Epidemiology of bacterial co-infections and risk factors in COVID-19-hospitalized patients in Spain: a nationwide study.

BACKGROUND: We performed a nationwide population-based retrospective study to describe the epidemiology of bacterial co-infections in coronavirus disease 2019 (COVID-19)-hospitalized patients in Spain in 2020. We also analyzed the risk factors for co-infection, the etiology and the impact in the outcome. METHODS: Data were obtained from records in the Minimum Basic Data Set (MBDS) of the National Surveillance System for Hospital Data in Spain, provided by the Ministry of Health and annually published with 2 years lag. COVID-19 circulated in two waves in 2020: from its introduction to 31st June and from 1st July to 31st December. The risk of developing a healthcare-associated bacterial co-infection and the risk for in-hospital and intensive care unit (ICU) mortality in co-infected patients was assessed using an adjusted logistic regression model. RESULTS: The incidence of bacterial co-infection in COVID-19 hospitalized patients was 2.3%. The main risk factors associated with bacterial co-infection were organ failure, obesity and male sex. Co-infection was associated with worse outcomes including higher in-hospital, in-ICU mortality and higher length of stay. Gram-negative bacteria caused most infections. Causative agents were similar between waves, although higher co-infections with Pseudomonas spp. were detected in the first wave and with Haemophilus influenzae and Streptococcus pneumoniae in the second. CONCLUSIONS: Co-infections are not as common as those found in other viral respiratory infections; therefore, antibiotics should be used carefully. Screening for actual co-infection to prescribe antibiotic therapy when required should be performed.

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010-2013).

OBJECTIVE: To describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs. DESIGN: A retrospective, descriptive, epidemiological study. SETTING: This study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period. PARTICIPANTS: We selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period. MAIN OUTCOME MEASURES: We calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI. RESULTS: During the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93). CONCLUSIONS: The incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

Trends in nontuberculous mycobacterial disease in hospitalized subjects in Spain (1997-2010) according to HIV infection.

OBJECTIVES: The aim of the study was to estimate the incidence of nontuberculous mycobacterial (NTM) disease and the rate of NTM disease-related mortality and to analyse trends in these variables according to HIV infection. METHODS: We performed a retrospective study for the period 1997-2010 using data from the Minimum Basic Data Set (MBDS) provided by the Spanish Ministry of Health. The exposure variables were: (i) HIV infection (HIV positive versus HIV negative); (ii) calendar period in relation to widespread use of combination antiretroviral therapy (cART) [1997-1999 (early cART period), 2000-2003 (middle cART period) and 2004-2010 (late cART period)]. The outcome variables were (i) new NTM disease diagnosis and (ii) mortality. RESULTS: A total of 3729 cases of incident NTM disease were collected in MBDS, 1795 in the HIV-negative group and 1934 in the HIV-positive group, among whom 602 deaths occurred, 223 in the HIV-negative group and 379 in the HIV-positive group. The incidence of NTM disease and the rate of NTM disease-related mortality were 1000-fold higher in the HIV-positive group than in the HIV-negative group. Regarding the incidence of NTM disease, in the HIV-negative group the incidence increased from 2.91 to 3.97 events per 1,000,000 patient-years from 1997-1999 to 2004-2010 (P < 0.001), while in the HIV-positive group the incidence decreased from 2.29 to 0.71 events per 1000 patient-years from 1997-1999 to 2004-2010 (P < 0.001). Regarding mortality, in the HIV-negative group mortality increased from 2.63 to 4.26 events per 10,000,000 patient-years from 1997-1999 to 2000-2003 (P = 0.059), and then the rate stabilized at around 3.87 events per 10,000,000 patient-years in 2004-2010 (P = 0.128), while in the HIV-positive group mortality decreased from 4.28 to 1.39 events per 10,000 patient-years from 1997-1999 to 2004-2010 (P < 0.001). CONCLUSIONS: HIV infection was associated with a higher NTM disease incidence and higher NTM disease-related mortality than in the general population, but these rates decreased in the HIV-positive group from 1997-1999 to 2004-2010, whereas the NTM disease incidence increased in the HIV-negative group.

Epidemiology of suicide in Spain, 1981-2008: a spatiotemporal analysis.

