Assessment of a semi-automated enrichment system (Uroquattro HB&L) for detection of faecal carriers of ESBL-/AmpC-producing Enterobacterales / Evaluación de un sistema de enriquecimiento semiautomático (Uroquattro HB&L(TM)) para la detección de portadores fecales de Enterobacterales productoras de beta-lactamasas de espectro extendido (BLEE)/AmpC

INTRODUCTION: Early detection of patients carrying multiresistant bacteria is an effective implement in surveillance programs. Our objective was to compare the semi-automatic Uroquattro HB&L "ESBL/AmpC Screening" (Alifax®) system with the routine culture on selective media to detect ESBL/pAmpC-producing microorganisms (3CGRE). METHODS: A total of 201 rectal swabs samples were processed by inoculating them into the Uroquattro HB&L system, performing growth curve measurements at 6.5 and 10 h, and into direct culture medium. RESULTS: Thirty-five samples yielded 3CGRE. Measurements at 10 h incremented the positive 3GCRE detection 5.7% in comparison with routine culture medium. In negative rectal swabs, the overall percent agreement at 6.5 h and 10 h versus routine culture medium was 93% and 90%, respectively. CONCLUSIONS: The Uroquattro HB&L system increased the detection of ESBL/pAmpC-producing bacteria compared to direct plating with an incubation time of 10 h and shortens the time to report a negative sample

INTRODUCCIÓN: La detección temprana de pacientes portadores de bacterias multirresistentes es una medida eficaz de los programas de vigilancia. Nuestro objetivo fue comparar el sistema semiautomático Uroquattro HB&L™ «ESBL/AmpC screening» (Alifax®) frente al cultivo habitual en medios selectivos para detectar microorganismos productores de beta-lactamasas de espectro extendido (BLEE)/AmpC (3CGRE). MÉTODOS: Se procesaron 201 frotis rectales mediante inoculación en el sistema Uroquattro HB&L™, se midió el crecimiento a las 6,5 y 10 h, y en el medio de cultivo directo. RESULTADOS: Treinta y cinco muestras fueron positivas para 3CGRE. La lectura a las 10 h incrementó la detección un 5,7% en comparación con el medio habitual. En muestras rectales negativas, la concordancia de la lectura global a las 6,5 y 10 h con el medio de cultivo habitual fue del 93 y 90%, respectivamente. CONCLUSIONES: El sistema Uroquattro HB&L™ incrementó la detección de bacterias productoras de BLEE/pAmpC en comparación con el cultivo directo con un tiempo de incubación de 10 h y acorta los tiempos de detección de muestras negativas

Assessment of a semi-automated enrichment system (Uroquattro HB&L) for detection of faecal carriers of ESBL-/AmpC-producing Enterobacterales.

INTRODUCTION: Early detection of patients carrying multiresistant bacteria is an effective implement in surveillance programs. Our objective was to compare the semi-automatic Uroquattro HB&L "ESBL/AmpC Screening" (Alifax®) system with the routine culture on selective media to detect ESBL/pAmpC-producing microorganisms (3CGRE). METHODS: A total of 201 rectal swabs samples were processed by inoculating them into the Uroquattro HB&L system, performing growth curve measurements at 6.5 and 10h, and into direct culture medium. RESULTS: Thirty-five samples yielded 3CGRE. Measurements at 10h incremented the positive 3GCRE detection 5.7% in comparison with routine culture medium. In negative rectal swabs, the overall percent agreement at 6.5h and 10h versus routine culture medium was 93% and 90%, respectively. CONCLUSIONS: The Uroquattro HB&L system increased the detection of ESBL/pAmpC-producing bacteria compared to direct plating with an incubation time of 10h and shortens the time to report a negative sample.

Targeted simplification versus antipseudomonal broad-spectrum beta-lactams in patients with bloodstream infections due to Enterobacteriaceae (SIMPLIFY): a study protocol for a multicentre, open-label, phase III randomised, controlled, non-inferiority clinical trial.

