Usefulness of Preoperative Determination of Serum MR-ProAdrenomedullin Levels to Predict the Need for Postoperative Organ Support in Abdominal Oncological Surgery.

The need for postoperative organic support is associated with patient outcomes. Biomarkers may be useful for detecting patients at risk. MR-ProADM is a novel biomarker with an interesting profile that can be used in this context. The main objective of this study was to verify whether there was an association between the preoperative serum levels of MR-ProADM and the need for organic support after elective abdominal cancer surgery, and to determine the preoperative MR-ProADM value that predicts the need for postoperative organic support. This was a multicenter prospective observational study conducted by four tertiary hospitals in Spain between 2017 and 2018. Plasma samples were collected for the quantification of MR-ProADM from adults who underwent major abdominal surgery during 2017-2018. The primary outcome was the need for organic support in the first seven postoperative days and its association with the preoperative levels of MR-ProADM, and the secondary outcome was the preoperative levels of MR-ProADM in the study population. This study included 370 patients with a mean age of 67.4 ± 12.9 years. Seventeen percent (63 patients) required some postoperative organic support measures in the first week. The mean preoperative value of MR-ProADM in patients who required organic support was 1.16 ± 1.15 nmol/L. The AUC-ROC of the preoperative MR-ProADM values associated with the need for organic support was 0.67 (95% CI: 0.59-0.75). The preoperative MR-ProADM value, which showed the best compromise in sensitivity and specificity for predicting the need for organic support, was 0.70 nmol/L. The negative predictive value was 91%. A multivariate analysis confirmed that a preoperative level of MR-ProADM ≥ 0.70 nmol/L is an independent factor associated with risk of postoperative organic support (OR 2, 6). Elevated preoperative MR-ProADM levels are associated with the need for postoperative organic support. Therefore, MR-ProADM may be a useful biomarker for perioperative risk assessment.

Evaluación de un paquete de medidas para la prevención de la infección de localización quirúrgica en cirugía colorrectal / Evaluation of a preventive surgical site infection bundle in colorectal surgery

OBJETIVO: Evaluar la efectividad de un protocolo para la prevención de la infección de localización quirúrgica (ILQ) en cirugía colorrectal. PACIENTES Y MÉTODOS: Evaluación de 2 cohortes de pacientes intervenidos de colon y recto en un hospital público de tercer nivel: una cohorte histórica (2008-2011) y otra prospectiva (posterior a la implementación del programa en 2012). Las principales medidas establecidas fueron: adecuación de la profilaxis antimicrobiana prequirúrgica, mantenimiento de la normotermia del paciente en el quirófano y adecuación del cambio de guante durante la intervención. Se determinó la comparabilidad de ambas cohortes mediante un análisis bivariable de la edad, sexo, factores e índices de riesgo (índice NNIS, índice ASA, tiempos quirúrgicos, transfusión periquirúrgica, diagnóstico, diabetes, insuficiencia renal). RESULTADOS: Se evaluó a 342 pacientes (256 intervenidos de colon y 86 de recto), distribuidos en 2 cohortes: periodo previo (218) y periodo postimplementación del programa (124). La incidencia acumulada de ILQ de la primera cohorte fue del 27,5% (IC 95% = 21,6-33,4), y de la cohorte postintervención 16,9% (IC 95% = 10,3-23,5; p = 0,03). La mortalidad postoperatoria fue del 9,2% (IC 95% = 5,4-13) en la primera cohorte y del 3,2% (IC 95% = 0,1-6,3) en la cohorte postintervención (p = 0,04). La administración inadecuada de la profilaxis disminuyó del 37,4% (IC 95% = 30,4-44,6) al 18,9% (IC 95% = 11,9-26,1; p = 0,001). CONCLUSIONES: Tras la implementación de un protocolo para la prevención de la infección quirúrgica en cirugía colorrectal se verifica una disminución significativa de la frecuencia de ILQ, de la mortalidad posquirúrgica y de la profilaxis antimicrobiana inadecuada

