Outbreaks by Klebsiella oxytoca in neonatal intensive care units: Analysis of an outbreak in a tertiary hospital and systematic review.

OBJECTIVE: Klebsiella oxytoca can cause nosocomial infections, affecting vulnerable newborns. There are few studies describing nosocomial outbreaks in the neonatal intensive care units (NICU). In this study, a systematic review of the literature was carried out to know the main characteristics of these outbreaks and the evolution of one is described. METHODS: We conducted a systematic review in the Medline database up to July 2022, and present a descriptive study of an outbreak with 21 episodes in the NICU of a tertiary hospital, between September 2021 and January 2022. RESULTS: 9 articles met the inclusion criteria. The duration of outbreaks was found to be variable, of which 4 (44.4%) lasted for a year or more. Colonization (69%) was more frequent than infections (31%) and the mortality rate was 22.4%. In studies describing sources, the most frequent was the environmental origin (57.1%). In our outbreak there were 15 colonizations and 6 infections. The infections were mild conjunctivitis without sequelae. Molecular typing analysis made it possible to detect 4 different clusters. CONCLUSIONS: There is an important variability in the evolution and results of the published outbreaks, highlighting a greater number of colonized, use of PFGE (pulsed-field gel electrophoresis) techniques for molecular typing and implementation of control measures. Finally, we describe an outbreak in which 21 neonates were affected with mild infections, resolved without sequelae and whose control measures were effective.

Vitamin D status and the Cdx-2 polymorphism of the vitamin D receptor gene are determining factors of bone mineral density in young healthy postmenopausal women.

UNLABELLED: Bone mineral density (BMD) is a main determinant of osteoporotic fractures. A cross-sectional study was conducted in 229 young, healthy postmenopausal women (PMW) to evaluate the contribution of the vitamin D endocrine system and other clinical, biochemical and genetic parameters. Clinical risk factors for osteoporosis were obtained by a questionnaire. Serum concentrations of 25OHD, 1,25(OH)2D, PTH, and bone turnover markers were measured. The BsmI, FokI and Cdx-2 polymorphisms of the vitamin D receptor (VDR) gene were determined. DXA and the WHO criteria were applied for the diagnosis of osteoporosis. Univariate logistic and multivariate logistic regression analyses were carried out. RESULTS: The prevalence of vitamin D deficiency (<50nmol/l) was 50%. Age increased osteoporosis risk; whereas body mass index (BMI), number of reproductive years, 25OHD level and the Cdx-2 polymorphism in the VDR gene (when allele A is present) were found to be protective. Therefore, both serum 25OHD and VDR polymorphism should be taken into account in the evaluation and implementation of therapeutic strategies concerning PMW, especially as the prevalence of vitamin D deficiency is still alarmingly high even at Southern latitudes. This article is part of a Special Issue entitled 'Vitamin D Workshop'.

Infección quirúrgica en un hospital de tercer nivel. Estudio de vigilancia prospectivo (2001–2004) / Surgical site infection in a tertiary hospital. A prospective surveillance study (2001–2004)

Introducción: La infección de localización quirúrgica (ILQ), superficial y profunda, es un problema muy frecuente dentro de la infección hospitalaria. Supone un riesgo para la seguridad del paciente y, por tanto, su reducción es una prioridad para los sistemas sanitarios. El objetivo del estudio fue analizar la incidencia de ILQ en los servicios quirúrgicos de un hospital de tercer nivel. Material y métodos: Estudio de cohortes prospectivo sobre 14.455 pacientes ingresados desde enero de 2001 hasta diciembre de 2004. Se calcularon la incidencia acumulada (IA), cruda y ajustada por el índice del National Nosocomial Infection Surveillance (NNIS) y densidad de incidencia (DI) de ILQ. Resultados: La IA de pacientes con ILQ fue 3,4% (IC95%: 3,0–3,7%), la IA de ILQ 3,5% (IC95%: 3,2–3,8%) y la DI 0,28/100 pacientes intervenidos-día. Las unidades con IA más elevadas fueron cirugía maxilofacial (6%), digestiva (5,3%) y cardiovascular (5,1%). Ajustando por la estancia, urología y cirugía pediátrica registraron las mayores tasas de incidencia, mientras que oftalmología y neurocirugía obtuvieron las menores. La cirugía de colon y recto tuvieron los parámetros más elevados (IA=10%; DI=0,57), seguido de la revascularización miocárdica y la prótesis de cadera. En el conjunto de las unidades y en los procedimientos investigados, la IA de ILQ aumentó con el índice NNIS. Conclusiones: La IA y la DI de ILQ fueron similares a las obtenidas en los proyectos de vigilancia europeos e inferiores a las registradas en 1994 en este mismo hospital, reflejo de una mayor intensidad en la vigilancia y de una mayor concienciación en la aplicación de sus medidas de control (AU)

