[Epidemiology and clinical of infections and colonizations caused by Enterobacterales producing carbapenemases in a tertiary hospital]. / Epidemiología y clínica de las infecciones y colonizaciones causadas por enterobacterias productoras de carbapenemasas en un hospital de tercer nivel.

OBJECTIVE: To describe the epidemiology of Enterobacterales producing carbapenemases (EPC) in a tertiary hospital. METHODS: A retrospective observational study, all patients with a positive sample for EPC treated in hospitalization or in the Emergency Department were included, between January 1, 2014 and December 31, 2016. RESULTS: A total of 272 patients (316 samples) were included: 155 (57%) male. Mean age of 70.4 years (95% CI 68.2 -72.7). Mean Charlson index was 3.6 (95% CI 3.4-3.8). In 63.2% the acquisition was nosocomial, in 35.3% it was health-care associated (HA). 55.1% presented infection, the most frequent infection was urinary tract infection (UTI) (58.7%). The most frequent species were Klebsiella pneumoniae (62.7%) and Enterobacter cloacae (10.1%). The most frequent types of carbapenemase were OXA-48 (53.8%) and VIM (43%). The nosocomial acquisition was associated with the male gender, transplantation, immunosuppression, admission to the Intensive Care Unit (ICU) or surgical service, prior antibiotic treatment, Enterobacter, VIM, respiratory and intra-abdominal infections. The HA acquisition was associated with age and comorbidity, nursery home origin, bladder catheterization, greater number of outpatient procedures, previous hospital admission, K. pneumoniae and E. coli, OXA-48, coproduction of extended spectrum betalactamases, UTI and sepsis. CONCLUSIONS: Patients who acquire EPC in nursery homes frequently have an infection. Patients with nosocomial acqui-sition are colonized by EPC in the ICU, in relation to invasive procedures and transplantation. This population has a higher mortality due to developing respiratory infections by EPC.

[Antibiotic treatment optimization by means of antibiotic treatment experts participation]. / Optimización del tratamiento antibiótico mediante la participación de expertos en antibióticos.

BACKGROUND: Antibiotics account for a high percentage of hospital pharmacy expenses. An elevated proportion of the prescriptions are considered inappropriate. Infectious diseases specialist could help other physicians in improving antibiotics prescriptions. METHODS: Treatments in all patients hospitalized in four surgical wards were checked daily and recommendations were made in cases with signs of inadequate antibiotics prescriptions. The program was carried out during for 4 months and the results were compared with a similar period of the previous year. RESULTS: 562 treatments of 393 patients were reviewed . Five hundred twenty four recommendations were made (90% of them were accepted). There was a significant reduction in the number of inadequate prescriptions. Antibiotic expenditure decreased by 29,262 euros (7,240 euros/month), implying a reduction of 2.35 euros/hospitalization-bed/day. There were no statistically significant differences in the amount of hospital resistant bacteria nor in mortality between the two periods. CONCLUSIONS: Following application of a non-compulsory control program, antibiotic prescription improved and expenditure decreased, with no change in mortality. Acceptation of the program by the physicians of the departments implicated was favourable.

Optimización del tratamiento antibiótico mediante la participación de expertos en antibióticos / Antibiotic treatment optimization by means of antibiotic experts participation

