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.

Effective definition of low humoral response to Clostridioides difficile infection.

BACKGROUND: Determination of the humoral response to Clostridioides difficile (CD) toxins could be of great value in the management of patients with CD infection (CDI). METHODS: A prospective study was conducted on the clinical characteristics and humoral response in patients with CDI. Determination of ELISA IgG CD anti-toxin B (tgcBiomics, Germany) was performed. The following dilutions were planned for each patient, 1:100, 1: 200, 1: 400, 1: 800: 1: 1600. A significant concentration of antibody was considered to be present in each dilution if an optical density 0.2 units higher than the negative control of the technique was evident. RESULTS: Eighty-five patients were included during the study period, November 2018-February 2020. The median age was 73 years (interquartile range: 62.5-85 years), with female predominance (45 patients, 52.9%). Thirty-nine patients (45.9%) had a severe infection. Seven patients (8.2%) had suffered an episode of CDI in the previous three months. Seventeen patients (20%) had one or more recurrent episodes during the three-month follow-up: No patient died during admission or required surgery for severe-complicated infection. The incidence of recurrence in patients with no antibody detected at 1:400 dilution was 25.4% (16 patients) while it was 4.3% (one patient) in patients with antibody present at that dilution (p = 0.03). Liver cirrhosis was associated with higher humoral response against CD. CONCLUSIONS: Antibodies IgG CD anti-toxin B detection at a dilution of 1:400, using a B ELISA technique, effectively identified patients at increased risk of recurrence. This information could help assist in the management of patients.

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.

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.

Risk Factors for Clostridium Difficile Diarrhea in Patients With Solid Organ Transplantation.

BACKGROUND: There is limited knowledge about specific risk factors for Clostridium difficile infection (CDI). METHOD: A retrospective study comparing cases of CDI in solid organ transplant (SOT) recipients with controls (SOT recipients who did not present CDI). RESULTS: Thirty patients with SOT from 1340 transplantation recipients had at least 1 episode of CDI (2.23%). The accumulated incidence was 3.06% in liver transplantation, 2.78% in lung transplantation, 2.36% in kidney transplantation, and 0.33% in heart transplantation. Seven (23%) cases occurred during the first 2 months. Fifteen (50%) cases were community acquired. Colonoscopy was performed in 6 (20%) cases, but pseudomembranes were observed in only 1 (16%) case. Independent variables found to be related to CDI were previous treatment with proton pump inhibitors (PPIs; odds ratio [OR] 5.5; 95% confidence interval [CI] 1.2-32.0), immunosuppressive regimen including mycophenolate (OR 5.2; 95%CI 1.1-18), hospitalization during the previous 3 months (OR 5.1; 95%CI 1.1-17), and antibiotic treatment during the previous month (OR 6.7; 95%CI 1.4-23). Five (16.7%) patients did not respond to the initial treatment. Recurrences were noted in 6 (20%) patients. CONCLUSIONS: Liver transplant recipients presented the highest incidence. Risk factors for CDI were previous treatment with PPIs, immunosuppressive regimen containing mycophenolate, prior hospitalization, and prior antibiotic treatment.

Control strategies for carbapenemase-producing Enterobacteriaceae at different levels of the healthcare system.

There has been a rapid increase in recent years in the incidence of infection and colonization by carbapenemase-producing Enterobacteriaceae (CPE). A number of clusters and outbreaks have been reported, some of which have been contained, providing evidence that these clusters and outbreaks can be managed effectively when the appropriate control measures are implemented. This review outlines strategies recommended to control CPE dissemination both at the healthcare facility level (acute and long-term care) and from the public health point of view. A dedicated prepared plan should be required to prevent the spread of CPE at the hospital level. At the front line, activities should include management of patients at admission and new cases, active surveillance culturing and definition of high-risk groups. High compliance with standard precautions for all patients and full or modified contact precautions for defined categories of patients should be implemented. Long-term care facilities are areas where dissemination can also take place but more importantly they can become a reservoir as patients are admitted and released to other Health care facilities. From the public health point of view, surveillance must be tailored to identify regional spread and interfacility transmission to prevent further dissemination. Finally, a comprehensive set of activities at various levels is necessary to prevent further spread of these bacteria in the community.

[Surgical site infections: antibiotic prophylaxis in surgery]. / Infección de la localización quirúrgica. Profilaxis antimicrobiana en cirugía.

