Primera onda pandémica de COVID-19 en Navarra, febrero-junio 2020 / First wave of the COVID-19 pandemic in Navarre, Spain, February-June 2020

Fundamento. En 2020 se declaró la pandemia de COVID-19. La escasez de pruebas diagnósticas limitó la monitorización de la primera onda pandémica. El objetivo fue estimar y describir esta onda en Navarra (España). Métodos. La primera onda pandémica en Navarra, desde febrero a junio de 2020, se caracterizó a partir de la vigilancia epidemiológica reforzada, de la encuesta seroepidemiológica nacional y del registro de mortalidad. Resultados. Se confirmaron 10.358 personas con COVID-19 (1,6 % de la población), 1.943 requirieron ingreso hospitalario (3 por 1.000 habitantes), 139 ingresaron en UCI (21 por 100.000) y 529 fallecieron (80 por 100.000). La mortalidad aumentó exponencialmente con la edad, superando el 1 % en mayores de 85 años. El 58 % de las defunciones ocurrieron en residentes en centros socio-sanitarios. El registro de mortalidad recibió notificación de 733 muertes por COVID-19 confirmado o probable, mientras que el exceso de mortalidad fue de 613 defunciones (20,9 %) concentradas entre mediados de marzo y finales de abril. Al final de la onda, se estima que el 6,7 % (n = 44.000) de la población tenía anticuerpos detectables frente al SARS-CoV-2 y el 10,3 % había pasado la infección. La incidencia de infección estimada aumentó abruptamente en la primera quincena de marzo y descendió rápidamente durante el confinamiento domiciliario en la segunda quincena de marzo. Conclusiones. La primera onda pandémica produjo un número enorme de casos, hospitalizaciones y defunciones en Navarra en pocas semanas. El marcado descenso de los contagios durante el confinamiento domiciliario sugiere una eficacia y un impacto considerables de esta medida en la contención de la transmisión.(AU)

Background. The COVID-19 pandemic was declared in 2020. The shortage of diagnostic tests limited monitoring of the first wave of the pandemic. This study estimates and describes the wave in Navarre (Spain). Methods. Enhanced epidemiological surveillance, seroepidemiological survey estimates and mortality registries were used to characterise the first wave of the COVID-19 pandemic from February to June 2020 in Navarre. Results. A total of 10,358 persons (1.6 % of population) were confirmed with COVID-19, 1,943 cases were hospitalized (3 per 1,000 inhabitants), 139 were admitted to the ICU (21 per 100,000 inhabitants), and 529 people died from confirmed COVID-19 (80 per 100,000). Mortality increased exponentially with age, exceeding 1 % in people over 85 years. 58 % of deaths occurred amongst nursing home residents. The mortality registry received reporting of 733 confirmed or probable COVID-19 deaths, while the excess deaths during this period were 613 (20.9 %) concentrated from mid-March to the end of April. It is estimated that, at the end of June, 6.7 % (n = 44,000) of the population had detectable antibodies against SARS-CoV-2 and 10.3 % had had the infection. The estimates of SARS-CoV-2 infection incidence increased sharply in the first half of March and decreased quickly during the home lockdown in the second half of March. Conclusions. The first wave of the pandemic produced a high number of cases, hospitalizations and deaths in Navarre in a few weeks. The pronounced decrease of SARS-CoV-2 infections during the home lockdown suggests considerable efficacy and impact of this measure for transmission control.(AU)

[First wave of the COVID-19 pandemic in Navarre, Spain, February-June 2020].