Antecedentes: Los antibióticos representan un porcentaje elevado del gasto de farmacia de un hospital. Una elevada proporción de las prescripciones se consideran inapropiadas. La ayuda prestada por infectólogos con una formación extensa en el manejo de los antibióticos podría mejorar la prescripción de este tipo de medicamentos. Métodos: Revisión diaria de las prescripciones antibióticas realizadas en cuatro salas de hospitalización de varias especialidades quirúrgicas. Examen diario de los casos que cumplían algunos de los signos de sospecha de prescripción inadecuada. Si existían casos sugestivos de este tipo de prescripción se efectuaba una recomendación a los médicos prescriptores. La intervención se realizó durante 4 meses. Se compararon los resultados con un periodo similar del año anterior. Resultados: Se revisaron 562 tratamientos en 393 pacientes. Se realizaron 524 recomendaciones (el 90% fueron aceptadas). Se logró una reducción importante de prescripciones consideradas inadecuadas. Se consiguió una disminución del gasto en antibióticos de 29.363 € (7.240 €/mes), lo que supone un ahorro de 2,35 €/cama de hospitalización/día. No hubo diferencias estadísticamente significativas ni en la en mortalidad ni en el aislamiento de bacterias nosocomiales resistentes Conclusiones: Empleando un programa de asesoramiento sobre el tratamiento antibiótico se consiguió una mejor utilización y una disminución del gasto en antibióticos, sin variaciones en la mortalidad. El programa fue muy bien aceptado por los médicos de los servicios implicados

Background: Antibiotics account for a high percentage of hospital pharmacy expenses. An elevated proportion of the prescriptions are considered inappropriate. Infectious diseases specialist could help other physicians in improving antibiotics prescriptions Methods: Treatments in all patients hospitalized in four surgical wards were checked daily and recommendations were made in cases with signs of inadequate antibiotics prescriptions. The program was carried out during for 4 months and the results were compared with a similar period of the previous year. Results: 562 treatments of 393 patients were reviewed . Five hundred twenty four recommendations were made (90% of them were accepted). There was a significant reduction in the number of inadequate prescriptions. Antibiotic expenditure decreased by 29,262 euros (7,240 euros/month), implying a reduction of 2.35 euros/hospitalizationbed/ day. There were no statistically significant differences in the amount of hospital resistant bacteria nor in mortality between the two periods. Conclusions: Following application of a non-compulsory control program, antibiotic prescription improved and expenditure decreased, with no change in mortality. Acceptation of the program by the physicians of the departments implicated was favourable

[Mortality and prognostic factors in patients admitted with community-acquired bacteremia]. / Mortalidad y factores pronósticos en pacientes hospitalizados por bacteriemia adquirida en la comunidad.

BACKGROUND: Community-acquired bacteremia is a frequently clinical problem and is associated with a high mortality. The Pitt bacteremia score that is calculated using body temperature, mental status, and some respiratory and circulatory features is an useful tool in order to know the prognosis of patients with bacteremia. Objectives were to know microbial etiology of bacteremia in our community, percentage of patients that received an inadequate empiric antibiotic treatment and independent prognostic factors associated with mortality, including Pitt bacteremia score. METHOD: Observational study of a cohort of patients over 18 years admitted at a tertiary hospital due to an infection with a community-acquired bacteremia. Twenty-eight cases were rejected because possible blood culture contamination. RESULTS: Seventy-five patients were included, the mean age was 68.6 +/- 18.2 years, 38 women (51%). Mortality rate was 23% [IC95% 13.8-33.8]. More frequent bacteria isolated were Escherichia coli, Staphylococcus aureus, coagulase negative staphylococci, Pseudomonas aeruginosa, Streptococcus viridans, enterococci and Klebsiella spp. Mortality in patients treated with an inadequate antibiotic therapy (18%, 3 patients) was not lower than in adequately treated patients (24%, 14 patients, p = 0.42). Independent prognostic factors related to mortality were serum albumin concentration, OR = 5.17 (IC 95% 1.45-16.7) for every downing step of 1 g/dl, the Pitt bacteremia score OR = 1.50 (IC 95% 1.01-2.24) for every unit increase, and a high score at McCabe and Jackson classification OR = 5.08 ( IC 95% 1.43-16.7). CONCLUSIONS: An inadequate empiric antibiotic therapy was not associated with a worse vital prognosis. Independent prognostic factors related to mortality were serum albumin concentration, the Pitt bacteremia score, and the McCabe and Jackson classification.

