Vigilancia de infecciones y otros eventos adversos en pacientes en diálisis en el área sur de Gran Canaria / Surveillance for infections and other adverse events in dialysis patients in southern Gran Canaria

Introducción: Las infecciones bacterianas representan un gran desafío en las estrategias de gestión del riesgo, prevención y seguridad del paciente en hemodiálisis de las cuales las infecciones del acceso vascular (AV) representan la primera causa morbi-mortalidad en estos pacientes. Métodos: Estudio prospectivo de incidencia de eventos adversos e infecciones de 7 meses (marzo-septiembre 2008) en las unidades de Hemodiálisis del Área sanitaria Sur de Gran Canaria (Hospital y Centro periférico) utilizando la metodología del Dialysis Surveillance Network del CDC. Resultados: Se vigilaron 1545 pacientes/mes, 60,5% con fístula (FAV), 35,5% con catéter permanente (CP), 3,0% con prótesis y 1,0% con catéter temporal. La incidencia de eventos en ambos centros fue 8,7 casos por 100 pacientes-mes; la tasa de eventos infecciosos fue de 9,1 para FAV y 20,6 para CP en ámbito hospitalario, mientras las tasas de otras infecciones (respiratorias, herida, orina) fueron similares. Se realizó cultivo antes de empezar tratamiento antibiótico en el 91,0% frente a sospecha de bacteriemia y/o infección AV. El 90,0% de tratamientos se ajustaron con antibiograma. Destaca una baja incidencia de bacterias mutirresistentes mientras que las infecciones relacionadas con el AV fueron causadas en proporción similar por bacterias grampositivas y gramnegativas. Conclusiones: El acceso vascular es el principal factor de riesgo para el desarrollo de infecciones. La vigilancia epidemiológica he permitido detectar oportunidades de mejora en ámbitos asistenciales distintos, integrándose como elemento fundamental en el desarrollo de estrategias multidisciplinarias de seguridad del paciente (AU)

Background: Bacterial infections pose a great challenge to risk management activities in the area of chronic haemodialysis, as vascular access related infections are the main cause of mortality among these patients. Methods: Prospective surveillance study lasting 7 months (March-September, 2008) at the two haemodialysis units in a district health area in Gran Canaria, Spain. We have used methodology proposed by CDC´s Dialysis Surveillance Network. Results: 1545 patientsmonth were enrolled, 60,5% having an arterio-venous fistula (AVF), 35,5% permanent catheter (PC), 3,0% graft and 1,0% temporary catheters. Events incidence rate at both centers was 8,6 cases per 100 patients-month, 9,1 rate for FAV and 2,9 rates for CP, So, the greatest incidence of vascular access related infections was for permanent catheter as compared with AFV. Nevertheless the other type of infections (respiratory, urinary tract, skin and chronic ulcers) showed a similar rate. Microbiological cultures before antibiotic treatment were performed in 82,2 %, but increased up to 91,0% when a vascular related infection was suspected. Empiric treatment was adjusted to antibiogram results in 90,0% of occasions. A low incidence of multirresistant microbes was seen. Gram-positive and gram-negative bacteria appeared in a similar proportion. Conclusions: Vascular access is the main risk factor for infectious events. Epidemiological surveillance has allowed us to detect areas of improvement in different settings, appearing as a key element in the risk management and patient safety areas (AU)

Surveillance for infections and other adverse events in dialysis patients in southern Gran Canaria.

BACKGROUND: Bacterial infections pose a major challenge to risk management activities in the area of chronic haemodialysis, as vascular access-related infections are the main cause of mortality among these patients. METHODS: Prospective surveillance study lasting 7 months (March-September, 2008) at two haemodialysis units in a district health area Gran Canaria, Spain. We used the methodology proposed by CDC´s Dialysis Surveillance Network. RESULTS: 1545 patients/month were recorded, 60.5% with an arteriovenous fistula (AVF), 35.5% with a permanent catheter (PC), 3.0% with grafts and 1.0% with temporary catheters. The rate of adverse events was 8.6 cases per 100 patients/month, 9.1 for AVF patients, and 2.9 for PC. Nevertheless, the other types of infections (respiratory, urinary tract, skin and chronic ulcers) showed similar rates. Microbiological cultures were taken in 82.2%, but this rate increased to 91.0% when a vascular access-related infection was suspected. Empirical treatment was adjusted to antibiogram results in 90.0% of occasions. A low incidence of multi-resistant microbes was observed. Gram-positive and gram-negative bacteria appeared in similar proportions. CONCLUSIONS: Vascular access is the main risk factor for infectious events. Epidemiological surveillance has allowed us to detect areas of improvement in different settings, acting as a key element in risk management and patient safety.

Pielonefritis xantogranulomatosa: dos casos nuevos / Childhood xanthogranulomatous pyelonephritis: two new cases

Presentamos dos casos clínicos de pielonefritis xantogranulomatosa (PNX) en la infancia. En los dos casos la clínica fue inespecífica y se demostró infección urinaria asociada. En uno de ellos el diagnóstico fue preoperatorio, según las nuevas técnicas de imagen (AU)

We report two cases of xanthogranulomatous pyelonephritis in children. In both cases, the symptoms were nonspecific, but the presence of urinary tract infection was demonstrated. One case coud be diagnosed preoperatively on the basis of new imaging techniques (AU)