OBJECTIVE: To analyse the epidemiology of suicide, and compare its occurrence between the sexes and in various regions in Spain. METHOD: Age-specific analysis and spatiotemporal analysis to analyse death by suicide between 1981 and 2008 in Spain. STUDY DESIGN: Ecological study. RESULTS: Death by suicide has decreased since the 1990s in Spain, although peaks in suicides correspond with times of economic crisis. Death by suicide was more common among men than among women, although the suicide mortality rate increased over the study period among women aged 35-49 years. Geographical analysis showed that rural populations and areas with historically higher levels of unemployment have higher suicide rates. In contrast, less-populated regions have lower suicide rates. CONCLUSION: Suicides in Spain exhibit a clear geographic pattern and occur at different rates between the genders. The results suggest an increasing number of suicides among women aged 35-49 years over the study period.

Factors involved in health-related transitions after curative resection for pancreatic cancer. 10-years experience: a multi state model.

BACKGROUND: Pancreatic cancer is one of the least common tumours, nevertheless it is one of the most lethal. This lethality is mainly due to the fact that the vast majority of patients are diagnosed in an advanced stage. The purpose of this study was to investigate how different covariates affect the transition to death or discharge with and without complications after pancreatic resection. METHODS: We analyse the impact of different factors on transitions after pancreatic resection based on a multi state model. RESULTS: Transitions of interest include the transition to death/discharge with/without complications after pancreatic resection. We consider presence of comorbidities, higher age (>60), gender-male, lower hospital volume (<10 cases per year), type of surgery, localization of tumour and transfusion received as covariates with a potentially negative effect on the transition intensities to death with or without complications. CONCLUSIONS: The multi-state model allows for a very detailed analysis of the impact of covariates on each transition, since effects of covariates may change depending on the current state of the patient, thus helping surgeons and patients throughout the surgical process and counselling patients if needed.

Breast cancer mortality in Spain: has it really declined for all age groups?

OBJECTIVES: In recent years, the incidence of breast cancer has increased in Spain but mortality has decreased, particularly since 1992. Despite the general decrease in mortality, the intensity of this disease differs between age groups. The main objective of this study was to examine mortality due to breast cancer for different age groups in Spain from 1981 to 2007, and to forecast the mortality rate in 2023. STUDY DESIGN: Ecological study. METHODS: Trends in mortality due to breast cancer were analysed using the Lee-Carter model, which is the typical analysis for mortality in the general population but is rarely used to analyse specific causes of death. RESULTS: This study found a decreasing trend in mortality due to breast cancer from 1993 to 2007, and it is predicted that this trend will continue. However, mortality rates varied between age groups: a decreasing trend was seen in younger and middle-aged women, whereas mortality rates remained stable in older women. CONCLUSIONS: Preventive breast cancer practices should differ by patient age.

In-hospital death caused by pancreatic cancer in Spain: application with a bayesian network.

Pancreatic cancer is one of the least common tumors (2.1%), but it remains one of the most lethal. This lethality is primarily due to late stage diagnosis in the vast majority of patients. Here we demonstrate, using a Bayesian network, that we can determine a posteriori, with a high probability of success, the probability of in-hospital death of pancreatic cancer in hospitals across Spain with information related to the type of admission, the type of procedure, the primary diagnosis or the Charlson co-morbidity index. The advantages of using a Bayesian network are that it allows us to examine multiple hypotheses and to measure the effect of the introduction of variables on our hypotheses. Being able to determine deceases in the probability of survival based on hospital admission data, such as the diagnosis resulting in the present admission or the presence of co-morbidities, could facilitate the detection of deficiencies in the patient treatment and improve hospital management. Moreover, the control of related co-morbidities may have an impact on the in-hospital deaths of these patients.

[Epidemiology of hospitalizations caused by rubella in the general population in Spain (1997-2006)]. / Epidemiología de las hospitalizaciones causadas por rubéola en la población general en España (1997-2006).

BACKGROUND: Rubella is benign in children, but in pregnant women it can produce Congenital Rubella Syndrome (CRS) with severe consequences for the foetus. In spite of vaccination coverage in Spain being above 95%, isolated cases and outbreaks continue to occur. The aim of this study is to estimate the incidence of hospitalisations due to rubella in Spain (1997-2006). METHODS: Utilising the basic minimum dataset (National System of Epidemiological Surveillance) we calculated: rate of hospitalisation, average stay and cost. RESULTS: There were 267 hospitalisations, amongst them 144 due to rubella during pregnancy, 1 due to CRS and 8 due to encephalomyelitis. The overall rate of hospitalisation was 0.065 per 105 inhabitants (IC95%=0.0649-0.0654). The average stay was 3 days. The average cost of a hospitalisation was 2,082 euros, and if complicated by encephalomyelitis it rose to 8.191 euros. CONCLUSION: There continue to be hospitalisations due to rubella, basically due to problems in gestation and to complications in the existing susceptible population group.