INTRODUCTION: Within the context of antimicrobial stewardship programmes, de-escalation of antimicrobial therapy is one of the proposed strategies for reducing the unnecessary use of broad-spectrum antibiotics (BSA). The empirical treatment of nosocomial and some healthcare-associated bloodstream infections (BSI) frequently includes a beta-lactam with antipseudomonal activity as monotherapy or in combination with other drugs, so there is a great opportunity to optimise the empirical therapy based on microbiological data. De-escalation is assumed as standard of care for experts in infectious diseases. However, it is less frequent than it would desirable. METHODS AND ANALYSIS: The SIMPLIFY trial is a multicentre, open-label, non-inferiority phase III randomised controlled clinical trial, designed as a pragmatic 'real-practice' trial. The aim of this trial is to demonstrate the non-inferiority of de-escalation from an empirical beta-lactam with antipseudomonal activity to a targeted narrow-spectrum antimicrobial in patients with BSI due to Enterobacteriaceae. The primary outcome is clinical cure, which will be assessed at the test of cure visit. It will be conducted at 19 Spanish public and university hospitals. ETHICS AND DISSEMINATION: Each participating centre has obtained the approval of the ethics review committee, the agreement of the directors of the institutions and authorisation from the Spanish Regulatory Agency (Agencia Española del Medicamento y Productos Sanitarios). Data will be presented at international conferences and published in peer-reviewed journals. DISCUSSION: Strategies to reduce the use of BSA should be a priority. Most of the studies that support de-escalation are observational, retrospective and heterogeneous. A recent Cochrane review stated that well-designed clinical trials should be conducted to assess the safety and efficacy of de-escalation. TRIAL REGISTRATION NUMBER: The European Union Clinical Trials Register: EudraCT number 2015-004219-19. Clinical trials.gov: NCT02795949. Protocol version: V.2.0, dated 16 May 2016. All items from the WHO Trial Registration Data Set are included in the registry.

Medidas de prevención de la transmisión de microorganismos entre pacientes hospitalizados. Higiene de manos / Preventive measures for avoiding transmission of microorganisms between hospitalised patients. Hand higiene

Las infecciones relacionadas con la asistencia sanitaria constituyen un importante problema de salud pública mundial. Su incidencia es un indicador de la calidad asistencial prestada. Las medidas de prevención de la transmisión de los microorganismos hospitalarios pueden agruparse en 4 grandes áreas: precauciones estándar, precauciones específicas (incluyendo, cuando procede, las medidas de aislamiento), medidas de limpieza y desinfección ambiental, y actividades de vigilancia (incluyendo los datos de incidencia y la monitorización de procedimientos). La higiene de manos y el uso correcto de guantes son las principales medidas para prevenir las infecciones relacionadas con la asistencia sanitaria y evitar la diseminación de microorganismos multirresistentes. Se necesitan actividades de formación continuas, pero se consigue un impacto duradero mediante la vigilancia del cumplimiento de las recomendaciones de higiene de manos con retroalimentación de los resultados a los sanitarios. Son múltiples las iniciativas complementarias que se están evaluando. Entre ellas se encuentran el tratamiento de descolonización previa a determinadas cirugías, la aplicación de bundles en pacientes con catéter venoso central o sometidos a ventilación mecánica, o la higiene corporal universal con clorhexidina. El debate actual se centra en precisar en qué situaciones y a qué grupos de riesgo sería eficaz y eficiente aplicar cada una de ellas

Health-care associated infections are an important public health problem worldwide. The rates of health-care associated infections are indicators of the quality of health care. The infection control activities related to prevention of transmission of hospital microorganisms can be grouped in 4 mayor areas: standard precautions, specific precautions (including isolation if appropriate), environmental cleaning and disinfection, and surveillance activities (including providing infection rates and monitoring procedures). Hand hygiene and the correct use of gloves are the most important measures to prevent health-care associated infections and to avoid the dissemination of multidrug-resistant microorganisms. Continuous educational activities aimed at improving adherence to hand hygiene are needed. Periodical assessment of adherence to hand hygiene recommendations with feed-back have been shown to provide sustained improvement. Several complementary activities are being evaluated, including skin decolonization prior to certain surgeries, a package of measures in patients with central venous catheters or mechanical ventilation, and universal body hygiene with chlorhexidine. The present area of discussion concerns in which situations and in which groups would such measures be effective and efficient

[Preventive measures for avoiding transmission of microorganisms between hospitalised patients. Hand hygiene]. / Medidas de prevención de la transmisión de microorganismos entre pacientes hospitalizados. Higiene de manos.

Health-care associated infections are an important public health problem worldwide. The rates of health-care associated infections are indicators of the quality of health care. The infection control activities related to prevention of transmission of hospital microorganisms can be grouped in 4 mayor areas: standard precautions, specific precautions (including isolation if appropriate), environmental cleaning and disinfection, and surveillance activities (including providing infection rates and monitoring procedures). Hand hygiene and the correct use of gloves are the most important measures to prevent health-care associated infections and to avoid the dissemination of multidrug-resistant microorganisms. Continuous educational activities aimed at improving adherence to hand hygiene are needed. Periodical assessment of adherence to hand hygiene recommendations with feed-back have been shown to provide sustained improvement. Several complementary activities are being evaluated, including skin decolonization prior to certain surgeries, a package of measures in patients with central venous catheters or mechanical ventilation, and universal body hygiene with chlorhexidine. The present area of discussion concerns in which situations and in which groups would such measures be effective and efficient.

El envejecimiento, la asignaturaolvidada en la universidad española: ¿El iceberg de un tipode negligencia? / Ageing, the forgotten course in Spanish university: the iceberg type of negligence?

