Nosocomial infection surveillance in a surgical intensive care unit in Spain, 1996-2000: a time-trend analysis.

OBJECTIVE: To establish the occurrence, distribution, and secular time trend of nosocomial infections (NIs) in a surgical intensive care unit (ICU). DESIGN AND SETTING: Follow-up study in a teaching hospital in Spain. METHODS: In May 1995 we established an nosocomial infection surveillance system in our surgical ICU. We collected information daily for all patients who were in the ICU for at least 48 hours (546 patients from 1996 through 2000). We used the Centers for Disease Control and Prevention definitions and criteria for infections. Monthly, we determined the site-specific incidence densities of NIs, the rates of medical device use, and the Poisson probability distribution, which determined whether the case count equalled the number of expected cases (the mean number of cases during the previous year, with extreme values excluded). We compared yearly and monthly infection rates by Poisson regression, using site-specific NIs as a dependent variable and year and month as dummy variables. We tested annual trends with an alternative Poisson regression model fitting a single linear trend. RESULTS: The average rate of catheter-associated urinary tract infections was 8.4 per 1000 catheter-days; that of ventilator-associated pneumonia, 21 per 1000 ventilator-days; and that of central line-associated bloodstream infections, 30 per 1000 central line-days. The rate of urinary tract infections did not change over the study period, but there was a trend toward decreases in the rates of central line-associated bloodstream infections and ventilator-associated pneumonia. CONCLUSION: An NI surveillance and control program contributed to a progressive decrease in NI rates.

Relationship between the Arg72Pro polymorphism of p53 and outcome for patients with traumatic brain injury.

OBJECTIVE: To determine the relationship between the Arg72Pro polymorphism of p53 and the outcome after traumatic brain injury (TBI) in humans. DESIGN AND SETTING: A prospective study was carried out in a ten-bed surgical intensive care unit (SICU) of a university hospital. PATIENTS: The study included 90 caucasian patients who had experienced a severe TBI within the previous 24 h. The exclusion criterion was a previous deficit in the central nervous system. MEASUREMENTS AND RESULTS: The main recorded outcomes were values on the Glasgow Outcome Scale (GOS) at discharge from the SICU (GOS-0) and 6 months later (GOS-6). A blood sample was taken from each patient and all samples were analyzed by an allele-specific polymerase chain reaction for detection of Arg72Pro polymorphism of p53. These polymorphisms were tested for their association with values of GOS-0 and GOS-6. A two-tailed value of p<0.05 was considered statistically significant. The frequency of the argine/argine (Arg/Arg) genotype was greater among the patients who had a bad outcome at GOS-0 (69 vs 31% in the bad-outcome group; p=0.029). A multiple logistic regression analysis showed that patients with the Arg/Arg variation had a 2.9-fold greater risk of having a bad outcome at discharge from the SICU (95% confidence interval, 1.05-8.31; p=0.039 ). There was no similar relationship with respect to GOS-6. CONCLUSION: The Arg/Arg genotype of the Arg72Pro polymorphism in p53 is associated with increased likelihood of a bad outcome at discharge from the SICU.

[Analysis of outpatients readmitted to an ambulatory surgery program]. / Análisis de los reingresos hospitalarios domiciliarios en un programa de cirugía mayor ambulatoria.

OBJECTIVES: To quantify readmission rates due to both major and minor complications per year of study in an ambulatory surgery program and to assess the effect of including patients with greater severity on the results. PATIENTS AND METHOD: We performed a retrospective study of patients undergoing surgery in an ambulatory surgery program in our health center between 1998 and 2003. During the study period, 25,553 patients met the selection criteria for elective ambulatory surgery. To analyze the evolution of complications over the study period, the first year of the study period was taken as the reference, and the chi(2) test was used to measure tendency, obtaining annual odd ratios (OR) and their respective confidence intervals. RESULTS: The substitution index in the study period was 55.25%. The proportional risk of a major complication in our series was 1:426. The number of patients readmitted from home represented 0.83% of the total number of patients undergoing ambulatory surgery. The most common causes of readmission were surgically-related occurrences, mainly bleeding from the surgical site. Most complications were minor, the most frequently found problem being pain in the surgical wound. CONCLUSIONS: Safety is an attitude and when the surgeon and the anesthesiologist apply appropriate patient selection criteria and perform a careful preanesthesia evaluation, there is no reason to expect more complications in ambulatory patients than in inpatients.

Full breastfeeding and hospitalization as a result of infections in the first year of life.

OBJECTIVE: Our objective was to assess the effect of breastfeeding on the probability of hospitalization as a result of infectious processes during the first year of life METHODS: We followed 1385 infants from birth to age 1 year between 1996 and 1999. Recruitment and data collection were done at the 6-month well-infant visit under the National Child Health Program. Full breastfeeding, hospital admission, and other relevant variables related to the delivery, infant, mother, health services system, and sociologic aspects were recorded. The statistical analysis included Kaplan-Meier test, Cox regression to obtain the hazard ratio, and the adjusted attributable risk. RESULTS: Full breastfeeding at discharge after delivery and at 3, 4, and 6 months of age were 85%, 52%, 41%, and 15%, respectively; 78 hospital admissions as a result of infections were recorded (38 respiratory tract, 16 gastrointestinal tract). Mean age at admission was 4.1 months. After estimating the attributable risk, it was found that 30% of hospital admissions would have been avoided for each additional month of full breastfeeding. Seemingly, 100% of full breastfeeding among 4-month-old infants would avoid 56% of hospital admissions in infants who are younger than 1 year. CONCLUSIONS: On the basis of the present data, we conclude that full breastfeeding would lower the risk for hospital admission as a result of infections among infants who are younger than 1 year within an industrialized country.

[Incidence of infectious spondylitis in the province of Albacete (Spain)]. / Incidencia de la espondilitis infecciosa en la provincia de Albacete.

BACKGROUND: Infectious spondylitis (IS) is an infrequent disease, although there are few data on its real incidence. To date, only one study, carried out in Denmark, that rigorously assesses the incidence of this disease has been published. OBJECTIVES: To determine the incidence of IS in the nonpediatric population of the province of Albacete, and to analyze differences according to etiology, age, sex, and geographical area. METHODS: We carried out a retrospective search of all the IS cases diagnosed in the province of Albacete during the period 1990-2002 and calculated the adjusted incidence rates using census data. RESULTS: The incidence of IS was 2.40 cases/10(5) inhabitants/year. Brucellar spondylitis had an incidence of 1.18 cases/10(5) inhabitants/year, with a predominance in the rural area and in men. Distribution by age was bimodal, with a first peak around 40 years old and a second peak around 60 years old. The incidence has significantly decreased in the last few years. Pyogenic spondylitis (incidence of 0.64 cases/10(5) inhabitants/year) showed a maximum incidence at around 60 years old, while its distribution by sex and geographical area was more uniform. Tuberculous spondylitis had an incidence of 0.45 cases/10(5) inhabitants/year and its frequency increased with age. CONCLUSION: The incidence rates of IS were higher than those reported in most previous studies, although they were similar to those observed in the most rigorous reports. These findings suggest that the frequency of IS could have been underestimated. The three etiologic groups analyzed showed distinct epidemiological profiles.