Efectividad de un paquete de medidas para reducir las bacteriemias asociadas a catéter venoso central / Effectiveness of a bundle of measures for reducing central line-associated bloodstream infections

INTRODUCCIÓN: Las infecciones asociadas a catéter son la principal causa de bacteriemia nosocomial. El objetivo principal fue demostrar una posible disminución en las tasas de bacteriemia asociada a catéter venoso central (BACVC) del entorno perioperatorio tras implementar un paquete de medidas. El objetivo secundario fue determinar qué factores se asociaban a mayor riesgo de BACVC tras la implementación del paquete de medidas. MÉTODOS: El paquete de medidas consistió en: subclavia como acceso de elección, desinfección con clorhexidina alcohólica 2%, paño estéril de cuerpo entero, funda estéril para ecógrafo y check-list de inserción. La incidencia acumulada (IA) y densidad de incidencia (DI) de BACVC se compararon antes y después de la intervención. La asociación entre las características de pacientes o CVC y BACVC se resumieron mediante odds ratio e intervalos de confianza al 95%, obtenidos mediante regresión logística múltiple, ajustado por edad, sexo, comorbilidades y días con CVC. RESULTADOS: Antes de la implementación del paquete de medidas entre enero-noviembre de 2016 la IA de BACVC fue 5,05% y de DI 5,17‰. En el mismo periodo de 2018 la IA de BACVC fue 2,28% y de DI 2,27‰, suponiendo una reducción del 54% en IA (p = 0,072) y del 56% en DI (p = 0,068). En el análisis multivariable se asociaron a mayor riesgo de BACVC: reemplazo del CVC (OR: 11,01; IC 95%: 2,03-59,60, p = 0,005), 2 o más cateterizaciones (OR: 10,05; IC 95%: 1,77-57,16; p = 0,009) y nutrición parenteral (OR: 23,37; IC 95%: 4,37-124,91; p < 0,001). CONCLUSIONES: Las tasas de BACVC disminuyeron tras implementar el paquete de medidas de inserción. El reemplazo del CVC, 2 o más cateterizaciones y la nutrición parenteral se asociaron a BACVC tras implementar el paquete de medidas

INTRODUCTION: Catheter-associated infections are the main cause of nosocomial bacteremia. The main objective of this study was to demonstrate a possible decrease in CLABSI rates in perioperative environment after the implementation of a bundle of measures. Secondary objective was to determine which factors were associated with an increased risk of CLABSI, after the implementation of the bundle. METHODS: Insertion bundle consisted of: subclavian vein as access of choice, disinfection with alcoholic 2% chlorhexidine, central-line full body drapes, sterile ultrasound probe-cable covers and insertion check-list. Cumulative Incidence (CI) and Incidence Density Rate (IR) of CLABSIs were compared before and after the intervention. Associations between patient or CVC characteristic and CLABSI were summarized with odds ratios and 95% confidence interval, obtained from multiple logistic regression, adjusting for age, sex, comorbidities and days with CVC. RESULTS: Before implementing the bundle, from January to November 2016, CI of CLABSI was 5.05% and IR was 5.17 ‰. In the same period of 2018, CI of CLABSI was 2.28% and IR was 2.27 ‰, which means a reduction of 54.8% in CI (P=.072) and of 56% in IR (P=.068) In multivariable analyses, replacement of CVC was associated with a higher risk of CLABSI (OR 11.01, 95%CI 2.03-59.60, P=.005), as well as 2 or more catheterizations (OR 10.05, 95%CI 1.77-57.16, P=.009), and parenteral nutrition (OR 23.37, 95%CI 4.37-124.91, P<.001). CONCLUSIONS: CLABSI rates decreased after the implementation of the insertion bundle. CVC replacement, 2 or more catheterizations and parenteral nutrition were associated with CLABSI after bundle implementation

Effectiveness of a bundle of measures for reducing central line-associated bloodstream infections. / Efectividad de un paquete de medidas para reducir las bacteriemias asociadas a catéter venoso central.

