Resistencia antibiótica de Escherichia coli en infecciones urinarias nosocomiales y adquiridas en la comunidad del Sector Sanitario de Huesca 2016-2018 / Evolution of antibiotic resistance of Escherichia coli in nosocomial urinary tract infections in Primary and Hospital Care in Huesca

OBJETIVO: Determinar la resistencia in vitro del uropatógeno más frecuente, Escherichia coli, a varios antimicrobianos en nuestro Sector Sanitario y deducir opciones de tratamiento empírico. DISEÑO: Estudio epidemiológico descriptivo retrospectivo. MATERIAL Y MÉTODOS: Desde el 1 de enero de 2016 al 31 de diciembre de 2018 se estudiaron las cepas de E. coli aisladas de urocultivos de pacientes procedentes de Atención Primaria y Hospitalaria del Sector de Huesca. Se procesaron un total de 42004 muestras. Se determinó la sensibilidad a once antibióticos de uso frecuente. Se analizó la existencia de diferencias estadísticamente significativas de sensibilidad en los años estudiados, comparando sus correspondientes intervalos de confianza al 95 % (método de Fisher). RESULTADOS: E. coli ha sido la bacteria más frecuentemente aislada durante el periodo de estudio. La resistencia se ha mantenido por debajo del 4 % frente a fosfomicina y nitrofurantoína y por debajo del 12% a cefalosporinas de tercera generación. En cefuroxima y amoxicilina-clavulánico se ha observado un significativo aumento de la resistencia en las cepas hospitalarias con respecto a las de la comunidad en este periodo. Los máximos niveles de resistencia (superior al 20%) se encontraron en los antibióticos administrados vía oral y frecuentemente indicados en infecciones urinarias no complicadas: trimetoprim-sulfametoxazol, ciprofloxacino y amoxicilina. CONCLUSIONES: Estos resultados sugieren que el tratamiento empírico de primera elección para las infecciones urinarias en nuestra área sanitaria podrían ser fosfomicina, nitrofurantoína o cefalosporinas de segunda generación, aunque estas últimas sólo a nivel comunitario, mientras que en hospital su uso sin testar en antibiograma estaría desaconsejado por el porcentaje creciente de resistencias. No se recomendaría como tratamiento de primera elección trimetoprim-sulfametoxazol ni quinolonas

OBJECTIVES: To determine in-vitro resistance of the most frequent uropathogen, Escherichia coli, to several antibiotics in our health sector, and to deduce empirical treatment options. DESIGN: Retrospective descriptive epidemiological study. MATERIAL AND METHODS: E. coli strains isolated from urine cultures of patients from Primary and Hospital Care in Huesca Sector, between 1 January 2016 and 31 December 2018, were studied. A total of 42004 samples were processed. The sensitivity to eleven frequently used antibiotics was determined. The existence of statistically significant differences in sensitivity for the years under study was analyzed, comparing their corresponding 95% confidence intervals (Fisher's method). RESULTS: E. coli has been the most frequently isolated bacteria during the study period. Resistance to fosfomycin and nitrofurantoin has remained below 4%, and resistance to third generation cephalosporins below 12%. Regarding cefuroxime and amoxicillin-clavulanic acid, a significant increase in resistance in hospital strains with respect to community strains has been observed in this period. The highest levels of resistance (more than 20%) were found in antibiotics administered orally and frequently indicated in uncomplicated urinary tract infections: trimethoprim-sulfamethoxazole, ciprofloxacin, and amoxicillin. CONCLUSIONS: These results suggest that the first choice empirical treatments for urinary tract infections in our health area are fosfomycin, nitrofurantoin, or second generation cephalosporins. The latter is only at a community level, whereas its use in hospitals without testing in antibiogram is not recommended due to an increasing percentage of resistance. Trimethoprim-sulfamethoxazole or quinolones are not recommended as first choice treatment

Parálisis facial: guía de práctica clínica de la Sociedad Española de ORL / Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology

La parálisis de Bell es la forma más común de paresia o parálisis facial. Sin embargo, no todos los pacientes con parálisis facial tienen una parálisis de Bell. Otras causas frecuentes incluyen las secuelas del tratamiento del neurinoma del VIII par, el cáncer de cabeza y cuello, la iatrogenia, el zóster ótico y los traumatismos. El abordaje de cada una de estas situaciones es totalmente diferente. El objetivo de esta guía es servir de consejo para el tratamiento y el seguimiento de los pacientes con parálisis facial. Nuestra idea es que la guía sea práctica, haciendo hincapié en recomendaciones efectivas y útiles en el manejo diario de los pacientes. Esta guía ha sido promovida por la Sociedad Española de ORL y escrita por médicos con experiencia en la enfermedad del nervio facial, incluyendo al menos un especialista de cada comunidad autónoma. Redactada en un formato de preguntas y respuestas, incluye 56 cuestiones relevantes relacionadas con el nervio facial

Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve

Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology. / Parálisis facial: guía de práctica clínica de la Sociedad Española de ORL.

Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve.

Actualización del consenso sobre el diagnóstico y tratamiento de la sordera súbita idiopática / Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss

Introducción: La sordera súbita idiopática (SSI) es aquella hipoacusia neurosensorial de inicio súbito de causa desconocida. Objetivos: Actualización del consenso sobre el diagnóstico, tratamiento y seguimiento de la SSI. Material y métodos: Presentamos una tercera actualización del consenso de SSI, mediante revisión sistemática de la literatura sobre la SSI desde 1966 hasta marzo de 2018, sobre los términos MESH "(acute or sudden) hearing loss or deafness", con 1.508 artículos relevantes. Resultados: En cuanto al diagnóstico, ante una sospecha clínica de SSI, las pruebas diagnósticas que se consideran necesarias son las siguientes: otoscopia, acumetría, audiometría tonal, audiometría verbal y timpanograma para descartar causas transmisivas de sordera. Una vez hecho el diagnóstico clínico de SSI, antes de comenzar el tratamiento, se solicitará una batería analítica. Deberá completarse más tarde el estudio con RM de oído interno, idealmente en los primeros 15 días, para descartar causas específicas de sordera súbita neurosensorial y para contribuir a elucidar posibles mecanismos fisiopatológicos. A pesar de la controversia en cuanto al tratamiento de SSI, se recomienda, por los efectos en la calidad de vida de la SSI y los raros eventos indeseables con esteroides a corto plazo, que el tratamiento de la SSI esté basado fundamentalmente en los corticoides, que pueden utilizarse por vía oral o intratimpánica, en función del paciente. En caso de fracaso de la vía sistémica, se recomienda usar corticoides intratimpánicos como rescate. Respecto al seguimiento, se realizará un control a la semana del inicio, a los 7 días y hasta los 12 meses. Conclusiones: Como consenso, el resultado de los tratamientos aplicados debería presentarse tanto en cantidad de decibelios recuperados en el umbral auditivo tonal como con parámetros de audiometría verbal

Introduction: Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden, unexplained unilateral hearing loss. Objectives: To update the Spanish Consensus on the diagnosis, treatment and follow-up of ISSNHL. Material and methods: After a systematic review of the literature from 1966 to March 2018, on MESH terms "(acute or sudden) hearing loss or deafness", a third update was performed, including 1508 relevant papers. Results: Regarding diagnosis, 11ISSNHL is clinically suspected, the following diagnostic tests are mandatory: otoscopy, acumetry, tonal audiometry, speech audiometry, and tympanometry, to discount conductive causes. After clinical diagnosis has been established, and before treatment is started, a full analysis should be performed. An MRI should then be requested, ideally performed during the first 15 days after diagnosis, to discount specific causes and to help to understand the physiopathological mechanisms in each case. Although treatment is very controversial, due to its effect on quality of life after ISSNHL and the few rare adverse effects associated with short-term steroid treatment, this consensus recommends that all patients should be treated with steroids, orally and/or intratympanically, depending on each patient. In the event of failure of systemic steroids, intratympanic rescue is also recommended. Follow-up should be at day 7, and after 12 months. Conclusion: By consensus, results after treatment should be reported as absolute decibels recovered in pure tonal audiometry and as improvement in speech audiometry

Implantes activos de oído medio / Active middle ear implants

Los implantes activos de oído medio son prótesis implantadas quirúrgicamente, que estimulan la cadena osicular o los fluidos del oído interno a través de la ventana oval o redonda. Estos implantes pueden ser útiles para el tratamiento de determinados pacientes con pérdida auditiva neurosensorial, así como para pérdida auditiva conductiva o mixta. Esta guía clínica pretende resumir los conocimientos actuales sobre las características básicas y las indicaciones de los implantes de oído medio más utilizados, como Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia) y CodacsTM. (Cochlear, Australia)

