Prevalencia de infección relacionada con la asistencia sanitaria en centros sanitarios de cuidados prolongados de Cataluña. Programa de Vigilancia de la Infección Nosocomial en Cataluña (VINCat) / Prevalence of healthcare-associated infections in long-term care facilities in Catalonia. VINCat Program

Introducción: Los centros sanitarios de cuidados prolongados (CSCP) se han convertido en receptores de enfermos con un alto riesgo de aparición de infecciones relacionadas con la asistencia sanitaria (IRAS). Objetivo: Determinar la prevalencia de las IRAS en los CSCP de nuestro medio. Método: Durante el periodo 2011-2014 se realizaron 2 estudios anuales de prevalencia siguiendo las definiciones y metodología del estudio Healthcare-associated infections in long-term-care facilities (HALT). Resultados: La muestra final fue de 28.360 pacientes. La prevalencia de IRAS en los datos agregados fue de 10,2%. Las unidades de subagudos, con un 22,3%, y paliativos, con un 18,7%, fueron las que presentaron un mayor porcentaje de infecciones. Las infecciones más frecuentes fueron las respiratorias (35,8%) y las urinarias (35,8%). Conclusión: La prevalencia de infección en nuestros CSCP fue muy superior a la publicada en el estudio HALT. Nuestros resultados muestran la necesidad de desarrollar programas preventivos específicos en estos centros, garantizando un número suficiente de personal especializado en el control de las infecciones (AU)

Introduction: Long-term care facilities (LTCFs) have become receptors of patients with a high risk of healthcare-associated infections (HAIs). Objective: To determine the prevalence of HAIs in LTCFs. Method: During the period 2011-2014 2 annual prevalence studies were performed according to Healthcare-associated infections in long-term-care facilities (HALT) study definitions and methodology. Results: A total of 28,360 patients were included in the study. The overall prevalence rate of HAIs was 10.2%. Subacute units and palliative care units showed the highest rates, 22.3% and 18.7%, respectively. Main infections were respiratory tract infection (35.8%) and urinary tract infection (35.8%). Conclusion: These results were higher than other similar experiences, a fact that suggests the need to extend the specific strategies and programs to LTCFs, and ensuring a sufficient number of specialised staff in infection control (AU)

Prevalence of healthcare-associated infections in long-term care facilities in Catalonia. VINCat Program. / Prevalencia de infección relacionada con la asistencia sanitaria en centros sanitarios de cuidados prolongados de Cataluña. Programa de Vigilancia de la Infección Nosocomial en Cataluña (VINCat).

INTRODUCTION: Long-term care facilities (LTCFs) have become receptors of patients with a high risk of healthcare-associated infections (HAIs). OBJECTIVE: To determine the prevalence of HAIs in LTCFs. METHOD: During the period 2011-2014 2 annual prevalence studies were performed according to Healthcare-associated infections in long-term-care facilities (HALT) study definitions and methodology. RESULTS: A total of 28,360 patients were included in the study. The overall prevalence rate of HAIs was 10.2%. Subacute units and palliative care units showed the highest rates, 22.3% and 18.7%, respectively. Main infections were respiratory tract infection (35.8%) and urinary tract infection (35.8%). CONCLUSION: These results were higher than other similar experiences, a fact that suggests the need to extend the specific strategies and programs to LTCFs, and ensuring a sufficient number of specialised staff in infection control.

Seasonality and paleoecology of the late Cretaceous multi-taxa vertebrate assemblage of "Lo Hueco" (central eastern Spain).

