetically distinct clinical isolates. CONCLUSIONS Non-C. albicans Candida species were predominant, with C. tropicalis being the most responsible for most cases of candiduria.
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Affiliation(s)
- Milena Melges Pesenti de Santana
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Hugo Dias Hoffmann-Santos
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Luciana Basili Dias
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Tomoko Tadano
- University Hospital Júlio Muller (HUJM), Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Abdon Salam Khaled Karhawi
- University Hospital Júlio Muller (HUJM), Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Valéria Dutra
- Molecular Biology Laboratory, Faculty of Veterinary Sciences, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Stephano Luiz Cândido
- Molecular Biology Laboratory, Faculty of Veterinary Sciences, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Rosane Christine Hahn
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil.
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Delgado M, Capdevila JA, Sauca G, Méndez J, Rodriguez A, Yébenes JC. Positive-pressure needleless connectors did not increase rates of catheter hub colonization respecting the use of neutral-pressure needleless connectors in a prospective randomized trial. Enferm Infecc Microbiol Clin 2019; 38:119-122. [PMID: 31668861 DOI: 10.1016/j.eimc.2019.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to compare the colonization rates of central venous catheter (CVC) and arterial catheter (ArtC) hubs fitted with two types of needleless connectors (NCs). METHODS We designed a prospective randomized study to compare rates of catheter hub colonization of CVC and ArtC hubs fitted with two types of needleless connectors: neutral-pressure NCs (NP-NCs) and positive-pressure NCs (PP-NCs) in critically ill patients. All NCs were replaced every 7 days of use. RESULTS We obtained 326 cultures from 146 catheters (81 CVC and 65 ArtC) in 70 patients. The total cumulative days of risk were 1250 catheter-days. Global swab cultures were positive in NP-NCs in 29/198 (14.6%) versus 17/128 (13.3%) in PP-NCs during catheter use. We did not observe any cases of CRBSI. CONCLUSIONS In our experience, the use of PP-NCs did not result in significantly more frequent hub colonization with respect to NP-NCs.
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Affiliation(s)
- Maria Delgado
- Internal Medicine Service, Hospital de Mataró, Mataró, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Spain.
| | - Josep A Capdevila
- Internal Medicine Service, Hospital de Mataró, Mataró, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Goretti Sauca
- Microbiology Service, Hospital de Mataró, Mataró, Barcelona, Spain
| | - Juan Méndez
- Intensive Care Unit, Hospital de Mataró, Mataró, Barcelona, Spain
| | - Alejandro Rodriguez
- Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain
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Heredia-Rodríguez M, Álvarez-Fuente E, Bustamante-Munguira J, Poves-Alvarez R, Fierro I, Gómez-Sánchez E, Gómez-Pesquera E, Lorenzo-López M, Eiros JM, Álvarez FJ, Tamayo E. Impact of an ultraviolet air sterilizer on cardiac surgery patients, a randomized clinical trial. Med Clin (Barc) 2018; 151:299-307. [PMID: 29807859 DOI: 10.1016/j.medcli.2018.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Numerous studies have evaluated the use of ultraviolet-C devices for terminal disinfection in hospitals, however, to date there is little information about the device's final impact on patients. We investigated the effect of an ultraviolet air sterilizer (UVAS) on the clinical outcomes of cardiac surgery patients. MATERIALS AND METHODS This random, prospective and non-interventional study included 1097 adult patients undergoing elective cardiac surgery: 522 stayed in an ICU room with UVAS (Medixair®) and 575 patients ICU room without UVAS and were used as a control. The primary outcome measure was to evaluate the effect of a UVAS on the overall prevalence of nosocomial infections in postoperative cardiac patients in ICUs. RESULTS No significant differences in ventilator-associated pneumonia (4.6% vs. 5.0%, p=0.77) and total infection (14.0% vs. 15.5%, p=0.45) rates were detected in patients with and without the UVAS. The length of stay in the intensive care unit and at the hospital was similar in both groups, UVAS (4.6 (8.2) days and 18.3 (5.5) days) and without UVAS (4.6 (7.3) days and 19.2 (18.6) days). The 30-day in-hospital mortality rate was 5.3%, no significant differences between groups were observed (p=0.053). CONCLUSION Novel ultraviolet-C technology has not been shown to significantly reduce nosocomial infections or mortality rates in cardiac surgery patients.
