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1.
Eur J Clin Microbiol Infect Dis ; 39(10): 1837-1844, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32372127

RESUMO

Endoscope contamination is infrequent but can be the source of nosocomial infections and outbreaks. In August 2016, an unexpected increase in the incidence of amikacin-resistant P. aeruginosa isolates (AK-Pae) was observed at a tertiary care center in the south of Spain. An epidemiological and microbiological investigation (August-October 2016) was performed to explain this finding. Isolates from clinical and environmental samples (2 endoscopes used for retrograde cholangiopancreatography; ERCP) were identified by MALDI-TOF. Antimicrobial susceptibility testing was performed using the MicroScan system. Whole-Genome-Sequencing (Miseq, Illumina) was performed to determine the resistome and virulome. Clonal relatedness among isolates was assessed by SpeI-PFGE and MLST. A Caenorhabditis elegans killing assay was performed for virulence testing. Biofilm formation was performed using a colorimetric assay. Four of the 5 patients infected and/or colonized with AK-Pae in August 2016 had undergone ERCP ≤5 days before sample collection. Two endoscopes were contaminated with AK-Pae. Isolates from one endoscope showed an identical PFGE pattern to 9 isolates (cluster I) and differed (1-2 bands) to 5 isolates (cluster II). Isolates from these clusters belonged to the ST17 clone. This S17 clone was characterized by its low virulence in the C. elegans killing assay, and its biofilm-forming ability, slightly superior to that of high-risk clones of P. aeruginosa ST175 and ST235. This outbreak was caused by an endoscope used for ERCP contaminated with an invasive, moderately virulent, biofilm-forming AK-Pae ST17 clone, suggesting the possible emergence of a new high-risk lineage of this clone.


Assuntos
Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Surtos de Doenças , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Amicacina/farmacologia , Antibacterianos/farmacologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana , Endoscópios Gastrointestinais/efeitos adversos , Endoscópios Gastrointestinais/microbiologia , Contaminação de Equipamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/etiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/efeitos dos fármacos , Espanha/epidemiologia
3.
Arch. bronconeumol. (Ed. impr.) ; 51(11): 564-570, nov. 2015. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-144371

RESUMO

Introducción: El objetivo de este estudio es el análisis del impacto de los trastornos asociados al consumo de alcohol (TCA) en las neumonías neumocócicas adquiridas en la comunidad (NNAC), en términos de exceso de mortalidad intrahospitalaria, prolongación de estancias y sobrecostes. Material y métodos: Estudio observacional retrospectivo de una muestra de pacientes que presentaron NNAC recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. Se calculó la mortalidad, la prolongación de estancias y los sobrecostes atribuibles a los TCA controlando mediante análisis multivariado de la covarianza variables como la edad y el sexo, el tipo de hospital, los trastornos adictivos y las comorbilidades. Resultados: Se estudiaron 16.202 ingresos urgentes por NNAC de 18 a 74años de edad, entre los cuales hubo 2.685 pacientes con TCA. Los ingresos con NNAC y TCA fueron predominantemente varones, con mayor prevalencia de trastornos por tabaco y drogas y con índices de comorbilidad de Charlson más elevados. Los pacientes con NNAC y TCA presentaron importantes excesos de mortalidad (50,8%; IC95%: 44,3-54,3%), prolongación indebida de estancias (2,3 días; IC 95%: 2,0-2,7 días) y sobrecostes (1.869,2 Euros; IC95%: 1.498,6-2.239,8 Euros). Conclusiones: De acuerdo con los resultados de este estudio, los TCA en pacientes con NNAC aumentan significativamente la mortalidad, la duración de la estancia hospitalaria y sus costes


Introduction: The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. Methods: Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. Results: Among 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3 days; CI95%: 2.0-2.7 days) and increased costs (1,869.2 Euros; CI95%: 1,498.6-2,239.8 Euros). Conclusions: According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending


Assuntos
Humanos , Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Induzidos por Álcool/epidemiologia , Pneumonia Pneumocócica/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Mortalidade , Efeitos Psicossociais da Doença , Tempo de Internação/estatística & dados numéricos , Estudos Retrospectivos
4.
Cir. Esp. (Ed. impr.) ; 93(7): 444-449, ago.-sept. 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-143036