Surgical site infections (SSI) are very common, and represent more than 20% of all hospital-acquired infections. SSIs are associated with a higher mortality, as well as to an extended hospital stay and costs, depending on the surgical procedure and type of SSI. Advances in control practices for these infections include improvement in operating room ventilation, sterilization methods, barriers, and surgical techniques, as well as in surgical antimicrobial prophylaxis. For the latter, the antimicrobial agent should: be active against the most common pathogens, be administered in an appropriate dosage and in a time frame to ensure serum and tissue concentrations over the period of potential contamination, be safe, and be administered over the shortest effective time period to minimize adverse events, development of resistances, and cost.

Lead, mercury and cadmium in umbilical cord blood and its association with parental epidemiological variables and birth factors.

BACKGROUND: In Spain, few studies have evaluated prenatal exposure to heavy metals. The objective of this study was to describe lead, mercury and cadmium concentrations in blood from a sample of newborn-mother-father trios, as well as to investigate the association between metals in cord blood and parental variables. We also explored the relationship between cord blood metal concentrations and child characteristics at birth. METHODS: Metal correlations among family members were assessed using Spearman Rank Correlation Coefficient. Linear regression was used to explore the association between parental variables and log-transformed cord blood lead and cord blood mercury concentrations. In the case of cadmium, tobit regression was used due to the existence of samples below the detection limit. The association between cord blood metal concentrations and child characteristics at birth was evaluated using linear regression. RESULTS: Geometric means for lead, mercury and cadmium were 14.09 µg/L, 6.72 µg/L and 0.27 µg/L in newborns; 19.80 µg/L, 3.90 µg/L and 0.53 µg/L in pregnant women; and 33.00 µg/L, 5.38 µg/L and 0.49 µg/L in men. Positive correlations were found between metal concentrations among members of the trio. Lead and cadmium concentrations were 15% and 22% higher in newborns from mothers who smoked during pregnancy, while mercury concentrations were 25% higher in newborns from mothers with greater fish intake. Cord-blood lead levels showed seasonal periodicity, with lower concentrations observed in winter. Cord blood cadmium concentrations over 0.29 µg/L were associated with lower 1-minute and 5-minute Apgar scores. CONCLUSIONS: These results reinforce the need to establish biomonitoring programs in Spain, and provide support for tobacco smoke and fish consumption as important preventable sources of heavy metal exposure in newborns. Additionally, our findings support the hypothesis that cadmium exposure might be deleterious to fetal development.

[Cost of Clostridium difficile associated diarrhea in Spain]. / Coste de la diarrea asociada a Clostridium difficile en España.

BACKGROUND: There are not available adequate studies of the costs of Clostridium difficile-associated diarrhea (CDAD) in Spain. The aim of the study is to estimate the cost of CDAD for the National Health Service (NHS). METHODS: an economic model was carried out to calculate the cost per episode of CDAD (due to antimicrobials, prolonged hospitalization, surgical procedures, measures to control the infection, recurrences of infections treated) and the CDAD annual cost. Resources use in clinical practice was obtained through a Delphi panel of Spanish clinicians with expertise in CDAD and unit costs (€ 2012) from Spanish Sources. RESULTS: An estimated 7,601 episodes of CDAD occur annually in Spain (incidence of 17.1 episodes/year/10,000 hospital discharges) with an annual cost to the NHS of € 32,157,093. Cost per episode of CDAD: € 3,901 (initial infection), € 4,875 (first recurrence) and € 5,916 (second recurrence). Total cost of recurrences: € 10,426,750 annually. The 95.6% of spending is due to the prolonged hospitalization, 0.5% to antibiotic treatment, 2.8% for surgery and 1.1% for measures of control infection. Study results are sensitive to incidence and case fatality rate of CDAD in Spain and the prolongation of duration of hospital stay due to CDAD. CONCLUSIONS: According to this study, the expense associated with CDAD is primarily due to the prolongation of hospitalization and has a great economic impact on the NHS.

[Aetiology of surgical infections in patients undergoing craniotomy]. / Etiología de las infecciones quirúrgicas en pacientes sometidos a craneotomía.

