[Antibiotic prophylaxis in prostatic surgery: Adherence to the hospital protocol. Prospective cohort study.] / Profilaxis antibiótica en cirugía de próstata: adecuación al protocolo hospitalario. Estudio de cohortes prospectivo.

OBJECTIVES: To assess the adherence to the antibiotic prophylaxis protocol in patients undergoing prostate surgery and evaluate the effect of antibiotic prophylaxis on surgical site infections (SSI). MATERIAL AND METHODS: A prospective cohort study was carried out between January 2009 and September 2016. The global compliance with the antibiotic prophylaxis protocol was evaluated studying the items: time of onset, route of administration, antibiotic prescribed, duration and dose. Percentages of adequacy are described. The incidence of infection was calculated after 30 days of follow-up. Relationship between the adequacy to the protocol and the surgical site infection are described with the relative risk. RESULTS: A total of 595 patients were studied. The global adequacy was 93.8%. The leading cause of inadequacy was the time of onset 3%. The incidence of surgical site infection was 1%. No relationship between the inadequacy of antibiotic prophylaxis and surgical site infection (RR=1.1%; 95%CI: 1.0-1.2) was found. No relationship between the procedure (laparoscopic or open surgery) and surgical site infection (RR=0.4%; 95%CI: 0.1-1.9) was found. CONCLUSIONS: The adequacy of antibiotic prophylaxis was high. The incidence of surgical site infection was low and compliance of antibiotic prophylaxis contributes to diminish surgical site infection incidence.

OBJETIVO: El objetivo de este trabajo ha sido evaluar la adecuación de la profilaxis antibiótica y su relación con la incidencia de infección de sitio quirúrgico (ISQ) en pacientes sometidos a cirugía de próstata.MATERIAL Y MÉTODOS: Estudio de cohortes prospectivo, realizado de enero de 2009 a septiembre de 2016. Se evaluó la adecuación global al protocolo de profilaxis antibiótica y de cada apartado de la profilaxis (inicio, vía de administración, antibiótico de elección, duración y dosis). Se describieron los porcentajes de adecuación. Se calculó la incidencia de infección tras un periodo máximo de 30 días de incubación. Se evaluó la adecuación entre adecuación de la profilaxis e ISQ mediante el riesgo relativo (RR). RESULTADOS: Se incluyeron 595 pacientes en el estudio. La adecuación global fue del 93,8%. La mayor causa de incumplimiento fue el inicio de la profilaxis con un 3,0%. La incidencia de infección de sitio quirúrgico fue del 1,0%. No se encontró relación entre la inadecuación de la profilaxis antibiótica y la infección de sitio quirúrgico (RR=1,01; IC95%: 1,00-1,02). No se encontró relación en el riesgo de infección entre la cirugía laparoscópica y la cirugía abierta (RR=0,37; IC95%: 0,08-1,98). CONCLUSIONES: La adecuación de la profilaxis antibiótica fue alta. La incidencia de infección de sitio quirúrgico fue baja y la adecuada cumplimentación de la profilaxis antibiótica en la cirugía de próstata permite reducir la incidencia de infección de sitio quirúrgico.

Profilaxis antibiótica en cirugía de próstata: adecuación al protocolo hospitalario. Estudio de cohortes prospectivo / Antibiotic prophylaxis in prostatic surgery: Adherence to the hospital protocol. Prospective cohort study

OBJETIVO: El objetivo de este trabajo ha sido evaluar la adecuación de la profilaxis antibiótica y su relación con la incidencia de infección de sitio quirúrgico (ISQ) en pacientes sometidos a cirugía de próstata. MATERIAL Y MÉTODOS: Estudio de cohortes prospectivo, realizado de enero de 2009 a septiembre de 2016. Se evaluó la adecuación global al protocolo de profilaxis antibiótica y de cada apartado de la profilaxis (inicio, vía de administración, antibiótico de elección, duración y dosis). Se describieron los porcentajes de adecuación. Se calculó la incidencia de infección tras un periodo máximo de 30 días de incubación. Se evaluó la adecuación entre adecuación de la profilaxis e ISQ mediante el riesgo relativo (RR). RESULTADOS: Se incluyeron 595 pacientes en el estudio. La adecuación global fue del 93,8%. La mayor causa de incumplimiento fue el inicio de la profilaxis con un 3,0%. La incidencia de infección de sitio quirúrgico fue del 1,0%. No se encontró relación entre la inadecuación de la profilaxis antibiótica y la infección de sitio quirúrgico (RR = 1,01; IC95%: 1,00-1,02). No se encontró relación en el riesgo de infección entre la cirugía laparoscópica y la cirugía abierta (RR = 0,37; IC95%: 0,08-1,98). CONCLUSIONES: La adecuación de la profilaxis antibiótica fue alta. La incidencia de infección de sitio quirúrgico fue baja y la adecuada cumplimentación de la profilaxis antibiótica en la cirugía de próstata permite reducir la incidencia de infección de sitio quirúrgico

