Factores asociados a la infección por Clostridium difficile en un servicio de hospitalización domiciliaria / Factors associated to Clostridium difficile infection in a hospital-based home care service

Antecedentes y objetivo: No hay datos relativos a los factores de riesgo asociados a la infección por Clostridium difficile (ICD) en los servicios de hospitalización domiciliaria (SHD) del sistema sanitario español. Pacientes y métodos: Estudio casos-controles. Los casos fueron pacientes ingresados en un SHD entre 1 de enero de 2011 y el 31 de diciembre de 2016, que desarrollaron ICD. Los controles procedían de la misma población, con sospecha clínica de ICD y toxina CD(-). Se analizaron 82 variables. Resultados: Fueron evaluados 17 casos y 95 controles, sin diferencias por sexo, edad o comorbilidad. Se registró diarrea en el 94% y 92%, y un porcentaje de exitus del 18% y 1%, respectivamente (p=0,001). La hemiplejia/paraplejia se asoció significativamente con la ICD (odds ratio [OR] ajustada=26,4; IC 95%: 2,9-235,6; p=0,003), mientras que la enfermedad respiratoria crónica y el uso de cefalosporinas presentaron una significación marginal (OR ajustadas de 2,9 [0,8-10,3] y 3,1 [0,8-11,3], ambas p=0,08). Conclusiones: Las acciones en el SHD frente a la ICD deberían incluir una reducción en el uso de antibióticos de riesgo -según lo observado, las cefalosporinas- especialmente ante ciertas comorbilidades, como una hemiplejia/tetraplejia o una enfermedad respiratoria crónica

Background and objective: There are no data related to the risk factors associated with CDI in a Hospital-Based Home Care Service (HBHCS) of the Spanish health system. Patients and methods: Case-control study. The cases were patients admitted to the HBHCS between 01/01/2011 and 31/12/2016 who developed CDI. The controls came from the same population, with suspected CDI and CD(-) toxin. We analysed 82 variables. Results: We analysed 17 cases and 95 controls, without differences in sex, age or comorbidity. Diarrhoea was noted in 94% and 92%, and a percentage of deaths of 18% and 1%, respectively (P=.001). The presence of hemiplegia/paraplegia (adjusted odds ratio [OR]=26.4, 95% CI 2.9-235.6, P=.003) showed a significant relationship with CDI, while chronic respiratory disease and the use of cephalosporins did so with marginal significance (adjusted OR=2.9, 95% CI 0.8-10.3 and 3.1, 95% CI 0.8-11.3, respectively, both P=.08). Conclusions: Actions in the HBHCS directed towards CDI should include a reduction in the use of high-risk antibiotics -according to our results, cephalosporins- especially in patients with specific comorbidities, such as hemiplegia/tetraplegia or a chronic respiratory disease

Factors associated to Clostridium difficile infection in a hospital-based home care service. / Factores asociados a la infección por Clostridium difficile en un servicio de hospitalización domiciliaria.

BACKGROUND AND OBJECTIVE: There are no data related to the risk factors associated with CDI in a Hospital-Based Home Care Service (HBHCS) of the Spanish health system. PATIENTS AND METHODS: Case-control study. The cases were patients admitted to the HBHCS between 01/01/2011 and 31/12/2016 who developed CDI. The controls came from the same population, with suspected CDI and CD(-) toxin. We analysed 82 variables. RESULTS: We analysed 17 cases and 95 controls, without differences in sex, age or comorbidity. Diarrhoea was noted in 94% and 92%, and a percentage of deaths of 18% and 1%, respectively (P=.001). The presence of hemiplegia/paraplegia (adjusted odds ratio [OR]=26.4, 95% CI 2.9-235.6, P=.003) showed a significant relationship with CDI, while chronic respiratory disease and the use of cephalosporins did so with marginal significance (adjusted OR=2.9, 95% CI 0.8-10.3 and 3.1, 95% CI 0.8-11.3, respectively, both P=.08). CONCLUSIONS: Actions in the HBHCS directed towards CDI should include a reduction in the use of high-risk antibiotics -according to our results, cephalosporins- especially in patients with specific comorbidities, such as hemiplegia/tetraplegia or a chronic respiratory disease.

Interobserver agreement using Schlapbach graded scale for diffuse idiopathic skeletal hyperostosis (DISH): can we reduce the cut-off point of vertebral affection?

