Etiología y resistencias a los antibióticos en las infecciones de piel y partes blandas / No disponible

Las infecciones de piel y partes blandas (IPPB) son un grupo de infecciones frecuentes en los pacientes hospitalizados. La resistencia de los microorganismos a los antimicrobianos no ha dejado de aumentar en los últimos años. El objetivo de este estudio es informar de la etiología de las IPPB, de la frecuencia de sus resistencias a los antibióticos, así como caracterizar algunos de los factores que se asocian a IPPB por microorganismos resistentes (MR) en los pacientes hospitalizados. Métodos. Se realizaron encuestas anuales de prevalencia de infecciones en los pacientes hospitalizados durante el período de 1999-2005 siguiendo el protocolo del estudio EPINE. Se seleccionaron todas las IPPB presentes en los pacientes. La información se obtiene a partir de la historia clínica: características demográfico- administrativas de los pacientes, datos microbiológicos, así como la presencia de potenciales factores de riesgo intrínseco y extrínseco. Para el análisis se utilizó la prueba de Chi-cuadrado de Mantel Haenszel o la Chii-cuadrado de tendencias y un modelo multivariante por regresión logística múltiple. Resultados: Se identificaron un total de 7.876 OPPB en las que se aislaron 6.093 microorganismos. Los más frecuentes fueron: Staphylococcus aureus (21,6%), Pseudomonas aeruginosa (11,6%), Escherichia coli (10,0%) y Enterococcus sp. (8,0%). Las resistencias a los antibióticos de los microorganismos principales experimentaron un incremento bruto del 53% desde el año 1999 hasta el 2005. Las resistencias a las cerfalosporinas de tercera generación oscilan entre el 9,4% para E. coli y el 18,7% para la P.aeruginosa (solamente para la ceftazidima); y las resistencias a las fluorquinolonas, entre el 7,7% para Enterobacter s.p. y el 26% para E. coli y P. aeruginosa. S. aureus es resistente a la oxacilina en el 32% de los aislados (AU)

Skin and soft tissue infections (SSI) are a frequent group of infections in hospitalized patients. Microorganism resistant to antimicrobials has been increasing the precedent year. The objective of this study is to report on the etiology of SSI, the frequency of antimicrobial resistance, as well as characterize some of the factors associated to infections by resistant microorganisms (RM) in hospitalized patients. Methods. A series of yearly prevalence surveys in hospitalized patients during the period 1999 through 2005, as defined by the EPINE protocol. Information is gathered from medical records: administrative and demographics, microbiological data, as well as the presence of potential intrinsic and extrinsic risk factors. To analyzed data Mantel – Haenszel Chi – square, or Chi- square for trends and a multivariate model by logistic regression analysis were perfomed. Results. A total of 7,876 SSI were identified yielding 6,093 microorganisms. The most frequent microorganisms isolated were: Staphylococcus aureus (21,6%), Pseudomonas aeruginosa (11,6%), Escherichia coli (10,0%) and Enterococcus sp. (8,0%). Antimicrobial resistance of main pathogens experienced a crude increase of 53% form year 1999 through year 2005. Third generation cephalosporin resistance ranged from 9,4% for E. Coli, to 18,7% for P. aeruginosa (only to ceftazidime), and fluorquinolones resistance form 7,7% for Enterobacter sp. Through 26% for E. coli and P. aeruginosa S. aureus showed resistance to oxaciline in 32% of isolates (AU)

Nosocomial and community-acquired meticillin-resistant Staphylococcus aureus infections in hospitalized patients (Spain, 1993-2003).