BACKGROUND: The COVID-19 pandemic was declared in 2020. The shortage of diagnostic tests limited monitoring of the first wave of the pandemic. This study estimates and describes the wave in Navarre (Spain). METHODS: Enhanced epidemiological surveillance, seroepidemiological survey estimates and mortality registries were used to characterise the first wave of the COVID-19 pandemic from February to June 2020 in Navarre. RESULTS: A total of 10,358 persons (1.6?% of population) were confirmed with COVID-19, 1,943 cases were hospitalized (3 per 1,000 inhabitants), 139 were admitted to the ICU (21 per 100,000 inhabitants), and 529 people died from confirmed COVID-19 (80 per 100,000). Mortality increased exponentially with age, exceeding 1?% in people over 85 years. 58?% of deaths occurred amongst nursing home residents. The mortality registry received reporting of 733 confirmed or probable COVID-19 deaths, while the excess deaths during this period were 613 (20.9?%) concentrated from mid-March to the end of April. It is estimated that, at the end of June, 6.7?% (n?=?44,000) of the population had detectable antibodies against SARS-CoV-2 and 10.3?% had had the infection. The estimates of SARS-CoV-2 infection incidence increased sharply in the first half of March and decreased quickly during the home lockdown in the second half of March. CONCLUSIONS: The first wave of the pandemic produced a high number of cases, hospitalizations and deaths in Navarre in a few weeks. The pronounced decrease of SARS-CoV-2 infections during the home lockdown suggests considerable efficacy and impact of this measure for transmission control.

Comparación de las características clínicas y diagnósticas de los subgrupos A y B del virus respiratorio sincitial / Comparison of clinical features and diagnosis between the A and B subgroups of respiratory syncytial virus

Fundamento: La infección del tracto respiratorio inferior por virus respiratorio sincitial (VRS) es la causa más frecuente de ingreso en menores de 2 años. Los subgrupos de VRS A y B pueden circular indistintamente. Nuestro objetivo fue determinar si existían diferencias clínicas entre los VRS subgrupo A y B, y si la sensibilidad del test de detección rápida de antígeno del VRS por inmunocromatografía difiere de la técnica de referencia (RT-PCR). Material y métodos: Estudio retrospectivo, observacional realizado en el hospital terciario desde octubre de 2013 a marzo de 2014. Se consultó la historia clínica y las analíticas de los niños menores de 5 años ingresados en por infección respiratoria de vías bajas con RT-PCR positivo a VRS en una muestra de lavado nasal. De la misma muestra previamente se había realizado el test de detección rápida de antígeno de VRS. Resultados: Se confirmaron 198 niños menores de 5 años para VRS mediante RT-PCR: 55 (28%) fueron VRS-A, 132 (67%) VRS-B y 11 (5%) fueron positivos para ambos subgrupos. No encontramos diferencias entre subgrupos en antecedentes, clínica, radiología, analítica y gravedad. La sensibilidad del test de detección rápida fue 52%, mayor para VRS-A (69%) que para VRS-B (44%, p=0,001). Conclusiones: Los dos subgrupos de VRS fueron indistinguibles por su presentación clínica y pronóstico. La sensibilidad del test rápido en comparación con la RT-PCR fue baja, lo que limita su utilidad en la toma de decisiones clínicas (AU)

Background: Lower respiratory tract infection by respiratory syncytial virus (RSV) is the most frequent cause of admission in children under 2 years old. The RSV subgroups A and B may circulate simultaneously. We aimed to determine whether clinical differences exist between RSV subgroups A and B. Additionally, we tested the sensitivity of the rapid antigen detection test (RADT) based on immunochromatography in diagnosing subgroups A and B, taking the polymerase chain reaction assay (RT-PCR) as reference. Methods: A retrospective observational study was performed in a tertiary hospital from October 2013 to March 2014. Clinical records and analytical variables of all children under 5 admitted with lower respiratory tract infection and RT-PCR positive for RSV in nasal lavage were consulted. Previously, the RADT for RSV had been performed from the same sample. Results: A total of 198 children under 5 were diagnosed with RSV by RT-PCR: 55 (28%) were RSV-A, 132 (67%) RSVB and 11 (5%) were positive for both subgroups. No differences were observed between subgroups in medical history, symptoms, radiological and analytical findings, and severity. The sensitivity of RADT for RSV was 52%, higher for RSV-A (69%) than for RSV-B (44%, p=0.001). Conclusions: The two RSV subgroups were indistinguishable in symptoms and prognosis. The sensitivity of RADT compared to RT-PCR was low and limits its usefulness for clinical decision-making (AU)

