Evaluación de la implantación de un bundle para la prevención de la infección de localización quirúrgica en artroplastia de rodilla y cadera en un hospital universitario / No disponible

Objetivo: Analizar el resultado de la implantación de un Bundle para la prevención de infección de localización quirúrgica (ILQ) en artroplastia de rodilla y cadera. Material y métodos: Estudio de intervención antes-después. Intervención: Bundle. Determinaciones: incidencia acumulada (IA) de ILQ y cumplimiento del Bundle. La medición de la IA de ILQ se realizó mediante un sistema de vigilancia prospectiva y la medición del cumplimiento del Bundle mediante la revisión de historias clínicas. Resultados: En 2012 la IA de ILQ fue del 4,4% frente a 1,6% en 2013. El Bundle se implantó en 2013, para el cumplimiento se revisó una muestra aleatoria del 33% de los pacientes intervenidos de prótesis de rodilla y cadera ese año. El cumplimiento de cada medida fue variable. Conclusiones: Se ha evidenciado una reducción de la ILQ coincidente con la puesta en marcha del Bundle. Se han identificado puntos críticos de incumplimiento y tomado medidas para su mejora

Objetivo: Analyze the result of the implantation of a Bundle for the prevention of surgical site infection (SSI) in knee and hip arthroplasty. Material y métodos: Intervention study before-after. Intervention: Bundle. Determinations: cumulative incidence (CI) of patients with SSI and Bundle compliance. The measurement the CI of SSI was made through a prospective vigilance system and the measurement of the Bundle compliance through a review of the medical histories. Results: In 2012, CI of SSI was 4,4% versus 1,6% in 2013. The Bundle was implanted in 2013, to size the compliance was revised a random sample of 33% of the patients who received knee and hip prosthesis that year. The compliance of each measurement varied.Conclusions: A reduction of the SSI coinciding with the commissioning of the Bundle has been evidenced. Critical points of failure were identified and measures have been implemented

Greater acceptance of routine HIV testing (opt-out) by patients attending an infectious disease unit in Spain.

OBJECTIVE: Our objective was to determine attitudes and opinions of patients seen in our ID Unit on conducting HIV testing universally. METHODS: The survey was conducted in patients between 18 and 65 years without known HIV infection. Requested information about the test was previous embodiment, reasons for rejection, opinion on the universal realization, benefits and/or drawbacks, possible test performance, and availability of results "test negative stigma." RESULTS: We surveyed 91 patients (54.9% males). Surprisingly, up to 18.7% of patients mistakenly believed that HIV testing is routinely performed without consent. A great majority (98.9%) felt that universal performance on the test would benefit mainly in early diagnosing and/or preventing transmission. Patients younger than 42 years were significantly more prone to doing the test as a routine procedure. Only 4 (4.4%) patients did not participate because they believed they were "not infected." A vast majority (80.5%) of respondents would prefer to have results within the first 24 hours. In addition, 20.7% would have a problem with confidentiality if HIV serology testing was done. CONCLUSIONS: In summary, the vast majority (95.6%) of the surveyed patients had a fair opinion about universal HIV testing. Only 4 patients (4.4%) would not consent to HIV testing (because of low-risk perception). Availability of rapid HIV tests can facilitate fast result delivery, facilitating linkage to care. Considering favorable patients' opinion, recent opt-out screening recommendations, highest HIV prevalence in admitted patients, and cost-effectiveness, studies favor universal HIV testing.

Black tongue associated with linezolid.

Darkening of the tongue and oral mucosa is a reaction pattern that can be related to a number of physiologic, metabolic, and toxic disorders, and medications and exogenous substances. Black discoloration of the tongue should be distinguished from black "hairy" tongue, which is characterized by hypertrophy of the filiform papillae. We report a case of a 42-year-old man presented with a black discoloration of his tongue during treatment with linezolid for spondylodiscitis. So in conclusion, tongue discoloration is a benign and reversible condition and a probable adverse event associated with linezolid. We present this case to increase clinicians' awareness of a new potential adverse effect of linezolid.