A series of annual surveys on the prevalence of infections in hospitalized patients in Spain was undertaken from 1993 to 2003 to describe clinical and demographic characteristics, trends and geographical variations in the proportion of meticillin-resistant Staphylococcus aureus (MRSA). A total of 8312 S. aureus infections in patients from 296 acute care hospitals pertaining to 17 regions in Spain were observed during the study period. Overall, 23.8% of these organisms were reported as meticillin resistant. The proportion of MRSA varied widely across regions and during the study period. Patients with nosocomial infections (NIs) had a two-fold higher prevalence of MRSA (31%) than patients with community-acquired infections (CAIs) (14%; P<0.001). Nevertheless, there was an increasing trend in the prevalence of MRSA isolates, both in patients with NI (from 22% to 41%; P<0.001) and with CAI (from 7% to 28%; P<0.001) throughout the 11-year period. Geographical variations over the last three years (2001-2003) show a centripetal gradient, with the lowest MRSA prevalence in south-west Spain and the highest MRSA prevalence in the central regions. Almost five-fold differences in MRSA proportions were seen between regions (range 10.3-54.5%). Compared with bloodstream infections, infections in other sites were more likely to be caused by MRSA (adjusted odds ratios for surgical site, urinary tract, skin and respiratory infections of 1.2, 1.2, 1.5 and 2.1, respectively).

Exámentes de salud médico-preventivos con criterios de salud ocupacional. Adaptación de protocolos de vigilancia sanitaria específicos para trabajadores de atención de salud / No disponible

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Epidemiology and economic impact of varicella in immunocompetent children in Spain. A nation-wide study.

The epidemiology and burden of varicella was assessed through the prospective study of 683 children under 15 years, by 58 primary care paediatricians working on seven autonomous communities of Spain. The mean age was 4.5+/-2.7 years, and 566 (83%) were secondary cases. There were 111 complications in 101 children (14.8%), skin superinfection being the most frequent (8.9%), followed by respiratory tract (4.5%) and eye (2.2%) infections. The mean number of visits to the paediatric clinic was 1.42 (95% C.I. 1.37-1.47), and 5.6% of the children were attended in the emergency department of a hospital previously. All children had at least one prescription, being antihistamines and antipyretics the most prescribed. Thirteen percent received systemic antibiotics and 11% acyclovir. Children were mainly cared by grandparents, and parents were off work for a mean of 0.97 days (1.61 if children under 5 years attended day-care facilities; 0.51 if they did not). Costs derived from medical attention totalled 32.5, and social indirect costs were 63.77.

Comparative pharmacoeconomic study of vancomycin and teicoplanin in intensive care patients.

Randomized clinical trials and meta-analyses have not demonstrated any statistically significant differences between teicoplanin and vancomycin with regard to efficacy. A cost-minimization analysis was conducted to compare the economical impact of the treatment with vancomycin and teicoplanin in intensive care patients. Information on resource utilization was retrospectively collected from 100 consecutive clinical histories of patients hospitalized in a Spanish Intensive Care Unit, who had been given a glycopeptide antibiotic (50 teicoplanin and 50 vancomycin) for the treatment of a suspected or proven infection. Although personnel, material, and monitoring costs were higher in the vancomycin group, the acquisition costs and the total costs were much lower in this group, so the resulting total costs per day were 5508 ptas (33 euros) for vancomycin-treated patients and 9893 ptas (59.5 euros) for teicoplanin-treated patients. The savings with vancomycin for a 10-day course of treatment would be approximately 40697 ptas (244.5 euros) per patient. Results were consistent for a variety of conditions that were included in the sensitivity analysis.

[Double-blind clinical trial comparing 5 days of dirithromycin versus 7 days of diacetylmidecamycin in acute bronchitis and acute exacerbations of chronic bronchitis]. / Ensayo clínico doble ciego comparando 5 días de diritromicina frente a 7 días de diacetilmidecamicina en bronquitis aguda y exacerbaciones agudas de bronquitis crónica.