[Comparative study of HIV-1/2 antibody confirmatory assay: Geenius™ versus INNO-LIA™]. / Estudio comparativo de técnicas confirmatorias de anticuerpos frente VIH-1/2: Geenius™versus INNO-LIA™.

OBJECTIVE: The aim of the study is to compare two confirmatory tests for HIV-1/2 infection. METHODS: A prospective study was carried out between 01/01/2015 and 12/31/2015. Serum samples with repeatedly positive results in the Antibody-Antigen-HIV-1/2 (Architect, Abbott) screening assay were included. The serum samples corresponding to new diagnosed cases were selected and were used to compare the two confirmatory assays: Geenius™ HIV-1/2 (Bio-Rad) and INNO-LIA™ HIV-1/2 score line-immunoassay (Innogene-tics®). The HIV-1 viral load (Cobas® AmpliPrepHIV, Ro-che) was performed in discordant or indeterminate cases. RESULTS: Eight five samples were included. The results of both confirmatory assays were concordant in 80/85 samples: 53 HIV-1, 1 HIV-2, 25 negative and one indeterminate. Cohen's Kappa concordance coefficient between Geenius™ and INNO-LIA™ techniques was very high (0.878). CONCLUSIONS: The concordance between the two assays is high. The procedure for Geenius™ is simple and fast. Geenius™ is a good alternative to include in the HIV-1/2 diagnostic algorithm.

Moderate influenza vaccine effectiveness against hospitalisation with A(H3N2) and A(H1N1) influenza in 2013-14: Results from the InNHOVE network.

We conducted a multicentre test negative case control study to estimate the 2013-14 influenza vaccine effectiveness (IVE) against hospitalised laboratory confirmed influenza in 12 hospitals in France, Italy and Spain. We included all ≥18 years hospitalised patients targeted by local influenza vaccination campaign reporting an influenza-like illness within 7 days before admission. We defined as cases patients RT-PCR positive for influenza and as controls those negative for all influenza virus. We used a logistic regression to calculate IVE adjusted for country, month of onset, chronic diseases and age. We included 104 A(H1N1)pdm09, 157 A(H3N2) cases and 585 controls. The adjusted IVE was 42.8% (95%CI: 6.3;65;0) against A(H1N1)pdm09. It was respectively 61.4% (95%CI: -1.9;85.4), 39.4% (95%CI: -32.2;72.2) and 19.7% (95%CI:-148.1;74.0) among patients aged 18-64, 65-79 and ≥80 years. The adjusted IVE against A(H3N2) was 38.1% (95%CI: 8.3;58.2) overall. It was respectively 7.8% (95%CI: -145.3;65.4), 25.6% (95%CI: -36.0;59.2) and 55.2% (95%CI: 15.4;76.3) among patients aged 18-64, 65-79 and ≥80 years. These results suggest a moderate and age varying effectiveness of the 2013-14 influenza vaccine to prevent hospitalised laboratory-confirmed influenza. While vaccination remains the most effective prevention measure, developing more immunogenic influenza vaccines is needed to prevent severe outcomes among target groups.

Cause of death in hospitalized patients with laboratory-confirmed influenza.

BACKGROUND: We analyzed the underlying cause of death recorded in hospitalized patients with laboratory-confirmed influenza. METHODS: The present study included all patients with a laboratory-confirmed diagnosis of influenza during the influenza seasons 2009-2010 to 2013-2014 who were attended to in hospital and died. Their underlying cause of death according to the International Classification of Diseases 10th Revision was obtained from the Navarre Mortality Registry. RESULTS: Among 49 patients studied, the underlying causes of death were 35% influenza, 4% pneumonia, 14% other respiratory diseases, 10% circulatory disease and 37% other causes. CONCLUSIONS: Non-cardiorespiratory causes accounted for a third of deaths in patients with confirmed influenza, thus all-cause mortality should be considered in estimating the full burden of influenza mortality.

