Adequacy of antibiotic prophylaxis and incidence of surgical site infections in neck surgery.

Health care-related infections are frequent and among them surgical site infection (SSI) are the most frequent in hospitals. The objective was to evaluate the adequacy of antibiotic prophylaxis in patients undergoing neck surgery and its relationship with the incidence of surgical site infection (SSI). Prospective cohort study. The adequacy of antibiotic prophylaxis in patients undergoing neck surgery was evaluated. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol (antibiotic used, time of administration, administration route, dose and duration). The cumulative incidence of SSI was calculated, and the relationship between SSI and antibiotic prophylaxis adequacy was determined using adjusted relative risk (RR). Antibiotic prophylaxis was administered in 63 patients and was adequate in 85.7% (95% CI 75.0-92.3) of them. The cumulative incidence of SSI was 6.4% (95% CI 3.4-11.8). There was no significant relationship between antibiotic prophylaxis inadequacy and the incidence of SSI (RR = 2.4, 95% CI 0.6-10.6). Adequacy of antibiotic prophylaxis was high and it did not affect the incidence of SSIs.

[Evaluation of compliance with the antibiotic prophylaxis protocol in hysterectomy. Prospective cohort study]. / Evaluación de la adecuación al protocolo de profilaxis antibiótica en histerectomías. Estudio de cohortes prospectivo.

OBJECTIVE: Health care-related infections are a public health problem, among them surgical site infection (SSI) are the most frequent in hospitals. The objetive of this study was to assess the effect of the compliance to antibiotic prophylaxis protocol on the incidence of surgical site infection in hysterectomized patients. METHODS: A prospective cohort study was carried out between October 2009 and December 2018. The incidence of SSI was studied after a maximum period of 30 days from the moment of surgery. The degree of adequacy of antibiotic prophylaxis in hysterectomy and the effect of its inadequacy on the incidence of infection was evaluated using relative risk (RR) adjusted with a logistic regression model. RESULTS: A total of 1,025 interventions were studied in 1,022 women. The cumulative incidence of SSI was 2,1% (n = 22). The most frequent etiology of infection was Escherichia coli (23.1%) and Proteus mirabilis (23.1%). Antibiotic prophylaxis was indicated in 1,014 interventions (98.9%) being administered in 1,009 of them (99.5%). The adherence to the protocol was 92,5%. The main cause of non-compliance was the time of onset (40.9%), followed by the choice of the antibiotic (35.2%). The effect of inadequate prophylaxis on the incidence of infection was RR = 0.9; 95% CI 0.2-3.9; p> 0.05. CONCLUSIONS: The adequacy of antibiotic prophylaxis was very high, with a low incidence of surgical site infection. No association was found between adequacy of prophylaxis and incidence of infection in hysterectomy. The continuous improvement of epidemiological surveillance in gynecology should be emphasized.

Evaluación de la adecuación al protocolo de profilaxis antibiótica en cirugía de mama y su efecto sobre la incidencia de infección quirúrgica / Evaluation of compliance with the antibiotic prophylaxis protocol in breast surgery and its effect on the incidence of surgical infection

Fundamento: La profilaxis antibiótica es una de las formas más eficaces de evitar la infección de sitio quirúrgico (ISQ). En este estudio se evalúan el cumplimiento del protocolo de profilaxis antibiótica y el efecto de su inadecuación en la incidencia de ISQ en cirugía de mama. Material y métodos: Estudio prospectivo de cohortes realizado entre julio de 2008 y julio de 2018. Se evaluaron el grado de cumplimiento de la profilaxis antibiótica en cirugía de mama y las causas de no cumplimiento: elección del antibiótico, vía de administración, tiempo de inicio, dosis y duración. Se estudió la incidencia de ISQ durante los 30 días posteriores a la intervención (90 en caso de implantes o prótesis). Para evaluar el efecto de la inadecuación de la profilaxis se utilizó el riesgo relativo (RR). Resultados: Se estudiaron 1.328 intervenciones en 1.212 mujeres. La incidencia acumulada de ISQ fue del 1,7% (n=22) y la etiología más frecuente Staphylococcus aureus (47,1%). El cumplimiento global del protocolo de profilaxis antibiótica fue del 95,3% (incluyendo las 568 cirugías donde no estaba indicada). Las causas principales de no cumplimiento fueron el tiempo de inicio (46,8%) y la elección del antibiótico (40,3%). La inadecuación aumentó significativamente la incidencia de ISQ (8,1 vs 1,3%, p=0,003) y el riesgo de sufrirla (RR=6,5; IC95% 2,3-18,1). Conclusiones: La tasa global de adecuación al protocolo fue muy alta. La inadecuación de la profilaxis antibiótica duplicó, al menos, el riesgo de sufrir ISQ en cirugía de mama