Mortalidad y factores pronósticos en pacientes hospitalizados por bacteriemia adquirida en la comunidad / Mortality and prognostic factors in patients admitted with community-acquired bacteremia

Introducción: La bacteriemia adquirida en la comunidad es un problema frecuente y de elevada mortalidad. El índice de Pitt, calculado en base a la temperatura, el estado mental, y las funciones circulatoria y respiratoria del paciente es una herramienta útil para conocer el pronóstico de pacientes con bacteriemia. Los objetivos fueron conocer la etiología de las bacteriemias adquiridas en la comunidad en nuestro entorno, el porcentaje de pacientes con tratamiento empírico incorrecto, y determinar la mortalidad y los factores independientes asociados con el fallecimiento del paciente, incluido el índice de Pitt. Método: Estudio observacional de una cohorte de pacientes mayores de 18 años ingresados en un hospital terciario por una infección adquirida en la comunidad con bacteriemia. Veintiocho casos fueron desestimados por considerar el aislamiento bacteriano como contaminante. Resultados: Se incluyeron 75 enfermos con un promedio de edad de 68,6 ± 18,2 años, 38 mujeres (51%). La mortalidad fue del 23% [IC95% 13,8 – 33,8]. Las bacterias más frecuentemente aisladas en los hemocultivos fueron Escherichia coli, Staphylococcus aureus, estafilococos coagulasa negativo, Pseudomonas aeruginosa, Streptococcus viridans, enterococos y Klebsiella spp. La mortalidad de los pacientes con un tratamiento antibiótico empírico inadecuado (18%, 3 pacientes) no fue inferior a los que recibieron un tratamiento empírico correcto en urgencias (24 %, 14 pacientes, p = 0,42). Los factores independientes pronósticos de mortalidad, fueron la baja concentración plasmática de albúmina, OR = 5,17 (IC 95% 1,45-16,7) para cada descenso de 1 g/dl, el elevado índice de Pitt OR = 1,50 (IC 95% 1,01-2,24) para cada aumento de una unidad, y la elevada gravedad de la enfermedad de base medida por el índice de McCabe y Jackson OR = 5,08 ( IC 95% 1,43-16,7). Conclusiones: El tratamiento antibiótico empírico incorrecto no influyó en la mortalidad de pacientes con bacteriemia comunitaria. Los factores pronósticos de mortalidad fueron la concentración plasmática de albúmina, el índice de Pitt y la gravedad de la enfermedad de base medida por el índice de McCabe y Jackson

Background: Community-acquired bacteremia is a frequently clinical problem and is associated with a high mortality. The Pitt bacteremia score that is calculated using body temperature, mental status, and some respiratory and circulatory features is an useful tool in order to know the prognosis of partients with bacteremia. Objetives were to know microbial etiology of bacteremia in our community, percentage of patients that received an inadequate empiric antibiotic treatment and indepedent prognostic factors associated with mortality, including Pitt bacteremia score. Method: Observational study of a cohort of patients over 18 years admitted at a tertiary hospital due to an infection with a community-acquired bacteremia. Twenty-eight cases were rejected because possible blood culture contamination. Results: Seventy-five patients were included, the mean age was 68.6 ± 18.2 years, 38 women (51%). Mortality rate was 23% [IC95% 13.8 – 33.8]. More frequent bacteria isolated were Escherichia coli, Staphylococcus aureus, coagulase negative staphilococci, Pseudomonas aeruginosa, Streptococcus viridans, enterococci and Klebsiella spp. Mortality in patients treated with an inadequate antibiotic therapy (18%, 3 patients) was not lower than in adequately treated patients (24%, 14 patients, p=0.42). Indepedent prognostic factors related to mortality were serum albumin concentration, OR=5.17 (IC 95% 1.45-16.7) for every downing step of 1 g/dl, the Pitt bacteremia score OR=1.50 (IC 95% 1.01-2.24) for every unit increase, and a high score at McCabe and Jackson classification OR=5.08 ( IC 95% 1.43-16.7) Conclusions: An inadequate empiric antibiotic therapy was not associated with a worse vital prognosis. Indepedent prognostic factors related to mortality were serum albumin concentration, the Pitt bacteremia score, and the McCabe and Jackson classification

[Prevalence and risk factors associated to malnutrition in elderly inpatients]. / Prevalencia y factores asociados a malnutrición en ancianos hospitalizados.