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Affiliation(s)
- María Heredia-Rodríguez
- Department of Anaesthesiology, Hospital Clínico Universitario, Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
| | - Elisa Álvarez-Fuente
- Department of Anaesthesiology, Hospital Clínico Universitario, Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
| | | | - Rodrigo Poves-Alvarez
- Department of Anaesthesiology, Hospital Clínico Universitario, Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain.
| | - Inmaculada Fierro
- Department of Health Sciences, European University Miguel de Cervantes, Valladolid, Spain
| | - Esther Gómez-Sánchez
- Department of Anaesthesiology, Hospital Clínico Universitario, Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
| | - Estefanía Gómez-Pesquera
- Department of Anaesthesiology, Hospital Clínico Universitario, Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
| | - Mario Lorenzo-López
- Department of Anaesthesiology, Hospital Clínico Universitario, Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
| | - José María Eiros
- Department of Microbiology, Hospital Río Hortega, Valladolid, Spain
| | | | - Eduardo Tamayo
- Department of Pharmacology, University of Valladolid, Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
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Blázquez-Garrido RM, Cuchí-Burgos E, Martín-Salas C, Ruiz-Garbajosa P. Microbiological monitoring of medical devices after cleaning, disinfection and sterilisation. Enferm Infecc Microbiol Clin 2017; 36:657-661. [PMID: 29146038 DOI: 10.1016/j.eimc.2017.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
The use of reusable semi-critical devices has been extended in current medical practice for both diagnostic and therapeutic purposes. However, reuse of these instruments carries the risk of cross-transmission of microorganisms from one patient to another. The process of cleaning and disinfecting these devices is complex, long, expensive and very error-prone. This paper analyses the epidemiological aspects of infections associated with the reuse of semi-critical devices and the role of the Microbiology laboratory in monitoring the cleaning and disinfecting process through microbiological controls. The recommendations of different scientific societies on the relevance of such controls are reviewed and specific recommendations are proposed for the taking and processing of the samples, interpretation of the results and measures to be taken depending on the results obtained.
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Affiliation(s)
| | | | - Carmen Martín-Salas
- Servicio de Microbiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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9
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Cierco Garrido MC, García Muñoz R, Pérez Castro I, Sanz Moncusi M. Incidence of cross infection in liver transplant patients. Risk factors and role of nursinge. Enferm Clin (Engl Ed) 2017; 28:20-26. [PMID: 28822713 DOI: 10.1016/j.enfcli.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the incidence and risk factors of infection in liver transplant recipients immediately post-transplant, during admission to a liver transplant unit during the immediate post-transplant admission. METHODOLOGY Descriptive, prospective study performed in the Liver Transplant Unit of Hospital Clínic, Barcelona. All liver transplant recipients between January 2012 and August 2015 (n=241) were included. Statistical analysis was performed with R Commander. Variables were compared with Chi-square and Student's t-test. A value of p≤.05 was considered significant. RESULTS The incidence of infection was 34.8%. The most frequent infections were bacterial (75.3%), particularly urinary infections (34.6%) caused by Escherichia coli and Klebsiella pneumoniae. Independent risk factors for the development of bacterial infections according to multivariate analysis were sex, age and length of hospital stay. CONCLUSIONS Infections are a significant problem in the early post-transplant period, and are associated with longer hospitalisation periods. The role of nursing in preventing infections, by identifying risk factors, correctly applying nursing protocols in insertion, maintenance and early withdrawal of medical devices and fulfilling hand hygiene, is essential.
