Infección quirúrgica en un hospital de tercer nivel. Estudio de vigilancia prospectivo (2001–2004) / Surgical site infection in a tertiary hospital. A prospective surveillance study (2001–2004)

Introducción: La infección de localización quirúrgica (ILQ), superficial y profunda, es un problema muy frecuente dentro de la infección hospitalaria. Supone un riesgo para la seguridad del paciente y, por tanto, su reducción es una prioridad para los sistemas sanitarios. El objetivo del estudio fue analizar la incidencia de ILQ en los servicios quirúrgicos de un hospital de tercer nivel. Material y métodos: Estudio de cohortes prospectivo sobre 14.455 pacientes ingresados desde enero de 2001 hasta diciembre de 2004. Se calcularon la incidencia acumulada (IA), cruda y ajustada por el índice del National Nosocomial Infection Surveillance (NNIS) y densidad de incidencia (DI) de ILQ. Resultados: La IA de pacientes con ILQ fue 3,4% (IC95%: 3,0–3,7%), la IA de ILQ 3,5% (IC95%: 3,2–3,8%) y la DI 0,28/100 pacientes intervenidos-día. Las unidades con IA más elevadas fueron cirugía maxilofacial (6%), digestiva (5,3%) y cardiovascular (5,1%). Ajustando por la estancia, urología y cirugía pediátrica registraron las mayores tasas de incidencia, mientras que oftalmología y neurocirugía obtuvieron las menores. La cirugía de colon y recto tuvieron los parámetros más elevados (IA=10%; DI=0,57), seguido de la revascularización miocárdica y la prótesis de cadera. En el conjunto de las unidades y en los procedimientos investigados, la IA de ILQ aumentó con el índice NNIS. Conclusiones: La IA y la DI de ILQ fueron similares a las obtenidas en los proyectos de vigilancia europeos e inferiores a las registradas en 1994 en este mismo hospital, reflejo de una mayor intensidad en la vigilancia y de una mayor concienciación en la aplicación de sus medidas de control (AU)

Introduction: Surgical site infection (SSI) is a very common problem in hospital infection control. It represents a risk for the safety of the patient and therefore its reduction is a priority in Health Services. The aim of the study is to analyse the incidence of SSI in the surgical departments of a tertiary hospital. Material and methods: A prospective cohort study was conducted on 14,455 patients admitted from January 2001 to December 2004. The cumulative incidence (CI) crude and adjusted for the National Nosocomial Infection Surveillance (NNIS) index and the incidence density (ID) of SSI were calculated. Results: The CI of patients with SSI was 3.4% (95% CI: 3.0–3.7%), the CI of SSI was 3.5% and the observed ID was 0.28/100 surgical patients/day. Surgical units with the highest CI were maxillofacial (6%), gastrointestinal (5.3%) and cardiovascular (5.1%). Adjusting for length of stay, urology and paediatric surgery recorded the highest incidence rates, while ophthalmology and neurosurgery had the least. Colorectal surgery had the highest parameters (CI=10%; ID=0.57), followed by myocardial revascularisation and hip prosthesis. Among the surgical units and operative procedures assessed, the CI of SSI increased with the NNIS index. Conclusions: The CI and ID of SSI observed in this study were similar to those obtained in previous European surveillance projects, and lower than those recorded in our hospital in 1994 which reflects a higher level of vigilance and a higher awareness in applying control measure (AU)

[Surgical site infection in a tertiary hospital. A prospective surveillance study (2001-2004)]. / Infección quirúrgica en un hospital de tercer nivel. Estudio de vigilancia prospectivo (2001-2004).

INTRODUCTION: Surgical site infection (SSI) is a very common problem in hospital infection control. It represents a risk for the safety of the patient and therefore its reduction is a priority in Health Services. The aim of the study is to analyse the incidence of SSI in the surgical departments of a tertiary hospital. MATERIAL AND METHODS: A prospective cohort study was conducted on 14,455 patients admitted from January 2001 to December 2004. The cumulative incidence (CI) crude and adjusted for the National Nosocomial Infection Surveillance (NNIS) index and the incidence density (ID) of SSI were calculated. RESULTS: The CI of patients with SSI was 3.4% (95% CI: 3.0-3.7%), the CI of SSI was 3.5% and the observed ID was 0.28/100 surgical patients/day. Surgical units with the highest CI were maxillofacial (6%), gastrointestinal (5.3%) and cardiovascular (5.1%). Adjusting for length of stay, urology and paediatric surgery recorded the highest incidence rates, while ophthalmology and neurosurgery had the least. Colorectal surgery had the highest parameters (CI=10%; ID=0.57), followed by myocardial revascularisation and hip prosthesis. Among the surgical units and operative procedures assessed, the CI of SSI increased with the NNIS index. CONCLUSIONS: The CI and ID of SSI observed in this study were similar to those obtained in previous European surveillance projects, and lower than those recorded in our hospital in 1994 which reflects a higher level of vigilance and a higher awareness in applying control measures.