Isotopic studies of multi-taxa terrestrial vertebrate assemblages allow determination of paleoclimatic and paleoecological aspects on account of the different information supplied by each taxon. The late Campanian-early Maastrichtian "Lo Hueco" Fossil-Lagerstätte (central eastern Spain), located at a subtropical paleolatitude of ~31°N, constitutes an ideal setting to carry out this task due to its abundant and diverse vertebrate assemblage. Local δ18OPO4 values estimated from δ18OPO4 values of theropods, sauropods, crocodyliforms, and turtles are close to δ18OH2O values observed at modern subtropical latitudes. Theropod δ18OH2O values are lower than those shown by crocodyliforms and turtles, indicating that terrestrial endothermic taxa record δ18OH2O values throughout the year, whereas semiaquatic ectothermic taxa δ18OH2O values represent local meteoric waters over a shorter time period when conditions are favorable for bioapatite synthesis (warm season). Temperatures calculated by combining theropod, crocodyliform, and turtle δ18OH2O values and gar δ18OPO4 have enabled us to estimate seasonal variability as the difference between mean annual temperature (MAT, yielded by theropods) and temperature of the warmest months (TWMs, provided by crocodyliforms and turtles). ΔTWMs-MAT value does not point to a significantly different seasonal thermal variability when compared to modern coastal subtropical meteorological stations and Late Cretaceous rudists from eastern Tethys. Bioapatite and bulk organic matter δ13C values point to a C3 environment in the "Lo Hueco" area. The estimated fractionation between sauropod enamel and diet is ~15‰. While waiting for paleoecological information yielded by the ongoing morphological study of the "Lo Hueco" crocodyliforms, δ13C and δ18OCO3 results point to incorporation of food items with brackish influence, but preferential ingestion of freshwater. "Lo Hueco" turtles showed the lowest δ13C and δ18OCO3 values of the vertebrate assemblage, likely indicating a diet based on a mixture of aquatic and terrestrial C3 vegetation and/or invertebrates and ingestion of freshwater.

Nasal carriage of coagulase positive staphylococci in patients of a Primary-Healthcare-Center: genetic lineages and resistance and virulence genes.

INTRODUCTION: Staphylococcus aureus and Staphylococcus pseudintermedius are highly important due to their capacity for producing diseases in humans and animals, respectively. The aim of the study was to investigate and characterize the coagulase positive Staphylococcus (CoPS) carriage in a Primary Healthcare Center population. METHODS: Nasal swabs were obtained from 281 non-infectious patients. The CoPS isolates recovered were typed, and their resistance phenotype and genotype, as well as their virulence profiles, were analyzed. RESULTS: CoPS isolates were recovered from 56/281 patients (19.9%). Fifty-five were S. aureus (19.6%), 54 were methicillin susceptible (MSSA) and one was methicillin resistant (MRSA). The remaining isolate was S. pseudintermedius (0.4%). A high diversity of spa-types (n=40) was detected, with 6 of them being new ones. The multi-locus-sequence-typing of 13 MSSA and one MRSA selected isolates was performed and the STs detected were: ST8, ST15, ST30, ST34, ST121, ST146, ST398, ST554, ST942, ST2499, and ST2500 (the last two STs being new). One MSSA isolate was typed as t1197-ST398-(Clonal complex)CC398. The MRSA isolate was typed as t002-ST146-CC5-SCCmec-IVc, and exhibited a multiresistance phenotype. The detected resistances were: penicillin (76%), macrolides (7%), tetracycline (7%), trimethoprim-sulfamethoxazole (7%), quinolones (7%), and lincosamides (5%). Five isolates contained lukF/lukS-PV genes, 17 tst gene, one eta gene, and two etb gene. The S. pseudintermedius isolate presented a new spa-type (t57) (belonging to a new ST180) and the genes lukS/F-I, siet, se-int, and expB. CONCLUSIONS: A high genetic diversity of S. aureus was detected. Mention must be made of the identification of MSSA CC398 and S. pseudintermedius isolates in two patients, one of them with animal contact. The detection of the genes lukF/lukS-PV and tst should be noted.