INTRODUCTION: Catheter-associated infections are the main cause of nosocomial bacteremia. The main objective of this study was to demonstrate a possible decrease in CLABSI rates in perioperative environment after the implementation of a bundle of measures. Secondary objective was to determine which factors were associated with an increased risk of CLABSI, after the implementation of the bundle. METHODS: Insertion bundle consisted of: subclavian vein as access of choice, disinfection with alcoholic 2% chlorhexidine, central-line full body drapes, sterile ultrasound probe-cable covers and insertion check-list. Cumulative Incidence (CI) and Incidence Density Rate (IR) of CLABSIs were compared before and after the intervention. Associations between patient or CVC characteristic and CLABSI were summarized with odds ratios and 95% confidence interval, obtained from multiple logistic regression, adjusting for age, sex, comorbidities and days with CVC. RESULTS: Before implementing the bundle, from January to November 2016, CI of CLABSI was 5.05% and IR was 5.17 ‰. In the same period of 2018, CI of CLABSI was 2.28% and IR was 2.27 ‰, which means a reduction of 54.8% in CI (P=.072) and of 56% in IR (P=.068) In multivariable analyses, replacement of CVC was associated with a higher risk of CLABSI (OR 11.01, 95%CI 2.03-59.60, P=.005), as well as 2 or more catheterizations (OR 10.05, 95%CI 1.77-57.16, P=.009), and parenteral nutrition (OR 23.37, 95%CI 4.37-124.91, P<.001). CONCLUSIONS: CLABSI rates decreased after the implementation of the insertion bundle. CVC replacement, 2 or more catheterizations and parenteral nutrition were associated with CLABSI after bundle implementation.

Receta para prescribir fósforo durante hemodiálisis / Follow a recipe to prescribe phosphate during hemodialysis

La adición de fósforo (P) en el líquido de hemodiálisis (LD) mediante enema con fosfato de sodio (enema Casen®) se utiliza habitualmente en pacientes con hipofosforemia. El cálculo de la cantidad y los problemas que puede presentar no se describen en la literatura. Nuestro trabajo hace un abordaje práctico de cómo poner fósforo en LD con una fórmula razonada para calcular cuánto volumen de enema añadir en función del concentrado de diálisis utilizado y los problemas que pueden aparecer (AU)

The addition of phosphorus (P) to the dialysate (LD) in the form of enema Casen® is common practice in patients with hypophosphatemia. The estimation of the amount to be used and the identification of the problems that may can occur are not well defined. As a result of our work we propose a practical approach of how to proceed to increase phosphate concentration in the hemodialysate. We present a reasoned formula to calculate how much enema has to be added and the problems that may arise (AU)

Diagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis.

BACKGROUND: Procalcitonin is released in response to bacterial infection and it is not released in Inflammatory and viral diseases. OBJECTIVE: To show the diagnostic efficacy and prognostic value of procalcitonin for sepsis. METHODS: A consecutive series of 103 patients with suspected sepsis were admitted to the intensive care unit over a 2-year period. During the first 24 hours of the admission procalcitonin, C-reactive protein, and complement proteins were determined. The diagnostic efficacy was tested with predictive values, likelihood ratios, receiver operating characteristic curves, and multiple logistic regression. The association of procalcitonin with mortality was assessed by the Multivariate Cox proportional hazards model. RESULTS: Procalcitonin had a better positive likelihood ratio than C-reactive protein -2.2 (95% confidence interval: 1.3-3.7) versus 1.1 (95% confidence interval: 0.9-1.2). Sequential Organ Failure Assessment yielded the highest discriminative value, with an area under the curve of 0.82 (95% confidence interval: 0.73-0.92), followed by procalcitonin (0.81; 95% confidence interval: 0.72-0.89). Multivariate regression analysis showed procalcitonin (adjusted odds ratio: 3.8; 95% confidence interval: 1.2-11.8) and Sequential Organ Failure Assessment score (adjusted odds ratio: 5.3; 95% confidence interval: 1.4-19.9) as the only variables independently associated with infection. Multivariate Cox regression analysis revealed that procalcitonin was not independently associated with mortality. CONCLUSIONS: The diagnostic accuracy of procalcitonin was higher than C-reactive protein and complement proteins. Procalcitonin in combination with Sequential Organ Failure Assessment was useful to diagnose infection. C-reactive protein, Sequential Organ Failure Assessment score, age, and gender showed to be helpful to improve the prediction of mortality risk, but not procalcitonin.

Cribado neonatal selectivo de anemia de células falciformes / Selective neonatal screening for sickle cell disease

No disponible

[Differences in the synthesis pattern of vasoactive factors in gestational hypertension and preeclampsia]. / Diferencias en el patrón de síntesis de factores vasoactivos en la hipertensión gestacional y en la preeclampsia.