OBJECTIVES: To assess the adherence to the antibiotic prophylaxis protocol in patients undergoing prostate surgery and evaluate the effect of antibiotic prophylaxis on surgical site infections (SSI). MATERIAL AND METHODS: A prospective cohort study was carried out between January 2009 and September 2016. The global compliance with the antibiotic prophylaxis protocol was evaluated studying the items: time of onset, route of administration, antibiotic prescribed, duration and dose. Percentages of adequacy are described. The incidence of infection was calculated after 30 days of follow-up. Relationship between the adequacy to the protocol and the surgical site infection are described with the relative risk. RESULTS: A total of 595 patients were studied. The global adequacy was 93.8%. The leading cause of inadequacy was the time of onset 3%. The incidence of surgical site infection was 1%. No relationship between the inadequacy of antibiotic prophylaxis and surgical site infection (RR = 1.1%; 95%CI: 1.0-1.2) was found. No relationship between the procedure (laparoscopic or open surgery) and surgical site infection (RR = 0.4%; 95%CI: 0.1-1.9) was found. CONCLUSIONS: The adequacy of antibiotic prophylaxis was high. The incidence of surgical site infection was low and compliance of antibiotic prophylaxis contributes to diminish surgical site infection incidence

Incidencia de infección de sitio quirúrgico y factores de riesgo en cirugía de recto. Estudio de cohortes prospectivo / Incidence of surgical site infection and risk factors in rectal surgery: A prospective cohort study

INTRODUCCIÓN: La infección de sitio quirúrgico (ISQ) es la principal causa de infección nosocomial. El objetivo de este trabajo fue estudiar la incidencia de ISQ y evaluar los factores de riesgo que la determinan en pacientes intervenidos de cirugía de recto. MÉTODOS: Estudio de cohortes prospectivo, realizado de enero del 2013 a diciembre del 2016. Se recogieron variables relacionadas con el paciente, la intervención quirúrgica y la infección. Se calculó la incidencia de infección tras un periodo máximo de 30 días de incubación. Se evaluó el efecto de los diferentes factores de riesgo en la infección con la odds ratio ajustada con un modelo de regresión logística. RESULTADOS: El estudio incluyó a 154 pacientes, con una edad media de 69,5±12 años. Las comorbilidades más habituales fueron diabetes mellitus (24,5%), enfermedad pulmonar obstructiva crónica (17%) y obesidad (12,6%). La incidencia global de ISQ durante el periodo de seguimiento fue de 11,9% (IC95%: 7,8-17,9) y el microorganismo más frecuente fue Escherichia coli (57,9%). Los factores de riesgo asociados a la infección quirúrgica en el análisis univariante fueron la transfusión sanguínea, el uso de drenajes y la administración de fármacos vasoactivas (p < 0,05). CONCLUSIONES: La incidencia de ISQ en cirugía de recto fue baja. Es muy importante evaluar la incidencia de infección y tratar de identificar los posibles factores de riesgo de infección. Recomendamos la implantación de programas prospectivos de vigilancia y control de la infección hospitalaria

INTRODUCTION: Surgical site infection (SSI) is the main cause of nosocomial infection in Spain. The aim of this study was to analyze the incidence of SSI and to evaluate its risk factors in patients undergoing rectal surgery. METHODS: Prospective cohort study, conducted from January 2013 to December 2016. Patient, surgical intervention and infection variables were collected. Infection rate was calculated after a maximum period of 30 days of incubation. The effect of different risk factors on infection was assessed using the odds ratio adjusted by a logistic regression model. RESULTS: The study included 154 patients, with a mean age of 69.5 ± 12 years. The most common comorbidities were diabetes mellitus (24.5%), chronic obstructive pulmonary disease (17%) and obesity (12.6%). The overall incidence of SSI during the follow-up period was 11.9% (CI95%: 7.8-17.9) and the most frequent microorganism was Escherichia coli (57.9%). Risk factors associated with surgical wound infection in the univariate analysis were blood transfusion, drain tubes and vasoactive drug administration (P<.05). CONCLUSIONS: The incidence of SSI in rectal surgery was low. It is crucial to assess SSI incidence rates and to identify possible risk factors for infection. We recommend implementing surveillance and hospital control programs

Incidence of surgical site infection and risk factors in rectal surgery: A prospective cohort study. / Incidencia de infección de sitio quirúrgico y factores de riesgo en cirugía de recto. Estudio de cohortes prospectivo.