Síndrome de Ross: una causa infrecuente neurológica de trastorno de la sudoración / Ross syndrome: an infrequent neurological cause of sweating disorders

No disponible

Infección nosocomial en centros sanitarios de cuidados prolongados / Nosocomial infections in long-term health care facilities

Los centros sanitarios de cuidados prolongados (CSCP) pueden definirse como el nivel asistencial que organiza de manera integrada las prestaciones sanitarias y de servicios sociales de acuerdo con las necesidades de los destinatarios. Existe una gran variabilidad dependiendo de las características de los usuarios, del personal asistencial y de la accesibilidad a medios técnicos de diagnóstico, tratamiento o rehabilitación. En los CSCP la coexistencia de una elevada prevalencia de infecciones y de colonización por microorganismos multirresistentes, junto con altos índices de prescripción de antibióticos, a menudo inadecuada, la elevada transferencia de pacientes con el hospital y la escasez de medios diagnósticos, plantea importantes retos en el control de infecciones relacionadas con la asistencia sanitaria. Al estudiar la infección en CSCP, uno de los principales problemas es la utilización de criterios estandarizados de infección. Las características especiales de presentación de la infección en el anciano y la escasa disponibilidad de recursos hacen necesario establecer criterios de infección nosocomial estandarizados y validados a nivel mundial que permitan realizar una correcta prevención, vigilancia y control de la infección nosocomial. La infección nosocomial más frecuente es la de tipo respiratorio, seguida por la urinaria, piel y partes blandas, tracto gastrointestinal y ojos. Los microorganismos problemáticos más frecuentemente identificados en los CSCP son las enterobacterias productoras de betalactamasas de espectro extendido, Pseudomonas aeruginosa multirresistente y Staphylococcus aureus resistente a la meticilina (SARM). La eficacia en las medidas de control de la infección se basa fundamentalmente en un elevado cumplimiento de las precauciones estándar y la clasificación de pacientes según el riesgo de transmisión de un determinado multirresistente, especialmente del SARM. Esta gradación del riesgo permite racionalizar las medidas a aplicar y la incorporación de aspectos éticos y legales. El nivel de estratificación se establece principalmente en función de la condición de ser colonizado o infectado, de la localización anatómica del germen multirresistente y del grado de las alteraciones de la conducta que puede presentar el paciente. No están indicados los programas de cribado extensivo o programas de vigilancia complejos propios de los hospitales de agudos. La vigilancia epidemiológica debe adaptarse de forma práctica a las guías clínicas, siendo clave el registro de pacientes colonizados o infectados y la coordinación, mediante la aplicación de programas globales de control, entre los sistemas de salud y sociales

The long-term care facilities (LTCF) are the health care level that integrates medical assistance and social services according to the requirements of its beneficiaries. There is a great variability depending on the users profile, the professional staff and accessibility to technical resources for diagnosis, treatment or rehabilitation. In LTCF different factors are shaping a challenge in the infection control. These factors are high prevalence of infection and colonization by multiresistant microorganisms (MROs), a high rate of, often inadequate, antibiotic prescriptions, the high transfer of hospital patients, and the lack of diagnostic resources. In infection studies in LTCF, one of the main problems is the lack of standard, and well defined, infection criteria. The special features of infections in the elderly population, together with the limited resources, make it necessary to establish standard and worldwide validated criteria in order achieve appropriate monitoring and control of infection. The most common infection is the respiratory, followed by the urinary, skin and soft tissue, gastro-intestinal tract, and eyes. The problematic microorganisms most frequently identified in LTCF are enterobacteriaceae extended spectrum beta lactamase, Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). A successful infection control mainly depends on two actions. First, a high compliance of standard precautions and second, patient organization according to the risk of transmission of a particular MROs infection, especially MRSA. This risk classification may be a way to rationalize application measures, and the incorporation of ethical and legal issues. The level of stratification is established mainly according to the condition of being colonized or infected, the MROs anatomical location, and the degree of behavioral disorders suffered by the patient. Implementation of extensive screening programs or complex monitoring programs, as in acute care hospitals are not indicated. The epidemiological surveillance must adapt to clinical guidelines, with the registering of colonized and infected patients being mandatory, along with the coordination between health and social systems by applying global control programs

[Nosocomial infections in long-term health care facilities]. / Infección nosocomial en centros sanitarios de cuidados prolongados.

