RESUMO
OBJECTIVE: Despite its great ubiquity and morbidity and mortality, the scientific evidence on the hospital control of multiresistant Acinetobacter baumanii (ABMR) outside the Intensive Care Units in Spain is scarce. The objective was to describe an epidemic outbreak by MRAB and analyze the effectiveness of the actions carried out. METHODS: Prospective observational study of admitted-rotated patients in a multipathological control at the University Hospital of Guadalajara, Spain, during the outbreak (September 20-November 3, 2017); using Mambrino Electronic Health Record. A genetic study of the resistance mechanism and molecular characterization of the strains were carried out. Frequency measurements were estimated, with subsequent comparative analysis of cases vs controls. RESULTS: The median age of the study population (N=138) was 83.2 years (Interquartile Range [IR]=69.7-90.1). There were 3 cases of ABMR infection among them. Thirteen percent required issolation, 17% because of MRAB. The MRAB incidence was 2.2 cases/100 admitted-rotated (mortality rate=33%). The excess stay for cases was 17±4.3 (95%CI=8.5-25.6), with an incidence density of 3 cases/103 days. The responsible strain was carbapenemase OXA-23. We found a single case in the colonization study of contacts. No MRAB was isolated from environmental samples. CONCLUSIONS: Along with epidemiological research, coordination and compliance with precautions; prompt identification and management of an outbreak are crucial to minimize the colonization pressure and to stop dissemination.
OBJETIVO: Pese a su gran ubicuidad y morbimortalidad, la evidencia científica sobre el control hospitalario de Acinetobacter baumanii multirresistente (ABMR) fuera de las Unidades de Cuidados Intensivos en España es escasa. El objetivo fue describir un brote epidémico por ABMR y analizar la efectividad del manejo. METODOS: Se realizó un estudio observacional retrospectivo de los ingresados-rotados (N=138) en un control de pluripatológicos del Hospital Universitario de Guadalajara (España), durante el brote (20 septiembre-3 noviembre de 2017), utilizando la Historia Clínica Electrónica Mambrino. Se realizó un estudio genético del mecanismo de resistencia y caracterización molecular de cepas. Se estimaron medidas de frecuencia y análisis comparativo de casos respecto a controles. RESULTADOS: La mediana de edad de la población expuesta fue de 83,2 años (Rango Intercuartílico [RI]=69,7-90,1). Hubo entre ellos tres casos de infección por ABMR. Requirieron aislamiento un 13% de los ingresados-rotados, el 17% por ABMR. La incidencia de ABMR fue de 2,2 por cada 100 ingresados-rotados (tasa de mortalidad=33%). El exceso de estancia de los casos fue de 17±4,3 días (IC95%=8,5-25,6), con una densidad de incidencia de 3/103 días. La cepa responsable fue carbapenemasa OXA-23. En el estudio de colonización de contactos se evidenció un caso. El estudio ambiental resultó negativo. CONCLUSIONES: Junto a la investigación epidemiológica, la coordinación y el cumplimiento de precauciones, la prontitud en la identificación y gestión del brote son determinantes para minimizar la presión de colonización y frenar la cadena de diseminación.
