Preparación prequirúrgica, profilaxis antibiótica y vigilancia de infección de herida quirúrgica en cirugía de mama / Preoperative preparation, antibiotic prophylaxis and surgical wound infection in breast surgery

Introducción El impacto de la infección de herida quirúrgica (IHQ) en salud pública justifica su vigilancia y prevención. Nuestros objetivos fueron estimar la incidencia de IHQ en cirugía de mama y evaluar sus protocolos de profilaxis antibiótica y preparación prequirúrgica. Métodos Estudio de cohortes prospectivo multicéntrico de incidencia de IHQ. Se evaluó la incidencia de IHQ, se estratificó por índice de riesgo NNIS y se calculó la razón estandarizada de incidencia (REI). La REI se comparó con las tasas nacionales y americanas. Se evaluó el cumplimiento y adhesión del protocolo de profilaxis antibiótica y de preparación prequirúrgica y su influencia en la IHQ con el riesgo relativo. Resultados Se estudiaron 592 intervenciones de mama procedentes de 10 hospitales de la Comunidad de Madrid. La incidencia de IHQ acumulada fue de 3,89% (IC 95%: 2,3-5,5). La REI fue de 1,82 sobre la tasa nacional y de 2,16 sobre la americana. Se administraron el 97,81% de las profilaxis antibióticas indicadas con una adhesión global al protocolo del 75%. La preparación prequirúrgica fue correcta en el 53,8%. No se encontró asociación de la infección con la adhesión a la profilaxis antibiótica ni con el cumplimiento de la preparación prequirúgica (p>0,05). Conclusión Nuestra incidencia ha sido algo superior a la de los programas nacionales de vigilancia. Hay que mejorar la adhesión de la profilaxis antibiótica y el registro de los datos de preparación prequirúrgica (AU)

Introduction: The impact of surgical wound infection on public health justifies its surveillance and prevention. Our objectives were to estimate the incidence of surgical wound infection in breast procedures and assess its protocol of antibiotic prophylaxis and preoperative preparation. Methods: Observational multicentre prospective cohort study of incidence of surgical wound infection. Incidence was evaluated, stratified by National Nosocomial Infection Surveillance (NNIS) risk index and we calculated the standardized incidence ratio (SIR). The SIR was compared with Spanish rates andU.S. rates. The compliance and performance of the antibiotic prophylaxis and preoperative preparation protocol were assessed and their influence in the incidence of infection with the relative risk. Results: Ten hospitals from the Comunidad de Madrid were included, providing 592 procedures. The cumulative incidence of surgical wound infection was 3.89% (95% CI: 2.3-5.5). The SIR was 1.82 on the Spanish rate and 2.16 on the American. Antibiotic prophylaxis was applied in 97.81% of cases, when indicated. The overall performance of antibiotic prophylaxis was 75%, and 53% for preoperative preparation. No association was found between infection and performance of prophylaxis or preoperative preparation (P > .05). Conclusion: Our incidence is with in those seen in the literature although it is some what higher than the national surveillance programs. The performance of prophylaxis antibiotic must be improved, as well as the recording of preoperative preparation data (AU)

[Preoperative preparation, antibiotic prophylaxis and surgical wound infection in breast surgery]. / Preparación prequirúrgica, profilaxis antibiótica y vigilancia de infección de herida quirúrgica en cirugía de mama.

INTRODUCTION: The impact of surgical wound infection on public health justifies its surveillance and prevention. Our objectives were to estimate the incidence of surgical wound infection in breast procedures and assess its protocol of antibiotic prophylaxis and preoperative preparation. METHODS: Observational multicentre prospective cohort study of incidence of surgical wound infection. Incidence was evaluated, stratified by National Nosocomial Infection Surveillance (NNIS) risk index and we calculated the standardized incidence ratio (SIR). The SIR was compared with Spanish rates and U.S. rates. The compliance and performance of the antibiotic prophylaxis and preoperative preparation protocol were assessed and their influence in the incidence of infection with the relative risk. RESULTS: Ten hospitals from the Comunidad de Madrid were included, providing 592 procedures. The cumulative incidence of surgical wound infection was 3.89% (95% CI: 2.3-5.5). The SIR was 1.82 on the Spanish rate and 2.16 on the American. Antibiotic prophylaxis was applied in 97.81% of cases, when indicated. The overall performance of antibiotic prophylaxis was 75%, and 53% for preoperative preparation. No association was found between infection and performance of prophylaxis or preoperative preparation (P>.05). CONCLUSION: Our incidence is within those seen in the literature although it is somewhat higher than the national surveillance programs. The performance of prophylaxis antibiotic must be improved, as well as the recording of preoperative preparation data.