Active middle ear implants are surgically implanted prosthesis, which intend to stimulate the ossicular chain or the inner ear fluids through the oval or round windows. These implants may be useful for the treatment of certain patients with sensorineural hearing loss as well as for conductive or mixed hearing loss. This clinical guide attempts to summarize the current knowledge concerning the basic characteristics and indications of the most commonly used middle ear implants, including Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia), and CodacsTM. (Cochlear, Australia)

Guía clínica sobre implantes cocleares / Guideline on cochlear implants

Introducción: En la última década son numerosos los hospitales que han iniciado su actividad en pacientes candidatos a un implante coclear (IC), y se han producido numerosos y relevantes avances para el tratamiento de la hipoacusia neurosensorial que han desembocado en una ampliación de las indicaciones de los IC. Objetivos: Ofrecer a los especialistas de otorrinolaringología, de otras especialidades médicas, autoridades sanitarias y a la sociedad en general una guía clínica sobre implantes cocleares. Métodos: Las comisiones científicas de otología, otoneurología y audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC), de manera coordinada y consensuada, han llevado a cabo una revisión del estado actual de los IC basándose en las reglamentaciones existentes y en las publicaciones científicas que se referencian en la bibliografía del documento elaborado. Resultados: La guía clínica sobre implantes cocleares aporta información sobre: a) definición y descripción sobre IC; b) indicaciones de los IC; y c) requisitos organizativos para un programa de IC. Conclusiones: Se ha elaborado por un comité de expertos de la SEORL-CCC una Guía clínica sobre implantes cocleares que aporta coordenadas de actuación para todos aquellos agentes de la sanidad en la toma de decisiones en el ámbito de los IC como forma de tratamiento de la discapacidad auditiva

Introduction: In the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants. Objectives: To provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general. Methods: The Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted. Results: The clinical guideline on cochlear implants provides information on: a) Definition and description of Cochlear Implant; b) Indications for cochlear implants; c) Organizational requirements for a cochlear implant programme. Conclusions: A clinical guideline on cochlear implants has been developed by a Committee of Experts of the SEORL-CCC, to help and guide all the health professionals involved in this field of CI in decision-making to treathearing impairment

Active middle ear implants. / Implantes activos de oído medio.

Active middle ear implants are surgically implanted prosthesis, which intend to stimulate the ossicular chain or the inner ear fluids through the oval or round windows. These implants may be useful for the treatment of certain patients with sensorineural hearing loss as well as for conductive or mixed hearing loss. This clinical guide attempts to summarize the current knowledge concerning the basic characteristics and indications of the most commonly used middle ear implants, including Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia), and CodacsTM. (Cochlear, Australia).

Guideline on cochlear implants. / Guía clínica sobre implantes cocleares.

INTRODUCTION: In the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants. OBJECTIVES: To provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general. METHODS: The Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted. RESULTS: The clinical guideline on cochlear implants provides information on: a) Definition and description of Cochlear Implant; b) Indications for cochlear implants; c) Organizational requirements for a cochlear implant programme. CONCLUSIONS: A clinical guideline on cochlear implants has been developed by a Committee of Experts of the SEORL-CCC, to help and guide all the health professionals involved in this field of CI in decision-making to treathearing impairment.

Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss. / Actualización del consenso sobre el diagnóstico y tratamiento de la sordera súbita idiopática.

INTRODUCTION: Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden, unexplained unilateral hearing loss. OBJECTIVES: To update the Spanish Consensus on the diagnosis, treatment and follow-up of ISSNHL. MATERIAL AND METHODS: After a systematic review of the literature from 1966 to March 2018, on MESH terms «(acute or sudden) hearing loss or deafness¼, a third update was performed, including 1508 relevant papers. RESULTS: Regarding diagnosis, 11ISSNHL is clinically suspected, the following diagnostic tests are mandatory: otoscopy, acumetry, tonal audiometry, speech audiometry, and tympanometry, to discount conductive causes. After clinical diagnosis has been established, and before treatment is started, a full analysis should be performed. An MRI should then be requested, ideally performed during the first 15 days after diagnosis, to discount specific causes and to help to understand the physiopathological mechanisms in each case. Although treatment is very controversial, due to its effect on quality of life after ISSNHL and the few rare adverse effects associated with short-term steroid treatment, this consensus recommends that all patients should be treated with steroids, orally and/or intratympanically, depending on each patient. In the event of failure of systemic steroids, intratympanic rescue is also recommended. Follow-up should be at day 7, and after 12 months. CONCLUSION: By consensus, results after treatment should be reported as absolute decibels recovered in pure tonal audiometry and as improvement in speech audiometry.