Cause of death in hospitalized patients with laboratory-confirmed influenza / Causa de muerte en pacientes hospitalizados con gripe confirmada por laboratorio

Background: We analyzed the underlying cause of death recorded in hospitalized patients with laboratory-confirmed influenza. Methods: The present study included all patients with a laboratory-confirmed diagnosis of influenza during the influenza seasons 2009-2010 to 2013-2014 who were attended to in hospital and died. Their underlying cause of death according to the International Classification of Diseases 10th Revision was obtained from the Navarre Mortality Registry. Results: Among 49 patients studied, the underlying causes of death were 35% influenza, 4% pneumonia, 14% other respiratory diseases, 10% circulatory disease and 37% other causes. Conclusions: Non-cardiorespiratory causes accounted for a third of deaths in patients with confirmed influenza, thus all-cause mortality should be considered in estimating the full burden of influenza mortality (AU)

Fundamento: La mortalidad por gripe no se conoce bien porque la mayoría de las personas que mueren por gripe no se confirman por laboratorio. Analizamos la causa básica de muerte registrada en los pacientes hospitalizados con gripe confirmada por laboratorio. Métodos: Se incluyeron todos los pacientes con diagnóstico de gripe por laboratorio que habían sido atendidos en el hospital y murieron durante las temporadas 2009-2010 a 2013-2014 en Navarra. La causa básica demuerte se obtuvo del Registro de Mortalidad. Resultados: Entre los 49 pacientes estudiados, la causa básica de muerte fue en el 35% gripe, en el 4% neumonía, en el 14% otras enfermedades respiratorias, en el 10% enfermedades cardiovasculares y en el 37% otras causas. Conclusiones: Un tercio de las muertes en pacientes con gripe confirmada se asignaron a causas no cardiorrespiratorias. Deberían tenerse en cuenta todas las causas para estimar la carga total de la mortalidad por gripe (AU)

Cryptosporidium hominis genotypes involved in increased incidence and clusters of cases, Navarra, Spain, 2012.

SUMMARY Two clusters of confirmed cryptosporidiosis infections were detected in Navarra, Spain, in the summer of 2012, in the context of an increased incidence in the region. Molecular subtyping of Cryptosporidium hominis determined that one cluster, occurring in an urban area, was due to the predominant circulating subtype IbA10G2R2 and the other cluster, with cases occurring in a rural area, was due to a rare subtype IaA18R3. No single exposure was associated with infection, although exposure to certain children's pools was reported by a majority of patients interviewed in each cluster. Genotyping tools were useful in the investigation and could aid investigation of cryptosporidiosis outbreaks in Spain in the future.

Vaccine effectiveness in preventing laboratory-confirmed influenza in Navarre, Spain: 2013/14 mid-season analysis.

We estimate mid-2013/14 season vaccine effectiveness (VE) of the influenza trivalent vaccine in Navarre, Spain. Influenza-like illness cases attended in hospital (n=431) and primary healthcare (n=344) were included. The overall adjusted VE in preventing laboratory-confirmed influenza was 24% (95% CI: -14 to 50). The VE was 40% (95% CI: -12 to 68) against influenza A(H1)pdm09 and 13% (95% CI: -36 to 45) against influenza A(H3). These results suggest a moderate preventive effect against influenza A(H1)pdm09 and low protection against influenza A(H3).

Early estimates of influenza vaccine effectiveness in Navarre, Spain: 2012/13 mid-season analysis.