BACKGROUND: Postoperative infections in patients undergoing craniotomy constitute significant complications associated with increased hospital stay and patient morbidity and mortality. Knowing the aetiology of surgical infections after craniotomy may contribute to improving antibiotic prophylaxis and empirical treatment. METHOD: Information relating to surgical infections in patients undergoing craniotomy was obtained from a series of annual surveys on prevalence of infections in Spanish hospitals (EPINE) during the period 1999-2006. The study protocol collected relevant clinical information on patients with infection. Presence of infection was determined according to the Centres for Disease Control infection criteria. RESULTS: During the time period considered, 107 cases of surgical infections in patients undergoing craniotomy were diagnosed. Forty patients were women (37%) and 67 were male (63%). The mean age was 51.7 years (median 55, range 6-86 years). The duration of the intervention was over 180minutes in 49 patients (45.8%).Thirty-eight patients (35.5%) underwent emergency surgery. Seventy-eight patients (73%) received surgical prophylaxis. Thirty-eight patients (35.5%) had superficial infection of the surgical wound, 38 patients (35.5%) had deep wound infection (including bone flap) and 31 patients (29%), postoperative infections of organ or space (meningitis, subdural empyema or brain abscess). The most common aetiology corresponded to staphylococci (50%), mainly S. aureus (one third of them methicillin-resistant), Pseudomonas aeruginosa (11%), Enterobacter spp (10%) and Acinetobacter baumannii (9%). CONCLUSION: Empirical treatment of these infections should include a glycopeptide such as vancomycin and a beta-lactam with coverage against non-fermenting gram-negative bacilli.

[Microbiology of surgical site infections in abdominal tract surgery patients]. / Microbiología de las infecciones del sitio quirúrgico en pacientes intervenidos del tracto digestivo.

INTRODUCTION: Knowledge of the microbiology of surgical infections after abdominal surgery can be of use when prescribing effective empirical antibiotic treatments. METHOD: Analysis of surgical infections after abdominal surgery in patients enrolled in the Prevalence of Infections in Spanish Hospitals (EPINE) corresponding to the years 1999-2006. RESULTS: During the period of the study, 2,280 patients who were subjected to upper or lower abdominal tract surgery were diagnosed with an infection at the surgical site (SSI). Eight hundred and eighty three patients (37%) had an operation of the upper abdominal tract (gastric, hepatobiliary, and pancreatic surgery) and 1,447 patients (63%) lower abdominal tract surgery (appendectomy and colon surgery). A total of 2,617 bacterial species were isolated in the 2,280 patients included in the analysis. The most frequent microorganisms isolated were, Escherichia coli (28%), Enterococcus spp. (15%), Streptococcus spp. (8%), Pseudomonas aeruginosa (7%), and Staphylococcus aureus (5%, resistant to methicillin 2%). In the surgical infections after upper abdominal tract procedures, there were a higher proportion of isolations of staphylococci, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp. and Candida albicans and less Escherichia coli, Bacteroides fragilis and Clostridium spp. CONCLUSION: The microbiology of SSI produced after upper abdominal tract surgery did not show any significant differences compared to those of the lower tract. However, more cases of SSI were detected due to staphylococci, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp. and Candida albicans and less caused by Escherichia coli, Bacteroides fragilis and Clostridium spp.

Mercury, lead and cadmium in human milk in relation to diet, lifestyle habits and sociodemographic variables in Madrid (Spain).

BACKGROUND: Although breastfeeding is the ideal way of nurturing infants, it can be a source of exposure to toxicants. This study reports the concentration of Hg, Pb and Cd in breast milk from a sample of women drawn from the general population of the Madrid Region, and explores the association between metal levels and socio-demographic factors, lifestyle habits, diet and environmental exposures, including tobacco smoke, exposure at home and occupational exposures. METHODS: Breast milk was obtained from 100 women (20 mL) at around the third week postpartum. Pb, Cd and Hg levels were determined using Atomic Absorption Spectrometry. Metal levels were log-transformed due to non-normal distribution. Their association with the variables collected by questionnaire was assessed using linear regression models. Separate models were fitted for Hg, Pb and Cd, using univariate linear regression in a first step. Secondly, multivariate linear regression models were adjusted introducing potential confounders specific for each metal. Finally, a test for trend was performed in order to evaluate possible dose-response relationships between metal levels and changes in variables categories. RESULTS: Geometric mean Hg, Pb and Cd content in milk were 0.53 µg L(-1), 15.56 µg L(-1), and 1.31 µg L(-1), respectively. Decreases in Hg levels in older women and in those with a previous history of pregnancies and lactations suggested clearance of this metal over lifetime, though differences were not statistically significant, probably due to limited sample size. Lead concentrations increased with greater exposure to motor vehicle traffic and higher potato consumption. Increased Cd levels were associated with type of lactation and tended to increase with tobacco smoking. CONCLUSIONS: Surveillance for the presence of heavy metals in human milk is needed. Smoking and dietary habits are the main factors linked to heavy metal levels in breast milk. Our results reinforce the need to strengthen national food safety programs and to further promote avoidance of unhealthy behaviors such as smoking during pregnancy.

