[The factors associated with a lengthy hospital stay in a third-level unit]. / Los factores asociados con la estancia hospitalaria prolongada en una unidad de tercer nivel.

A descriptive, cross-sectional and retrospective design was developed in order to assess the frequency of patients with lengthy hospital stay (LHS) and associated factors at the Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, in Mexico City from January to April, 1993. Some 2,488 patients were discharged during this period and 541 were selected at random. There were 23.9% (n = 131) of patients who had LHS, with a specific mean of 7.7 days and a total mean of 18 days of hospital stay compared with 5 days for those patients who did not have LHS. The associated factors were: patient's origin, admission conditions, complications, hospital infections, category and specialty of attending physician, delay in laboratory and diagnostic imaging exams and results, delay in surgical interventions, and need of outside transportation at time of discharge. Characteristics of patients with greater probabilities of having LHS are outside origin, diagnosis of malignant tumor, complications, hospital infections, and delay in laboratory exams and in surgical interventions. Some of these characteristics can be modified in order to improve LHS and quality of medical care. Further investigations are required to individually analyze these characteristics as well as the justification for LHS and its costs.

Screening for ampicillin resistant Hemophilus influenzae and penicillin resistant Streptococcus Pneumoniae in healthy carriers.

800 samples of pharyngeal exudate were taken from healthy children and 28 healthy intrafamilial contacts of children with meningitis caused by H. influenzae type b. H. influenzae type be was isolated in 8.7 per cent of nursery children, H. influenzae type e in 0.12 per cent and non typifiable H. influenzae in 5.8 per cent. On intrafamilial contacts, 32 per cent had H. influenzae type b and non typifiable in 3.5 per cent. Percent age of ampicillin resistant H. influenzae type b was 14 per cent. No strains were found resistant to chloramphenicol. S. pneumoniae was isolated in 37 per cent of pharyngeal exudate samples. 25.5 per cent of strains tested were penicillin sensitive; 74.5 per cent has a decrease sensitivity. Based on these results we consider chloramphenicol to the the first drug of choice for treatment of severe H. influenzae infections and penicillin for S. pneumoniae infections recommending in the latter higher doses when dealing with central nervous system infections.