Introduction: Surgical site infection (SSI) is a very common problem in hospital infection control. It represents a risk for the safety of the patient and therefore its reduction is a priority in Health Services. The aim of the study is to analyse the incidence of SSI in the surgical departments of a tertiary hospital. Material and methods: A prospective cohort study was conducted on 14,455 patients admitted from January 2001 to December 2004. The cumulative incidence (CI) crude and adjusted for the National Nosocomial Infection Surveillance (NNIS) index and the incidence density (ID) of SSI were calculated. Results: The CI of patients with SSI was 3.4% (95% CI: 3.0–3.7%), the CI of SSI was 3.5% and the observed ID was 0.28/100 surgical patients/day. Surgical units with the highest CI were maxillofacial (6%), gastrointestinal (5.3%) and cardiovascular (5.1%). Adjusting for length of stay, urology and paediatric surgery recorded the highest incidence rates, while ophthalmology and neurosurgery had the least. Colorectal surgery had the highest parameters (CI=10%; ID=0.57), followed by myocardial revascularisation and hip prosthesis. Among the surgical units and operative procedures assessed, the CI of SSI increased with the NNIS index. Conclusions: The CI and ID of SSI observed in this study were similar to those obtained in previous European surveillance projects, and lower than those recorded in our hospital in 1994 which reflects a higher level of vigilance and a higher awareness in applying control measure (AU)

[Surgical site infection in a tertiary hospital. A prospective surveillance study (2001-2004)]. / Infección quirúrgica en un hospital de tercer nivel. Estudio de vigilancia prospectivo (2001-2004).

INTRODUCTION: Surgical site infection (SSI) is a very common problem in hospital infection control. It represents a risk for the safety of the patient and therefore its reduction is a priority in Health Services. The aim of the study is to analyse the incidence of SSI in the surgical departments of a tertiary hospital. MATERIAL AND METHODS: A prospective cohort study was conducted on 14,455 patients admitted from January 2001 to December 2004. The cumulative incidence (CI) crude and adjusted for the National Nosocomial Infection Surveillance (NNIS) index and the incidence density (ID) of SSI were calculated. RESULTS: The CI of patients with SSI was 3.4% (95% CI: 3.0-3.7%), the CI of SSI was 3.5% and the observed ID was 0.28/100 surgical patients/day. Surgical units with the highest CI were maxillofacial (6%), gastrointestinal (5.3%) and cardiovascular (5.1%). Adjusting for length of stay, urology and paediatric surgery recorded the highest incidence rates, while ophthalmology and neurosurgery had the least. Colorectal surgery had the highest parameters (CI=10%; ID=0.57), followed by myocardial revascularisation and hip prosthesis. Among the surgical units and operative procedures assessed, the CI of SSI increased with the NNIS index. CONCLUSIONS: The CI and ID of SSI observed in this study were similar to those obtained in previous European surveillance projects, and lower than those recorded in our hospital in 1994 which reflects a higher level of vigilance and a higher awareness in applying control measures.

Urinary bladder cancer risk factors in men: a Spanish case-control study.

The rising incidence of urinary bladder cancer is alarming and potential relationships with different risk factors have been postulated. The purpose of this study was to examine the possible relationship between different environmental risk factors and urinary bladder cancer. All men with urinary bladder cancer who were admitted to the Department of Urology of Reina Sofia University Hospital of Cordoba, Spain over 1 year were included in our study. Men were administered an interview questionnaire, which included data on history of known urinary bladder cancer risk factors. Comparisons between men with urinary bladder cancer (cases) and those with nonmalignant urological disease (controls) were made. The study included 74 cases and 89 controls. The variables associated with malignant lesions on univariate analysis were age, smoking and drinking alcohol. Meanwhile, fish, poultry and beef consumption were proved to be protective factors. The risk factors identified by the logistic regression analysis were age, smoking and fluid intake. The independent protective factors on the multivariate analysis were fish and poultry consumptions. Smoking was found to be the principal independent risk factors for urinary bladder cancer. Our results call for further investigation of urinary bladder cancer risk factors; future studies should preferably be performed on large prospective cohorts, to increase their validity.

Urinary bladder cancer and the petroleum industry: a quantitative review.