Levels of N-terminal-pro-brain natriuretic peptide in congenital heart disease surgery and its value as a predictive biomarker.

OBJECTIVES: To explore the value of N-terminal-pro-brain natriuretic peptide (NT-ProBNP) as a predictive biomarker of postoperative cardiovascular surgery. METHODS: A prospective study of 68 patients (0-15 years), submitted to open-heart surgery was conducted. NT-ProBNP and other biochemical and clinical markers were measured preoperatively and during the first 48 postoperative hours. RESULTS: NT-ProBNP preoperative reduced one hour after surgery, increased significantly later, and remained without change between 12 hours and 48 hours postoperatively. Peak values (24 hours) were correlated with preoperative levels (R=0.73; P<0.001), risk adjustment congenital heart surgery-1 (R=0.37; P<0.002), length of cardiopulmonary bypass (CPB) (R=0.57; P<0.001); age (R=-0.55; P<0.001) and weight of patients (R=-0.46; P<0.001). Independent predictors of NT-ProBNP-peak were preoperative value (ß=0.42) and CPB length (ß=0.24; R(2) of model 0.63; P<0.001). The peak values were correlated to a maximum inotropic score (R=0.46; P<0.001), duration of inotropic therapy (R=0.44; P<0.001), duration of mechanical ventilation support (R=0.39; P<0.001) and length of stay in the Pediatric Intensive Care Unit (R=0.45; P<0.001). Independent predictors of enhanced intensive care unit stay, controlling by risk adjustment score, were high preoperative NT-ProBNP (OR 5.5, 95% CI 1.2-25.5), and high postoperative troponine (OR 10.5, 95% CI 2.2-49.2). CONCLUSIONS: NT-ProBNP concentration is dependent on time during the perioperative period, it peaks at 24 hours and depends on the preoperative value and CPB length. A high peptide level before surgery is an independent predictor of prolonged stay in intensive pediatric care.

Timing of DVT prophylaxis and risk of postoperative knee prosthesis infection.

This multicenter prospective study was performed to determine risk factors for knee prosthesis infection and the effect of timing doses of prophylactic low-molecular-weight heparins (LMWH) related to time of surgery on the risk of knee prosthesis infection. A total of 5496 consecutive patients who underwent total knee arthroplasty from 2005 to 2006 in 13 orthopedic centers were prospectively followed up for 6 months, and the incidence of knee prosthesis infection was recorded. A case control study was nested in the cohort. Case patients were matched to uninfected (control) patients, and the timing of perioperative LMWH was recorded as the main risk factor. Fifty patients developed postoperative knee prosthesis infection during the follow-up period, yielding an incidence of prosthesis infection of 0.91% (95% CI, 0.68%-1.20%). Forty-four patients were matched to 106 controls. Case patients received the first LMWH dose ±12 hours from the start of surgery more frequently than their control counterparts (odds ratio, 1.5; 95% CI, 0.73-3.0). After adjusting by main risk factors, no statistical association was found between close perioperative timing of LMWH and risk of prosthesis infection. Diabetes mellitus (adjusted odds ratio, 3.2; 95% CI, 1.2-8.8) and wound hematoma (adjusted odds ratio, 4.2; 95% CI, 1.1-16.5) were found to be independent risk factors for prosthesis infection.

Age-related variation of intraepithelial lymphocytes subsets in normal human duodenal mucosa.