Eficacia de la insulina de administración oral/bucal en el tratamiento de la diabetes mellitus / Efficacy of oral/buccal insulin in the treatment of diabetes mellitus

ObjetivoValorar la eficacia y la seguridad de la insulina de administración oral/bucal.DiseñoRevisión sistemática.Fuentes de datosBases de datos referenciales MEDLINE, EMBASE, Scopus, Current Contents, Web of Science, Cochrane Library, Agencia Europea del Medicamento, Food and Drug Administration, Red Internacional de Agencias de Evaluación de Tecnologías, Red Europea de Detección Precoz de Tecnologías (EuroScan) y varios registros de investigación.Selección de los estudiosSe recuperaron 2 ensayos clínicos. Se excluyeron aquellos estudios que no comparaban la insulina oral/bucal con el tratamiento estándar con insulina inyectada en términos de parámetros clínicos en la población con diabetes.Extracción de datosLectura crítica según la metodología propuesta por el programa CASPe y la escala de Jadad.ResultadosLa insulina bucal produjo una reducción mayor y más temprana en la glucemia posprandial medida a los 30min en el grupo intervención frente al grupo control (reducción de 55mg/dl) y un pico de insulinemia mayor y más rápido (98 frente a 65μU/ml). Respecto a la insulina oral, los niveles de glucemia posprandial fueron equivalentes a los obtenidos con la insulina inyectada, y la concentración máxima de insulina fue superior (110±130 frente a 96,3±69,7μU/ml).ConclusionesLa insulina oral/bucal presentó, al menos, resultados equivalentes al tratamiento estándar. No obstante, los estudios presentaron problemas metodológicos de validez interna y externa.ConclusionesSe precisan estudios de mayor duración para evaluar la eficacia y la seguridad a largo plazo(AU)

ObjectiveTo evaluate the efficacy and safety of administering oral/buccal insulin.DesignSystematic review.Data sourcesReference databases, MEDLINE, EMBASE, Scopus, Current Contents, Web of Science, and Cochrane Library, European Drugs Agency, Food and Drug Administration, International Network of Technological Evaluation Agencies, European Network for New and Emerging Technologies (EuroScan), and gravel research registers.Selection of the studiesTwo clinical trials were found. Those studies that did not compare oral/buccal insulin with the standard treatment with injected insulin in terms of clinical parameters in a population with diabetes were excluded.Extraction of dataCritical reading according to the method proposed by the CASPe program and the Jadad scale.ResultsBuccal insulin produced a greater and earlier reduction in post-prandial blood glucose at 30min in the intervention group compared to the control group (decrease of 55mg/dl) and a higher and more rapid peak blood insulin (98 compared to 65μU/mL). The postprandial levels with oral insulin were similar to those obtained with injected insulin, and had a higher maximum insulin concentration (110±130 vs. 96.3±69.7μU/mL).ConclusionsOral/buccal insulin gives, at least, results similar to the standard treatment. However, the studies had methodological problems of internal and external validity. Studies of longer duration are required to evaluate the long-term efficacy and safety(AU)

Safety and immunogenicity of prepandemic H5N1 influenza vaccines: a systematic review of the literature.

A systematic review was performed to assess the safety and immunogenicity of the prepandemic H5N1 influenza vaccines licensed so far. A bibliographic search according to the COSI protocol was carried out and 8 of 235 potentially relevant publications were selected. Quality assessment was defined with both CASP and Jadad checklists. Taken together, the results from the present systematic review suggest that the inactivated split-virion formulation that includes a low antigen dose (3.8 microg) and an oil-in-water emulsion-based adjuvant, represents the best option in the case of a pandemic, due to its antigen-sparing capacity and its favorable safety profile.