BACKGROUND: Malnutrition is a frequent clinical finding in elderly inpatients that is deleterious to the physiologic function of several body's organs or systems that is accompanied of an increase of the length of hospitalization, economic burden and mortality. Protein-energy malnutrition risk factors in elderly patients are not well defined. METHOD: A transversal study of inpatients over 70 years in a internal medicine ward was undertaken in order to know the protein-energy malnutrition's prevalence a possible risk factors. It was considered that a patient suffered from had protein-energy malnutrition if he or she had a tricipital skinfold thickness or an arm circumference under 10th percentile and/or had low levels of two of the following clinical parameters: plasmatic albumin (under 3.5 mg/100 ml). Plasmatic transferrin (under 150 mg/100 ml) or a lymphocytic cell count (under 1,500 cells/ml). RESULTS: A hundred and five patients were included. Mean age was 83.0 +/- 6.4 years with a predominance of the female sex (61%). Thirty-three patients (31%) were sent from nursing homes. A 35% were very dependent and frail elderly patients. Fifty-eight patients presented at hospital with protein-energy malnutrition (prevalence = 57.1%; CI 95% 47.1%-66.8%). Chronic obstructive pulmonary disease (COPD) and a acute infectious disease were independent risk factors associated protein-energy malnutrition (prevalence ratio of 1.4 and 0.5, respectively). CONCLUSIONS: Protein-energy malnutrition's prevalence in elderly inpatients is very important. Infectious diseases and COPD are positively and negatively associated with protein-energy malnutrition.

Prevalencia y factores asociados a malnutrición en ancianos hospitalizados / Prevalence and risk factors associated to malnutrition in elderly inpatients

Fundamento: La malnutrición en ancianos que son ingresados en los hospitales es un hecho frecuente y ocasiona un deterioro en distintos órganos y sistemas que condiciona un aumento de la estancia hospitalaria, costes sanitarios y mortalidad. Los factores de riesgo de malnutrición en este grupo de enfermos no están bien estudiados. Método: Se realizó un estudio transversal de pacientes mayores de 70 años que ingresaron en una sala de hospitalización de medicina interna para conocer la prevalencia de malnutrición al ingreso y sus posibles factores de riesgo. Se consideró que un paciente padecía malnutrición si el pliegue tricipital o el perímetro braquial se situaba por debajo del percentil 10 y/o presentaba valores inferiores a la normalidad en al menos dos de los siguientes parámetros: albúmina plasmática (menor de 3,5 mg/dl), transferrina plasmática (menor de 150 mg/dl) o recuento linfocitario en sangre periférica (menor de 1500/mm3). Resultados: El promedio de edad de los 105 pacientes incluidos en el estudio fue de 83,0 ± 6,4 años, con un predominio de pacientes del sexo femenino (61 por ciento). Treinta y tres pacientes (31 por ciento) procedían de residencias de ancianos. Un 35 por ciento que presentaban un deterioro grave del estado funcional. Cincuenta y ocho pacientes presentaron malnutrición en el momento del ingreso (prevalencia = 57,1 por ciento; IC95 por ciento 47,1 - 66,8 por ciento). Los únicos factores asociados a malnutrición al ingreso fueron presentar una enfermedad infecciosa y padecer enfermedad pulomonar obstructiva crónica (EPOC, razones de prevalencia 1,4 y 0,5 respectivamente). Conclusiones: La prevalencia de malnutrición en los ancianos hospitalizados de más de 70 años es muy elevada. Las enfermedades infecciosas en el momento del ingreso y la EPOC se asocian positiva y negativamente al riesgo de presentar malnutrición (AU)

[Internet physician's offices: main reasons for consultation and differences with Primary Care offices]. / Consultorios médicos por internet: principales motivos de consulta y diferencias con la Atención Primaria.