Epidemiología de las hospitalizaciones causadas por rubéola en la población general en España (1997-2006) / Epidemiology of hospitalisations caused by rubella in the general population in Spain (1997-2006)

Fundamento. La rubéola es benigna en niños, pero enembarazadas puede producir el síndrome de rubéolacongénita (SRC) con graves consecuencias para el feto.A pesar de que en España la cobertura vacunal actuales mayor del 95%, siguen produciéndose casos aisladosy brotes. El objetivo de este estudio es estimar la incidenciade hospitalizaciones por rubéola en España,(1997-2006).Material y método. Utilizando el conjunto mínimo básicode datos (Sistema Nacional de Vigilancia Epidemiológica)se ha calculado: tasa de hospitalización, estanciamedia y coste.Resultados. Hubo 267 hospitalizaciones, entre ellas 144por rubéola en el embarazo, 1 por SRC y 8 casos porencefalomielitis. La tasa de hospitalización global fuede 0,065 por 105 habitantes (IC95%=0,0649-0,0654). Lamediana del tiempo de hospitalización fue de 3 días. Elcoste medio de una hospitalización fue de 2.082 € y si secomplica con encefalomielitis asciende a 8.191 €.Conclusión. En España, sigue habiendo hospitalizacionespor rubéola, debidas fundamentalmente a problemasen la gestación y a complicaciones en el grupo depoblación susceptible existente(AU)

Background. Rubella is benign in children, but in pregnantwomen it can produce Congenital Rubella Syndrome(CRS) with severe consequences for the foetus. Inspite of vaccination coverage in Spain being above 95%,isolated cases and outbreaks continue to occur. Theaim of this study is to estimate the incidence of hospitalisationsdue to rubella in Spain (1997-2006).Methods. Utilising the basic minimum dataset (NationalSystem of Epidemiological Surveillance) we calculated:rate of hospitalisation, average stay and cost.Results. There were 267 hospitalisations, amongst them144 due to rubella during pregnancy, 1 due to CRS and8 due to encephalomyelitis. The overall rate of hospitalisationwas 0.065 per 105 inhabitants (IC95%=0.0649-0.0654). The average stay was 3 days. The average costof a hospitalisation was 2,082 €, and if complicated byencephalomyelitis it rose to 8.191 €.Conclusion. There continue to be hospitalisations dueto rubella, basically due to problems in gestation andto complications in the existing susceptible populationgroup(AU)

Ingresos hospitalarios por rotavirus en niños menores de 5 años en España durante el año 2005 / Burden of hospitalizations attributable to rotavirus infection in children < 5 years old in Spain, 2005

El rotavirus es el agente etiológico más importantede diarrea aguda en niños en todo el mundo. Elobjetivo de este estudio es estimar la incidencia dehospitalizaciones atribuidas a infección por rotavirusen niños menores de 5 años en España en el año2005 y los costes asociados a estas hospitalizaciones.Se han utilizado los datos del CMBD (ConjuntoMínimo Básico de Datos hospitalarios) de admisioneshospitalarias en niños menores de 5 años conprimer diagnóstico al alta de gastroenteritis de cualquierorigen.La incidencia anual de hospitalizaciones por rotavirusen el año 2005 fue de 22 casos por 10.000 niñosmenores de 5 años. La estancia media hospitalariafue de 3,99 días y el coste anual total de8.549.368 euros.La gastroenteritis por rotavirus tiene impacto en lamorbilidad de la población, por lo que es necesarioestablecer estrategias efectivas de prevención

Rotavirus is the most important etiologic agent ofacute diarrea in children worldwide. The aim of thisstudy is provide estimates on the incidence of rotavirusinfection requiring hospitalization in children < 5years old in Spain in 2005 and the associated costsof these hospitalizations.Data from hospital data surveillance system(CMBD) for all hospital admissions in children < 5years of age with a first-listed diagnosis of any causegastroenteritis.The annual incidence of hospitalization for rotavirusin 2005 was 22 cases for 10,000 children < 5 years.The average length of stay was 3.99 days andthe annual total cost was euros 8.549.368.Gastroenteritis due to the rotavirus has an impactin child morbidity. It is necessary to establish effective strategies of prevention (AU)