Etiología y Resistencias a los antibióticos en las infecciones de la localización quirúrgica tras cirugía abdominal / Etiology and antimicrobial resistance of surgical site infections after abdominal surgery

Las infecciones de la localización quirúrgica (ILQ) tras cirugía abdominal son una complicación frecuente. La resistencia de los microorganismos a los antimicrobianos ha aumentado progresivamente en los últimos años. El objetivo es describir la etiología de las ILQ, la frecuencia de resistencias de los microorganismos, y caracterizar los factores que se asocian a las ILQ por microorganismos resistentes (MR). MÉTODOS. Encuestas anuales de prevalencia de infecciones en los pacientes hospitalizados durante el periodo 1999-2005. Se seleccionaron todas las ILQ presentes en los pacientes que habían recibido cirugía abdominal. Se recogieron características demográficas de los pacientes, datos microbiológicos, y de potenciales factores de riesgo. RESULTADOS. Se identificaron un total de 3.564 ILQ en las que se aislaron 3.590 microorganismos. Los más frecuentes fueron: Escherichia coli (25,9%), Enterococcus faecalis (9,4%), Pseudomonas aeruginosa (7,0%) y Staphylococcus aureus (6,5%). Las resistencias a cefalosporinas de tercera generación oscilan entre el 2,5% para K. pneumoniae y el 30% para Enterobacter sp., y para las fluorquinolonas entre el 3,8% de K. pneumoniae y el 16,1% para E. coli (25% en el año 2005). S aureus es resistente a la oxacilina en el 38,2% de los aislados. Los principales factores asociados a infecciones por MR son el año de la encuesta, el tamaño del hospital, y el número de factores de riesgo intrínseco del paciente. CONCLUSIONES. Los microorganismos implicados en las ILQ han aumentado progresivamente sus resistencias antimicrobianas durante el periodo 1999 a 2005. El grado de resistencia a los antimicrobianos está condicionado por el nivel de riesgo intrínseco de los pacientes y el tamaño del hospital (AU)

Surgical site infection (SSI) is a common complication after abdominal surgery. Microorganism resistance to antimicrobials has been increasing progressively during the last years. The objective is to describe the aetiology of SSI, the frequency of antimicrobial resistance and to characterize the factors associated to SSI caused by resistant microorganims (RM).METHODS. A series of yearly prevalence surveys of hospitalized patients during the period 1999-2005 in Spain. Selection of all SSI developed by patients operated on by abdominal procedures. Information recorded included demographic characteristic of patients, microbiological data, and potential risk factors. RESULTS. A total 3,590 microorganisms corresponding to a 3,564 SSI were identified. The most frequent microorganisms isolated were Escherichia coli (25.9%), Enterococcus faecalis (9.4%), Pseudomonas aeruginosa (7.0%) and Staphylococcus aureus (6.5 %). Third generation cephalosporin resistance ranged from 2.5% (K. pneumoniae) and 30% (Enterobacter sp.). Fluorquinolone resistance ranged from 3.8% (K. pneumoniae) and 16.1% (E. coli) (25% for the year 2005). Methicillin resistant S. aureus reached 38% of isolates. The main factors associated to MR infections were year of the survey, size of the hospital and the number of intrinsic risk factors of the patients. CONCLUSIONS Microorganisms involved in SSI have been progressively increasing antimicrobial resistance during the period 1999 through 2005. Patient intrinsic risk and the size of the hospital condition the level of antimicrobial resistance (AU)

[The use of the potential years of life between the ages of 1 and 64 as an indicator of premature mortality in Aragón during 1987]. / Utilización de los años potenciales de vida perdidos entre las edades de 1 y 64 años como un indicador de la mortalidad prematura ocurrida en Aragón durante 1987.

BACKGROUND: Years of potential life lost (YPLL) are a health indicator which allows to discriminate the main causes of premature mortality weighting up the deaths according to the age of dead person. METHODS: Premature mortality in Aragón during 1987 is analysed by means of the indicator YPLL between the ages 1 and 64 years. The information given by this indicator along with that supplied by the mortality rates is used to obtain a more complete information of the role and relative importance of each one of the main groups of diseases of the International Classification of Diseases (ICD-9th revision) within the mortality in Aragón during that whole year. RESULTS: The biggest rates of YPLL by one thousand population were due to tumours (9.87), traumatisms and poisonings (8.84), vascular diseases (5.65) and digestive diseases (1.96). Mortality and YPLL rates were higher for males than for females and statistically significant differences were also observed when comparing the provinces of Zaragoza and Huesca with the province of Teruel (higher rates in the first ones) and when comparing rural with urban areas (higher rates in the second case). CONCLUSIONS: According to this indicator the preventive programs in Aragón should lead to the prevention of tumors, traumatisms, vascular diseases and digestive diseases, without forgetting that these illnesses have a bigger effect on male population and on urban areas.