INTRODUCTION: Direct communication between patients and physicians through internet can represent an opportunity for medical consultation because of higher access that provides this medium. METHODS: A retrospective observational study was conducted in order to know the content and the characteristics of the consultations of a free medical physician's office by internet and its differences with the consultations in Primary Care. RESULTS: During a period of 45 days 221 consultations of which 188 corresponded to health problems were received. The average age of the consultants was very young (21.5 15.7 years; average SD), with predominance of men over women (1,4:1). In the consultations by internet, and in comparison with those of Primary Care, dermatological (relative risk: 6.1; CI 95%: 5.2-10.8), nervous system and sense organs (RR: 1.9; CI 95%: 1.3-2.8), genitourinary (RR: 2.0; CI 95%: 1.3-3.2), and digestive system (RR: 1.7; CI 95%: 1.1-2.6) consultations were carried out more frequently; less frequent consultations were those of respiratory tract (RR: 0.30; CI 95%: 0.16-0.56) and circulatory system (RR: 0.11; CI 95%: 0.03-0.33). CONCLUSIONS: The characteristics of this type of consultations and of the population group that ask for them are the reasons that their content and the grade of resolution of problems are very far from those of Primary Care.

Linfocitos intraepiteliales en la enfermedad celíaca / Intraepithelial lymphocytes in celiac disease

La enfermedad celíaca es una intolerancia permanente a los componentes del gluten que cursa con una alteración de la mucosa del intestino delgado generalmente reversible al excluir el gluten de la dieta. La patogenia del proceso es inmunitaria y se sabe que, además de un estrechísimo ligamiento con ciertos alelos HLA, en esta enfermedad existen alteraciones constantes en los linfocitos intraepiteliales (i-LIE). El desarrollo de una técnica para su determinación por citometría de flujo (CMF) nos ha permitido profundizar en el conocimiento de estas alteraciones y utilizar su determinación en el diagnóstico clínico. Nuestra experiencia demuestra que esta prueba presenta una excelente sensibilidad y especificidad en el diagnóstico de la enfermedad celíaca y que su utilidad es especialmente relevante en las presentaciones atípicas de la enfermedad. En este trabajo se resumen los resultados obtenidos y se discuten algunas de las hipótesis que se han vertido acerca de la posible participación de los LIE en la patogenia de la enfermedad (AU)

[Intraepithelial lymphocytes in celiac disease]. / Linfocitos intraepiteliales en la enfermedad celíaca.

Coeliac disease (CD) is a permanent intolerance to gluten that provokes alterations in the mucosa of the small intestine. The disease can usually be controlled by excluding gluten from the diet. CD is immunologically-mediated, with a strong linkage to certain HLA alleles and a permanently altered intraepithelial lymphocytes (IEL) pattern. The development of a flow cytometric technique for the evaluation of IEL subsets has increased our understanding of these alterations and has prepared the ground for its clinical application. Our experience shows that this procedure has excellent sensitivity and specificity in the diagnosis of CD and that it is particularly useful in the evaluation of atypical presentations of the disease. The present article reviews our experience in the diagnosis of CD and discusses some of the hypotheses that have been put forward on the possible role of IEL in its pathogenesis.

[The risk factors associated with colonization and bacteremia in non-tunnelled central venous catheters]. / Factores de riesgo asociados a colonización y bacteriemia en catéteres venosos centrales no tunelizados.