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Affiliation(s)
- M Carmen Cierco Garrido
- Unidad de Cirugía Hepática y Trasplante Hepático, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España.
| | - Raquel García Muñoz
- Unidad de Cirugía Hepática y Trasplante Hepático, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
| | - Immaculada Pérez Castro
- Unidad de Cirugía Hepática y Trasplante Hepático, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
| | - Miquel Sanz Moncusi
- Unidad de Cirugía Hepática y Trasplante Hepático, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona, Barcelona, España
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Capdevila-Reniu A, Capdevila JA. Peripheral venous catheter, a dangerous weapon. Key points to improve its use. Rev Clin Esp 2017; 217:464-467. [PMID: 28576382 DOI: 10.1016/j.rce.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 11/26/2022]
Abstract
Catheter-related bacteremia is one of the most important causes of nosocomial infection. Is associated to high rates of morbidity and mortality, including an economic burden. Peripheral venous catheter bacteremia is a leading cause of nosocomial infection in internal medicine departments. In this article, we review some important key points to improve its use and avoid infections.
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Affiliation(s)
| | - J A Capdevila
- Servicio de Medicina Interna, Hospital de Mataró, Mataró, Spain.
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11
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González-Castro A, Alsasua A, Peñasco Y, Rodríguez JC, Duerto J. Tracheo-bronchitis and pneumonia associated with mechanical ventilation by Chryseobacterium indologenes. ACTA ACUST UNITED AC 2017; 64:294-8. [PMID: 28242035 DOI: 10.1016/j.redar.2016.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/20/2022]
Abstract
The development of nosocomial infections by germs resistant to carbapenems inherently increases mortality, and causes an increase in health spending. The knowledge and study of these infections is important in improving epidemiological and therapeutic performance protocols. We present a descriptive study of eight patients diagnosed with tracheobronchitis (TAVM) and pneumonia (NAVM) associated with mechanical ventilation Chryseobacterium indologenes (CBI), over a period of five years. CBI isolation occurred at 11 days on average (rank 7-18) of remaining patients connected to mechanical ventilation. The average length of patients on mechanical ventilation was 36 days (range 10-140). The average ICU stay was 49 days (range 14-180). There was no death at 28 days, but the intra-hospital mortality was 2 cases (25%). Nosocomial respiratory infection secondary to CBI in mechanically ventilated patients has increased in recent years, so that should be included in the differential diagnostic of NAMV.
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Mesa Del Castillo-Payá C, Rodríguez-Esteban M, Quijada-Fumero A, Carballo-Arzola L, Farrais-Villalba M, Afonso R, Trugeda-Padilla A. Infective endocarditis in patients with oncological diseases. Enferm Infecc Microbiol Clin 2016; 36:72-77. [PMID: 27986340 DOI: 10.1016/j.eimc.2016.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Cancer patients may constitute a special risk group for the development of infective endocarditis (IE) because they are often subjected to invasive procedures. The aim of this study is to determine the differential clinical profile and prognosis of patients with IE and cancer. METHODS A retrospective observational study was conducted on all patients consecutively diagnosed with IE in a single centre between 2005 and 2015. A comparative analysis was performed between patients with cancer and those free of disease, as well as a long-term follow-up. RESULTS There were 208 IE cases, of which 32 had a cancer diagnosis. There were no significant differences in age (67.5 [59.2-74] vs. 64 [51-74] years). The Charlson comorbidity index was same whether cancer was diagnosed or not (4 [2.2-5] vs. 3.9 [2-5]). IE in cancer patients was mainly associated with health care (59.5% vs 24.4%, P<.001). Staphylococcus aureus was the main causative agent (35%), and the tricuspid location was three times more common (18.8% vs. 6.2%). Surgery was not performed in 18.7% of patients, despite having an indication, compared with 7.4% of patients without cancer. In-hospital mortality for cancer patients was 45.5%, and the probability of survival at one year was 40%. CONCLUSIONS IE in patients with cancer is predominantly caused by staphylococci, and has high early mortality. Although it is often related to health care, patients are limited from the therapeutic point of view.
