Epidemiology of Clostridioides difficile infection in hospitalized patients in Spain: An eight-year review (2012-2019).

BACKGROUND: Clostridioides difficile infection (CDI) is a disease that is potentially preventable by vaccination. A good knowledge of its epidemiology, which can change over time, is warranted for prevention purposes and to help decision-making on the use of vaccines in public health programs. The objective of the research was to determine the epidemiology of healthcare-associated CDI (HA-CDI) and community-associated CDI (CA-CDI) in hospitalized patients in Spain using point prevalence data. METHODS: Point prevalence survey data on infections of hospitalized patients for years 2012-2019 were analyzed. HA-CDI and CA-CDI prevalence rates were calculated. Both HA-CDI and CA-CDI, as well as age group prevalence rates, were examined for trends. Patient comorbidities were tested for association to CDI. RESULTS: The prevalence of CDI in Spanish hospitals has grown exponentially from 14.1% in 2012 to 35.9% in 2019 (cases/10.000 hospitalized patients). Almost two thirds of the cases are of nosocomial onset. This increase was observed for HA-CDI and CA-CDI at an annual rate of 1.11% (CI 95% 1.08-1.15) and 1.09% (CI 95% 1.04-1.13), respectively. Patients 50 years old or older represent 87% of the total number of cases. Patients suffering from neoplasm (OR 1.39), immunodeficiency (OR 3.26), neutropenia (OR 3.70), cirrhosis (OR 1.92) and chronic renal failure (OR 1.91) have a significant increased risk of developing CDI, after adjusting for age. CONCLUSION: In Spain, the prevalence rate of both HA-CDI and CA-CDI have been increasing. Burden of CDI as well as clinical and epidemiological characteristics of CDI patients will help to support public health decision-making.

SARS-COV-2 seroprevalence among all healthcare workers in a tertiary hospital in Spain.

BACKGROUND: Healthcare workers (HCWs) have been a critical and vulnerable population during SARS-CoV-2 pandemic. The aim of this study was to determine the overall seroprevalence and to evaluate occupational risk factors among HCWs in one of the countries most affected by this pandemic. METHODS: We conducted a seroprevalence study for SARS-CoV-2 in a tertiary hospital in Madrid (Spain) between 24 April and 8 May 2020. A total of 4894 HCWs were invited for serologic testing. Serum samples were tested for SARS-CoV-2 IgM and IgG antibodies using Enzyme Immunoassay (ELISA) and Electro-Chemiluminescence Immunoassay (ECLIA) techniques. We calculated odds ratios to assess association between demographic and occupational characteristics with SARS-CoV-2 seroconversion. RESULTS: We processed 4324 serum samples. Overall, seroprevalence was of 16.6% (95% CI: 15.5-17.7). We found statistically significant differences in SARS-CoV-2 seroprevalence by type of employee, professional category, department and type of activity performed during the pandemic period, while no differences were identified between the personnel working in the COVID-19 wards compared to those working in non-COVID-19 wards. We confirmed 268 (26.7%) infections among 1005 hospital staff members tested by PCR. 60.5% of HCWs infected by SARS-CoV-2, assessed either by PCR or serology, could be considered asymptomatic or paucisymptomatic. CONCLUSIONS: HCWs have an increased risk of SARS-CoV-2 infection but COVID-19 patient exposure was not a determining factor. Universal mask wearing should be mandatory in healthcare settings given the important number of asymptomatic and paucisymptomatic cases.

Caracterización de una IPS de mediana complejidad en Ingeniería Clínica en Norte de Santander, Colombia / Characterization of a Médium Complexity Healthcare Institution in Clinicai Engineering in Norte de Santander, Colombia