OBJECTIVE: To identify risk factors for colonization and bacteremia among patients with non-tunnelled central venous catheters. MATERIALS AND METHODS: A prospective study was conducted of a cohort of patients carrying non-tunnelled central venous catheters. Different parameters were obtained and the degree of its association with colonization of the distal portion of the catheter or with bacteremia associated with colonization was estimated. The CDC (centers for Disease Control) diagnostic criteria of colonization and catheter-related bacteremia were used. RESULTS: A total of 118 catheters were eventually analyzed, corresponding to 114 patients, with a catheterization mean time of 14 +/- 8 days (mean +/- SD); out of these 114 patients, 51 were colonized and in 22 the presence of associated bacteremia was confirmed. The parameters associated with a higher risk for catheter colonization included length of colonization, femoral location, number of lumina and a vital prognosis lower than one month. All these factors, with the exception of the increase in the number of lumina, showed an independent association with colonization on the multivariate analysis [catheterization length (in weeks): OR 1.46; 95% CI: 1.0-2.11; femoral location: OR 3.73; 95% CI: 1.16-11.9; vital prognosis lower than one month: OR 12.7; 95% CI: 1.4-112.7]. As for risk for catheter-related bacteremia, the univariate analysis showed an association with catheterization length and a vital prognosis lower than one month; the latter was the only factor that maintained an independent association in the multivariate analysis (OR 5.75; 95% CI: 1.17-28.27). CONCLUSION: The present study documents the relevance of prolonged catheterization as a consistent risk for colonization of non-tunnelled central venous catheters. This risk increases independently in canalization at femoral site and particularly among severely ill patients. The presence of these factors allows the identification of a high risk population for the development of catheter related bacteremia.

Factores de riesgo asociados a colonización y bacteriemia en catéteres venosos centrales no tunelizados / Risk factors associated with colonization and bacteremia in non-tunnelled central venous catheters

Objetivo. Identificar factores de riesgo de colonización y de bacteriemia en pacientes con catéteres venosos centrales no tunelizados. Material y métodos. Se estudió de forma prospectiva una cohorte de pacientes portadores de catéteres venosos centrales no tunelizados. Se recogieron diferentes variables y se calculó la magnitud de su asociación con la colonización del segmento distal del catéter o con bacteriemia asociada a dicha colonización. Se utilizaron los criterios diagnósticos de colonización y bacteriemia asociada a catéter establecidos por los Centers for Diseases and Control. Resultados. Se analizaron finalmente 118 catéteres, correspondientes a 114 pacientes, cuya media de cateterización fue de 14 ñ 8 días (media ñ DE), de los que 51 resultaron colonizados y de los que en 22 se confirmó la presencia de bacteriemia asociada. Las variables asociadas con un mayor riesgo de colonización del catéter fueron la duración de cateterización, la localización femoral, el número de luces y un pronóstico vital inferior a un mes; todos ellos, salvo el incremento en el número de luces, demostraron una asociación independiente con colonización en el análisis multivariante [duración de cateterización (en semanas): OR 1,46; IC95 por ciento: 1,0-2,11; localización femoral: OR 3,73; IC95 por ciento: 1,16-11,9; pronóstico vital inferior a un mes: OR 12,7; IC95 por ciento: 1,4-112,7]. En relación al riesgo de bacteriemia asociada a catéter, el análisis univariante demostró asociación con la duración de la cateterización y el pronóstico vital inferior a un mes; este último es el único que se mantuvo asociado de forma independiente en el análisis multivariante (OR 5,75; IC95 por ciento: 1,17-28,27). Conclusión. El presente trabajo confirma la importancia de la cateterización prolongada como un claro riesgo de colonización de los catéteres venosos centrales no tunelizados, incrementándose este riesgo de forma independiente en las canalizaciones a nivel femoral, y sobre todo en los pacientes graves. La presencia de estos factores nos permite identificar una población de alto riesgo para el desarrollo de bacteriemia asociada a catéter (AU)

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Risk factors for surgical-wound infection in general surgery: a prospective study.