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Affiliation(s)
| | - Marcos Rodríguez-Esteban
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España.
| | - Alejandro Quijada-Fumero
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Leidimar Carballo-Arzola
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Marcos Farrais-Villalba
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Ruth Afonso
- Servicio de Oncología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Antonio Trugeda-Padilla
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
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Smithson A, Bosch L, Ramos X, Martínez-Santana V. [Impact of an intervention to improve indwelling urinary catheter use and reduce urinary tract infections]. Rev Calid Asist 2016; 31:227-233. [PMID: 26705914 DOI: 10.1016/j.cali.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/21/2015] [Accepted: 10/25/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the impact of an intervention regarding the adequate use and improvement in the care of indwelling urinary catheters (IUC) and the frequency of catheter-associated urinary tract infections (CAUTI) in hospitalised patients. MATERIAL AND METHODS A quasi-experimental study was performed. Basic data on the use of IUC were recorded before and after the intervention, which consisted of training on IUC use and the implementation of reminders for their removal. RESULTS There were 197 patients in the pre-intervention period and 194 in the post-intervention period. There was a non-significant decrease in the prevalence (17.3% versus 15.3%) and days with IUC (4.8±5.8 versus 4.3±4.2). There was an increase in adequately prescribed (41.1% versus 61.9%; P<.001) and attached IUC (0% vs 38.1%; P<.001), and a decrease in the urine collection bags on the floor (26.4% vs 6,2%; P<.001). The increase in the appropriate indications for IUC (86.8% vs 92.3%) and the decrease in CAUTI incidence density (2.1 vs 1.2 episodes/1,000 catheter days) were not significant, although above the standards. CONCLUSIONS After the intervention there was a significant increase in the number of adequately prescribed and attached IUC, and a decrease in the number of urine collection bags on the floor. Improvement in IUC indication and frequency of CAUTI reached the quality standards. Educational activities and the use of reminders improve safety of hospitalised patients with IUC.
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Affiliation(s)
- A Smithson
- Unidad de Infecciones, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, España.
| | - L Bosch
- Enfermería, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, España
| | - X Ramos
- Servicio de Medicina Interna, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, España
| | - V Martínez-Santana
- Servicio de Farmacia. Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, España
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Sopena-Galindo N, Hornero-Lopez A, Freixas-Sala N, Bella-Cueto F, Pérez-Jové J, Limon-Cáceres E, Gudiol-Munté F. [Survey of methicillin-resistant Staphylococcus aureus control measures in hospitals participating in the VINCat program]. Enferm Infecc Microbiol Clin 2015; 34:409-14. [PMID: 26589755 DOI: 10.1016/j.eimc.2015.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION VINCat is a nosocomial infection surveillance program in hospitals in Catalonia. The aim of the study was to determine the surveillance and control measures of methicillin-resistant Staphylococcus aureus (MRSA) in these centres. METHODS An e-mail survey was carried out from January to March 2013 with questions related to the characteristics of the hospitals and their control measures for MRSA. RESULTS A response was received from 53 hospitals (>500 beds: 7; 200-500 beds: 14;<200 beds: 32; had ICU: 29). Computer alert of readmissions was available in 63%. There was active surveillance of patients admitted from another hospital (46.2%) or a long-term-care centre (55.8%), both being significantly more common measures in hospitals with a rate of MRSA≤22% (global median). Compliance with hand hygiene was observed in 77.4% of the centres, and was greater than 50% in 69.7% of them. All hospitals had contact precautions, although 62.3% did not have exclusive frequently used clinical material in bedrooms. The room cleaning was performed more frequently in 54.7% of hospitals, and 67.9% of them had programs for the appropriate use of antibiotics. CONCLUSIONS This study provides information on the implementation of measures to prevent MRSA in hospitals participating in the VINCat program. Most of the centres have an MRSA protocol, however compliance with it should be improved, especially in areas such as active detection on admission in patients at risk, hand hygiene adherence, cleaning frequency and optimising the use of antibiotics.
