Impact of the “Zero Resistance” program on acquisition of multidrug-resistant bacteria in patients admitted to Intensive Care Units in Spain. A prospective, intervention, multimodal, multicenter study / Impacto del Proyecto “Resistencia Zero” en la adquisición de bacterias multirresistentes en pacientes ingresados en Unidades de Cuidados Intensivos en España. Estudio de intervención, multimodal y multicéntrico

Objective To assess the impact of a multimodal interventional project (“Zero Resistance”) on the acquisition of multidrug-resistant bacteria (MDR-B) during the patient’s ICU stay. Design Prospective, open-label, interventional, multicenter study. Setting 103 ICUs. Patients Critically ill patients admitted to the ICUs over a 27-month period. Interventions Implementation of a bundle of 10 recommendations to prevent emergence and spread of MDR-B in the ICU. Main variable of interest Rate of patients acquiring MDR-B during their ICU stay, with differentiation between colonization and infection. Results A total of 139,505 patients were included. In 5409 (3.9%) patients, 6020 MDR-B on ICU admission were identified, and in 3648 (2.6%) patients, 4269 new MDR-B during ICU stay were isolated. The rate of patients with MDR-B detected on admission increased significantly (IRR 1.43, 95% CI 1.31–1.56) (p<0.001) during the study period, with an increase of 32.2% between the initial and final monthly rates. On the contrary, the rate of patients with MDR-B during ICU stay decreased non-significantly (IRR 0.93, 95% CI 0.83–1.03) (p=0.174), with a 24.9% decrease between initial and final monthly rates. According to the classification into colonization or infection, there was a highly significant increase of MDR-B colonizations detected on admission (IRR 1.69, 95% CI 1.52–1.83; p<0.0001) and a very significant decrease of MDR-B-infections during ICU stay (IRR 0.67, 95% CI 0.57–0.80, p<0.0001). Conclusions The implementation of ZR project-recommendations was associated with a significantly reduction an infection produced by MDR-B acquired during the patient’s ICU stay (AU)

Objetivo Evaluar el impacto de un proyecto de intervención multimodal (“Resistencia Zero”, RZ) en la adquisición de bacterias multirresistentes (BMR) durante la estancia en UCI. Diseño Estudio prospectivo, abierto, intervencionista, multicéntrico. Ámbito 103 UCI. Pacientes Pacientes críticos ingresados en UCI, durante un período de 27 meses. Intervenciones Implementación de un paquete de 10 recomendaciones para prevenir la aparición y propagación de BMR en UCI. Principal variable de interés Tasa de pacientes que adquieren BMR durante su estancia en UCI, diferenciando entre colonización e infección. Resultados Se incluyeron 139.505 pacientes. En 5.409(3,9%), se identificaron 6.020 BMR al ingreso y en 3.648(2,6%), se aislaron 4.269 nuevas BMR durante la estancia en UCI. La tasa de pacientes con BMR detectadas al ingreso aumentó significativamente (IRR 1,43, IC 95% 1,31–1,56) (p<0,001) durante el periodo de estudio, con un incremento del 32,2% entre las tasas mensuales inicial y final. Por el contrario, la tasa de pacientes con BMR detectadas durante la estancia en UCI disminuyó, no significativamente (IRR 0,93, IC 95% 0,83–1,03) (p=0,174), con una disminución del 24,9% entre las tasas mensuales iniciales y finales. Según la clasificación en colonización o infección, hubo un aumento significativo de colonizaciones por BMR detectadas al ingreso (IR 1,69, IC 95% 1,52–1,83; p<0,0001) y una disminución significativa de infecciones producidas por BMR adquiridas durante la estancia en UCI (IR 0,67, IC 95% 0,57–0,80, p<0,0001). Conclusiones La implementación de las recomendaciones del proyecto RZ se asoció con una reducción significativa de pacientes con infecciones por BMR adquiridas en UCI (AU)

Impact of the "Zero Resistance" program on acquisition of multidrug-resistant bacteria in patients admitted to Intensive Care Units in Spain. A prospective, intervention, multimodal, multicenter study.

OBJECTIVE: To assess the impact of a multimodal interventional project ("Zero Resistance") on the acquisition of multidrug-resistant bacteria (MDR-B) during the patient's ICU stay. DESIGN: Prospective, open-label, interventional, multicenter study. SETTING: 103 ICUs. PATIENTS: Critically ill patients admitted to the ICUs over a 27-month period. INTERVENTIONS: Implementation of a bundle of 10 recommendations to prevent emergence and spread of MDR-B in the ICU. MAIN VARIABLE OF INTEREST: Rate of patients acquiring MDR-B during their ICU stay, with differentiation between colonization and infection. RESULTS: A total of 139,505 patients were included. In 5409 (3.9%) patients, 6020 MDR-B on ICU admission were identified, and in 3648 (2.6%) patients, 4269 new MDR-B during ICU stay were isolated. The rate of patients with MDR-B detected on admission increased significantly (IRR 1.43, 95% CI 1.31-1.56) (p<0.001) during the study period, with an increase of 32.2% between the initial and final monthly rates. On the contrary, the rate of patients with MDR-B during ICU stay decreased non-significantly (IRR 0.93, 95% CI 0.83-1.03) (p=0.174), with a 24.9% decrease between initial and final monthly rates. According to the classification into colonization or infection, there was a highly significant increase of MDR-B colonizations detected on admission (IRR 1.69, 95% CI 1.52-1.83; p<0.0001) and a very significant decrease of MDR-B-infections during ICU stay (IRR 0.67, 95% CI 0.57-0.80, p<0.0001). CONCLUSIONS: The implementation of ZR project-recommendations was associated with a significantly reduction an infection produced by MDR-B acquired during the patient's ICU stay.