[Efficacy of oral/buccal insulin in the treatment of diabetes mellitus.]. / Eficacia de la insulina de administración oral/bucal en el tratamiento de la diabetes mellitus.

OBJECTIVE: To evaluate the efficacy and safety of administering oral/buccal insulin. DESIGN: Systematic review. DATA SOURCES: Reference databases, MEDLINE, EMBASE, Scopus, Current Contents, Web of Science, and Cochrane Library, European Drugs Agency, Food and Drug Administration, International Network of Technological Evaluation Agencies, European Network for New and Emerging Technologies (EuroScan), and gravel research registers. SELECTION OF THE STUDIES: Two clinical trials were found. Those studies that did not compare oral/buccal insulin with the standard treatment with injected insulin in terms of clinical parameters in a population with diabetes were excluded. EXTRACTION OF DATA: Critical reading according to the method proposed by the CASPe program and the Jadad scale. RESULTS: Buccal insulin produced a greater and earlier reduction in post-prandial blood glucose at 30 min in the intervention group compared to the control group (decrease of 55 mg/dl) and a higher and more rapid peak blood insulin (98 compared to 65 microU/mL). The postprandial levels with oral insulin were similar to those obtained with injected insulin, and had a higher maximum insulin concentration (110+/-130 vs. 96.3+/-69.7 microU/mL). CONCLUSIONS: Oral/buccal insulin gives, at least, results similar to the standard treatment. However, the studies had methodological problems of internal and external validity. Studies of longer duration are required to evaluate the long-term efficacy and safety.

[Efficacy and safety of inhaled insulin in diabetes mellitus treatment]. / Eficacia y seguridad de la insulina inhalada en el tratamiento de la diabetes mellitus.

OBJECTIVE: To evaluate the efficacy and safety of inhaled insulin. DESIGN: Systematic review. DATA SOURCES: Reference data bases, MEDLINE (1999 to November 2005) and EMBASE (2000 to November 2005), the CENTRAL base (Cochrane Library), the European Drug Agency, the Food and Drug Administration, the International Network of Technology Evaluation Agencies, the European Network for Early Detection (EuroScan), and various research registers. STUDIES: Eight clinical trials were recovered. Studies not comparing inhaled with subcutaneous insulin and those that did not measure metabolic control or satisfaction and quality of life were excluded. DATA EXTRACTION: Critical reading using the methods proposed by the CASPe programme. RESULTS: The difference between the 2 groups in mean values of descent of glycosylated haemoglobin was -0.07% (95% CI, -0.32 to 0.17) for type-2 diabetics; and between 0.16% (95% CI, -0.01 to 0.32) and -0.16% (95% CI, -0.34 to 0.01) in type-1 diabetics. Hypoglucaemias per subject-month were similar (between 0.83 and 1.57 in type-2 diabetics and between 8.6 and 9.9 in type-1 diabetics). Quality of life and satisfaction were favourable to the intervention group (P< .05). Secondary effects were comparable except in the appearance of cough (21%-27% in inhaled and 2%-7% in subcutaneous insulin). CONCLUSIONS: Inhaled insulin is comparable to subcutaneous insulin in metabolic control, the number of hypoglucaemias and side-effects. However, the trials reviewed showed certain problems of internal and external validity. Studies with longer follow-up are needed, in order to evaluate possible lung disorders.

Eficacia y seguridad de la insulina inhalada en el tratamiento de la diabetes mellitus / Efficacy and safety of inhaled insulin in diabetes mellitus treatment

