Incidencia y coste de las infecciones nosocomiales en una unidad de lesionados medulares / Incidence and cost of nosocomial infection at a Medullar Lesion Unit

El objetivo es conocer la incidencia y el coste de las infecciones nosocomiales diagnosticadas en pacientes con lesión medular ingresados en la Unidad de Lesionados Medulares del hospital Vall d'Hebron. Durante 1995-1996 se han diagnosticado 229 infecciones nosocomiales en 312 pacientes. El coste sanitario del diagnóstico y tratamiento ha sido de 7.305.559 pesetas. En las infecciones del tracto urinario moderadas se ha realizado un análisis coste-efectividad, agrupando los tratamientos según el tipo de antibiótico y según la vía de administración, obteniéndose una mejor relación coste-efectividad en los tratamientos en que se ha utilizado "antibiótico de uso libre" y en los que se ha administrado "por vía oral", ya que el coste sanitario ha sido menor y la efectividad, valorada por el índice de curación, similar (AU)

Methicillin-resistant Staphylococcus aureus: a four-year experience in a spinal cord injury unit in Spain.

Methicillin-Resistant Staphylococcus aureus (MRSA) infection poses a problem for both acute and long-term-care facilities, Spinal Cord Injury units included. This paper describes the 4-year evolution of MRSA outbreaks in a SCI unit in a university hospital where control measures were implemented from the first case detected. The protocol procedure was as follows: contact isolation, washing with antiseptic soap both those infected and those sharing the same room, contacts study and monitoring of MRSA patients up to the time when three consecutive negative cultures (sampled at time lapses of over 48 h) were obtained, antiseptic soap for the health-care personnel to wash their hands, and cultures of the nares done on the personnel in the event of an outbreak. Twenty-one (3.4%) MRSA positive cases were detected out of 550 admissions registered during the study period (November 1990 through October 1994). The evolution occurred in three outbreaks and six isolated MRSA positive patients without secondary cases. 71.5% of the cases were nosocomial. Seven (33%) were colonizated and 14 (67%) infected. The 14 patients infected presented 15 infections: nine with urinary tract infections, three surgical wound infections, two tracheostomy wound infections, and one patient with a decubitus ulcer infection. Two of those with urinary tract infections presented with secondary sepsis. No carriers were detected amongst the personnel. Urinary tract colonizations responded to treatment with cotrimoxazol except in two cases in which combined treatment was required (cotrimoxazol plus rifampicin). The patients with a MRSA positive tracheal aspirate were negative after combined treatment. Wounds and cultures of the nares responded favorably to initial treatment. One of the patients with a urinary tract infection and sepsis died the infection being a contributing cause. The prospective follow-up of the patients with MRSA positive cultures and the precocious implementation of isolation measures allow for the limitation of transmission, even although complete eradication is not possible.