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Affiliation(s)
- Nieves Sopena-Galindo
- Control de Infección Nosocomial, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Anna Hornero-Lopez
- Control de Infección Nosocomial, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Núria Freixas-Sala
- Control de Infección, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
| | - Feliu Bella-Cueto
- Servicio de Medicina Interna, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España
| | - Josefa Pérez-Jové
- Microbiología, CatLab, Parc Logístic de Salut, Viladecavalls, Barcelona, España
| | - Enric Limon-Cáceres
- Centro Coordinador Programa VINCat, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Francesc Gudiol-Munté
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Olaechea PM, Álvarez-Lerma F, Palomar M, Gimeno R, Gracia MP, Mas N, Rivas R, Seijas I, Nuvials X, Catalán M. Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011). Med Intensiva 2015; 40:216-29. [PMID: 26456793 DOI: 10.1016/j.medin.2015.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/19/2015] [Accepted: 07/13/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the case-mix of patients admitted to intensive care units (ICUs) in Spain during the period 2006-2011 and to assess changes in ICU mortality according to severity level. DESIGN Secondary analysis of data obtained from the ENVN-HELICS registry. Observational prospective study. SETTING Spanish ICU. PATIENTS Patients admitted for over 24h. INTERVENTIONS None. VARIABLES Data for each of the participating hospitals and ICUs were recorded, as well as data that allowed to knowing the case-mix and the individual outcome of each patient. The study period was divided into two intervals, from 2006 to 2008 (period 1) and from 2009 to 2011 (period 2). Multilevel and multivariate models were used for the analysis of mortality and were performed in each stratum of severity level. RESULTS The study population included 142,859 patients admitted to 188 adult ICUs. There was an increase in the mean age of the patients and in the percentage of patients >79 years (11.2% vs. 12.7%, P<0.001). Also, the mean APACHE II score increased from 14.35±8.29 to 14.72±8.43 (P<0.001). The crude overall intra-UCI mortality remained unchanged (11.4%) but adjusted mortality rate in patients with APACHE II score between 11 and 25 decreased modestly in recent years (12.3% vs. 11.6%, odds ratio=0.931, 95% CI 0.883-0.982; P=0.008). CONCLUSION This study provides observational longitudinal data on case-mix of patients admitted to Spanish ICUs. A slight reduction in ICU mortality rate was observed among patients with intermediate severity level.
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Affiliation(s)
- P M Olaechea
- Service of Intensive Care Medicine, Hospital de Galdakao-Usansolo, B° Labeaga s/n, 48960 Galdakao, Bizkaia, Spain.
