A survey on practices for active surveillance of carriage of multidrug-resistant bacteria in hospitals in the Autonomous Community of Valencia, Spain.

A questionnaire-based cross-sectional study was conducted to gather information on current microbiological practices for active surveillance of carriage of multidrug-resistant (MDR) bacteria in hospitals from 14 health departments of the Autonomous Community of Valencia (ACV), Spain, which together provided medical attention to 3,271,077 inhabitants in 2017, approximately 70% of the population of the ACV. The survey consisted of 35 questions on MDR bacteria screening policies, surveillance approach chosen (universal vs. targeted), and microbiological methods and processes in use for routine detection and reporting of colonization by MDR bacteria, including the anatomical sites scheduled to be sampled for each MDR bacterial species, and the methodology employed (culture-based, molecular-based, or both). Our study revealed striking differences across centers, likely attributable to the lack of consensus on optimal protocols for sampling, body sites for screening, and microbiological testing, thus underscoring the need for consensus guidelines on these issues.

[Predictors of the therapeutic discharge in patients with dual pathology admitted to a therapeutic community with a psychiatric unit]. / Variables predictivas del alta terapéutica entre pacientes con patologia dual grave atendidos en una comunidad terapéutica de drogodependencias con unidad psiquiátrica.

This study aims to analyze the variables on which depends therapeutic discharge, in patients with a severe dual diagnosis admitted to a professional therapeutic community where their pathology is treated. 325 patients admitted between June 2000 and June 2009 to the therapeutic community. This is a retrospective, cross-sectional study with no control group, based on the detailed analysis of the information collected in a model of semi-structured clinical interview designed in the therapeutic community. The 29.5% of the individuals included in the sample were therapeutically discharged. Of all the variables introduced in this analysis the most significant ones were gender, age at the beginning of treatment, education level, opiate dependence, polidrug abuse, and the presence of psychotic disorders and borderline personality disorder. In our study, gender determines the type of discharge, being therapeutic discharge more frequent among women. A higher educational also increases a better prognosis with a higher rate of therapeutic discharge among individuals with higher education level. A later age at the beginning of the treatment reduces the likelihood of therapeutic discharge. Likewise, polidrug abuse, diagnosis of psychotic disorders and borderline personality disorder are associated to a lower rate of therapeutic discharge. Recognizing these characteristics will allow the early identification of those patients more at risk of dropping treatment hastily, while trying to prevent it by increasing the therapeutic intensity.

Variables predictivas del alta terapéutica entre pacientes con patologia dual grave atendidos en una comunidad terapéutica de drogodependencias con unidad psiquiátrica / Predictors of the therapeutic discharge in patients with dual pathology admitted to a therapeutic community with a psychiatric unit

Este trabajo tiene como objetivo analizar las variables de las que depende el alta terapéutica en los pacientes con patología dual grave (PDG) ingresados en una comunidad terapéutica profesional (CTP) donde se realiza el tratamiento integrado de su patología. 325 pacientes ingresaron entre junio de 2000 y junio de 2009 en la CTP. Se trata de un estudio retrospectivo y transversal sin grupo control, basado en el análisis detallado de la información recogida en un modelo de entrevista clínica semi-estructurada diseñado en la CTP. El 29,5% de la muestra recibió alta terapéutica. De todas las variables estudiadas han resultado significativas el género, la edad al inicio del tratamiento, el nivel de estudios del paciente, la dependencia de opiáceos, el “policonsumo”, la presencia de trastornos psicóticos y la de trastorno límite de personalidad. En nuestro estudio, el género condiciona el tipo de alta, encontrándose mayores porcentajes de alta terapéutica para las mujeres. El mayor nivel de estudios incrementa también el mejor pronóstico entendido como mayor frecuencia de alta terapéutica en individuos con estudios superiores. La edad más tardía al inicio del tratamiento disminuye la probabilidad de alta terapéutica. Del mismo modo, el policonsumo, el diagnóstico de trastornos psicóticos y de trastorno límite de personalidad se relacionan con peores resultados obteniéndose menores porcentajes de altas terapéuticas. Reconocer estas características permitirá la identificación precoz de los pacientes que tienen más riesgo de abandonar precipitadamente el tratamiento, para tratar de prevenirlo aumentando la intensidad terapéutica (AU)

This study aims to analyze the variables on which depends therapeutic discharge, in patients with a severe dual diagnosis admitted to a professional therapeutic community where their pathology is treated. 325 patients admitted between June 2000 and June 2009 to the therapeutic community. This is a retrospective, cross-sectional study with no control group, based on the detailed analysis of the information collected in a model of semi-structured clinical interview designed in the therapeutic community. The 29.5% of the individuals included in the sample were therapeutically discharged. Of all the variables introduced in this analysis the most significant ones were gender, age at the beginning of treatment, education level, opiate dependence, polidrug abuse, and the presence of psychotic disorders and borderline personality disorder. In our study, gender determines the type of discharge, being therapeutic discharge more frequent among women. A higher educational also increases a better prognosis with a higher rate of therapeutic discharge among individuals with higher education level. A later age at the beginning of the treatment reduces the likelihood of therapeutic discharge. Likewise, polidrug abuse, diagnosis of psychotic disorders and borderline personality disorder are associated to a lower rate of therapeutic discharge. Recognizing these characteristics will allow the early identification of those patients more at risk of dropping treatment hastily, while trying to prevent it by increasing the therapeutic intensity (AU)