OBJECTIVE: To assess the effectiveness of a protocol for prevention of surgical site infection (SSI) in colorectal surgery. PATIENTS AND METHODS: Evaluation of 2 cohorts of patients undergoing colon and rectal surgery in a tertiary public hospital: A historical cohort (2008-2011) and a prospective one (after the implementation of the program in 2012). The main measures established were: Adequacy of preoperative antimicrobial prophylaxis, maintaining patient normothermia and appropriate glove change during the intervention. Comparability of the two cohorts was determined by a bivariate analysis of age, sex, NNIS index, ASA index, surgical time, perioperative transfusion, diagnosis, diabetes and renal failure. RESULTS: We assessed 342 patients (256 underwent colon surgery and 86 rectal surgery), divided into 2 cohorts: prior period (218), and post-implementation period (124). The cumulative incidence of SSI in the first cohort was 27.5% (95% CI, 21.6- 33.4), and in the post-intervention cohort 16.9% (95% CI, 10.3-23.5, P = .03). Postoperative mortality was 9.2% (95% CI, 5.4-13) in the first cohort and 3.2% (95% CI, 0.1-6.3) in the post-intervention cohort (P = .04). The inadequacy of prophylaxis decreased from 37.4% (95% CI, 30.4-44.6) to 18.9% (95% CI, 11.9- 26.1) (P = .001). CONCLUSION: A significant decrease in the frequency of SSI, post-surgical mortality and inadequate antimicrobial prophylaxis is verified after the implementation of a protocol in colorectal surgery

Evaluation of a preventive surgical site infection bundle in colorectal surgery.

OBJECTIVE: To assess the effectiveness of a protocol for prevention of surgical site infection (SSI) in colorectal surgery. PATIENTS AND METHODS: Evaluation of 2 cohorts of patients undergoing colon and rectal surgery in a tertiary public hospital: A historical cohort (2008-2011) and a prospective one (after the implementation of the program in 2012). The main measures established were: Adequacy of preoperative antimicrobial prophylaxis, maintaining patient normothermia and appropriate glove change during the intervention. Comparability of the two cohorts was determined by a bivariate analysis of age, sex, NNIS index, ASA index, surgical time, perioperative transfusion, diagnosis, diabetes and renal failure. RESULTS: We assessed 342 patients (256 underwent colon surgery and 86 rectal surgery), divided into 2 cohorts: prior period (218), and post-implementation period (124). The cumulative incidence of SSI in the first cohort was 27.5% (95% CI, 21.6- 33.4), and in the post-intervention cohort 16.9% (95% CI, 10.3-23.5, P=.03). Postoperative mortality was 9.2% (95% CI, 5.4-13) in the first cohort and 3.2% (95% CI, 0.1-6.3) in the post-intervention cohort (P=.04). The inadequacy of prophylaxis decreased from 37.4% (95% CI, 30.4-44.6) to 18.9% (95% CI, 11.9- 26.1) (P=.001). CONCLUSION: A significant decrease in the frequency of SSI, post-surgical mortality and inadequate antimicrobial prophylaxis is verified after the implementation of a protocol in colorectal surgery.

Update on catheter-related bloodstream infections in ICU patients.

The present article is an update of the literature on catheter-related bloodstream infections in ICU patients. A multidisciplinary group of Spanish physicians with an interest in bloodstream infections selected the most important recently published papers produced in the field. One of the members of the group discussed the content of each of the selected papers, with a critical review by other members of the panel. After a review of the state of the art, papers from the fields of epidemiology, causative microorganisms (bacterial and fungal), risk factors and prognosis, pathogenesis, laboratory diagnosis and prevention were discussed by the group.

Update on catheter-related bloodstream infections in ICU patients

ResumenEl artículo presente recoge una actualización bibliográfica de la bacteriemia relacionada con catéteres en unidades de cuidados intensivos. Un grupo multidisciplinario de clínicos españoles con experiencia en las infecciones relacionadas con catéteres seleccionó las publicaciones más importantes en este campo aparecidas recientemente. El contenido de cada uno de los artículos seleccionados fue expuesto y discutido por uno de los miembros del grupo, después de lo cual los miembros restantes efectuaron una revisión crítica.Tras la revisión de la situación actual, el grupo discutió las publicaciones procedentes de los campos de la epidemiología, la etiología, la detección de factores de riesgo, la evolución y el pronóstico, la patogénesis, el diagnóstico de laboratorio y la prevención (AU)

The present article is an update of the literature on catheter-related bloodstream infections in ICU patients.A multidisciplinary group of Spanish physicians with an interest in bloodstream infections selected themost important recently published papers produced in the field. One of the members of the group discussedthe content of each of the selected papers, with a critical review by other members of the panel.After a review of the state of the art, papers from the fields of epidemiology, causative microorganisms(bacterial and fungal), risk factors and prognosis, pathogenesis, laboratory diagnosis and prevention werediscussed by the group (AU)