| | - F Álvarez-Lerma
- Service of Intensive Care Medicine, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Spain
| | - M Palomar
- Service of Intensive Care Medicine, Hospital Arnau de Vilanova. Lleida, Institut de Reserca Biomèdica (IRB) y Universitat Autónoma de Barcelona, Barcelona, Spain
| | - R Gimeno
- Intensive Care Unit, Hospital Universitario La Fe, Valencia, Spain
| | - M P Gracia
- Service of Intensive Care Medicine, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Mas
- Service of Intensive Care Medicine, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - R Rivas
- Service of Intensive Care Medicine, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - I Seijas
- Service of Intensive Care Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - X Nuvials
- Service of Intensive Care Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Catalán
- Service of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
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Moreno Camacho A, Ruiz Camps I. [Nosocomial infection in patients receiving a solid organ transplant or haematopoietic stem cell transplant]. Enferm Infecc Microbiol Clin 2014; 32:386-95. [PMID: 24950613 PMCID: PMC7103322 DOI: 10.1016/j.eimc.2014.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 12/25/2022]
Abstract
Bacterial infections are the most common infections in solid organ transplant recipients. These infections occur mainly in the first month after transplantation and are hospital-acquired. Nosocomial infections cause significant morbidity and are the most common cause of mortality in this early period of transplantation. These infections are caused by multi-drug resistant (MDR) microorganisms, mainly Gram-negative enterobacteria, non-fermentative Gram-negative bacilli, enterococci, and staphylococci. The patients at risk of developing nosocomial bacterial infections are those previously colonized with MDR bacteria while on the transplant waiting list. Intravascular catheters, the urinary tract, the lungs, and surgical wounds are the most frequent sources of infection. Preventive measures are the same as those applied in non-immunocompromised, hospitalized patients except in patients at high risk for developing fungal infection. These patients need antifungal therapy during their hospitalization, and for preventing some bacterial infections in the early transplant period, patients need vaccinations on the waiting list according to the current recommendations. Although morbidity and mortality related to infectious diseases have decreased during the last few years in haematopoietic stem cell transplant recipients, they are still one of the most important complications in this population. Furthermore, as occurs in the general population, the incidence of nosocomial infections has increased during the different phases of transplantation. It is difficult to establish general preventive measures in these patients, as there are many risk factors conditioning these infections. Firstly, they undergo multiple antibiotic treatments and interventions; secondly, there is a wide variability in the degree of neutropenia and immunosuppression among patients, and finally they combine hospital and home stay during the transplant process. However, some simple measures could be implemented to improve the current situation.
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Affiliation(s)
- Asunción Moreno Camacho
- Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, España.
| | - Isabel Ruiz Camps
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
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Lupión C, López-Cortés LE, Rodríguez-Baño J. [Preventive measures for avoiding transmission of microorganisms between hospitalised patients. Hand hygiene]. Enferm Infecc Microbiol Clin 2014; 32:603-9. [PMID: 24661995 DOI: 10.1016/j.eimc.2014.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 12/12/2022]
Abstract
Health-care associated infections are an important public health problem worldwide. The rates of health-care associated infections are indicators of the quality of health care. The infection control activities related to prevention of transmission of hospital microorganisms can be grouped in 4 mayor areas: standard precautions, specific precautions (including isolation if appropriate), environmental cleaning and disinfection, and surveillance activities (including providing infection rates and monitoring procedures). Hand hygiene and the correct use of gloves are the most important measures to prevent health-care associated infections and to avoid the dissemination of multidrug-resistant microorganisms. Continuous educational activities aimed at improving adherence to hand hygiene are needed. Periodical assessment of adherence to hand hygiene recommendations with feed-back have been shown to provide sustained improvement. Several complementary activities are being evaluated, including skin decolonization prior to certain surgeries, a package of measures in patients with central venous catheters or mechanical ventilation, and universal body hygiene with chlorhexidine. The present area of discussion concerns in which situations and in which groups would such measures be effective and efficient.
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Affiliation(s)
- Carmen Lupión
- Unidad de Gestión Clínica Intercentro de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, España; Departamento de Enfermería, Universidad de Sevilla, Sevilla, España.
| | - Luis Eduardo López-Cortés
- Unidad de Gestión Clínica Intercentro de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, España
| | - Jesús Rodríguez-Baño
- Unidad de Gestión Clínica Intercentro de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España
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Zaragoza R, Ramírez P, López-Pueyo MJ. [Nosocomial infections in intensive care units]. Enferm Infecc Microbiol Clin 2014; 32:320-7. [PMID: 24661994 DOI: 10.1016/j.eimc.2014.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 02/23/2014] [Indexed: 12/22/2022]
Abstract
Nosocomial infections (NI) still have a high incidence in intensive care units (ICUs), and are becoming one of the most important problems in these units. It is well known that these infections are a major cause of morbidity and mortality in critically ill patients, and are associated with increases in the length of stay and excessive hospital costs. Based on the data from the ENVIN-UCI study, the rates and aetiology of the main nosocomial infections have been described, and include ventilator-associated pneumonia, urinary tract infection, and both primary and catheter related bloodstream infections, as well as the incidence of multidrug-resistant bacteria. A literature review on the impact of different nosocomial infections in critically ill patients is also presented. Infection control programs such as zero bacteraemia and pneumonia have been also analysed, and show a significant decrease in NI rates in ICUs.