RESUMEN Objetivo Caracterizar, en lo que a ingeniería clínica se refiere, el estado actual de una IPS de nivel II de mediana complejidad del departamento de Norte de Santander (Colombia). Metodología Se recopiló información de referencia sobre la disponibilidad de servicios de salud y los equipos médicos con el fin de determinar necesidades en tecnologías sanitarias basados en el análisis de los datos demográficos y epidemiológico. Resultados En el estudio se encontró que el área de influencia es grande para la poca capacidad instalada con la que cuenta la IPS. Se debe priorizar la adquisición de equipos biomédicos para las enfermedades no transmisibles. Se determinó que existen necesidades en cuanto al equipamiento biomédico y recursos humanos para el oportuno desarrollo de la prestación de los servicios. Discusión Teniendo en cuenta la situación actual de la pandemia ocasionada por el COVID-19, se evidencia que las IPS requieren que estas necesidades sean cubiertas con el fin de evitar un aumento en los casos de infectados y dar una atención oportuna a quienes padezcan esta enfermedad. Por ello se requiere un aumento de la capacidad Instalada de equipos biomédicos y servicios asistenciales. Esta caracterización va a permitirles a las IPS determinar cuáles son las carencias en equipos biomédicos, lo cual se hace fundamental en este momento, cuando se requiere un fortalecimiento de los servicios de salud que se prestan en el país.

ABSTRACT Objective To characterize the current state of the clinical engineering in a medium complexity (level 2) health institution in Norte de Santander, a State of Colombia, South America. Methodology Reference information was collected on the availability of health services and medical equipment to determine needs in health technologies based on the analysis of demographic and epidemiological data. Results The study resulted in that the area of influence is big y this have a little installed capacity, the acquisition of biomedical equipment for non-communicable diseases should be prioritized. It was determined that there are needs in terms of biomedical equipments and human resources for the timely development of the provision of services. Discussion Due to the current situation of the pandemic caused by COVID-19, it is evident that the IPS require that the needs be covered to avoid an increase in the cases of ¡nfected and assist the sick people, for that reason, an increase in the installed capacity of biomedical equipment and healthcare services is required. Finally, according to the economic aspect of the IPS, there are possible limitations for the acquisition of necessary biomedical equipment. This characterization will allow the IPS to determine what are the shortcomings in biomedical equipment, which is essential at this time when a strengthening of the health services provided in the country is required.

Epidemiology of Clostridioides difficile infection in hospitalized patients in Spain: An eight-year review (2012-2019).

BACKGROUND: Clostridioides difficile infection (CDI) is a disease that is potentially preventable by vaccination. A good knowledge of its epidemiology, which can change over time, is warranted for prevention purposes and to help decision-making on the use of vaccines in public health programs. The objective of the research was to determine the epidemiology of healthcare-associated CDI (HA-CDI) and community-associated CDI (CA-CDI) in hospitalized patients in Spain using point prevalence data. METHODS: Point prevalence survey data on infections of hospitalized patients for years 2012-2019 were analyzed. HA-CDI and CA-CDI prevalence rates were calculated. Both HA-CDI and CA-CDI, as well as age group prevalence rates, were examined for trends. Patient comorbidities were tested for association to CDI. RESULTS: The prevalence of CDI in Spanish hospitals has grown exponentially from 14.1% in 2012 to 35.9% in 2019 (cases/10.000 hospitalized patients). Almost two thirds of the cases are of nosocomial onset. This increase was observed for HA-CDI and CA-CDI at an annual rate of 1.11% (CI 95% 1.08-1.15) and 1.09% (CI 95% 1.04-1.13), respectively. Patients 50 years old or older represent 87% of the total number of cases. Patients suffering from neoplasm (OR 1.39), immunodeficiency (OR 3.26), neutropenia (OR 3.70), cirrhosis (OR 1.92) and chronic renal failure (OR 1.91) have a significant increased risk of developing CDI, after adjusting for age. CONCLUSION: In Spain, the prevalence rate of both HA-CDI and CA-CDI have been increasing. Burden of CDI as well as clinical and epidemiological characteristics of CDI patients will help to support public health decision-making.

A systematic review and meta-analysis of risk factors associated with acquisition of waterborne healthcare-associated infection or colonization in high-risk units.

In this meta-analysis, central venous catheter exposure (pooled odds ratio, 8.02; 95% confidence interval [CI], 2.19-29.31; P < .01) in neonates and length of stay (standardized mean difference, 0.65; 95% CI, 0.26-1.05; P = .01) in an adult population were associated with acquisition of waterborne healthcare-associated infections or colonization in ICUs. The quality of evidence was low.