Background: Antibiotic prophylaxis is one of the most effective ways to avoid surgical site infection (SSI). The present study evaluates compliance with the antibiotic prophylaxis protocol and the effect of non-compliance on the incidence of SSI in breast surgery. Methods: A prospective cohort study was carried out from July 2008 to July 2018. It assessed the degree of compliance with antibiotic prophylaxis in breast surgery and the causes of non-compliance: choice of antibiotic, route of administration, time of onset, dose and duration. The incidence of SSI was studied during the 30 days after intervention (90 in the case of implants or prostheses). Relative risk (RR) was used to assess the effect of inadequate prophylaxis. Results: We studied 1,328 interventions in 1,212 women. The cumulative incidence of SSI was 1.7% (n=22) and the most common etiology was Staphylococcus aureus (47.1%). Overall antibiotic prophylaxis protocol compliance was 95.3%, (including the 568 interventions where it was not indicated). The principle causes of non-compliance were the time of onset (46.8%) and choice of antibiotic (40.3%). Non-compliance significantly increased both incidence of SSI (8.1 vs 1.3%, p=0,003) and its risk (RR=6.5, CI95% 2.3-18.1). Conclusions: The overall protocol compliance rate was very high. Non-compliance with prophylaxis protocol at least doubled the risk of SSI in breast surgery

[Evaluation of compliance with the antibiotic prophylaxis protocol in breast surgery and its effect on the incidence of surgical infection]. / Evaluación de la adecuación al protocolo de profilaxis antibiótica en cirugía de mama y su efecto sobre la incidencia de infección quirúrgica.

BACKGROUND: Antibiotic prophylaxis is one of the most effective ways to avoid surgical site infection (SSI). The present study evaluates compliance with the antibiotic prophylaxis protocol and the effect of non-compliance on the incidence of SSI in breast surgery. METHODS: A prospective cohort study was carried out from July 2008 to July 2018. It assessed the degree of compliance with antibiotic prophylaxis in breast surgery and the causes of non-compliance: choice of antibiotic, route of administration, time of onset, dose and duration. The incidence of SSI was studied during the 30 days after intervention (90 in the case of implants or prostheses). Relative risk (RR) was used to assess the effect of inadequate prophylaxis. RESULTS: We studied 1,328 interventions in 1,212 women. The cumulative incidence of SSI was 1.7% (n=22) and the most common etiology was Staphylococcus aureus (47.1%). Overall antibiotic prophylaxis protocol compliance was 95.3%, (including the 568 interventions where it was not indicated). The principle causes of non-compliance were the time of onset (46.8%) and choice of antibiotic (40.3%). Non-compliance significantly increased both incidence of SSI (8.1 vs 1.3%, p=0,003) and its risk (RR=6.5, CI95% 2.3-18.1). CONCLUSIONS: The overall protocol compliance rate was very high. Non-compliance with prophylaxis protocol at least doubled the risk of SSI in breast surgery.

[Hand hygiene compliance with hydroalcoholic solutions in medical students. Cross-sectional study]. / Adherencia a la higiene de manos con soluciones hidroalcohólicas en estudiantes de medicina. Estudio descriptivo transversal.

OBJECTIVE: To assess hand hygiene compliance covertly in medical students in a university teaching hospital. METHODS: Cross-sectional study. Hand hygiene compliance in medical students was assessed in the units of Neonatology, Paediatrics, Neurology and Orthopaedic surgery. The five moments were covertly observed so as the hand rub technique. Hand hygiene compliance was described with the compliance percentages of the five moments. RESULTS: We studied 456 opportunities of hand hygiene. Global compliance was 44.3%. The most registered unit was Orthopaedic surgery (59.6%). According to the different moments, global compliance was better "after touching a patient" (60.2%). The unit with the highest hand hygiene compliance was Neonatology (60%). Hand hygiene compliance was better in the different hospitalisation units (50%) than in the office rooms (33%) (P<0.05) and the mean duration of hand hygiene was 22 seconds. CONCLUSIONS: Most of the moments were registered in the unit of Orthopaedic surgery and the moment with the highest hand hygiene compliance was "after touching a patient". The most hand hygiene compliance percentage was observed in Neonatology. Hand hygiene compliance was moderate, and it could and must be improved.