We present estimates of influenza vaccine effectiveness (VE) in Navarre, Spain, in the early 2012/13 season, which was dominated by influenza B. In a population-based cohort using electronic records from physicians, the adjusted VE in preventing influenzalike illness was 32% (95% confidence interval (CI): 15 to 46). In a nested test-negative case-control analysis the adjusted VE in preventing laboratory-confirmed influenza was 86% (95% CI: 45 to 96). These results suggest a high protective effect of the vaccine.

Decline in influenza vaccine effectiveness with time after vaccination, Navarre, Spain, season 2011/12.

This study evaluates the influenza vaccine effectiveness (VE) in preventing laboratory-confirmed cases in Navarre, Spain, in the 2011/12 season in which the peak was delayed until week 7 of 2012. We conducted a test-negative case­control study. Patients with influenza-like illness in hospitals and primary healthcare were swabbed for testing by reverse transcription-polymerase chain reaction. Influenza vaccination status and other covariates were obtained from healthcare databases. The vaccination status of confirmed cases and negative controls was compared after adjusting for potential confounders. VE was calculated as (1-odds ratio)x100. The 411 confirmed cases (93% influenza A(H3)) were compared with 346 controls. Most characterised viruses did not match the vaccine strains. The adjusted estimate of VE was 31% (95% confidence interval (CI): -21 to 60) for all patients, 44% (95% CI: -11 to 72) for those younger than 65 years and 19% (95% CI: -146 to 73) for those 65 or older. The VE was 61% (95% CI: 5 to 84) in the first 100 days after vaccination, 42% (95% CI: -39 to 75) between 100 and 119 days, and zero thereafter. This decline mainly affected people aged 65 or over. These results suggest a low preventive effect of the 2011/12 seasonal influenza vaccine, and a decline in VE with time since vaccination.

Influenza outbreaks in nursing homes with high vaccination coverage in Navarre, Spain, 2011/12.

In the 2011/12 season, three influenza outbreaks were studied in nursing homes with high vaccination coverage in Navarre, Spain. Attack rates ranged from 2.9% to 67%. Influenza A/Stockholm/18/2011(H3N2) virus strain was isolated from the three outbreaks. Vaccination should be complemented with other hygiene measures in nursing homes. Early detection of influenza outbreaks in nursing homes can aid in their control.

Endocarditis polimicrobiana por Streptococcus salivarius y Pseudomonas stutzeri: buena evolución tras cirugía precoz / Polimicrobial endocarditis by Streptococcus salivarius and Pseudomonas stutzeri: good evolution after early surgery

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Bacteriemia de origen comunitario / Community-acquired bacteremia