OBJECTIVE: To quantify surgical-infection rate, to assess adherence with the antibiotic prophylaxis protocol, and to identify independent factors associated with surgical-wound infection (SWI). METHODS: We carried out a prospective study of a cohort of 2,237 general surgery patients with postsurgery stays of more than 48 hours. Odds ratios (OR) were estimated using unconditional multiple logistic regression. SETTING: A 1,300-bed, university-affiliated, tertiary-care hospital in Madrid, Spain. RESULTS: 254 patients developed SWI. The rate of adherence to the antibiotic prophylaxis protocol was 63.5%. Eight factors were independently associated with risk of SWI: age (OR = 1.2 for every 10 years of age); wound classification (clean-contaminated, OR = 6.4; contaminated, OR = 3.7; dirty or infected, OR = 9.3); antimicrobial prophylaxis (OR = 0.5); stay prior to surgery (OR = 1.1 for every 3 days); duration of operation (OR = 1.5 for every 60 minutes); malignant neoplasm (OR = 1.7); emergency procedure (OR = 1.99); intensive-care unit stay prior to surgery (OR = 2.6); and antimicrobial prophylaxis administered 2 or more hours before operation (OR = 5.3). CONCLUSION: In general, antimicrobial prophylaxis protects against SWI (OR = 0.5); however, administration 2 hours or more before the operation increases the risk of SWI by a factor of 5.3. Therefore, measures should be taken to ensure the correct timing of antimicrobial prophylaxis.

[Surgical wound infection: the risk factors and a predictive model]. / Infección de la herida quirúrgica: factores de riesgo y modelo predictivo.

BACKGROUND: The identification of the factors associated with infection of the surgical wound and the groups of patients with greatest risk of developing the same may aid in the elaboration of prevention strategies. METHODS: A prospective follow up study of a group of 1,143 patients admitted to general and digestive surgical departments in the Ramón y Cajal Hospital over a period of 7 months was carried out to determine the accumulated incidence of infection of the surgical wound and quantify the associated risk factors. A mathematical model was developed by logistic multiple regression analysis allowing the identification of groups of patients with high risk of infection which were internally evaluated posteriorly. RESULTS: Surgically intervened patients (70% of those admitted) developed a mean of 11 wound infections out of 100 patients. Five independent factors (age, surgical classification, length of intervention, presurgical stay, and presence of a central route) were associated to increased risk of infection. CONCLUSIONS: The factors associated with surgical wound infection identified in this study are related to the degree of wound contamination, the intrinsic risk of the patients and quality of health care. The model obtained is more efficient than the traditional surgical classification for the identification of groups of patients with high risk of infection.

[Temporal trends in nosocomial infections in a unit of pediatric cardiac surgery (1984-1988)]. / Evolución de las tendencias temporales de infección nosocomial en una unidad de cirugía cardíaca infantil (1984-1988).

We have evaluated the variations and the evolution of the temporal trends of cumulative incidence of hospital infections, their different localizations and causative organisms in a hospital ward and intensive care area from a pediatric cardiac surgery unit during the period 1984-1988. We also evaluated the effectiveness of our control and surveillance program by calculating from monthly records the cumulative incidence of monthly ad yearly rates of hospital infections and their localizations. The cumulative yearly incidence showed a decreasing trend (CI x 100 = 4.30-0.492 years) (SE, beta = 0.144; p less than 0.001), mainly owing to the reduction in urinary tract infections (CI x 100 = 6.93-1.426 years) (SE, beta = 0.452; p less than 0.001) and other infections (CI x 100 = 1.1-0.232 years) (SE, beta = 0.062; p less than 0.01). The most commonly isolated pathogens were E. coli, Pseudomonas sp and K. pneumoniae. The patients from that unit had a low risk of hospital infection during the 1984-1988 period, and this risk decreased concomitantly with the development of the program.