INTRODUCTION: Surgical site infection (SSI) is the main cause of nosocomial infection in Spain. The aim of this study was to analyze the incidence of SSI and to evaluate its risk factors in patients undergoing rectal surgery. METHODS: Prospective cohort study, conducted from January 2013 to December 2016. Patient, surgical intervention and infection variables were collected. Infection rate was calculated after a maximum period of 30 days of incubation. The effect of different risk factors on infection was assessed using the odds ratio adjusted by a logistic regression model. RESULTS: The study included 154 patients, with a mean age of 69.5±12 years. The most common comorbidities were diabetes mellitus (24.5%), chronic obstructive pulmonary disease (17%) and obesity (12.6%). The overall incidence of SSI during the follow-up period was 11.9% (CI95%: 7.8-17.9) and the most frequent microorganism was Escherichia coli (57.9%). Risk factors associated with surgical wound infection in the univariate analysis were blood transfusion, drain tubes and vasoactive drug administration (P<.05). CONCLUSIONS: The incidence of SSI in rectal surgery was low. It is crucial to assess SSI incidence rates and to identify possible risk factors for infection. We recommend implementing surveillance and hospital control programs.

Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective single-centre analysis

Background: Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection. Methods: This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis. Results: The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%), followed by the moment of initiating its administration (8.9%). The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6). No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0), nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1). Conclusions: The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%). No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found (AU)

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Diagnostic validity of helical CT compared to ultrasonography in renal-ureteral colic.

OBJECTIVES: Helical CT without contrast is currently being evaluated for the diagnosis of renoureteral colic. Ureteral obstruction and other pathologies with similar symptoms can be rapidly identified. This study intends to evaluate the validity of CTh for these patients and to compare it with the ultrasound technique in order to consider the CTh as an efficient diagnostic alternative for these pathologies. METHODS: A diagnostic evaluation study was carried out between January 2004 and December 2006 in patients with persistent renoureteral colic after standard care. They were blindly evaluated by ultrasound and CTh, maintaining the follow up until the "gold standard" confirmation. Qualitative variables were described by frequency and 95%CI and quantitative variables by position and dispersion measures. The Chi2 test was used to compare qualitative variables. Validity indicators and 95% CI were calculated and compared with McNemar test. RESULTS: 124 patients were studied. Lithiasis and the other diagnosis had frequencies of 59.7% and 40.3% respectively. The percentage of lithiasis obtained by ultrasound (92) was 22.8% and by CTh (124) was 59.7%. Validity indicators for CTh were superior to 95%, with 100% sensitivity and positive predictive value. Ultrasound specificity and positive predictive value were 100%, but sensitivity was only 29.6% (p<0.05). CONCLUSION: CTh can be considered a good alternative diagnostic technique in the renoureteral colic management.

Brote de hepatitis C en una unidad de oncología / Hepatitis C outbreak in an oncology ward

Introducción Estudio de un brote de hepatitis C.Métodos Estudio de casos y controles. Se estudiaron pacientes con hepatitis C aguda y controles adecuados. Se estudió la odds ratio (OR) para varios factores de riesgo. Resultados Se estudiaron 7 casos y 46 controles. Se identificó como factor de riesgo el tener implantado un catéter central (OR=35; intervalo de confianza del 95%: 16,0 a 62,0).Conclusión La inadecuada manipulación del catéter con suero salino heparinizado, probablemente contaminado con virus de la hepatitis C, fue la causa del brote (AU)

Introduction Study of an outbreak of hepatitis C virus (HCV) infection. Methods Case-control study. Odds ratios for various risk factors were studied in patients with acute hepatitis C and an appropriate control group. Results Seven cases and 46 controls were included. Implantation of a central catheter was found to be an independent risk factor for hepatitis C (OR=35; 95% CI: 16.0–62.0).Conclusion Inadequate manipulation of central catheters with heparinized saline solution, which was likely to be HCV-contaminated, caused the outbreak (AU)

Validez diagnóstica de la TAC helicoidal frente a la ecografía en el cólico renoureteral / Diagnostic validity of helical CT compared to ultrasonography in renal-ureteral colic