La bacteriemia sigue siendo una de las causas más importantes de mortalidad a pesar de contar con numerosos antimicrobianos y del aumento de las medidas de soporte. Existen varios factores, como el tipo de microorganismo, la edad, la enfermedad de base y el lugar de la adquisición de la bacteriemia, que pueden modificar el pronóstico de esta infección. El objetivo del presente estudio es analizar los episodios de bacteriemia comunitaria recogidos de forma prospectiva en el Hospital de Basurto (Bilbao, España). Se estimó la incidencia de bacteriemia con un protocolo preestablecido (SEPSIS-DATA) desde enero de 1994 hasta septiembre de 2001. Se recogieron todos los episodios de bacteriemia llegados al hospital, seleccionando para este estudio únicamente los de adquisición extrahospitalaria, que fueron 2886 episodios. En nuestro hospital el 67,82 por ciento de las bacteriemias son comunitarias y este dato permanece estable a lo largo de los 8 años del periodo de estudio. El 54,64 por ciento de los pacientes eran varones, 1603 (55,54 por ciento) mayores de 60 años. Las enfermedades de base más frecuentes eran diabetes (15,75 por ciento), neoplasia (14,96 por ciento) e infección por VIH (12,9 por ciento). La mayoría de los episodios (2216, 76,8 por ciento) ingresaron en el área médica, 335 (11,6 por ciento) en cirugía, 200 (6,9 por ciento) en pediatría y 135 (4,67 por ciento) en UVI. El origen de la bacteriemia fue urinario (33 por ciento), gastrointestinal (18 por ciento) o respiratorio (18,26 por ciento). Los microorganismos más frecuentes fueron E. coli (36 por ciento), S. pneumoniae (13 por ciento), S. aureus (9,46 por ciento), S. enteritidis (2,87 por ciento), P. aeruginosa (2,71 por ciento), P. mirabilis (2,65 por ciento) y N. meningitidis (2,45 por ciento). La bacteriemia fue polimicrobiana en un 6,27 por ciento. Los antibióticos más utilizados fueron ceftriaxona (31 por ciento), gentamicina (7,3 por ciento) y amoxicilina-ácido clavulánico (6,9 por ciento). La mortalidad cruda fue del 13,82 por ciento. La frecuencia relativa comunitaria/nosocomial permanece estable en dos tercios del total de casos. Disminuyen las bacteriemias en el grupo de edad de 20-40 años e infección por VIH. Aumentan E. coli y S. pneumoniae; disminuye S. aureus. El consumo de imipenem y quinolonas ha aumentado. La resistencia de E. coli a las quinolonas pasa del 3,54 por ciento en el año 1995 al 14,36 por ciento en el 2000. La mortalidad ha disminuido ligeramente, sin diferencias significativas (AU)

[Community-acquired bacteremia]. / Bacteriemia de origen comunitario.

Bacteremia continues to be one of the main causes of mortality despite the existence of numerous antimicrobial agents and an increase in means of support. A variety of factors, such as the type of microorganism, age, the underlying disease and where the bacteremia was acquired, can change the prognosis of the infection. The aim of this study was to analyze the cases of community-acquired bacteremia gathered prospectively from the Basurto hospital in Bilbao, Spain. The incidence of bacteremia was estimated using preestablished protocol (SEPSIS-DATA) from January 1994 to September 2001. Information was gathered on all the cases of bacteremia at the hospital and only those which were of non-hospital origin (2886 cases) were selected for the study. In our hospital, 67.82% of the bacteremia cases were community-acquired, a figure which remained stable throughout the 8-year study period. A total of 54.64% of the patients were male, 1603 (55.54%) of whom were over age 60 years. The most common underlying diseases were diabetes (15.75%), neoplasia (14.96%) and HIV infection (12.9%). The majority of the cases (2216, 76.8%) were admitted to the general medicine ward, 335 (11.6%) to surgery, 200 (6.9%) to pediatrics and 135 (4.67%) to ICU. The origin of the bacteremia was urinary (33%), gastrointestinal (18%) or respiratory (18.26%). The most common microorganisms were E. coli (36%), S. pneumoniae (13%), S. aureus (9.46%), S. enteritidis (2.87%), P. aeruginosa (2.71%), P. mirabilis (2.65%) and N. meningitidis (2.45%). The bacteremia was polymicrobial in 6.27% of the cases. The most used antibiotics were ceftriaxone (31%), gentamicin (7.3%) and amoxicillin-clavulanic acid (6.9%). Overall mortality was 13.82%. The relative frequency of community-acquired/nosocomial infection remained stable in two-thirds of the total cases. The incidence of bacteremia decreased in the 20-40 year age group and in those with HIV infection. E. coli and S. pneumoniae increased, while S. aureus decreased. The use of imipenem and quinolones increased. E. coli resistance to quinolones increased from 3.54% in 1995 to 14.36% in 2000. Mortality decreased slightly, with no significant differences.

