Lesión cutánea y linfangitis en paciente inmunocompetente / Skin lesion and lymphangitis in an immunocompetent patient

No disponible

Endophthalmitis caused by Fusarium: An emerging problem in patients with corneal trauma. A case series / Endoftalmitis por Fusarium: un problema emergente en pacientes con traumatismo corneal. Serie de casos

Background: Although fortunately very rare in countries with a temperate climate, certain factors, such as clinical or pharmacological immunosuppression, may cause Fusarium-related fungal infections to become an emerging problem. Moreover, Fusarium is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers. Aims: The aim of this series of clinical cases is to identify characteristic clinical findings that may allow an early diagnosis and more efficient management of this ophthalmologic emergency. Methods: Three cases of endophthalmitis due to Fusarium solani and Fusarium oxysporum, diagnosed in 2009, 2010, and 2014 in patients from two different health regions belonging to the same health system and separated by around 43 miles, are presented. The Fusarium isolates were initially identified microscopically and the species subsequently confirmed by sequencing the elongation factor alpha (EFalfa) and internal transcribed spacers (ITS). Susceptibility to antifungal agents was determined using the EUCAST broth dilution method. Results: Evolution was poor as two of the three patients progressed to phthisis bulbi despite surgical measures and broad-spectrum antifungal antibiotic therapy. Conclusions: It is essential to rapidly instigate multidisciplinary measures to combat suspected endophthalmitis due to Fusarium given the poor prognosis of this type of infection

Antecedentes: Afortunadamente, las infecciones por Fusarium son poco frecuentes en países de clima templado; sin embargo, determinados factores como la inmunodepresión clínica o farmacológica, pueden convertirlas en un problema emergente. Fusarium es uno de los microrganismos etiológicos más importantes de la endoftalmitis exógena, favorecida habitualmente por una rotura de las barreras epiteliales. Objetivos: En esta serie de casos clínicos queremos identificar hallazgos clínicos característicos que puedan establecer un diagnóstico temprano y un tratamiento más eficiente de esta urgencia oftalmológica. Métodos: Se presentan tres casos de endoftalmitis por Fusarium solani y Fusarium oxysporum que se produjeron en los años 2009, 2010 y 2014, en pacientes de dos áreas de salud diferentes, pero pertenecientes al mismo sistema sanitario, las cuales distan 43 millas una de la otra. Las cepas aisladas de Fusarium se identificaron inicialmente por microscopia y su identidad se confirmó posteriormente mediante secuenciación del factor de elongación alfa (EFalfa) y de la región codificadora espaciadora interna (ITS). La sensibilidad a los antifúngicos se llevó a cabo por el método de dilución en caldo del EUCAST. Resultados: Se produjo una mala evolución, ya que dos de los tres pacientes evolucionaron haca la atrofia ocular a pesar de las medidas quirúrgicas y el tratamiento antibiótico y antifúngico de amplio espectro. Conclusiones: Es importante actuar rápidamente con medidas multidisciplinarias ante la sospecha de una endoftalmitis por Fusarium por el mal pronóstico de este tipo de infecciones

Endophthalmitis caused by Fusarium: An emerging problem in patients with corneal trauma. A case series.

BACKGROUND: Although fortunately very rare in countries with a temperate climate, certain factors, such as clinical or pharmacological immunosuppression, may cause Fusarium-related fungal infections to become an emerging problem. Moreover, Fusarium is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers. AIMS: The aim of this series of clinical cases is to identify characteristic clinical findings that may allow an early diagnosis and more efficient management of this ophthalmologic emergency. METHODS: Three cases of endophthalmitis due to Fusarium solani and Fusarium oxysporum, diagnosed in 2009, 2010, and 2014 in patients from two different health regions belonging to the same health system and separated by around 43 miles, are presented. The Fusarium isolates were initially identified microscopically and the species subsequently confirmed by sequencing the elongation factor alpha (EFα) and internal transcribed spacers (ITS). Susceptibility to antifungal agents was determined using the EUCAST broth dilution method. RESULTS: Evolution was poor as two of the three patients progressed to phthisis bulbi despite surgical measures and broad-spectrum antifungal antibiotic therapy. CONCLUSIONS: It is essential to rapidly instigate multidisciplinary measures to combat suspected endophthalmitis due to Fusarium given the poor prognosis of this type of infection.

[Acute complicated and uncomplicated pyelonephritis in the emergency department: process-of-care indicators and outcomes]. / Pielonefritis aguda complicada y no complicada en urgencias: indicadores de proceso y resultado.

OBJECTIVES: To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. MATERIAL AND METHODS: Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health processof- care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). RESULTS: A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. CONCLUSION: Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study.

OBJETIVO: Evaluar distintos indicadores de proceso y de resultado en la pielonefritis aguda (PNA) en el servicio de urgencias (SU) de un hospital general y compararlos entre las PNA no complicadas (PNAnc) y las complicadas (PNAc). METODO: Estudio retrospectivo de pacientes consecutivos con diagnóstico al alta de PNA. Se estudiaron indicadores de proceso (porcentaje de ingresos, hospitalización evitable, adecuación de antibioterapia inicial, urocultivos y hemocultivos obtenidos) y de resultado (duración ingreso, altas desde urgencias, reingresos, mortalidad, rendimiento pruebas microbiológicas). RESULTADOS: Se incluyeron 529 pacientes, el 59% con PNAc. La edad media de los pacientes con PNAnc fue significativamente inferior a la de los pacientes con PNAc (39 frente a 56 años). Escherichia coli fue el microorganismo más frecuente, aunque en el grupo de PNAc el porcentaje de aislados de E. coli fue menor (78% frente a 95%). En el grupo de PNAc los ingresos, los urocultivos y hemocultivos obtenidos, y la estancia fueron significativamente mayores y, además, esta última fue aún mayor si la antibioterapia inicial fue inadecuada. El porcentaje de altas desde el SU fue significativamente mayor en las PNAnc. El 61% de las mujeres con PNAnc fueron ingresadas y, en el 9% de estos casos, las hospitalizaciones se consideraron evitables. CONCLUSIONES: Las PNAc se diagnosticaron en personas de más edad, en las que la etiología por E. coli fue menor, y la estancia hospitalaria y la solicitud de urocultivos y hemocultivos fueron mayores. Las altas desde el SU fueron más frecuentes en PNAnc, aunque el porcentaje de ingresos convencionales, a juzgar por las hospitalizaciones que fueron consideradas evitables, fue elevado.

