Documento de consenso para la implantación y desarrollo del Código Sepsis en la Comunidad de Madrid / Consensus document for sepsis code implementation and development in the Community of Madrid

Se presenta aquí el documento de consenso para la implantación y desarrollo del Código Sepsis en la Comunidad de Madrid, cuya redacción se completó en abril de 2017. Este documento ha sido adoptado por la Consejería de Sanidad madrileña como base de trabajo para la puesta en marcha del Código Sepsis, tanto en el ámbito hospitalario (hospitales de agudos y de media y larga estancia) como en Atención Primaria y los Servicios de Emergencia Extrahospitalaria. Se publica ahora sin modificaciones con respecto a la versión original, añadiendo únicamente las referencias bibliográficas más significativas. El documento se estructura en cuatro partes: introducción, detección y valoración iniciales, tratamiento inicial y organización asistencial. En las partes segunda a cuarta se proponen 25 recomendaciones, consensuadas por los autores después de varias reuniones presenciales y una extensa discusión "online". Se incluyen nueve tablas que pretenden servir de guía práctica para la activación y aplicación del código sepsis. Tanto el contenido de las recomendaciones como su redacción formal se han realizado teniendo en cuenta su aplicabilidad en todos los ámbitos a los que se dirigen, que cuentan con recursos y características estructurales y funcionales muy dispares, por lo que deliberadamente se ha huido de un mayor grado de concreción: el objetivo no es que el código sepsis se organice y se aplique de forma idéntica en todos ellos, sino que los recursos sanitarios trabajen de forma coordinada alineados en la misma dirección

The consensus paper for the implementation and development of the sepsis code, finished in April 2017 is presented here. It was adopted by the Regional Office of Health as a working document for the implementation of the sepsis code in the Community of Madrid, both in the hospital setting (acute, middle and long-stay hospitals) and in Primary Care and Out-of-Hospital Emergency Services. It is now published without changes with respect to the original version, having only added the most significant bibliographical references. The document is divided into four parts: introduction, initial detection and assessment, early therapy and organizational recommendations. In the second to fourth sections, 25 statements or proposals have been included, agreed upon by the authors after several face-to-face meetings and an extensive «online» discussion. The annex includes nine tables that are intended as a practical guide to the activation of the sepsis code. Both the content of the recommendations and their formal writing have been made taking into account their applicability in all areas to which they are directed, which may have very different structural and functional characteristics and features, so that we have deliberately avoided a greater degree of concretion: the objective is not that the sepsis code is organized and applied identically in all of them, but that the health resources work in a coordinated manner aligned in the same direction

Infection Due to Saksenaea vasiformis Following a Spider Bite.

Cutaneous mucormycosis due to Saksenaea vasiformis species is exceptional. There have been about 40 reported cases worldwide, with most being fatal. We report an exceptional nonlethal case of mucormycosis due to S. vasiformis following a spider bite. The patient was in an immunosuppressed state owing to previous chemotherapy and diabetes mellitus. The origin of the inoculation was the bite of a Loxosceles laeta spider, which caused loxoscelism. The initial skin injury was quickly progressive, requiring amputation of the right upper limb. After surgical intervention and suitable antifungal treatment, the patient was discharged with resolution of accompanying pulmonary disease. Infections due to S. vasiformis are probably underdiagnosed. To avoid fatal outcomes, a high index of clinical suspicion in patients with quickly progressive necrotic lesions of soft tissues and systemic dissemination is important.

Cefditoreno: una realidad para el tratamiento de las infecciones comunitarias / Cefditoren: a reality for the treatment of community infections

Cefditoreno, una cefalosporina de tercera generación, es el betalactámico oral con mayor actividad sobre los principales patógenos que causan las infecciones respiratorias adquiridas en la comunidad (incluidos los fenotipos resistentes como Streptococcus pneumoniae resistente a penicilina y Haemophilus influenzae resistente a ampicilina), y similar a la de cefotaxima. La experiencia obtenida en ensayos clínicos y estudios posteriores (eficacia y seguridad) acreditan el uso de cefditoreno en las infecciones leves y moderadas más habituales de la comunidad como las respiratorias y las urinarias, sobre todo en zonas donde son prevalentes los fenotipos resistentes a los antibióticos orales más utilizados (AU)

Cefditoren, a third-generation cephalosporin, is the oral b-lactam more active against the main community-acquired respiratory tract pathogens (including resistance phenotypes such as penicillin-resistant Streptococcus pneumoniae and ampicillin-resistant Haemophilus influenzae), similar to cefotaxime. Data obtained from clinical trials and later evidence on efficacy and safety, support that cefditoren is an suitable option for the treatment of mild-to moderate community respiratory and urinary tract infections, particularly in regions where non-susceptible phenotipes to common oral antibiotics are prevalent (AU)

Autochthonous Crimean-Congo Hemorrhagic Fever in Spain.

Crimean-Congo hemorrhagic fever (CCHF) is a widely distributed, viral, tickborne disease. In Europe, cases have been reported only in the southeastern part of the continent. We report two autochthonous cases in Spain. The index patient acquired the disease through a tick bite in the province of Ávila - 300 km away from the province of Cáceres, where viral RNA from ticks was amplified in 2010. The second patient was a nurse who became infected while caring for the index patient. Both were infected with the African 3 lineage of this virus. (Funded by Red de Investigación Cooperativa en Enfermedades Tropicales [RICET] and Efficient Response to Highly Dangerous and Emerging Pathogens at EU [European Union] Level [EMERGE].).