Cellulose-Derived Absorbable Hemostatic Product as a Risk Factor for Mediastinitis after Cardiac Surgery.

Background: We describe the management and control of an outbreak of mediastinitis in a cardiac surgery department. Method: We performed a retrospective cohort study of 87 patients who underwent coronary artery bypass grafting (CABG), valve replacement, or both during a five-month period with a higher than normal number of cases of post-operative mediastinitis. In addition to medical records review, a survey was conducted among surgeons to estimate the frequency of cellulose-derived absorbable hemostatic (CDAH) use. Results: Eleven patients (12.5%) developed mediastinitis during the period. None of them died, and the course of the infections was benign. No differences were found between the infected and non-infected patients regarding clinical or demographic characteristics. The rate of infection by surgeon ranged from 0 to 21.4%. (p = 0.38). We found a significant linear relation between the frequency of CDAH use and the risk of infection, from 3.3% to 22.6% (p = 0.024). Cultures of unused CDAHs were negative. Cessation of product use led to no new cases for the following year and to a mediastinitis rate <1% for the following 24 months. Conclusion: We identified a cluster of undesired clinical outcomes compatible with mediastinitis that added morbidity and associated cost, but not deaths, related to the use of CDAH as a hemostatic. These data suggest keeping the use of CDAH in cardiothoracic surgery to a minimum.

A cluster of Chryseobacterium indologenes cases related to drainage water in intensive care units.

In this outbreak, 12 patients in intensive care units acquired a Chryseobacterium indologenes infection. Cultures from sinkholes and air samples were positive for C. indologenes. After removing wash basins, no new cases appeared. Sinkholes, potentially contaminated, can act as a reservoir for C. indologenes and other microorganisms. Thus, patients and equipment should be protected from sink splashes to avoid contamination.

Factores de riesgo en enfermedad cerebro vascular isquémica en paciente menores de 45 años / Risk factors of stroke in young people

Un Evento Cerebro Vascular (ECV) es un suceso dramático en un paciente joven, al considerar la discapacidad, el impacto social y los altos costos en procesos de rehabilitación. Por lo anterior, se han creado programas de prevención para los factores de riesgo implicados en la presentación de éstos. Con este trabajo, se pretende realizar una revisión teórica de los factores de riesgo, etiologías implicadas en la presentación de un ECV, además se presenta un informe de las historias clínicas de los pacientes que consultaron al Hospital San Juan de Dios, en el período comprendido entre enero de 1995 y junio del 2000, con el fin de describir los factores de riesgo, enfermedades asociadas en esta población y aportar una información preliminar

Trombosis de senos venosos cerebrales / Cerebral venous thrombosis

La trombosis de los senos venosos cerebrales ocurre como consecuencia de una alteración en los factores trombogénicos y fibrinolíticos, a su vez ocasionada por diversos factores locales o sistémicos. Entre las causas mejor conocidas se hallan las infecciosas, las alteraciones de la coagulación que acompañan la anticoncepción, el embarazo y el parto, el trauma y los neoplasmas. La prevalencia e incidencia de esta patología se ha aproximado mediante registros de casos, pero su notificación no es obligatoria y el subregistro es amplio. La presentación clìnica es variable por lo cual resulta más fácil tratar de reconocerla en diversos síndrome como: la hipertensión endocranea benigna, la cefalea aguda con signos focales y depresiòn de la conciencia, las convulsiones con paresia post ictal transitoria entre otros. El diagnóstico por imágenes ha sufrido un gran cambio con la aparición de la TAC y la resonancia magnética y han permitido una pronta confirmación, en la sospecha clìnica, frente a la bien conocida positividad de la angiografía. El tratamiento continua generando controversia pues algunos pacientes mejoran sin intervención alguna. Empero la anticoagulación con heparina a dosis plenas continùa siendo un tratamiento seguro y eficaz, incluso en presencia de hemorragia. La trombolisis local está indicada en aquellos casos en los cuales la anticoagulación no produce resultado. Se presentan para ilustración del lector, cinco casos atendidos en el Hospital San Juan de Dios de Bogotá