PURPOSE: To estimate the pooled risk of petroleum industry for urinary bladder cancer. MATERIAL AND METHODS: All observational studies that evaluated the association between urinary bladder risk and the petroleum industry were reviewed. We have only identified eight case-control studies. These studies were carried out between 1989 and 1995. RESULTS: Of the eight localized studies six were exclusively for males. The other two studies included both males and females, but none reported separately the risk among men and women. There was an obvious risk of petroleum industry in the pooled risk (odds ratio 1.4, 95% confidence interval (CI) 1.27-1.54). Also, Q test was not significant (P>0.1), denoting homogeneity across the pooled studies. Pooled analysis applying the random effect model was 1.50 (95% CI 1.29-1.75). CONCLUSION: Although our pooled estimate shows that the petroleum industry is associated with the risk of urinary bladder cancer, the eight studies were based on retrospective data from case-control studies. Further prospective studies evaluating the association between petroleum industry and urinary bladder cancer risk are strongly needed.

Respuesta de los autores. Vigilancia de la infección nosocomial en pacientes críticos ingresados en servicios de medicina intensiva / Reply. Nosocomial infection surveillance in critically ill patients in the intensive care units

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Vigilancia de la infección nosocomial: ¿todos medimos lo mismo? / Vigilance of nosocomial infection: Is the same measured by all of us?

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Invasive pulmonary aspergillosis: retrospective case record review.

Invasive pulmonary aspergillosis is a severe infection, with a sharp increase during the last decades. Our study aimed at identification of the epidemiological characteristics of invasive pulmonary aspergillosis during a period of four years. All clinical records with pulmonary isolation of Aspergillus species were reviewed, as a part of surveillance program at Reina Sofia University Hospital, from January 1995 to December 1998. Diagnosis of invasive pulmonary aspergillosis was based on criteria of Centers for Disease Control and Prevention. Of the 50 patients identified 78% were males and 44% were current or ex-smokers. Chronic respiratory diseases were identified in 64% of them, and 60% were receiving immunosuppressives. Twenty percent of our patients had been subjected to lung transplantation and 28% to organ transplantation in general. Only 78% had received specific antifungal treatment and 56% had fatal prognosis. Our findings match with previous studies, apart from the high frequency of lung transplantation in our series. We recommend further studies on large prospective cohorts.

[Factors influencing hospital infection in patients in the intensive care unit]. / Factores que influyen sobre la aparición de infecciones hospitalarias en los pacientes de cuidados intensivos.

OBJECTIVE: The accumulation of risk factors in hospitalized patients is one of the elements contributing to the increase in the frequency of nosocomial infection in the intensive care unit (ICU). Our aim was to identify nosocomial infection risk factors in the ICU of our hospital. METHODS: We performed a prospective cohort study of 1,134 patients admitted to the ICU for at least 24 hours in 2001. The patients were followed-up for 48 hours after leaving the ICU. Multivariate Cox regression analysis was used to identify risk factors. RESULTS: The intrinsic risk factors identified were the principal diagnosis motivating admission to the ICU, traumatic brain injury and renal insufficiency. Invasive techniques that were independently associated with nosocomial infection (from high to low risk) were urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheter, and total parenteral nutrition. CONCLUSIONS: Although endogenous risk factors, which cannot be modified, represented the most important associated factors, steps to reduce nosocomial infections should concentrate on the following exogenous risk factors: urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheters, and total parenteral nutrition.

Evolución temporal de aspergilosis pulmonar durante cuatro años en un hospital docente / Temporal development of pulmonary aspergillosis over a four-year period in a teaching hospital

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Invasive pulmonary aspergillosis: identification of risk factors.

Aspergillosis is the second most frequent fungal infection after candidiasis in teaching hospitals. Clinical manifestations of pulmonary aspergillosis range from asymptomatic colonization to disseminated disease. The aim of this study was to identify the risk factors associated with invasive pulmonary aspergillosis, in patients with positive pulmonary isolation of Aspergillus species. A review was undertaken of all clinical records with pulmonary isolation of Aspergillus species at Reina Sofia University Hospital from January 1995 to December 1998. Data collected were: age, gender, history of smoking, past medical history, such as chronic pulmonary disease, immunosuppression, granulocytopenia in the past 6 months and during the last admission, history of surgery including within the last year of the study period, number of hospital admissions and clinical evidence of invasive pulmonary aspergillosis. To investigate all the possible risk factors for invasive pulmonary aspergillosis, a multivariable logistic regression model was used. 132 patients with positive pulmonary isolation were identified, of which 42.4% had clinical evidence of invasive pulmonary aspergillosis. The independent factors significantly associated with invasive pulmonary aspergillosis were: granulocytopenia in the past 6 months, immunosuppression in the last admission and the number of hospital admissions within the past year. Patients with a history of granulocytopenia in the past 6 months and immunosuppression in the last admission are the high-risk group for invasive pulmonary aspergillosis. However, invasive pulmonary aspergillosis can also occur in mild granulocytopenic or even immunocompetent patients.