Objetivo. Valorar la eficacia y la seguridad de la insulina inhalada. Diseño. Revisión sistemática. Fuentes de datos. Bases de datos referenciales MEDLINE (1999 a noviembre 2005) y EMBASE (2000 a noviembre 2005), en la base CENTRAL (Cochrane Library), Agencia Europea del Medicamento, Food and Drug Administration, Red Internacional de Agencias de Evaluación de Tecnologías, Red Europea Detección Precoz de Tecnologías (EuroScan), y varios registros de investigación. Selección de los estudios. Se recuperaron 8 ensayos clínicos. Se excluyeron los estudios que no se compararon con la insulina subcutánea y los que no midieron el control metabólico o la satisfacción y la calidad de vida. Extracción de los datos. Lectura crítica según la metodología propuesta por el programa CASPe. Resultados. La diferencia de valores medios de descenso de la hemoglobina glucosilada en ambos grupos fue del ­0,07% (intervalo de confianza [IC] del 95%, ­0,32 a 0,17) para diabéticos tipo 2 y entre el 0,16% (IC del 95%, ­0,01 a 0,32) y el ­0,16% (IC del 95%, ­0,34 a 0,01) en diabéticos tipo 1. Las hipoglucemias por sujeto-mes fueron similares (entre 0,83 y 1,57 en diabéticos tipo 2 y entre 8,6 y 9,9 en diabéticos tipo 1). Los resultados de calidad de vida y satisfacción fueron favorables al grupo intervención (p < 0,05). Los efectos secundarios fueron comparables, excepto en la aparición de tos (el 21-27% en la insulina inhalada y el 2-7% en la insulina subcutánea). Conclusiones. La insulina inhalada es equiparable a la subcutánea en el control metabólico, el número de hipoglucemias y los efectos adversos. Sin embargo, los ensayos recuperados presentaron algunos problemas de validez interna y externa. Se precisan estudios con un mayor seguimiento para evaluar las posibles alteraciones pulmonares

Objective. To evaluate the efficacy and safety of inhaled insulin. Design. Systematic review. Data sources. Reference data bases, MEDLINE (1999 to November 2005) and EMBASE (2000 to November 2005), the CENTRAL base (Cochrane Library), the European Drug Agency, the Food and Drug Administration, the International Network of Technology Evaluation Agencies, the European Network for Early Detection (EuroScan), and various research registers. Studies. Eight clinical trials were recovered. Studies not comparing inhaled with subcutaneous insulin and those that did not measure metabolic control or satisfaction and quality of life were excluded. Data extraction. Critical reading using the methods proposed by the CASPe programme. Results. The difference between the 2 groups in mean values of descent of glycosylated haemoglobin was ­0.07% (95% CI, ­0.32 to 0.17) for type-2 diabetics; and between 0.16% (95% CI, ­0.01 to 0.32) and -0.16% (95% CI, ­0.34 to 0.01) in type-1 diabetics. Hypoglucaemias per subject-month were similar (between 0.83 and 1.57 in type-2 diabetics and between 8.6 and 9.9 in type-1 diabetics). Quality of life and satisfaction were favourable to the intervention group (P<.05). Secondary effects were comparable except in the appearance of cough (21%-27% in inhaled and 2%-7% in subcutaneous insulin). Conclusions. Inhaled insulin is comparable to subcutaneous insulin in metabolic control, the number of hypoglucaemias and side-effects. However, the trials reviewed showed certain problems of internal and external validity. Studies with longer follow-up are needed, in order to evaluate possible lung disorders

Respuesta de los autores. Vigilancia de la infección nosocomial en pacientes críticos ingresados en servicios de medicina intensiva / Reply. Nosocomial infection surveillance in critically ill patients in the intensive care units

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Vigilancia de la infección nosocomial: ¿todos medimos lo mismo? / Vigilance of nosocomial infection: Is the same measured by all of us?

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[Factors influencing hospital infection in patients in the intensive care unit]. / Factores que influyen sobre la aparición de infecciones hospitalarias en los pacientes de cuidados intensivos.

OBJECTIVE: The accumulation of risk factors in hospitalized patients is one of the elements contributing to the increase in the frequency of nosocomial infection in the intensive care unit (ICU). Our aim was to identify nosocomial infection risk factors in the ICU of our hospital. METHODS: We performed a prospective cohort study of 1,134 patients admitted to the ICU for at least 24 hours in 2001. The patients were followed-up for 48 hours after leaving the ICU. Multivariate Cox regression analysis was used to identify risk factors. RESULTS: The intrinsic risk factors identified were the principal diagnosis motivating admission to the ICU, traumatic brain injury and renal insufficiency. Invasive techniques that were independently associated with nosocomial infection (from high to low risk) were urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheter, and total parenteral nutrition. CONCLUSIONS: Although endogenous risk factors, which cannot be modified, represented the most important associated factors, steps to reduce nosocomial infections should concentrate on the following exogenous risk factors: urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheters, and total parenteral nutrition.