ABSTRACT
Introducció. Laccident ofídic és un motiu dhospitalitzacióa Catalunya, sobretot en època estival. Tot i que és unmotiu dingrés infreqüent, presenta una mortalitat no negligible. Sobre la base dun cas clínic, sen revisa el maneig iel tractament, sovint desconegut.Cas clínic. Pacient de 12 anys ingressada per accident ofídic i reacció al verí amb afectació cutània local i analítica.Necessita ingrés a la unitat de cures intensives, administració de sèrum antiofídic i dessensibilització a aquestabans de ladministració subcutània.Comentaris. Es presenta el cas amb lobjectiu de revisar els criteris dingrés, les proves analítiques i els criteris dadministració (via i dosi) del sèrum antiofídic. (AU)
Introducción. El accidente ofídico es un motivo de hospitalizaciónen Cataluña, sobre todo en época estival. Aunque es un motivo deingreso infrecuente, presenta una mortalidad no despreciable. Enbase a un caso clínico, se intenta revisar su manejo y tratamiento,a menudo desconocido.Caso clínico. Paciente de 12 años ingresada en el centro por accidente ofídico y reacción al veneno con afectación cutánea local yanalítica. Precisa ingreso hospitalario en unidad de cuidados intensivos, administración de suero antiofídico y realización de desensibilización a este, antes de su administración subcutánea.Comentarios. Se presenta el caso con el objetivo de revisar loscriterios de ingreso, pruebas analíticas y criterios de administración (vía y dosis) del suero antiofídico. (AU)
Introduction. Ophidic accidents are a cause for hospitalization inCatalonia, especially during summer. Despite their rarity, mortalityrate is not negligible. In this report we review the management ofophidic accidents.Case report. A 12-year-old patient was admitted to the hospital dueto an ophidic accident with severe local reaction to the venom,together with laboratory alterations, who required hospitalization in the intensive care unit and administration of antiophidic serumwith previous desensitization.Comments. The case is presented with the aim of reviewing theadmission criteria, laboratory tests and administration criteria(route and dose) of the antiophidic serum. (AU)
Subject(s)
Humans , Female , Child , Viper Venoms/adverse effects , Antivenins , Snake Bites/diagnosis , Snake Bites/drug therapy , Snake Bites/therapyABSTRACT
BACKGROUND: Healthcare-associated infections caused by Pseudomonas aeruginosa are associated with poor outcomes. However, the role of P. aeruginosa in surgical site infections after colorectal surgery has not been evaluated. The aim of this study was to determine the predictive factors and outcomes of surgical site infections caused by P. aeruginosa after colorectal surgery, with special emphasis on the role of preoperative oral antibiotic prophylaxis. METHODS: We conducted an observational, multicenter, prospective cohort study of all patients undergoing elective colorectal surgery at 10 Spanish hospitals (2011-2014). A logistic regression model was used to identify predictive factors for P. aeruginosa surgical site infections. RESULTS: Out of 3701 patients, 669 (18.1%) developed surgical site infections, and 62 (9.3%) of these were due to P. aeruginosa. The following factors were found to differentiate between P. aeruginosa surgical site infections and those caused by other microorganisms: American Society of Anesthesiologists' score III-IV (67.7% vs 45.5%, p = 0.001, odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.44-4.39), National Nosocomial Infections Surveillance risk index 1-2 (74.2% vs 44.2%, p < 0.001, OR 3.6, 95% CI 2.01-6.56), duration of surgery ≥75thpercentile (61.3% vs 41.4%, p = 0.003, OR 2.2, 95% CI 1.31-3.83) and oral antibiotic prophylaxis (17.7% vs 33.6%, p = 0.01, OR 0.4, 95% CI 0.21-0.83). Patients with P. aeruginosa surgical site infections were administered antibiotic treatment for a longer duration (median 17 days [interquartile range (IQR) 10-24] vs 13d [IQR 8-20], p = 0.015, OR 1.1, 95% CI 1.00-1.12), had a higher treatment failure rate (30.6% vs 20.8%, p = 0.07, OR 1.7, 95% CI 0.96-2.99), and longer hospitalization (median 22 days [IQR 15-42] vs 19d [IQR 12-28], p = 0.02, OR 1.1, 95% CI 1.00-1.17) than those with surgical site infections due to other microorganisms. Independent predictive factors associated with P. aeruginosa surgical site infections were the National Nosocomial Infections Surveillance risk index 1-2 (OR 2.3, 95% CI 1.03-5.40) and the use of oral antibiotic prophylaxis (OR 0.4, 95% CI 0.23-0.90). CONCLUSIONS: We observed that surgical site infections due to P. aeruginosa are associated with a higher National Nosocomial Infections Surveillance risk index, poor outcomes, and lack of preoperative oral antibiotic prophylaxis. These findings can aid in establishing specific preventive measures and appropriate empirical antibiotic treatment.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Pseudomonas Infections/prevention & control , Surgical Wound Infection/drug therapy , Administration, Oral , Aged , Aged, 80 and over , Colorectal Neoplasms/surgery , Elective Surgical Procedures , Female , Hospitalization , Humans , Inflammatory Bowel Diseases/surgery , Logistic Models , Male , Middle Aged , Multicenter Studies as Topic , Odds Ratio , Prospective Studies , Pseudomonas Infections/microbiology , Pseudomonas Infections/pathology , Pseudomonas aeruginosa/isolation & purification , Risk Factors , Surgical Wound Infection/microbiology , Surgical Wound Infection/pathologyABSTRACT
BACKGROUND: Surgical site infections (SSIs) are the leading cause of healthcare-associated infections in acute care hospitals in Europe. However, the risk factors for the development of early-onset (EO) and late-onset (LO) SSI have not been elucidated. AIM: This study investigated the predictive factors for EO-SSI and LO-SSI in a large cohort of patients undergoing colorectal surgery. METHODS: We prospectively followed-up adult patients undergoing elective colorectal surgery in 10 hospitals (2011-2014). Patients were divided into three groups: EO-SSI, LO-SSI, or no infection (no-SSI). The cut-off defining EO-SSI and LO-SSI was seven days (median time to SSI development). Different predictive factors for EO-SSI and LO-SSI were analysed, comparing each group with the no-SSI patients. FINDINGS: Of 3701 patients, 320 (8.6%) and 349 (9.4%) developed EO-SSI and LO-SSI, respectively. The rest had no-SSI. Patients with EO-SSI were mostly males, had colon surgery and developed organ-space SSI whereas LO-SSI patients frequently received chemotherapy or radiotherapy and had incisional SSI. Male sex (odds ratio (OR): 1.92; P < 0.001), American Society of Anesthesiologists' physical status >2 (OR: 1.51; P = 0.01), administration of mechanical bowel preparation (OR: 0.7; P = 0.03) and stoma creation (OR: 1.95; P < 0.001) predicted EO-SSI whereas rectal surgery (OR: 1.43; P = 0.03), prolonged surgery (OR: 1.4; P = 0.03) and previous chemotherapy (OR: 1.8; P = 0.03) predicted LO-SSI. CONCLUSION: We found distinctive predictive factors for the development of SSI before and after seven days following elective colorectal surgery. These factors could help establish specific preventive measures in each group.