BACKGROUND: Dirythromycin has several pharmacokinetic characteristics (long half life and high tissue concentrations) which suggest the possibility of administering shorter treatments than those conventionally used. The aim of this study was to determine and compare the efficacy of a 5 day treatment with dirythromycin once a day, versus diacetylmidecamycin twice a day over 7 days in the treatment of patients with acute bronchitis and acute exacerbations of chronic bronchitis. METHODS: A parallel, multicentric, randomized, double blind clinical study was carried out in 8 Spanish hospitals. RESULTS: One hundred seventy-four patients were included in the study, with 87 (80 evaluable) being randomly assigned to receive dirythromycin (500 mg/day over 5 days) and 87 (83 evaluable) diacetylmidecamycin (600 mg, twice daily over 7 days). A favorable symptomatic response (cure or improvement) was observed in 72/80 of the first group (90%) and in 74/83 (89.2%) of the second group. No statistically significant differences were found in the efficacy and safety between the two treatment groups in either the evaluable patients or on intention to treat analysis. CONCLUSIONS: The results of this study suggest that the administration of dirythromycin, once a day over 5 days, is as safe and effective as diacetylmidecamycin, twice a day over 7 days, in the treatment of acute bronchitis and acute exacerbations of chronic bronchitis.

Nosocomial infections in Spain: results of five nationwide serial prevalence surveys (EPINE Project, 1990 to 1994). Nosocomial Infections Prevalence Study in Spain.

OBJECTIVE: To determine trends in rates of nosocomial infections in Spanish hospitals. DESIGN: Prospective prevalence studies, performed yearly from 1990 through 1994. SETTING: A convenience sample of acute-care Spanish hospitals. PARTICIPANTS AND PATIENTS: The number of hospitals and patients included were as follows: 1990, 125 hospitals and 38,489 patients; 1991, 136 and 42,185; 1992, 163 and 44,343; 1993, 171 and 46,983; 1994, 186 and 49,689. A core sample of 74 hospitals, which participated in all five surveys and included a mean of 23,871 patients per year, was analyzed separately. RESULTS: The overall prevalence rate of patients with nosocomial infections in the five studies was as follows: 1990, 8.5%; 1991, 7.8%; 1992, 7.3%; 1993, 7.1%; and 1994, 7.2%. The prevalence rate of patients with nosocomial infection in the core sample of 74 hospitals was 8.9%, 8.0%, 7.4%, 7.6%, and 7.6%, respectively (test for trend, P = .0001). Patients admitted to intensive-care units had a 22.8% prevalence rate of nosocomial infection in 1994. The most common nosocomial infections by primary site were urinary tract infection and surgical site infections, followed by respiratory tract infections and bacteremia. More than 60% of all infections were supported by a microbiological diagnosis. CONCLUSIONS: The EPINE project provides a uniform tool for performing limited surveillance of nosocomial infections in most Spanish acute-care hospitals. Its use helps to spread an accepted set of definitions and methods for nosocomial infection control in the Spanish healthcare system. The surveys indicated that the prevalence of nosocomial infections has been reduced over the last 5 years in a core sample of Spanish hospitals.

Nosocomial infections in pediatric patients: a prevalence study in Spanish hospitals. EPINE Working Group.

BACKGROUND: The magnitude of the problem of nosocomial infection in children has never been studied in Spain. METHODS: In 1990, a nationwide cross-sectional study was conducted to determine the prevalence of nosocomial infection and associated risk factors. RESULTS: Among 38,489 patients surveyed, 4081 were pediatric patients. Three hundred forty-five patients (8.4%) had active nosocomial infection at the time of the survey. Pediatric intensive care units (29.7%), hematology (23%), and special units (22%) showed the highest rates. Infections were most common in patients younger than 1 year (prevalence, 12.3%). Frequencies of nosocomial infection by site were as follows: bloodstream, 22.1%; urinary tract, 13.1%; lower respiratory tract, 12.3%; postoperative wound, 8%; gastrointestinal tract, 7.6%; skin, 6.5%; eye, 5.8%; and others 24.6%. The factors most closely associated with a higher prevalence of nosocomial infection in pediatrics were as follows: age younger than 1 year, surgery, moderate and severe baseline risk, number of diagnoses, and all categories of extrinsic risk factors. The most frequent etiologic agents were gram-positive bacteria (45.8%). CONCLUSIONS: Although the overall prevalence is at an acceptable level, future efforts should be focused on developing more effective prevention strategies in specific areas.