Effects of the COVID-19 Pandemic on Incidence and Epidemiology of Catheter-Related Bacteremia, Spain.

We compared hospital-acquired catheter-related bacteremia (CRB) episodes diagnosed at acute care hospitals in Catalonia, Spain, during the COVID-19 pandemic in 2020 with those detected during 2007-2019. We compared the annual observed and predicted CRB rates by using the negative binomial regression model and calculated stratified annual root mean squared errors. A total of 10,030 episodes were diagnosed during 2007-2020. During 2020, the observed CRB incidence rate was 0.29/103 patient-days, whereas the predicted CRB rate was 0.14/103 patient-days. The root mean squared error was 0.153. Thus, a substantial increase in hospital-acquired CRB cases was observed during the COVID-19 pandemic in 2020 compared with the rate predicted from 2007-2019. The incidence rate was expected to increase by 1.07 (95% CI 1-1.15) for every 1,000 COVID-19-related hospital admissions. We recommend maintaining all CRB prevention efforts regardless of the coexistence of other challenges, such as the COVID-19 pandemic.

Quantification and Progress Over Time of Specific Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2 in Breast Milk of Lactating Women Vaccinated With BNT162b2 Pfizer-BioNTech Coronavirus Disease 2019 Vaccine (LacCOVID).

Background: Several observational studies demonstrated the passage of postvaccine antibodies through breast milk in women vaccinated against coronavirus disease 2019 (COVID-19), mostly with messenger RNA (mRNA)-based vaccines, but lacked long-term data. Methods: A 6-month prospective cohort study was performed to determine severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-induced antibody levels in the breast milk of 33 lactating healthcare workers at different timepoints after mRNA BNT162b2 Pfizer-BioNTech COVID-19 vaccination. Moreover, we examined the correlation of SARS-CoV-2 antibody levels between serum and breast milk, adverse events related to vaccination, and rate of SARS-CoV-2 infections. Results: Mothers' median age was 38 (interquartile range [IQR], 36-39) years and 15 (IQR, 10-22) months for infants. Median (IQR) SARS-CoV-2 immunoglobulin G (IgG) spike protein subunit S1 (S1) vaccine-induced levels at different timepoints for serum-milk pairs were 519 (234-937) to 1 (0-2.9) arbitrary units (AU)/mL at 2 weeks after first dose and 18 644 (9923-29 264) to 78 (33.7-128), 12 478 (6870-20 801) to 50.4 (24.3-104), 4094 (2413-8480) to 19.9 (10.8-51.9), 1350 (831-2298) to 8.9 (7.8-31.5) AU/mL at 2, 4, 12 and 24 weeks after second dose, respectively. We observed a positive correlation of antibody levels between serum and breast milk, no serious adverse events related to vaccination, and 2 (6%) COVID-19 vaccine breakthrough infections. Conclusions: Women vaccinated with Pfizer-BioNTech transmit antibodies into breast milk with a positive correlation with serum levels. Both decreased over time in a 6-month follow-up.

Trends in the epidemiology of catheter-related bloodstream infections; towards a paradigm shift, Spain, 2007 to 2019.

BackgroundCatheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death.AimTo analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat).MethodsA cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007-2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000 patient days. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000 patient days and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported.ResultsDuring the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate: 0.20 episodes/1,000 patient days). Patients' median age was 64.1 years; 36.6% (3,403/9,290) were female. In total, 73.7% (n = 6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n = 5,822) were related to central venous catheter (CVC), 24.1% (n = 2,236) to peripheral venous catheters (PVC) and 13.3% (n = 1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR: 0.94; 95%CI: 0.93-0.96), especially in the ICU (IRR: 0.88; 95%CI: 0.87-0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR: 0.88; 95%CI: 0.87-0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC: 1.08; 95%CI: 1.05-1.11; IRR PVC: 1.03; 95% 1.00-1.05).ConclusionsOver the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards.