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Abstract
The hospital acquired pneumonia (HAP) is one of the most common infections acquired among hospitalised patients. Within the HAP, the ventilator-associated pneumonia (VAP) is the most common nosocomial infection complication among patients with acute respiratory failure. The VAP and HAP are associated with increased mortality and increased hospital costs. The rise in HAP due to antibiotic-resistant bacteria also causes an increase in the incidence of inappropriate empirical antibiotic therapy, with an associated increased risk of hospital mortality. It is very important to know the most common organisms responsible for these infections in each hospital and each Intensive Care Unit, as well as their antimicrobial susceptibility patterns, in order to reduce the incidence of inappropriate antibiotic therapy and improve the prognosis of patients. Additionally, clinical strategies aimed at the prevention of HAP and VAP should be employed in hospital settings caring for patients at risk for these infections.
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Affiliation(s)
- Emili Díaz
- Servicio de Medicina Intensiva, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, CIBER Enfermedades Respiratorias, Sabadell, Barcelona, España
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Jordan García I, Arriourtúa AB, Torre JAC, Antón JG, Vicente JCDC, González CT. [A national multicentre study on nosocomial infections in PICU]. An Pediatr (Barc) 2011; 80:28-33. [PMID: 21233032 DOI: 10.1016/j.anpedi.2010.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 09/14/2010] [Accepted: 09/16/2010] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Nosocomial infection (NI) is a common complication in paediatric critical care units (PICU), with an associated mortality up to 11%. OBJECTIVE To describe NI epidemiology in the national PICU. To initiate an standard NI control measures to obtain paediatric incidence rates. PATIENTS AND METHOD Multicentre prospective study from 1 to 31 march 2007. Centre Disease Control diagnosis and methodological criteria were used. It was specially analyzed NI related to invasive devices: central venous catheter (CVC), mechanical ventilation (MV), urinary catheter (UC). RESULTS There were recruited 300 patients from 6 PICU, with 17 NI episodes in 16 patients (5,3% from admitted). NI rates resulted in 13,8 infections/1000 patients-day. Middle age from infected patients was 2,31 years (± 3,43), 9 males. Risk factors were found in 7 cases. NI location was: catheter-related bloodstream infection in 7 patients (6,7/1000 days CVC), ventilator associated pneumonia in 4 (9,4/1000 MV days), urinary-tract infection associated with UC in 4 (5,5/1000 UC days), one case of primary bloodstream infection and one surgical site infection. Isolated microorganisms were: 9 gram negatives bacillus, 4 Candida, 2 plasmocoagulase negative staphylococcus, 1 Haemophilus and 1 Staphylococcus aureus. Seven isolations were resistant microorganisms. There weren't any died related to NI. CONCLUSIONS NI epidemiology was similar to published data in our near countries. NI surveillance, with a standardized method of analysis is essential to the NI correct manage.
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Affiliation(s)
- I Jordan García
- Servicio de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues, Barcelona, España.
| | - A Bustinza Arriourtúa
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J A Concha Torre
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, España
| | - J Gil Antón
- Sección de Cuidados Intensivos Pediatría, Hospital de Cruces, Baracaldo, Vizcaya, España
| | - J C de Carlos Vicente
- Unidad de Cuidados Intensivos Pediatría, Hospital Son Dureta, Palma de Mallorca, Baleares, España
| | - C Téllez González
- Unidad de Cuidados Intensivos Pediatría, Grupo de Trabajo de Enfermedades Infecciosas de la SECIP, Hospital Virgen de la Arrixaca, El Palmar, Murcia, España
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