Clinical outbreak of linezolid-resistant Staphylococcus aureus in an intensive care unit.

CONTEXT: Linezolid resistance is extremely uncommon in Staphylococcus aureus. OBJECTIVE: To report an outbreak with linezolid and methicillin-resistant S. aureus (LRSA) in an intensive care department and the effective control measures taken. DESIGN, SETTING, AND PATIENTS: Outbreak study of consecutive critically ill patients colonized and/or infected with LRSA at an intensive care department of a 1000-bed tertiary care university teaching hospital in Madrid, Spain. Patients were placed under strict contact isolation. Daily updates of outbreak data and recommendations for the use of linezolid were issued. Extensive environmental sampling and screening of the hands of health care workers were performed. MAIN OUTCOME MEASURES: Linezolid use and clinical and epidemiological characteristics and outcomes using minimal inhibitory concentrations, pulsed-field gel electrophoresis, and polymerase chain reaction of LRSA isolates. RESULTS: Between April 13 and June 26, 2008, 12 patients with LRSA were identified. In 6 patients, LRSA caused ventilator-associated pneumonia and in 3 patients it caused bacteremia. Isolates were susceptible to trimethoprim-sulfamethoxazole, glycopeptides, tigecycline, and daptomycin. Genotyping identified 1 predominant clone and 3 other types. Cfr-mediated linezolid resistance was demonstrated in all isolates. Potential hospital staff carriers and environmental samples were negative except for one. Six patients died, 5 of them in the intensive care unit, with 1 death attributed to LRSA infection. Linezolid use decreased from 202 defined daily doses in April 2008 to 25 defined daily doses in July 2008. Between July 2008 and April 2010, no new cases have been identified in the weekly surveillance cultures or diagnostic samples. CONCLUSIONS: The first clinical outbreak, to our knowledge, with LRSA mediated by the cfr gene developed at our center, was associated with nosocomial transmission and extensive usage of linezolid. Reduction of linezolid use and infection-control measures were associated with the termination of the outbreak.

Resistance to linezolid is mediated by the cfr gene in the first report of an outbreak of linezolid-resistant Staphylococcus aureus.

BACKGROUND: From April through June 2008, we identified 12 patients in the intensive care unit and 3 patients on other wards infected with methicillin-resistant Staphylococcus aureus that was also resistant to linezolid. We investigated the mechanism of resistance--point mutations in domain V of 23S ribosomal RNA (rRNA) or presence of the cfr gene--involved in the outbreak. METHODS: Strains for the study were obtained in the intensive care unit and other wards. Minimal inhibitory concentrations were determined using automated methods, the E-test, or dilution in Mueller-Hinton agar in accordance with Clinical and Laboratory Standards Institute guidelines. Strains were genotyped using pulsed-field gel electrophoresis and were sequenced to determine the presence of point mutations in 23S rRNA. The presence of the cfr gene was determined by specific polymerase chain reaction. RESULTS: The minimal inhibitory concentrations of linezolid ranged from 16 mg/L to 32 mg/L, and all the strains were susceptible to tigecycline, vancomycin, and daptomycin. Typing of strains sequentially isolated by pulsed-field gel electrophoresis showed that each patient carried only 1 clonal type of linezolid-resistant, methicillin-resistant S. aureus as detected by sequential isolations. The presence of the cfr gene was confirmed in all the isolates. Furthermore, sequencing of domain V of 23S rRNA showed that the most common mechanism of linezolid resistance reported to date, mutation G2576T, was not detected in any of the strains analyzed. CONCLUSIONS: We report the presence of the cfr gene underlying the resistance mechanism involved in a clinical outbreak of linezolid-resistant S. aureus.