Utilización de la vía subcutánea en Atención Primaria / Use of the subcutaneous route in primary care

La vía subcutánea se presenta como una alternativa a la vía oral cuando ésta no es posible. En el manejo de los pacientes paliativos está extendido el uso de esta vía, pero no es así en el resto de pacientes. Existen distintas situaciones en Atención Primaria donde nuestros enfermos se pueden beneficiar en numerosas ocasiones del uso de esta forma de administración de fármacos. Revisamos varios artículos, capítulos de libros y guías clínicas donde se precisan las ventajas e inconvenientes de esta vía, las principales indicaciones, las técnicas de administración subcutánea de fármacos en bolo o en infusión continua y los fármacos más empleados. En definitiva, intentamos hacer una revisión del uso de la vía subcutánea útil para el médico de familia y para los diplomados en enfermería que trabajan en atención primaria, tanto en la consulta diaria como en la atención continuada (AU)

The subcutaneous route may be used as an alternative when the oral route is not possible This route is commonly used in the management of palliative care patients, but not in other kinds of patients. Patients could benefit from this type of drug administration in several Primary Care situations. We reviewed several articles, book chapters and clinical guidelines which point out the advantages and disadvantages of this route, its main indications for use, subcutaneous bolus or continuous subcutaneous infusion administration techniques and the most commonly used drugs. In short, we attempted to provide a review of the use of the subcutaneous route that will be useful for the Primary Care Physicians and Nurses, not only in daily practice but also in continued care (AU)

Experiencia Educativa con un Paciente Experto / Educational experience with the expert patient

El perfil de la relación médico-paciente ha cambiado en los últimos años pasando de un modelo paternalistaa un modelo en el que la autonomía del paciente ha adquirido una importancia fundamental.El paciente se está convirtiendo en un personaje activo, con unos derechos claros, como los de ser debidamente informado sobre su enfermedad o participar en las decisiones que afectan a su patología, pero también con los deberes de ser responsable de su enfermedad y de su estado de salud (1). Presentamos una experiencia realizada en nuestra consulta acerca de un paciente que se había responsabilizado de su problema de obesidad desde que se le diagnosticó, identifi cando muy bien losmotivos que le encaminaron a seguir nuestros indicaciones terapéuticas, las difi cultades que se lefueron planteando durante el tratamiento y cómo fue resolviendo algunas difi cultades

The doctor-patient relationship has changed considerably in recent years, from a paternalistic modelto one in which the patient’s autonomy has acquired a signifi cant relevance. The patient has becomean active individual, with clear rights, such as that of being well informed about his/her illness andparticipation in decisions that can affect their condition, but also certain obligations such as beingresponsible for their illness and health. We present an experiment carried out in our clinic of a patient who had taken on responsibility for his obesity since he was diagnosed, who clearly identifi ed the reasons for following our therapeutic indications, the difficulties he came across during the treatment and how he resolved some of them

Tratamiento periodontal y rehabilitación mediante implantes en un paciente con periodontitis agresiva: caso clínico / Periodontal treatment and rehabilitation by means of implants in a patient with aggressive periodontitis: clinical report

La periodontitis agresiva es una forma de enfermedad periodontal de evolución rápida, donde la destrucción de tejido de soporte es desproporcionada en relación a la presencia de placa bacteriana y cálculo. Presentamos el caso de un paciente diagnosticado con periodontitis agresiva que fue exitosamente tratado periodontalmente en la clínica y rehabilitado mediante implantes dentales y prótesis de función inmediata (AU)

Aggressive periodontit is is a form of periodontal disease with rapid evolution, when the support tissue destruction is disproportionate in relation to the presence of dental plaque and tartar. The following case illustrates the comprehensive treatment planning and successful rehabilitation with dental implants and immediate functioning of a patient who presented with generalized aggressive periodontitis (AU)

Reposición de dientes unitarios con cirugía mínimamente invasiva / Minimally invasive surgical replacement of single teeth

Se presenta un caso de ausencia de incisivos laterales superiores que fue tratado mediante cirugía mínimamente invasiva (flapless) y función inmediata, donde la colocación de coronas provisionales mejoró el confort de la paciente y consiguió remodelar el tejido blando que rodea la restauración. Los implantes utilizados fueron Nobel DirectTM de 3 milímetros de diámetro por 13 de longitud (AU)

A case is presented of absent upper lateral incisors that was treated with minimally invasive (flapless) surgery and immediate function, where placement of provisional crowns improved the patient’s comfort and remodeled the soft tissue surrounding the restoration. Nobel DirectTM implants were used, 3 millimeters in diameter and 13 in length (AU)