The enumeration of intestinal intraepithelial lymphocytes (IELs), and the phenotyping of CD3+CD 103+ (TcRalphabeta, TcRgammadelta) and CD3-CD103+ IEL subsets constitute useful diagnostic tools for the correct interpretation of the mucosal histology of duodenal/jejunal biopsies in many pathological conditions of the small intestine, particularly celiac disease (CD). This work evaluates the ranges of duodenal IEL counts by flow cytometry in healthy mucosa from pediatric and adult controls, establishing normal reference values for CD3+ TcRgammadelta and CD3- subsets and their variation with age. Seventy-four pediatric controls and 36 adult controls were identified on the basis of their normal histology from more than 1,000 duodenal diagnostic biopsies performed in Caucasian subjects. Total IEL counts and IEL subsets ("IEL lymphogram") were analyzed by four-color flow cytometry (FCM). IEL represent 7.7% +/- 0.4 (mean +/- SE) and 8.5% +/- 0.5 of the cells isolated from the epithelium in the pediatric and adult series, respectively. The upper normal range, considered as the 97 percentile, is 14% in pediatrics and 15% in adults. No significant difference was observed between TcRgammadeltaIEL percentages in children (6.9% +/- 0.5 of the total IELs) and adults (6.6% +/- 0.8). However, the density of CD3- IELs is significantly higher (p < 0.001) in the mucosa from controls under 3 years (50.2% +/- 2.6) than in adults (25.5% +/- 2.1). IEL lymphogram by flow cytometry is an easy, quick and reliable analysis performed in one of the biopsy specimens obtained during a diagnostic endoscopy, and confers specificity to the histopathological findings. IEL counts below 14% in children and 15% in adults should be considered within a normal range in the evaluation of duodenal mucosa by FCM. No differences with age were observed with respect to TcRgammadeltaIEL, while the CD3- IEL fraction was significantly higher on children under 3 years, with a trend to increase again in the elderly.

Preoperative low molecular weight heparin as venous thromboembolism prophylaxis in patients at risk for prosthetic infection after knee arthroplasty.

OBJECTIVE: To investigate the effect of preoperative initiation of low molecular weight heparin as prophylaxis for deep venous thrombosis in patients at risk of developing surgical-site infections after knee arthroplasty. DESIGN: Case-control study nested in a cohort. The incidence of surgical-site infection in the cohort was calculated. With the use of data extracted from medical histories and after adjustment for other risk factors, the effect of preoperative heparinization on the risk of incisional and prosthetic infection among case-patients and control-patients (1:3 ratio) was assessed. SETTING: Orthopedic department in a tertiary-care referral hospital. PATIENTS: A cohort of 160 consecutive patients who had received prosthetic knee implants between October 1, 2001, and November 30, 2003. RESULTS: Eighteen patients with surgical-site infections were identified, yielding an incidence of incisional and prosthetic infection of 6.9 (95% confidence interval [CI95], 3.5 to 12.0) and 4.4 (CI95, 1.8 to 8.8) cases per 100 patients undergoing surgery, respectively. Surgical-site infection was associated with preoperative use of low molecular weight heparin (odds ratio [OR], 6.2 after adjustment for medical and surgical factors; CI95 1.5 to 23). Prosthetic infection was strongly associated with preoperative use of prophylaxis (OR, undetermined [100% exposure in case-patients vs 35% exposure in control-patients]; P = .002), but incisional surgical-site infection was not. CONCLUSION: The use of low molecular weight heparins immediately before knee arthroplasty as prophylaxis for deep venous thrombosis should be questioned because of probable increased risk of prosthetic infection.

[Effectiveness of a group therapy intervention to quit smoking. Randomized clinical trial]. / Efectividad de la intervención grupal para la deshabituación tabáquica. Ensayo clínico aleatorizado.

BACKGROUND: Group therapy is a widely used technique for the treatment of tobacco, alcohol and other toxic addictions. Nevertheless, its effectiveness for smoking cessation remains to be established. Our objective was to evaluate the relative effectiveness of a group intervention versus an individual intervention for smoking cessation. METHOD: Randomized clinical trial of 106 smokers wishing to quit their addiction, who were assigned to two types of intervention: Short Individual Intervention (SII) and Group Intervention (GI). Nicotine patches were administered as supplemental therapy when needed in both instances. Results were assessed by intention to treat analysis. RESULTS: Although smoking cessation rates decreased in parallel with longer follow-up periods in each intervention group (from 39.6 to 26.4% and from 22.6 to 15.1% for GI and SII groups, respectively, at 3 and 6-months), the relative effectiveness was similar during both periods and there was no better response to any intervention at 3-months (relative risk [RR] = 1.75; CI95%, 0.96-3.18) and at 6-months (RR = 1.75; CI95%, 0.80-3.82). Compliance with GI was low and less than 60% of smokers attended to 5 out of 7 GI sessions. CONCLUSIONS: Group intervention (GI) is not more effective than short individual intervention to quit smoking. However, this fact could be due to the low compliance observed with regard to smokers' attendance to GI sessions.