RESUMO

INTRODUCCIÓN: Los objetivos de este estudio fueron el análisis de los factores asociados a la incidencia de dehiscencia postoperatoria de la laparotomía y el impacto de esta última en la mortalidad, las estancias y los costes hospitalarios. MÉTODOS: Estudio observacional retrospectivo de una muestra de pacientes intervenidos mediante laparotomía recogidos en los conjuntos mínimos básicos de datos de 87 hospitales españoles durante el periodo 2008-2010. RESULTADOS: Se estudiaron 323.894 ingresos por cirugía abdominal, entre los cuales hubo 2.294 pacientes con DPL. Los pacientes de mayor edad, varones, con ingreso urgente, con trastornos por alcohol, tabaco y drogas, y con más comorbilidades presentaron mayor incidencia. Además, aquellos con DPL presentaron un incremento de mortalidad (107,5%), una estancia mas prolongada (15,6 días) y un exceso de costes (14.327 euros). CONCLUSIONES: Hay una asociación entre ciertas variables demográficas, conductuales y comorbilidades, y la incidencia de DPL, y esta complicación aumenta la mortalidad, la duración de la estancia y su coste. Medidas preventivas podrían disminuir su incidencia y su impacto sanitario y económico


INTRODUCTION: The Charcot foot (CF) consists of a progressive deterioration of the bones and joints, most common in diabetic patients with advanced neuropathy. The great problem is that can be confused with other processes, delaying the diagnosis and specific treatment. The aim is to analyze the cases of CF diagnosed in our hospital and especially to highlight the role of the general surgeon. MATERIAL AND METHODS: Retrospective study of all registered cases diagnosed of CF between the diabetic population of our Department of Health. A review of the literature was performed. RESULTS: From 2008 to 2012, there 7 cases of CF were diagnosed (prevalence 1:710). Two of the patients were diagnosed erroneously of cellulitis. The average time of delay in the diagnosis was 10 weeks (minimum 1, maximum 24). The initial treatment was immobilization of the extremity. Once the edema was eliminated, an offload orthesis was placed according to Sanders's anatomical classification. Evolution was favorable in 5 patients, 1 patient needed amputation, and other one died of acute cardiac pathology. CONCLUSIONS: The CF is a more frequent pathology than we believe. The general surgeon is the fundamental prop in the diagnosis and initial treatment. Before the presence of inflammation and edema of the foot in a patient with diabetes and severe neuropathy, once cellulitis, osteomyelitis, and TVP are ruled out, Charcot neuroarthropathy should be considered


Assuntos
Humanos , Laparotomia/efeitos adversos , Deiscência da Ferida Operatória/complicações , Tempo de Internação/estatística & dados numéricos , Fatores de Risco , Efeitos Psicossociais da Doença , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
5.
Cir Esp ; 93(7): 444-9, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25956459

RESUMO

INTRODUCTION: The objectives of this study were to investigate the relationship between several factors and the incidence of postoperative abdominal wall dehiscence (POAD), and to estimate the influence of POAD on in-hospital mortality, excess length of stay and costs. METHODS: Retrospective observational study of a sample of abdominal surgery patients from a minimal basic data set of 87 Spanish hospitals during 2008-2010. RESULTS: Among 323,894 admissions for abdominal surgery reviewed there were 2,294 patients with POAD. Elderly patients, male, with non-elective admission, with alcohol, tobacco or drugs abuse, and with more comorbidities had higher incidence. POAD patients had an increase in in-hospital death (mortality excess of 107.5%), excess length of stay (15.6 days) and higher cost (14,327 euros). CONCLUSIONS: Certain demographic and behavioral variables, and several comorbidities are associated with the incidence of POAD, and this complication shows an increase in in-hospital mortality, the length of hospital stay and costs. Preventive measures might decrease the incidence of POAD and its impact on health and extra-costs.


Assuntos
Parede Abdominal/cirurgia , Custos de Cuidados de Saúde , Mortalidade Hospitalar , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Deiscência da Ferida Operatória/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
6.
Arch Bronconeumol ; 51(11): 564-70, 2015 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25766125

RESUMO

INTRODUCTION: The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. METHODS: Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. RESULTS: Among 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3days; CI95%: 2.0-2.7days) and increased costs (1,869.2€; CI95%: 1,498.6-2,239.8€). CONCLUSIONS: According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending.


Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Custos Hospitalares/estatística & dados numéricos , Pneumonia Pneumocócica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/economia , Infecções Comunitárias Adquiridas/economia , Comorbidade , Feminino , Mortalidade Hospitalar , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Papel do Médico , Vacinas Pneumocócicas , Pneumonia Pneumocócica/economia , Prevalência , Estudos Retrospectivos , Espanha/epidemiologia , Uso de Tabaco/epidemiologia
7.
Drug Alcohol Depend ; 137: 55-61, 2014 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-24529967

RESUMO

AIMS: Alcohol use disorders (AUD) have been associated with an increased risk of unplanned hospital readmissions (URA). We analyzed in a sample of 87 Spanish Hospitals if surgical patients with AUD had a higher risk of URA and if among patients with URA, those with AUD had an excess length of hospital stay, higher hospital expenses and increased risk of mortality. METHOD: We analyzed data of patients who underwent surgical operations during the period between 2008 and 2010. URA was defined as unplanned readmissions during the first 30 days after hospital departure. The primary outcome was risk of URA in patients with AUD. Secondary outcomes were mortality, excess length of stay and over expenditure. RESULTS: A total of 2,076,958 patients who underwent surgical operations were identified: 68,135 (3.3%) had AUD, and 62,045 (3.0%) had at least one URA. Among patients with AUD 4212 (6.2%) had at least one URA and among patients without AUD 57,833 (2.9%) had at least one URA. Multivariable analysis demonstrated that AUD was an independent predictor of developing URA (Odds ratio: 1.56; 95% CI: 1.50-1.62). Among surgical patients with URA, those with AUD had longer lengths of hospital stay (2.9 days longer), higher hospital costs (2885.8 Euros or 3858.3 US Dollars), higher risk of death (OR: 2.16, 95% CI: 1.92-2.44) and higher attributable mortality (11.2%). CONCLUSIONS: Among surgical patients, AUD increase the risk of URA, and among patients with URA, AUD heighten the risk of in-hospital death, and cause longer hospital stays and over expenditures.


Assuntos
Transtornos Relacionados ao Uso de Álcool/economia , Custos Hospitalares/tendências , Mortalidade Hospitalar/tendências , Tempo de Internação/tendências , Readmissão do Paciente/tendências , Complicações Pós-Operatórias/economia , Transtornos Relacionados ao Uso de Álcool/mortalidade , Transtornos Relacionados ao Uso de Álcool/terapia , Estudos de Coortes , Bases de Dados Factuais/tendências , Feminino , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Complicações Pós-Operatórias/mortalidade
8.
Med. clín (Ed. impr.) ; 116(5): 182-185, feb. 2001.
Artigo em Es | IBECS | ID: ibc-2933

RESUMO

FUNDAMENTO: En un brote de tuberculosis ocurrido en un instituto se valora la posible influencia de una excursión en autobús como causa de contagio entre un caso índice y los viajeros. POBLACIÓN, PACIENTES Y MÉTODO: Estudio de contactos realizado al conductor, tres maestros y 49 alumnos que pertenecían a clases diferentes, y que viajaron de Málaga a Sierra Nevada en marzo de 1998. Se incluyó a todos los alumnos de las clases donde apareció algún caso de tuberculosis desde abril a diciembre de 1998 y a todos los profesores del instituto. RESULTADOS: En el instituto se estudió a un total de 232 alumnos, la prevalencia de infección fue del 35 por ciento, encontrando un total de 12 nuevos casos entre los alumnos. Ningún profesor de los 123 estudiados enfermó. De los que viajaron en autobús, dos profesores y 19 alumnos estaban infectados, y la prevalencia entre los alumnos fue del 46 por ciento; cinco de ellos estaban enfermos. La odds ratio de infección para los que tenían un compañero de clase con baciloscopia positiva fue de 5,5. Independientemente, el viajar en autobús (con respecto a los que no viajaron) supuso una odds ratio de 3.4. La mayoría de los viajeros infectados tenían relación de proximidad con el caso índice. CONCLUSIONES: En el brote de tuberculosis estudiado algunos de los alumnos enfermos e infectados no tenían ninguna relación de proximidad ni amistad con el caso índice en el instituto, por lo que parece confirmarse que para algunos alumnos la transmisión de la tuberculosis se produjo dentro del autobús (AU)


Assuntos
Adolescente , Adulto , Masculino , Feminino , Humanos , Viagem , Veículos Automotores , Surtos de Doenças , Espanha , Meios de Transporte , Tuberculose , Busca de Comunicante , Mycobacterium tuberculosis , Instituições Acadêmicas
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