Antimicrobial stewardship program at a tertiary care academic medical hospital: Clinical, microbiological and economic impact. A 5-year temporary descriptive study.

INTRODUCTION: Few prospective studies analyze, with sufficient duration, the impact of an antimicrobial stewardship program (AMSP) carried out entirely in a hospital. METHODS: Descriptive study evaluating the consumption of antimicrobials expressed in defined daily doses (DDD) per 100 hospital occupied bed-days (OBDs) stratified in medical, surgical and intensive care unit (ICU) and the incidence of densities (ID) per 1,000 hospital OBDs of the prevalent multidrug-resistant organisms (MDRO) in a tertiary hospital, over a period of 5 years before and after the implementation of an AMSP. Analysis of direct costs and those associated with hospital stay and mortality. RESULTS: A total of 32,802 patients with antibiotic treatment were included in the intervention period (2013-2017). Non-imposed advice was exercised in 14.9%. The degree of adherence to recommendation was 87.9%, direct treatment and de-escalation being the most frequently admitted interventions (P<0.001). Overall hospital consumption of antibacterials in DDD/100s decreased by 5.7% (77.04 vs. 71.33) between 2008 and 2017. In ICU, the average DDD/100s showed a reduction from 155 to 113 (mean difference -18, P=0.005). There was a decrease in the DI/1000 OBDs of MDROs in the post-intervention period (RR 0.78; CI 95% [0.73, 0.84], P<0.001). The average annual cost of antibacterials declined from €1,435,048 to €955,805 (mean difference -€469,243; P=0.001). CONCLUSION: Long-term maintenance of a hospital AMSP was associated with a reduction in antibiotic consumption, especially in ICU, as well as a beneficial ecological impact and economic savings.

Tratamiento con dalbavancina de infección protésica de rodilla por Staphylococcus epidermidis resistente a la oxacilina / Dalbavancin treatment of prosthetic knee infection due to oxacillin-resistant Staphylococcus epidermidis

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Sepsis grave por infección de prótesis articular por Myroides odoratimimus / Severe sepsis caused by infected prosthesis joint due to Myroides odoratimimus

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Artritis infecciosa con osteomielitis debida a Scedosporium prolificans en un paciente inmunocompetente / Infectious arthritis with osteomyelitis due to Scedosporium prolificans in an immunocompetent patient

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Deflagración espontánea tras uso de solución de base alcohólica en la higiene de manos / Spontaneous flash fires during use of alcohol-based hand rubs

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Síndrome de Hoffmann como presentación de una miopatía hipotiroidea / Hoffmann’s syndrome as an onset for us of hypothyroid myopathy

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[Risk factors for total prosthetic joint infection. Case-control study]. / Factores de riesgo de infección de prótesis total articular: estudio de casos y controles.

BACKGROUND AND OBJECTIVE: To identify the infection risk factors in knee and hip total prosthesis. METHOD: Case-control study of arthoplasties performed during 10 years. RESULTS: By means of conditional multivariate analysis, infection risk factors with greater odds ratio (OR) were surgical risk rate >or= 2, according to the National Nosocomial Infections Surveillance (NNIS) (OR, 3.3; 95% confidence interval [CI], 1.1-10.8) and post-operative non-infectious complications (OR, 8.9; 95% CI, 1.1-83.1) (p < 0.05). The global infection rate was 2.4% (95% CI, 1.6%-3.2%) of 1,666 joint implants. Gram-positive cocci were the principal involved microorganisms (63%). CONCLUSIONS: A high NNIS together with non-infectious post-operative complications increase the risk of prosthesis infection.

Factores de riesgo de infección de prótesis total articular: estudio de casos y controles / Risk factors for total prosthetic joint infection. Case-control study

Fundamento y objetivo: El propósito del presente estudio es identificar los factores de riesgo de infección en prótesis totales de rodilla y cadera. Método: Se ha realizado un estudio de casos y controles entre las artroplastias efectuadas durante 10 años. Resultados: Mediante el ajuste con una regresión logística condicional múltiple, los factores de riesgo asociados a una mayor odds ratio (OR) de infección fueron: un índice de riesgo quirúrgico mayor o igual a 2 según el National Nosocomial Infections Surveillance (NNIS) (OR = 3,3; intervalo de confianza [IC] del 95%, 1,1-10,8) y las complicaciones no infecciosas posquirúrgicas (OR = 8,9; IC del 95%, 1,1-83,1) (p < 0,05). La tasa de infección global de las artroplastias fue del 2,4% (IC del 95%, 1,6-3,2%) sobre 40 casos de 1.666 implantes y los principales microorganismos fueron cocos grampositivos (63%). Conclusiones: Un índice NNIS elevado y las complicaciones posquirúrgicas no infecciosas incrementan el riego de infección de las prótesis articulares de rodilla y cadera

Background and objective: To identify the infection risk factors in knee and hip total prosthesis. Method: Case-control study of arthoplasties performed during 10 years. Results: By means of conditional multivariate analysis, infection risk factors with greater odds ratio (OR) were surgical risk rate >= 2, according to the National Nosocomial Infections Surveillance (NNIS) (OR, 3.3; 95% confidence interval [CI], 1.1-10.8) and post-operative non-infectious complications (OR, 8.9; 95% CI, 1.1-83.1) (p < 0.05). The global infection rate was 2.4% (95% CI, 1.6%-3.2%) of 1,666 joint implants. Gram-positive cocci were the principal involved microorganisms (63%). Conclusions: A high NNIS together with non-infectious post-operative complications increase the risk of prosthesis infection

Delirio inducido por azitromicina en un anciano / Azitromycin-induced delirium in on old patient

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