“Consultas de pasillo” (curbside consultation): otra actividad asistencial del infectólogo / Curbside consultation: Another healthcare activity of the infectious disease specialist

Introducción Se define “consulta de pasillo” (CP) como el proceso informal en el que un médico obtiene información de otro médico en el tratamiento de un paciente que nunca ha valorado el médico consultado. Material y métodos Estudio prospectivo observacional que tiene como objetivo conocer la frecuencia, los contenidos, los servicios demandantes y el resultado final de las CP realizadas a la Unidad de Enfermedades Infecciosas (UEI) en el período del 25-03-2008 al 5-12-2008. Las variables recogidas eran relativas al medio de contacto, tipo de pregunta, persona solicitante, complejidad del tema, tema relativo, recomendaciones y grado de seguimiento y evolución de la consulta. El grado de dificultad se evaluó mediante el sistema de la ACP (American Collage of Physicians). Se emplearon métodos estadísticos paramétricos y no paramétricos. ResultadosSe recabaron 208 CP (1,13/día), con una mediana de 2min. Los motivos de consulta más frecuentes fueron seleccionar un antimicrobiano (54,4%), evaluar el diagnóstico (10,5%), interpretación de datos microbiológicos (9,6%) y la combinación de varios motivos (27,4%). En el 5,8% se precisó ingreso para estudio y tratamiento de la enfermedad infecciosa. Se requirió una interconsulta formal en el 27% de los casos. Se encontraron diferencias significativas entre médicos adjuntos y residentes y las realizadas por servicios médicos y quirúrgicos. Conclusiones Queremos destacar que las CP suponen una parte importante de la actividad asistencial de la UEI, aunque en su mayoría son sencillas y no suponen una carga de trabajo excesiva. Sin embargo, cuando se trata de consultas de caso clínico, realizadas por staff, con un grado de dificultad alto y que implican servicios quirúrgicos generan una actividad formal significativa (AU)

Introduction “Curbside consultation” is the term used to describe an informal process in which a physician requests information from another physician about the management of a patient who has not been assessed by the person consulted. Material and Methods Prospective, observational study designed to determine the frequency, services requested, and final result of curbside consultations made over the period of 3 March to 12 May 2008. The variables recorded included the means by which contact was made, the type of question, person requesting information, complexity of the subject, related subject, recommendations, and degree of follow-up and evolution of the consultation. The degree of difficulty was evaluated using the system of the American Collage of Physicians. Parametric and nonparametric statistical tests were used in the analysis. Results A total of 208 consultations (1.13/day) were reported, lasting a median of 2 minutes. The most common reasons for consulting were selection of an antimicrobial agent (54.4%), evaluation of a diagnosis (10.5%), interpretation of microbiological data (9.6%), and a combination of reasons (27.4%). In 5.8% of cases, hospitalization was required to study and treat the infectious disease. A formal consultation was required in 27% of cases. Significant differences were found between staff physicians and medical residents and between medical and surgical departments. Conclusions Curbside consultations comprise an important part of healthcare activity in the Infectious Disease Department, although most requests are easily resolved and do not imply an excessive work burden. Nonetheless, when the consultation involves a difficult clinical case, the request is by a staff physician, and the surgery department is implicated, a significant amount of formal activity is generated (AU)

[Curbside consultation: another healthcare activity of the infectious disease specialist]. / "Consultas de pasillo" (curbside consultation): otra actividad asistencial del infectólogo.

INTRODUCTION: "Curbside consultation" is the term used to describe an informal process in which a physician requests information from another physician about the management of a patient who has not been assessed by the person consulted. MATERIAL AND METHODS: Prospective, observational study designed to determine the frequency, services requested, and final result of curbside consultations made over the period of 3 March to 12 May 2008. The variables recorded included the means by which contact was made, the type of question, person requesting information, complexity of the subject, related subject, recommendations, and degree of follow-up and evolution of the consultation. The degree of difficulty was evaluated using the system of the American Collage of Physicians. Parametric and nonparametric statistical tests were used in the analysis. RESULTS: A total of 208 consultations (1.13/day) were reported, lasting a median of 2 minutes. The most common reasons for consulting were selection of an antimicrobial agent (54.4%), evaluation of a diagnosis (10.5%), interpretation of microbiological data (9.6%), and a combination of reasons (27.4%). In 5.8% of cases, hospitalization was required to study and treat the infectious disease. A formal consultation was required in 27% of cases. Significant differences were found between staff physicians and medical residents and between medical and surgical departments. CONCLUSIONS: Curbside consultations comprise an important part of healthcare activity in the Infectious Disease Department, although most requests are easily resolved and do not imply an excessive work burden. Nonetheless, when the consultation involves a difficult clinical case, the request is by a staff physician, and the surgery department is implicated, a significant amount of formal activity is generated.