BACKGROUND AND OBJECTIVE: The gestational hypertension -HG- and preeclampsia -P- are hypertensive diseases whose pathogenic mechanism has not been determined yet. The aim of this work is to define some patterns of vasoactive factors release that allow to explain the origin of the differences between both entities. DESIGN: Prospective case-control study. MATERIAL AND METHODS: Two groups of target patients were consecutively selected, GH (n=21) and P patients (n=21). Every patient was matched with a pregnant of similar age and week of pregnancy. Two control groups were obtained, one respect to the GH and another one respect to the P group. A biochemistry, blood cell count, coagulation and quantification of vasoactive factors endothelin, nitrites and GMPc were performed in every woman. Results of GH and P groups were compared with their respective control group with the paired Student's t Test. RESULTS: Both systolic and diastolic arterial pressures were higher in hypertensive pregnants (GH and P) than in their respective controls. Moreover, blood endothelin and GMPc were higher in GH and P. GH pregnants showed decreased norepinephrine and increased epinephrine urinary excretion , as well as an increased plasma nitrites concentration than control group. P patients did not show statistically significant differences in catecholamines urinary excretion nor in plasma nitrites concentration respect their control group. CONCLUSION: There are relevant differences in the synthesis patterns of vasoactive factors between gestational hypertension and preeclampsia. These differences could account for a decreased tissue perfusion in preeclampsia and could also contribute to the genesis of the renal dysfunction of this entity.

Troponina I y su valor pronóstico en las complicaciones posinfarto / Troponin I and prognostic value in post-acute myocardial infarction complications

ObjetivoDemostrar que los pacientes con dolor torácico que tienen elevada la troponina I en las primeras 12 horas se mueren más o sufren más complicaciones al cabo de nueve meses. Secundario: valorar la eficacia diagnóstica de la cTnI en el infarto de miocardio. Diseño Entre junio y agosto del 2003 se determinó cTnI, CK, CKMB, ECG a pacientes que acudieron al servicio de urgencias del hospital con sospecha de infarto (diseño transversal). También se observó la aparición de complicaciones (muerte por causa cardiovascular; angina, insuficiencia cardiaca y la aparición de reinfarto) durante los nueve meses siguientes (diseño observacional hacia delante). Participantes 167 pacientes que acudieron de forma consecutiva al servicio de urgencias del hospital con dolor torácico sospechoso de infarto. Resultados Se ha encontrado asociación entre los marcadores y las complicaciones con un riesgo relativo de 1,9(1,02-3,56) para un punto de corte de Troponina I =0,6 ng/ml, no encontrándose para los respectivos puntos de corte de la CK y CKMB. La Troponina I presentó una sensibilidad = 0,95 (0,55-0,99), siendo superior a la encontrada con los otros marcadores, con un valor predictivo negativo de 0,96 (0,83-0,98) y un cociente de probabilidad negativo de 0,08 (0,06-0,30). En cambio, la especificidad de la Troponina fuede 0,72 (0,48-0,72), menor que para la CK y CKMB. Conclusiones La troponina I es un buen predictor de las complicaciones (y no la CK y CKMB) y posee elevada eficacia para descartar un infarto, destacando una elevada sensibilidad, valor predictivo y cociente de probabilidad negativos

Objective Our main objective was to know if high Troponin I concentration during the first 12 hours in patients with chest pain has an increased risk over the 9 months post-acute myocardial infarction complications and, additionally to show the diagnostic efficacy of serum Troponin I measurement on chest pain patients. Design The diagnostic efficacy was evaluated by a cross sectional design and the incidence of complications (cardiovascular death, angina pectoris, cadiac insufficiency and re-infarct)over the next 9 months by a forward observational design. Serum Troponin, CKand CKMB were measured in a Dimension RXL(Dade). Participants 167 consecutive patients with chest pain attending to the Emergency Room of our Hospital over June, July and August in 2003. Results It was found assotiation between serum Troponin I and complications. The Troponin (cut off: 0.6ng/ml) relative risk was 1.9 (1.02-3.56) but it was found no association for the usual CK and CKMB cut-offs. The sensitivity of Troponin I was 0.95(0.55-0.99), higher than the sensitivity of the other markers. The Troponin negative predictive value was 0.96 (0.83-0.98) and the negative likelihood ratio was 0.08 (0.06-0.30). By contrast, the Troponin specificity was 0.72 (0.48-0.72), less than that of CK and CKMB. Conclusions Troponin I results show that this marker is a good predictor of complications, as a statistically significant association with the 9 months post infarct outcomes was found, and not CK and CKMB. Additionally, serum Troponin measurement shows a high efficacy to rule out a myocardial infarct, emphasizing a high sensitivity and negative predictive value