Evaluation of a preventive surgical site infection bundle in colorectal surgery.

OBJECTIVE: To assess the effectiveness of a protocol for prevention of surgical site infection (SSI) in colorectal surgery. PATIENTS AND METHODS: Evaluation of 2 cohorts of patients undergoing colon and rectal surgery in a tertiary public hospital: A historical cohort (2008-2011) and a prospective one (after the implementation of the program in 2012). The main measures established were: Adequacy of preoperative antimicrobial prophylaxis, maintaining patient normothermia and appropriate glove change during the intervention. Comparability of the two cohorts was determined by a bivariate analysis of age, sex, NNIS index, ASA index, surgical time, perioperative transfusion, diagnosis, diabetes and renal failure. RESULTS: We assessed 342 patients (256 underwent colon surgery and 86 rectal surgery), divided into 2 cohorts: prior period (218), and post-implementation period (124). The cumulative incidence of SSI in the first cohort was 27.5% (95% CI, 21.6- 33.4), and in the post-intervention cohort 16.9% (95% CI, 10.3-23.5, P=.03). Postoperative mortality was 9.2% (95% CI, 5.4-13) in the first cohort and 3.2% (95% CI, 0.1-6.3) in the post-intervention cohort (P=.04). The inadequacy of prophylaxis decreased from 37.4% (95% CI, 30.4-44.6) to 18.9% (95% CI, 11.9- 26.1) (P=.001). CONCLUSION: A significant decrease in the frequency of SSI, post-surgical mortality and inadequate antimicrobial prophylaxis is verified after the implementation of a protocol in colorectal surgery.

Trends in the incidence of superficial versus deep-organ/space surgical site infection in a tertiary hospital.

BACKGROUND: The frequency of surgical site infection (SSI) in western countries shows a variable tendency because of technical improvements on one hand and an aging and an increasingly fragile population on the other. Our hypothesis is that there is no time trend in the incidence of SSI. The objective of this article was to assess incidence trends of SSI, after adjusting for confounders and variables associated with SSI frequency. METHODS: We studied trends of SSI over 13 y in our hospital in a cohort (26,810 patients), evaluating the factors associated with SSI (superficial or deep-organ/space), in a bivariate and multivariate analysis. RESULTS: Global SSI was 4.8%, most of which was superficial (3.4%). We obtained two well-adjusted equations (area under receiver operating characteristic curves: 0.77 and 0.78, with nine variables). Main risk factors for SSI were duration of surgery (>60 min), infection on hospital admission, emergency and vascular surgery. After controlling for all risk factors, we found that superficial SSI showed a significant reduction (75) yearly, but deep-organ/space SSI rates remained stable over time. CONCLUSIONS: We obtained a 7% yearly reduction in superficial SSI and no variation for deep-organ/space SSI after adjusting for eight risk and confounding factors.

Prevention of early-onset pneumonia in surgical patients by chemoprophylaxis.

BACKGROUND: The purpose of this study was to explore the impact of surgical antimicrobial chemoprophylaxis on the prevention of early-onset postsurgical pneumonia (EOPP) using a logistic regression model that included the principal risk or confusion factors associated with incidence of early-onset postsurgical pneumonia. MATERIALS AND METHODS: The sample chosen corresponded to 13 years during which the epidemiological surveillance system was in place in the general and digestive surgery department (N = 13,024 patients) and was designed as a prospective cohort study. Risk factors associated with EOPP development were analyzed using a cohort-nested case-control study. RESULTS: Cumulative incidence of EOPP in this series of patients was .6%, accounting for 24.7% of total nosocomial pneumonias. The multivariate model showed the following risks or confusion factors for EOPP: age, emergency admission, type of surgery, duration of surgical intervention, infection on admission, and antimicrobial chemoprophylaxis (administered, odds ratio = .18; 95% confidence interval, .09-.33). CONCLUSIONS: Surgical antimicrobial chemoprophylaxis was associated as an independent factor with incidence reduction of early-onset postsurgical pneumonia, and, aside from its known effect on surgical site infection, its administration, where indicated, is useful for the prevention of early-onset postsurgical pneumonia.

Emergence of CTX-M-15-producing Klebsiella pneumoniae of multilocus sequence types 1, 11, 14, 17, 20, 35 and 36 as pathogens and colonizers in newborns and adults.

OBJECTIVES: To characterize the population structure and resistance mechanisms of Klebsiella pneumoniae isolates that are highly resistant to third-generation cephalosporins, collected from five Spanish hospitals. METHODS: A total of 162 K. pneumoniae isolates from five hospitals located in three geographical areas of Spain were characterized. The number of isolates from each hospital ranged from 3 to 82. The genetic relationship between isolates was established by PFGE and multilocus sequence typing (MLST). bla(ESBL) types and other antibiotic resistance genes were analysed by PCR and sequencing. Plasmids were classified according to their incompatibility group by a PCR-based replicon-typing scheme. RESULTS: All 162 isolates carried the bla(CTX-15) gene. Fifty-eight isolates (35.8%) caused clinical infections and 104 (64.2%) were colonizers. Sixty-nine (42.6%) isolates were collected from newborns and 93 (57.4%) from adults. Using PGFE, the 162 isolates were grouped into seven clusters that were further identified as members of the MLST types 1, 11, 14, 17, 20, 35 and 36. Two hospitals each had two different clones and the remaining three hospitals had a single CTX-M-15-producing K. pneumoniae clone. All clones carried different antibiotic resistance genes, including bla(OXA-1), aac(3)-IIa, aac(6')-Ib-cr, qnrS1 and qnrB. In four of the seven (57.1%) clones the bla(CTX-M-15) gene was transferred by conjugation; in all cases plasmids of the incompatibility group IncF were identified by PCR. CONCLUSIONS: This study shows that multiresistant K. pneumoniae producing CTX-M-15 of MLST types 1, 11, 14, 17, 20, 35 and 36 are spreading as pathogens and colonizers among newborns and adult patients in Spain.

[Not Available]. / Cumplimiento del bundle de neumonía asociada a ventilación mecánica en el Hospital Universitario La Paz.

INTRODUCTION: Bundles are groups of interventions to reduce nosocomial infection rates. We evaluated the current status of ventilatorassociated pneumonia bundle compliance in our hospital to propose an improvement plan on the basis of the results. PATIENTS AND METHOD: Bundle includes: raising the head of the bed (30°, daily assessment of sedation requirements, peptic ulcer disease and deep venous thrombosis prophylaxis. It was evaluated in the intensive care unit (ICU) and two postoperative recovery units (called REA1 and REA3) from June 25 until July 20, 2007. RESULTS: In ICU, 222 observations were made (189 complete), in REA1 34 observations (26 complete) and in REA3, 35 observations (27 complete). Bundle compliance was 77.2% in ICU, 50% in REA1 and 70.2% in REA3. Lowest compliance component was raising the head of the bed (UCI, 85.8%; REA1, 57.6%, and REA3, 69%). Improved interventions proposed were to include standardized requirements for raising the head of the bed to 45°, to empower nurses to make daily "sedation vacations" (interruption of sedation to point of alertness) and mention in medical history when an item cannot be carried out. CONCLUSIONS: Improvement strategies through bundles are a quick and easy way to obtain process indicators that help us improve the prevention of nosocomial infections.