The long-term care facilities (LTCF) are the health care level that integrates medical assistance and social services according to the requirements of its beneficiaries. There is a great variability depending on the users profile, the professional staff and accessibility to technical resources for diagnosis, treatment or rehabilitation. In LTCF different factors are shaping a challenge in the infection control. These factors are high prevalence of infection and colonization by multiresistant microorganisms (MROs), a high rate of, often inadequate, antibiotic prescriptions, the high transfer of hospital patients, and the lack of diagnostic resources. In infection studies in LTCF, one of the main problems is the lack of standard, and well defined, infection criteria. The special features of infections in the elderly population, together with the limited resources, make it necessary to establish standard and worldwide validated criteria in order achieve appropriate monitoring and control of infection. The most common infection is the respiratory, followed by the urinary, skin and soft tissue, gastro-intestinal tract, and eyes. The problematic microorganisms most frequently identified in LTCF are enterobacteriaceae extended spectrum beta lactamase, Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). A successful infection control mainly depends on two actions. First, a high compliance of standard precautions and second, patient organization according to the risk of transmission of a particular MROs infection, especially MRSA. This risk classification may be a way to rationalize application measures, and the incorporation of ethical and legal issues. The level of stratification is established mainly according to the condition of being colonized or infected, the MROs anatomical location, and the degree of behavioral disorders suffered by the patient. Implementation of extensive screening programs or complex monitoring programs, as in acute care hospitals are not indicated. The epidemiological surveillance must adapt to clinical guidelines, with the registering of colonized and infected patients being mandatory, along with the coordination between health and social systems by applying global control programs.

Prevalence of nosocomial infections in acute care hospitals in Catalonia (VINCat Program).

The first objective of the Catalonian Nosocomial Infection Surveillance Program (VINCat) is to monitor the prevalence (%) of patients with nosocomial infections (NI), patients undergoing urinary catheterization with closed circuit drainage (%) and patients undergoing antibiotic treatment (%). We present the results for the period 2008-2010. Comprehensive and point annual prevalence surveys were conducted that included conventionally hospitalized patients in acute care hospitals belonging to the VINCat Program. The number of participating hospitals was 46 (2008), 48 (2009) and 61 (2010), most belonging to the Network of Public Use Hospitals of Servei Català de la Salut. The results are presented globally and by hospital size (<200 beds, 200-500 beds, >500 beds). The prevalence of patients with active NI acquired during the current or the previous hospitalization (global NI/P%) was 7.6 (2008), 6.2 (2009) and 6.3 (2010). The prevalence of patients with active NI acquired during the current (actual NI/P%) was 6.2 (2008), 4.7 (2009) and 4.6 (2010).The results by hospital size shows that the variation occurred mainly in <200 beds hospitals. The proportion of closed circuit urinary catheterization use was 90.2%. The use of antibiotics varied between 34.6% and 37.6%, with no differences due to hospital size. The global prevalence of NI provides information on the burden of NI at the institutional and regional level. Between 17.3% and 26.9% of patients with NI at the time of the study had acquired it in a previous hospitalization at the same institution.

Device-associated infection rates in Adult Intensive Care Units in Catalonia: VINCat Program findings.