Los gérmenes anaerobios como responsables de la infección quirúrgica / Anaerobic microorganisms responsible for surgical infection

Objetivo. Establecer la frecuencia de los gérmenes anaerobios en la aparición de la infección quirúrgica. Señalar cuáles son los principales responsables de los mismos. Valorar las posibles particularidades de la infección por anaerobios en nuestro medio. Material y métodos. Se estudian un total de 4.997 especímenes quirúrgicos de 6.599 pacientes intervenidos en nuestro servicio a lo largo de 6 años. Se analizan los gérmenes responsables, se establece la frecuencia de los anaerobios, destacando los más frecuentes, y las particularidades de los mismos. Resultados. Los aislamientos de gérmenes anaerobios constituyeron el 18,6 por ciento del total de los microorganismos aislados por el laboratorio. La mayor parte de los aislamientos se obtuvieron en líquido peritoneal, seguido de muestras de abscesos y herida quirúrgica, y el carácter de los mismos fue polimicrobiano. La patología de índole isquémica, seguida de la inflamatoria, fueron las principales responsables del aislamiento de estos microorganismos. Por familias, fueron los bacilos gramnegativos los más frecuentes, seguidos a distancia por los cocos grampositivos y los bacilos grampositivos, mientras que los cocos gramnegativos presentan escasa incidencia. Los gérmenes más frecuentes fueron Bacteroides fragilis, que junto con otros bacteroides (ovatus, uniformis, tetaiotaomicron) y Prevotella melaninogenica constituyen cerca del 50 por ciento del total de los anaerobios aislados. Conclusiones. Cabe destacar el importante significado clínico que en nuestra experiencia tiene el aislamiento de estos gérmenes (bacteroides y prevotelas), tanto por su relativa alta incidencia como por la elevada tasa de resistencias antimicrobianas de alguno de estos microorganismos (AU)

Modificaciones de los gérmenes aerobios y su sensibilidad en relación con el uso de los antibióticos / Modifications in aerobic microorganisms and in their sensitivity in response to the use of antibiotics

Objetivo. Valorar posibles modificaciones del espectro microbiológico aerobio responsable de la infección quirúrgica, y estudiar las eventuales variaciones en la sensibilidad antimicrobiana de los mismos. Pacientes y métodos. Se estudian un total de 4.714 especímenes quirúrgicos de los 6.236 pacientes intervenidos en nuestro servicio a lo largo de 6 años. Se valora la frecuencia anual de los gérmenes más frecuentes y su sensibilidad antimicrobiana, junto con sus posibles modificaciones en frecuencia y sensibilidad a lo largo de este período de tiempo. Resultados. Se han evidenciado modificaciones cualitativas de la bacteriología quirúrgica responsable de la infección. Se ha constatado un descenso del Staphylococcus aureus, con incremento de Staphylococcus epidermidis y de las levaduras. No hemos registrado variaciones en el caso de los microorganismos Escherichia coli, Streptococcus faecalis y Pseudomonas aeruginosa. En cuanto a las modificaciones en la sensibilidad bacteriológica, ceftazidima ha sido la cefalosporina más útil para P. aeruginosa, mientras que ésta ha evidenciado descensos en la sensibilidad a piperacilina y a cefotaxima y ha mantenido una sensibilidad constante a los aminoglucósidos. E. coli en orina ha mantenido una sensibilidad constante, mientras que en el resto de muestras ha presentado variaciones en su sensibilidad a cefalotina. S. aureus, S. epidermidis, S. faecalis y los hongos no han evidenciado modificaciones en la sensibilidad. Conclusiones. Cabe destacar el descenso como responsable de la infección quirúrgica de S. aureus, con el progresivo ascenso de S. epidermidis y de los hongos. No se han evidenciado modificaciones en los patrones de sensibilidad de los microorganismos estudiados, a excepción de P. aeruginosa y E. coli no urinario. Estimamos oportuno realizar evaluaciones periódicas de la frecuencia de los gérmenes aislados y de su comportamiento frente a los antibióticos de uso habitual, para conocer la flora microbiana propia de cada servicio y para valorar la necesidad de modificar las pautas de antibioterapia (AU)