Pielonefritis aguda complicada y no complicada en urgencias: indicadores de proceso y resultado / Acute complicated and uncomplicated pyelonephritis in the emergency department: process-of-care indicators and outcomes

Objetivos: Evaluar distintos indicadores de proceso y de resultado en la pielonefritis aguda (PNA) en el servicio de urgencias (SU) de un hospital general y compararlos entre las PNA no complicadas (PNAnc) y las complicadas (PNAc). Métodos: Estudio retrospectivo de pacientes consecutivos con diagnóstico al alta de PNA. Se estudiaron indicadores de proceso (porcentaje de ingresos, hospitalización evitable, adecuación de antibioterapia inicial, urocultivos y hemocultivos obtenidos) y de resultado (duración ingreso, altas desde urgencias, reingresos, mortalidad, rendimiento pruebas microbiológicas). Resultados: Se incluyeron 529 pacientes, el 59% con PNAc. La edad media de los pacientes con PNAnc fue significativamente inferior a la de los pacientes con PNAc (39 frente a 56 años). Escherichia coli fue el microorganismo más frecuente, aunque en el grupo de PNAc el porcentaje de aislados de E. coli fue menor (78% frente a 95%). En el grupo de PNAc los ingresos, los urocultivos y hemocultivos obtenidos, y la estancia fueron significativamente mayores y, además, esta última fue aún mayor si la antibioterapia inicial fue inadecuada. El porcentaje de altas desde el SU fue significativamente mayor en las PNAnc. El 61% de las mujeres con PNAnc fueron ingresadas y, en el 9% de estos casos, las hospitalizaciones se consideraron evitables. Conclusiones: Las PNAc se diagnosticaron en personas de más edad, en las que la etiología por E. coli fue menor, y la estancia hospitalaria y la solicitud de urocultivos y hemocultivos fueron mayores. Las altas desde el SU fueron más frecuentes en PNAnc, aunque el porcentaje de ingresos convencionales, a juzgar por las hospitalizaciones que fueron consideradas evitables, fue elevado (AU)

Objective: To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. Methods: Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health process of-care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). Results: A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. Conclusions: Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study (AU)

Control microbiológico ambiental / No disponible

El medio ambiente hospitalario raramente está implicado en la transmisión de infecciones salvo en pacientes inmunodeprimidos. Algunos autores no recomiendan los cultivos ambientales porque son caros y laboriosos y no deben utilizarse como sustitutos de controles de calidad y prácticas adecuadas en los procesos de desinfección y mantenimiento de instalaciones. No se recomiendan cultivos de vigilancia sistemáticos salvo en situaciones en que las muestras tengan importancia epidemiológica y los resultados puedan aplicarse para adoptar medidas de control de infección. La incidencia de infecciones nosocomiales puede minimizarse mediante un adecuado mantenimiento de dispositivos como la desinfección de endoscopios, la calidad del agua de diálisis o los sistemas de ventilación de quirófanos y unidades de aislamiento protector. En este artículo se revisan las indicaciones y los procedimientos de los cultivos de vigilancia para prevenir infecciones en unidades de inmunodeprimidos y quirófanos, diálisis y unidades de desinfección de endoscopios y brotes de infección nosocomial(AU)

The inanimate hospital environment is rarely implicated in infection transmission, except among vulnerable patients. Some authors argue against the use of environmental surveillance cultures because the tests can be expensive and time consuming, and because they should not be used instead of quality control and good practices in disinfection and maintenance procedures. Routine environmental sampling is not usually advised, except in situations where sampling is directed by epidemiologic principles, and results can be applied to adopt infection control measures. The incidence of health-care associated infections can be minimised by appropriate maintenance of medical equipment such as endoscope cleaning and disinfection, adherence to water-quality standards for haemodialysis, and to ventilation standards for specialised care environments such as isolation units, or operating rooms. This paper reviews the current knowledge on surveillance cultures in these settings in order to prevent iatrogenic infections in operating and isolation rooms, haemodialysis and endoscope reprocessing units, and cultures related to nosocomial infection outbreaks(AU)

[Article on SEIMC Procedure No.42: Environmental microbiological monitoring]. / Control microbiológico ambiental.

The inanimate hospital environment is rarely implicated in infection transmission, except among vulnerable patients. Some authors argue against the use of environmental surveillance cultures because the tests can be expensive and time consuming, and because they should not be used instead of quality control and good practices in disinfection and maintenance procedures. Routine environmental sampling is not usually advised, except in situations where sampling is directed by epidemiologic principles, and results can be applied to adopt infection control measures. The incidence of health-care associated infections can be minimised by appropriate maintenance of medical equipment such as endoscope cleaning and disinfection, adherence to water-quality standards for haemodialysis, and to ventilation standards for specialised care environments such as isolation units, or operating rooms. This paper reviews the current knowledge on surveillance cultures in these settings in order to prevent iatrogenic infections in operating and isolation rooms, haemodialysis and endoscope reprocessing units, and cultures related to nosocomial infection outbreaks.