OBJETIVO: La TAC helicoidal (TACh) sin contraste se evalúa como técnica diagnóstica en el cólico renoureteral. Permite un diagnóstico rápido de obstrucción ureteral y de otras patologías de sintomatología similar. Este estudio pretende evaluar la validez de la TACh frente a la ecografía en el diagnóstico de estos pacientes y plantear su inclusión, como una prueba más, en el algoritmo diagnóstico de esta patología.MÉTODOS: Estudio de evaluación de pruebas diagnósticas realizado entre enero de 2004 y diciembre de 2006 en pacientes valorados por cólico renoureteral no resuelto con atención estándar, estudiándolos de forma ciega mediante ecografía y TACh y siguiéndolos hasta confirmar el diagnóstico con un “patrón oro”. Las variables cualitativas se resumen con su distribución de frecuencias e IC95% y las cuantitativas con medidas de posición y dispersión. Se utilizó el test de χ2 para comparar variables cualitativas. Se calcularon los índices de validez diagnóstica con sus IC95% y se compararon con la prueba de McNemar.RESULTADOS: Se estudió a 124 pacientes, presentando litiasis el 59,7% y otros diagnósticos el 40,3%. Las 92 ecografías efectuadas diagnosticaron un 22,8% de litiasis frente al 59,7% obtenido con 124 TACh. Los índices de validez para la TACh fueron superiores al 95%, con una sensibilidad y valor predictivo positivo (VPP) de 100%. La ecografía presentó una especificidad y un VPP de 100% pero sensibilidad y valor predictivo negativo de 29,6% (p<0,05).CONCLUSIÓN: La TACh puede ser considerada una prueba más a utilizar en el diagnóstico del cólico renoureteral(AU)

OBJECTIVES: Helical CT without contrast is currently being evaluated for the diagnosis of renoureteral colic. Ureteral obstruction and other pathologies with similar symptoms can be rapidly identified. This study intends to evaluate the validity of CTh for these patients and to compare it with the ultrasound technique in order to consider the CTh as an efficient diagnostic alternative for these pathologies.METHODS: A diagnostic evaluation study was carried out between January 2004 and December 2006 in evapatientswith persistent renoureteral colic after standard care. They were blindly evaluated by ultrasound and CTh, maintaining the follow up until the “gold standard” confirmation. Qualitative variables were described by frequency and 95%CI and quantitative variables by position and dispersion measures. The χ2 test was used to compare qualitative variables. Validity indicators and 95% CI were calculated and compared with McNemar test.RESULTS: 124 patients were studied. Lithiasis and the other diagnosis had frequencies of 59.7% and 40.3% respectively. The percentage of lithiasis obtained by ultrasound (92) was 22.8% and by CTh (124) was 59.7%.Validity indicators for CTh were superior to 95%, with 100% sensitivity and positive predictive value. Ultrasound specificity and positive predictive value were 100%, but sensitivity was only 29.6% (p<0.05).CONCLUSION: CTh can be considered a good alternative diagnostic technique in the renoureteral colic management(AU)

[Hepatitis C outbreak in an oncology ward]. / Brote de hepatitis C en una unidad de oncología.

INTRODUCTION: Study of an outbreak of hepatitis C virus (HCV) infection. METHODS: Case-control study. Odds ratios for various risk factors were studied in patients with acute hepatitis C and an appropriate control group. RESULTS: Seven cases and 46 controls were included. Implantation of a central catheter was found to be an independent risk factor for hepatitis C (OR=35; 95% CI: 16.0-62.0). CONCLUSION: Inadequate manipulation of central catheters with heparinized saline solution, which was likely to be HCV-contaminated, caused the outbreak.

[Adequacy assessment of antibiotic prophylaxis in orthopedic and traumatologic surgery]. / Evaluación de la adecuación de la profilaxis antibiótica en cirugía ortopédica y traumatológica.

INTRODUCTION: Antibiotic prophylaxis is an essential strategy for preventing surgical wound infection. This study assesses the adequacy of surgical antibiotic prophylaxis in trauma and orthopedic patients. METHODS: Cross-sectional study including consecutive patients who underwent hip or knee replacement, or spinal surgery. Sample estimation was based on 95% confidence, 5% precision, an overall adequacy of 85%, and assuming a loss of 5%. Thus, 206 patients were required. The appropriateness of the indication, time of administration, administration route, and dose according to the hospital protocol was assessed. The cumulative incidence of surgical site infection at discharge was determined. RESULTS: A total of 221 patients were included, 33.5% men and 66.5% women; mean age was 61.1 (SD=14.1) for men and 67.1 (SD=12.4) for woman (P<0.05). Antibiotic prophylaxis was indicated in all patients. Overall adequacy of prophylaxis according to the hospital protocol was 89.1%. Cumulative incidence of surgical wound infection at discharge was 3.2%. There was no association between the adequacy of antibiotic prophylaxis and surgical site infection (P>0.05). CONCLUSIONS: The adequacy of postoperative antibiotic prophylaxis was high in this study, but it can be improved.