Assuntos
Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/enzimologia , Proteínas de Bactérias/metabolismo , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Unidades Hospitalares , beta-Lactamases/metabolismo , Acinetobacter baumannii/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Prospectivos , Espanha/epidemiologiaRESUMO
INTRODUCCIÓN: El objetivo fue estimar la efectividad de la vacuna (EV) trivalente inactivada para prevenir atenciones hospitalarias por gripe (AHG) en Guadalajara, Castilla-La Mancha (CLM), España, temporada 2018-2019. MATERIAL Y MÉTODOS: Estudio de cohortes retrospectivo; semanas 40/2018 a 13/2019. Fuentes: Programa Microbiología; historia clínica electrónica; censo poblacional (INE, 1/7/2018). Casos: AHG (urgencias y/u observación de urgencias o ingreso), confirmadas mediante prueba antigénica o PCR. Se calcularon: fracciones preventivas ([FPv(vacunados) y FPp(poblacional)]) y número necesario de pacientes a vacunar (NNV). RESULTADOS: Hubo 228 AHG (tasa incidencia [TI] acumulada=8,9/104; ≥ 65 años=65%; cobertura vacunal=13% [≥ 65 años=58%]; mortalidad=9%); con máxima incidencia en la semana 6.ª (TI=1,7/104) (en CLM, en la 4.ª). El mayor pico de VRS ocurrió en la 3.ª semana (en CLM, en la 52). La FPv entre 14-65 años fue del 96% (FPp=58%) y en ≥ 65, del 32% (FPp=21%). NNV=414. Como en España, predominó el virus A, siendo A(H3N2) un 13% más prevalente (cepa no concordante con la vacunal). CONCLUSIONES: La temporada se retrasó por una sostenida circulación del VRS. La EV resultó inferior a la nacional. Sería imprescindible impulsar próximas campañas para mejorar la cobertura
INTRODUCTION: The objective was to estimate the effectiveness of inactivated trivalent vaccine (VE) in preventing hospital flu care (HFC) in Guadalajara, Castile-La Mancha (CLM), Spain, 2018-19 season. MATERIAL AND METHODS: Retrospective cohort study (40/2018 to 13/2019 weeks). Sources: Microbiology programme; electronic medical history; population census (INE, 1/7/2018). Cases: Population requiring HFC (hospital emergencies and/or emergency observation unit and/or hospital admissions), confirmed by antigenic test and/or PCR. Preventive fractions [PFv(vaccinated) and PFp(population)] and Necessary number of patients to be vaccinated (NNV) were calculated. RESULTS: 228 HFT occurred [cumulative incidence rate (IR)=8.9/104; ≥65 years=65%; vaccination coverage=13% (≥65 years=58%); mortality=9%); maximum incidence in the 6th week (IR=1.7/104) (in CLM, in 4th)]. Highest peak of RSV occurred in the 3rd (in CLM, in the 52th). PFv (14-65 years) was 96% (PFp=58%) and in ≥65, 32% (PFp=21%). NNV=414. As in Spain, influenza virus A predominated, with A(H3N2) being 13% more prevalent (strain not included in the vaccine). CONCLUSIONS: The season was delayed by sustained VRS circulation. The VE was lower than the national one. It is be essential to promote future campaigns to improve vaccination coverage
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Influenza Humana/imunologia , Influenza Humana/prevenção & controle , Resultado do Tratamento , Assistência Hospitalar/organização & administração , Necessidades e Demandas de Serviços de Saúde , Vacinas contra Influenza , Estudos de Coortes , Cobertura Vacinal , Espanha , Estudos Retrospectivos , Vírus Sincicial Respiratório Humano/imunologia , Infecções por Vírus Respiratório Sincicial/epidemiologiaRESUMO
INTRODUCTION: The objective was to estimate the effectiveness of inactivated trivalent vaccine (VE) in preventing hospital flu care (HFC) in Guadalajara, Castile-La Mancha (CLM), Spain, 2018-19 season. MATERIAL AND METHODS: Retrospective cohort study (40/2018 to 13/2019 weeks). SOURCES: Microbiology programme; electronic medical history; population census (INE, 1/7/2018). CASES: Population requiring HFC (hospital emergencies and/or emergency observation unit and/or hospital admissions), confirmed by antigenic test and/or PCR. Preventive fractions [PFv(vaccinated) and PFp(population)] and Necessary number of patients to be vaccinated (NNV) were calculated. RESULTS: 228 HFT occurred [cumulative incidence rate (IR)=8.9/104; ≥65 years=65%; vaccination coverage=13% (≥65 years=58%); mortality=9%); maximum incidence in the 6th week (IR=1.7/104) (in CLM, in 4th)]. Highest peak of RSV occurred in the 3rd (in CLM, in the 52th). PFv (14-65 years) was 96% (PFp=58%) and in ≥65, 32% (PFp=21%). NNV=414. As in Spain, influenza virus A predominated, with A(H3N2) being 13% more prevalent (strain not included in the vaccine). CONCLUSIONS: The season was delayed by sustained VRS circulation. The VE was lower than the national one. It is be essential to promote future campaigns to improve vaccination coverage.