Caso 51 / Case 51

No disponible

Cambios epidemiológicos y diagnósticos en la estenosis hipertrófica de píloro / Changes in epidemiology and diagnosis of hypertrophic pyloric stenosis

Introducción: La estenosis hipertrófica de píloro es una de las causas más frecuentes de vómitos en los lactantes, con una importante repercusión clínica y metabólica, y más acentuados según progresa el tiempo de evolución. El objetivo de este estudio es detectar los cambios en su evolución epidemiológica y diagnóstica a lo largo de una década. Pacientes y métodos: Estudio descriptivo y retrospectivo de 141 pacientes tratados en nuestro hospital entre 2000 y 2009, ambos años inclusive. Se recogieron diversas variables epidemiológicas, clínicas y analíticas, y se compararon dos periodos elegidos de forma aleatoria, 2000-2004 y 2005-2009, para detectar posibles cambios. Resultados: La incidencia del 1,92‰ de recién nacidos vivos se mantuvo estable en el tiempo, con una relación entre varones y mujeres de 6:1. No se observaron cambios en el porcentaje de pérdida de peso de los pacientes. Sin embargo, se detectó un descenso del 33% en la edad en el momento del diagnóstico, así como un aumento de los pacientes diagnosticados con menos de 5 días de evolución. La disminución de las medidas ecográficas correspondientes a la longitud y el espesor de la pared indican un descenso en el diagnóstico de píloros de gran tamaño y, por tanto, más evolucionados. En cuanto a los parámetros analíticos estudiados, sólo la creatinina presenta una disminución de sus valores. Conclusiones: El diagnóstico de la estenosis hipertrófica de píloro ha experimentado una cierta anticipación. Los pacientes se diagnostican a una edad y con un tiempo de evolución menores y, por tanto, presentan una menor alteración clínica y analítica. El diagnóstico ecográfico ha desplazado de forma significativa al diagnóstico clínico (AU)

Introduction: Hypertrophic pyloric stenosis is one of the most common causes of vomiting in infants with significant clinical and metabolic impact, more pronounced as time progresses. The objective of this study is to detect epidemiological changes and diagnostic development of hypertrophic pyloric stenosis, over a decade. Patients and methods: Retrospective descriptive study of 141 patients treated in our hospital between 2000 and 2009, inclusive. Several epidemiological, clinical and laboratory variables were collected and compared between two periods of time chosen at random to detect changes: 2000-2004 and 2005-2009. Results: The incidence of 1.92 ‰ live births, remained stable over time, with a male: female ratio of 6:1. There were also no changes in the porcentage of patient weight loss. However, we detected a decrease of 33% in the age of infants at the time of diagnosis as well as an increase of patients with less than 5 days lasting symptoms. The decrease of ultrasound measurements, lenght and wall thickness lead to a decline in the diagnosis of large and therefore more evolved pylori. As for the analytical parameters studied, we only appreciated a decrease in creatinine values. Conclusions: The diagnosis of hypertrophic pyloric stenosis has experienced an anticipation. Patients are diagnosed younger with less hypertrophied pylorus and therefore less clinical and laboratory alteration. Diagnosis has shifted significantly from clinical to the ultrasound one (AU)

Factores pronósticos en la estenosis hipertrófica de píloro / Prognostic factors in hypertrophic pyloric stenosis

Introducción. Aunque el tratamiento quirúrgico de la estenosis hipertrófica de píloro está bien establecido, su manejo postquirúrgico y su principal complicación, los vómitos posquirúrgicos, son objeto de constantes revisiones. En este estudio se buscó algún factor pronóstico que nos indicase la aparición de esta complicación. Material y métodos. Se analizaron diferentes parámetros recogidos en las historias clínicas de 169 pacientes atendidos en un hospital de tercer nivel entre el año 2000 y el 2009, ambos inclusive, descartando aquellos pacientes que sufrieron algún tipo de complicación (n = 17) y los que siguieron una pauta diferente de reintroducción de la alimentación oral (n = 43).Resultados. La disminución del intervalo de tiempo entre la cirugía y la primera toma no condiciona la evolución de los pacientes. Sin embargo, se halló una correlación negativa entre el nivel de cloro medido en sangre con el número de vómitos postoperatorios. El tiempo requerido hasta alcanzar una correcta tolerancia, influenciado por el grado de alteración metabólica, sí influye tanto en el número de vómitos como en el tiempo requerido para alcanzar una correcta tolerancia. Otros parámetros analizados, como el tiempo quirúrgico y las medidas ecográficas de la oliva pilórica, no parecen influir en la evolución postoperatoria de los pacientes. Conclusión. Solo el grado de alteración metabólica y el nivel de cloro en sangre parecen influir en la diferente evolución postoperatoria, detectado por el tiempo requerido hasta alcanzar una correcta tolerancia y el número de vómitos postoperatorios (AU)