Resnick-Niwayama criteria for diagnosing DISH depict an advanced stage, and a new reduced cut-off point with three contiguous vertebrae affected (two bone bridges) has been proposed. The aim has been to know the interobserver agreement by using a graded scale of DISH in which grade II matches with the new proposed cut-off point and grade III matches with the first criterion of Resnick-Niwayama. Males ≥ 50 years and postmenopausal women included in a population-based prospective study (the Camargo Cohort) were analyzed. Sample size was obtained according to an expected kappa of 0.95 and an accuracy of ± 8%. Three physicians applied independently Schlapbach graded scale (ranged from grade 0, no ossification, to grade III, ≥ 3 consecutive bone bridges) on the lateral radiographs of thoracic and lumbar spine of participants. We calculated inter- and intra-observer agreement and correlation. One hundred and fifty eight radiographs (79 patients, 68 ± 9 years) were assessed. Kappa values (95% confidence interval) for grades 0, I, II, and III were 0.63 (0.50-0.77), 0.49 (0.37-0.62), 0.32 (0.17-0.47), and 0.69 (0.60-0.77), respectively. Weighted kappa for the three pairs of raters were 0.87 (0.82-0.93), 0.84 (0.77-0.91), and 0.81 (0.72-0.90). Grade III was the image that generated greater agreement, while a significant decrease was noted in grade II, the new proposed criterion. The simultaneous presence of an incomplete DISH and osteoarthritis, in a thoracic spinal segment with peculiar anatomical characteristics (reduced disk spaces, kyphotic curve), is thought to be a major cause of variability in the results.

Importancia y grado de conocimiento percibido por las enfermeras de Cantabria sobre farmacología, reacciones adversas medicamentosas e interacciones farmacológicas / Importance and level of knowledge perceived by nurses from Cantabria about pharmacology, adverse reactions to drugs, and drug-drug interactions

OBJETIVO: conocer la importancia y el grado percibido de conocimientos de las enfermeras de Cantabria sobre farmacología, reacciones adversas a medicamentos (RAM) e interacciones farmacológicas (IF); y determinar si existen diferencias en relación con sus características profesionales. MÉTODO: estudio descriptivo transversal. Se diseñó un cuestionario en papel autocumplimentado y anónimo de seis preguntas, tras revisión de la literatura, consenso y pilotaje de la herramienta. Mediante una muestra de conveniencia fueron encuestados profesionales enfermeros de hospitales, Atención Primaria (AP) y Atención Sociosanitaria (AS) de Cantabria. Se realizó estadística descriptiva y prueba de contraste de hipótesis con Chi cuadrado de Pearson. RESULTADOS: se recogieron 132 cuestionarios. El 72% y el 90,9% de los encuestados consideraban insuficiente la formación pregrado y postgrado en Farmacología, respectivamente. Se consideraba capacitado para reconocer RAM el 60% con una antigüedad < 6 años frente al 84,3% en >15 años (p= 0,01), y el 59,7% de eventuales frente al 77,1% de los fijos (p= 0,03). El 41,9% de los eventuales conocía las principales IF frente al 62,9% de los fijos (p= 0,02). La Enfermería hospitalaria fue el ámbito con mayor percepción de recibir una formación continuada adecuada en farmacología (p= 0,001). CONCLUSIONES: hay un importante déficit percibido de formación en farmacología. Existen ciertas características profesionales diferenciales: las enfermeras de hospitales, con contratos fijos y con una mayor experiencia, manifiestan mejores resultados respecto a los colectivos de enfermeras de AP, AS, eventuales y con menor experiencia laboral

OBJECTIVE: to understand the importance and perceived level of knowledge by nurses from Cantabria about pharmacology, adverse reactions to drugs (ARDs) and drug-drug interactions (DDIs); and to determine if there are differences according to their professional characteristics. METHOD: a cross-sectional descriptive study. A printed self-completion questionnaire was designed, anonymous and including six questions, after a literature review, consensus and pilot trial of the tool. Through convenience sampling, a survey was conducted on nursing professionals from hospitals, Primary Care (PC) and Healthcare and Social Work (HSW) from Cantabria. Descriptive statistics was conducted, as well as Hypothesis Contrast Test through Pearson's Chi Square. RESULTS: in total, 132 questionnaires were collected; 72% and 90.9% of participants considered insufficient the undergraduate and post-graduate training on Pharmacology, respectively. Sixty per cent (60%) with < 6-year seniority considered they were qualified to identify ARDs vs. 84.3% with >15 years (p= 0.01), and 59.7% of temporary workers vs. 77.1% of permanent workers (p= 0.03); 41.9% of temporary workers were aware of the main DDIs vs. 62.9% of permanent workers (p= 0.02). Hospital nursing was the setting with a higher perception of receiving an adequate continuous training on Pharmacology (p= 0.001). CONCLUSIONS: there is an important deficit perceived in terms of Pharmacology training. There are certain differentiating professional characteristics: hospital nurses with permanent contracts and higher experience show better results vs. the nurses in PC and HSW, temporary and with lower work experience