[Multiple inflammatory liver pseudotumors and Enterococcus durans bacteremia]. / Seudotumor inflamatorio hepático múltiple y bacteriemia por Enterococcus durans.

Inflammatory pseudotumors are rare benign lesions that can occur throughout the body. These masses are usually associated with fever, pain, and mass effect, and are frequently mistaken for malignant neoplasms. Liver pseudotumors are especially rare, with 150 cases reported up to 2007, since the original report of Pack and Baker in 1953. We describe the case of a patient with suspected multiple hepatic abscesses, who was finally diagnosed with an inflammatory pseudotumor by percutaneous biopsy. The patient received prolonged antibiotic therapy, with complete resolution of the pseudotumor. The differential diagnosis and management of this entity is discussed.

Seudotumor inflamatorio hepático múltiple y bacteriemia por Enterococcus durans / Multiple inflammatory liver pseudotumors and Enterococcus durans bacteremia

Los seudotumores inflamatorios son lesiones raras, benignas y con diferentes localizaciones. Habitualmente asocian fiebre, dolor y efecto masa, y con frecuencia pueden diagnosticarse erróneamente como neoplasias. Los seudotumores hepáticos son especialmente infrecuentes, con menos de 150 casos descritos hasta 2007 tras la primera descripción de Pack y Baker en 1953. Describimos el caso de un paciente con sospecha de abscesos hepáticos múltiples, diagnosticado finalmente de seudotumor inflamatorio hepático mediante biopsia de la lesión. Recibió tratamiento antibiótico prolongado hasta la resolución del cuadro. Se discutirá el manejo clínico y el diagnóstico diferencial(AU)

Inflammatory pseudotumors are rare benign lesions that can occur throughout the body. These masses are usually associated with fever, pain, and mass effect, and are frequently mistaken for malignant neoplasms. Liver pseudotumors are especially rare, with 150 cases reported up to 2007, since the original report of Pack and Baker in 1953. We describe the case of a patient with suspected multiple hepatic abscesses, who was finally diagnosed with an inflammatory pseudotumor by percutaneous biopsy. The patient received prolonged antibiotic therapy, with complete resolution of the pseudotumor. The differential diagnosis and management of this entity is discussed(AU)

Probable caso de anaplasmosis humana importada / Probable case of imported human anaplasmosis

No disponible

Meningitis por Bacteroides fragilis en pacientes con infección por el VIH / Bacteroides fragilis meningitis in HIV patient

No disponible

Porphyromonas asaccharolytica liver abscess.

The black pigmented Gram-negative anaerobes, Porphyromonas species, have been isolated from clinical specimens in cases of central nervous system, dental-oral, pleuropulmonary and genitourinary infections and bacteremia. Herein, we report an unusual case of liver abscess caused by Porphyromonas asaccharolytica that has not been previously reported.

Intoxicación aguda por hierro en un caso / Acute iron poisoning: report of case

The ingestion of iron-containing products is a potential toxicological emergency. It is a leading cause of pediatric unintentional ingestion fatalities because some iron-containing compounds are readily available (vitamin mixtures, iron pills). Among adults, it has been described as accidental overdoses (mainly in pregnancy) and as suicidal attempts. We report a 42 years old woman, admitted due to the intentional ingestion of iron pills with suicidal purposes. A plain abdominal X ray showed at least 20 pills in the gastric fundus and antrum. She was successfully treated with intravenous desferroxamine chelation. Plain abdominal X ray examination can be very useful in the diagnosis of acute iron poisoning