Introduction. Although the surgical treatment of hypertrophic pyloricstenosis is well established, its management and main complication after surgery, postoperative vomits, are subject to constant revisions. In this study, we sought a prognostic factor that indicates the occurrence of this complication. Methods. We analyzed different parameters listed in the medical histories of 169 patients treated at a tertiary hospital between 2000and 2009, both inclusive, ruling out those who suffered some type of complication (n = 17) and those who followed a different pattern of reintroduction of feeding (n = 43).Results. The decrease in the time interval between surgery and the first shot does not influence the outcome of patients. However, we found a negative correlation between the chlorine level in blood measured by the number of postoperative vomits. The time required to reach a correct tolerance, influenced by the degree of metabolic disorder, does influence both the number of vomits and the time required to achieve a proper tolerance. Other parameters analyzed, such as surgical time and ultrasound measurements of the pyloric olive, do not seem to influence the postoperative course of patients. Conclusion. Just the degree of metabolic disturbance and blood levels of chlorine seem to influence postoperative outcome, detected by the time required to reach a correct tolerance and the number of postoperative vomits (AU)

[Prognostic factors in hypertrophic pyloric stenosis]. / Factores pronósticos en la estenosis hipertrófica de píloro.

INTRODUCTION: Although the surgical treatment of hypertrophic pyloric stenosis is well established, its management and main complication after surgery, postoperative vomits, are subject to constant revisions. In this study, we sought a prognostic factor that indicates the occurrence of this complication. METHODS: We analyzed different parameters listed in the medical histories of 169 patients treated at a tertiary hospital between 2000 and 2009, both inclusive, ruling out those who suffered some type of complication (n = 17) and those who followed a different pattern of reintroduction of feeding (n = 43). RESULTS: The decrease in the time interval between surgery and the first shot does not influence the outcome of patients. However, we found a negative correlation between the chlorine level in blood measured by the number of postoperative vomits. The time required to reach a correct tolerance, influenced by the degree of metabolic disorder, does influence both the number of vomits and the time required to achieve a proper tolerance. Other parameters analyzed, such as surgical time and ultrasound measurements of the pyloric olive, do not seem to influence the postoperative course of patients. CONCLUSION: Just the degree of metabolic disturbance and blood levels of chlorine seem to influence postoperative outcome, detected by the time required to reach a correct tolerance and the number of postoperative vomits.

Hipertensión secundaria y síndrome metabólico / Secondary hypertension and metabolic syndrome

Mujer de 67 años en programa de obesidad desde hace 5 años. Se detecta hipercolesterolemia hace dos años, con colesterol total: 245 mg/dl, colesterol ligado a lipoproteínas de alta densidad (c-HDL): 50 mg/dl, colesterol ligado a lipoproteínas de baja densidad (c-LDL): 165 mg/dl, y triglicéridos: 149 mg/dl, en tratamiento con dieta. Ingresa por cuadro de abdomen agudo en el servicio de Cirugía General, siendo sometida a apendicectomía incidental tras analítica, ecografía y tomografía computarizada (TC) abdominal sugerentes de apendicitis aguda. Reingresa dos días después en Medicina Interna por persistencia del dolor abdominal y febrícula. Se detecta hipertensión arterial (HTA) y tras estudio exhaustivo el diagnóstico es dolor de origen genitourinario con buena resolución. En el informe de alta, aunque descartan la HTA secundaria vásculo-renal, no se valoran alteraciones analíticas: glucemia: 140 mg/dl, fósforo: 2,4 mg/dl, calcio en orina de 24 horas: 333,2 mg/24 horas y microalbuminuria que podrían sugerir otro origen. Ante la persistencia de alteraciones del metabolismo fosfocálcico se solicitan valores de hormona parotiroidea (PTH) que resultan elevados: 310 pg/ml. Se diagnostica de HTA secundaria a hiperparatiroidismo y síndrome metabólico

A 67 year old woman who has been included in an obesity program for 5 years with hypercholesterolemia detected 2 years ago. Total cholesterol is: 245 mg/dl, HDL-C: 50 mg/dl, LDL-c: 165 mg/dl and triglycerides: 149 mg/dl. She was following a treatment with diet. She was admitted in the General Surgery Department due to acute abdomen and underwent an appendectomy as a result of a blood test, abdominal ultrasonography and abdominal CT suggesting acute appendicitis. She was readmitted two days later in the Internal Medicine Department due to persistence of abdominal pain and low fever. High blood pressure was detected. After a thorough study, genitourinary pain with good outcome was diagnosed. In the discharge report, no blood tests abnormalities were assessed, although vasculo-renal secondary hypertension was ruled out: glycemia: 140 mg/dl, phosphorus: 2.4 mg/dl, 24 hour urine calcium: 333.2 mg/24 h and positive microalbuminuria that could suggest a different etiology. Given the persistence of phosphorus-calcium metabolism disorders, PTH values, which were elevated, were assessed: 310 pg/ml. The diagnosis was hyperparathyroidism with secondary hypertension and metabolic syndrome