Hospital-acquired infections are a leading cause of morbidity and mortality, especially in the intensive care unit (ICU). Surveillance of device-associated infections plays a major role in infection control programs. In 2006, the Surveillance Program of Nosocomial Infections in Catalonia (VINCat Program) was started, with the major aim of reducing infection rates through a process of active monitoring. The study period comprised calendar years 2008 (with 21 ICUs participating), 2009 (with 21 ICUs participating), and 2010 (with 28 ICUs participating). Each participating hospital was required to have an infection control team made up of at least one physician, an infection surveillance nurse, and a microbiology laboratory. Hospitals were classified into three groups according to their size. Central venous catheter-associated bloodstream infection (CVC-BSI) and ventilator-associated pneumonia (VAP) were chosen as the device-associated infections to analyze. Incidence rates of device-associated infections were calculated by dividing the total number of device-associated infection (VAP or CVC-BSI) days by the total number of days use for the relevant device. Mechanical ventilation use ranged from 0.10 to 0.85 days (overall, 0.35), and central venous catheter use ranged from 0.18 to 0.98 days (overall, 0.65). Incidence rates of VAP ranged from 7.2 ± 3.7 to 10.7 ± 9.6 episodes of VAP/1000 ventilator days. Incidence rates of CVC-BSl ranged from 1.9 ± 1.6 to 2.7 ± 2.0 episodes of CVC-associated bloodstream infection/1000 central venous catheter days. The implementation of the VINCat Program allowed monitoring of nosocomial device-associated infections in ICUs in Catalonia and enabled corrective measures in ICUs with increased incidences of device-associated infections.

Prevención y control de la infección relacionada con la asistencia en el ámbito sociosanitario / No disponible

La infección relacionada con la asistencia sanitaria (IRA) en los centros sociosanitarios (CSS) es uno de los principales problemas relacionados con la seguridad del paciente. En los últimos años, ha aumentado el componente agudo en los centros sociosanitarios. Los residentes de los CSS tienen un riesgo similar de desarrollar una IRA a de los pacientes de los hospitales agudos. Se ha publicadoun gran número de información y trabajos sobre programas de control de la infección en CSS. Las recomendaciones desarrolladas por los programas de control de infección en CSS están basadas en opiniones de expertos. Llama la atención la falta de meta-análisis y estudios controlados en este campo. El desarrollo de sistemas de vigilancia, con definiciones adaptadas de IRA en los CSS, permitela recogida sistemática de información, análisis de datos y uso de información orientado a mejorar los cuidados de los pacientes, reducir la incidencia prevenible de IRAS y comparar resultados concentros con características parecidas (AU)

The Health Care–Associated Infections (HCAI) in long-term care facilities (LTCFs) is one of the main problems related to patient safety. In recent years, acute health conditions have increased amongst nursing home residents. LTCF residents have a risk of developing HCAI that approaches that seen inacute care hospital patients. A great deal of information has been published concerning infections inthe LTCF, and infection control programs are nearly universal in that setting. Recommendations are developed for long-term care infection control programs based on expert opinions. The lack of metaanalyses and clinical randomised controlled trials in this field is surprising. The development of surveillance systems with appropriate definitions of HCAI to enable the systematic collection, data analysis and use of information in order to improve care to patients, reduce the incidence HCAI that can be prevented and enables to compare data from other facilities with same patient mix (AU)

Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: an observational, multicenter study comparing monotherapy with combination antibiotic therapy.

OBJECTIVE: To evaluate whether one antibiotic achieves equal outcomes compared with combination antibiotic therapy in patients with Pseudomonas aeruginosa ventilator-associated pneumonia. DESIGN: A retrospective, multicenter, observational, cohort study. SETTING: Five intensive care units in Spanish university hospitals. PATIENTS: Adult patients identified to have monomicrobial episodes of ventilator-associated pneumonia with significant quantitative respiratory cultures for P. aeruginosa. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: A total of 183 episodes of monomicrobial P. aeruginosa ventilator-associated pneumonia were analyzed. Monotherapy alone was used empirically in 67 episodes, being significantly associated with inappropriate therapy (56.7% vs. 90.5%, p < .001). Hospital mortality was significantly higher in the 40 patients with inappropriate therapy compared with those at least on antibiotic with activity in vitro (72.5% vs. 23.1%, p < .05). Excess mortality associated with monotherapy was estimated to be 13.6% (95% confidence interval -2.6 to 29.9). The use of monotherapy or combination therapy in the definitive regimen did not influence mortality, length of stay, development of resistance to the definitive treatment, or appearance of recurrences. Inappropriate empirical therapy was associated with increased mortality (adjusted hazard ratio 1.85; 95% confidence interval 1.07-3.10; p = .02) in a Cox proportional hazard regression analysis, after adjustment for disease severity, but not effective monotherapy (adjusted hazard ratio 0.90; 95% confidence interval 0.50-1.63; p = .73) compared with effective combination therapy (adjusted hazard ratio 1). The other two variables also independently associated with mortality were age (adjusted hazard ratio 1.02; 95% confidence interval 1.01-1.04; p = .005) and chronic cardiac insufficiency (adjusted hazard ratio 1.90; 95% confidence interval 1.04-3.47; p = .035). CONCLUSIONS: Initial use of combination therapy significantly reduces the likelihood of inappropriate therapy, which is associated with higher risk of death. However, administration of only one effective antimicrobial or combination therapy provides similar outcomes, suggesting that switching to monotherapy once the susceptibility is documented is feasible and safe.

Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock.

OBJECTIVE: To assess whether combination antibiotic therapy improves outcome of severe community-acquired pneumonia in the subset of patients with shock. DESIGN: Secondary analysis of a prospective observational, cohort study. SETTING: Thirty-three intensive care units (ICUs) in Spain. PATIENTS: Patients were 529 adults with community-acquired pneumonia requiring ICU admission. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Two hundred and seventy (51%) patients required vasoactive drugs and were categorized as having shock. The effects of combination antibiotic therapy and monotherapy on survival were compared using univariate analysis and a Cox regression model. The adjusted 28-day in-ICU mortality was similar (p = .99) for combination antibiotic therapy and monotherapy in the absence of shock. However, in patients with shock, combination antibiotic therapy was associated with significantly higher adjusted 28-day in-ICU survival (hazard ratio, 1.69; 95% confidence interval, 1.09-2.60; p = .01) in a Cox hazard regression model. Even when monotherapy was appropriate, it achieved a lower 28-day in-ICU survival than an adequate antibiotic combination (hazard ratio, 1.64; 95% confidence interval, 1.01-2.64). CONCLUSIONS: Combination antibiotic therapy does not seem to increase ICU survival in all patients with severe community-acquired pneumonia. However, in the subset of patients with shock, combination antibiotic therapy improves survival rates.

Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome.

INTRODUCTION: Our aims were to assess risk factors, clinical features, management and outcomes in critically ill patients in whom Aspergillus spp. were isolated from respiratory secretions, using a database from a study designed to assess fungal infections. METHODS: A multicentre prospective study was conducted over a 9-month period in 73 intensive care units (ICUs) and included patients with an ICU stay longer than 7 days. Tracheal aspirate and urine samples, and oropharyngeal and gastric swabs were collected and cultured each week. On admission to the ICU and at the initiation of antifungal therapy, the severity of illness was evaluated using the Acute Physiology and Chronic Health Evaluation II score. Retrospectively, isolation of Aspergillus spp. was considered to reflect colonization if the patient did not fulfil criteria for pneumonia, and infection if the patient met criteria for pulmonary infection and if the clinician in charge considered the isolation to be clinically valuable. Risk factors, antifungal use and duration of therapy were noted. RESULTS: Out of a total of 1756 patients, Aspergillus spp. were recovered in 36. Treatment with steroids (odds ratio = 4.5) and chronic obstructive pulmonary disease (odds ratio = 2.9) were significantly associated with Aspergillus spp. isolation in multivariate analysis. In 14 patients isolation of Aspergillus spp. was interpreted as colonization, in 20 it was interpreted as invasive aspergillosis, and two cases were not classified. The mortality rates were 50% in the colonization group and 80% in the invasive infection group. Autopsy was performed in five patients with clinically suspected infection and confirmed the diagnosis in all of these cases. CONCLUSION: In critically ill patients, treatment should be considered if features of pulmonary infection are present and Aspergillus spp. are isolated from respiratory secretions.