El envejecimiento poblacional ha condicionado que la mayorparte de la actividad profesional de numerosos tituladosde diferentes carreras se realice en personas ancianas.En su vertiente no intencional, el abandono del ancianocomo tipo de maltrato se puede deber a un conocimientoinadecuado (tal y como se define la impericia profesional).Por ello, la etapa de formación de la carrera reviste granimportancia en el cumplimiento de la misión universitaria.Así, todos los profesionales que desarrollen su actividadprofesional con mayores deben tener conocimientos en gerontologíaque les permitan obtener, en cada momento,los mejores resultados posibles. Metodología: análisis descriptivode los planes de estudio de las carreras de Enfermería,Medicina, Fisioterapia, Trabajo Social, TerapiaOcupacional y Ciencias de la Actividad Física y el Deporte.Conclusiones: excepto en Enfermería y Terapia Ocupacional,el resto de titulaciones universitarias no ofertanasignaturas troncales relacionadas con el envejecimiento (AU)

Population aging has conditioned most of the professionalactivity of many graduates of different degrees, to be conductedin older people. In its unintended side, abandoningthe elderly, such as type of abuse, may be due to inadequateknowledge (defined as the professional skill), so the trainingstage of the race of great importance in meeting the universitymission. Thus, all the professionals who develop theirprofessional activity with older should have knowledge ingerontology to enable them to obtain at each moment thebest possible results. Methodology: descriptive analysis ofthe curricula of degree programs in Nursing, Medicine,Physiotherapy, Social Work, Occupational Therapy andScience of Physical Activity and Sport. Conclusions: exceptin Nursing and Occupational Therapy, the other universitydegrees offered no core subjects related to aging (AU)

Control measures for Acinetobacter baumannii: a survey of Spanish hospitals.

INTRODUCTION: Control of Acinetobacter baumannii is a challenge. METHODS: A survey was conducted on the control measures introduced against A baumannii in 30 Spanish hospitals. RESULTS: We found significant differences in the application of contact precautions, active surveillance, hygiene of colonised patients, environmental cleaning, and educational activities. Hospitals with a written control program for A. baumannii had a lower incidence of colonisation/infection due to this organism. CONCLUSION: A multidisciplinary consensus document for the control of A. baumannii is needed in Spain.

Control measures for Acinetobacter baumannii: a survey of Spanish hospitals

Introduction Control of Acinetobacter baumannii is a challenge. Methods A survey was conducted on the control measures introduced against A baumannii in 30 Spanish hospitals. Results We found significant differences in the application of contact precautions, active surveillance, hygiene of colonised patients, environmental cleaning, and educational activities. Hospitals with a written control program for A. baumannii had a lower incidence of colonisation/infection due to this organism.ConclusionA multidisciplinary consensus document for the control of A. baumannii is needed in Spain (AU)

Introducción El control de Acinetobacter baumannii es complejo. Métodos Se realizó una encuesta sobre las medidas de control frente a A. baumannii en 30 hospitales españoles. Resultados Se encontraron diferencias en la aplicación de precauciones de contacto, cultivos de cribado, higiene de los pacientes colonizados, limpieza ambiental, y actividades formativas. Los hospitales con un programa escrito de control de A. baumannii tuvieron menor incidencia de este patógeno. Conclusión Es necesario elaborar un documento de consenso multidisciplinar para el control de A. baumannii en España (AU)

Long-term control of endemic hospital-wide methicillin-resistant Staphylococcus aureus (MRSA): the impact of targeted active surveillance for MRSA in patients and healthcare workers.

OBJECTIVE: To evaluate the long-term impact of successive interventions on rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation. DESIGN: Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis. SETTING: A 950-bed teaching hospital in Seville, Spain. PATIENTS: All patients admitted to the hospital during the period from 1995 through 2008. METHODS: Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers. RESULTS: Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptible S. aureus did not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care. CONCLUSION: Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.

[Arthroplasty-related infection: incidence, risk factors, clinical features, and outcome]. / Infecciones relacionadas con las prótesis articulares: incidencia, factores de riesgo, características clínicas y pronóstico.

INTRODUCTION: There is little information about the overall incidence, risk factors, and clinical management of arthroplasty-related infection in Spain. METHODS: The incidence of surgical site infection (SSI) in hip and knee arthroplasty from 2001 to 2005 was determined. Risk factors for SSI were investigated in 435 patients using multivariate logistic regression analysis. Clinical features and treatment were examined in a cohort of 58 consecutive patients with joint arthroplasty infection. RESULTS: The percentages of SSI in hip and knee arthroplasty stratified according to the National Nosocomial Infection Surveillance (NNIS) index were 1.86% and 1.62% (NNIS=0), 3.72% and 2.02% (NNIS=1), and 7.20% and 6.71% (NNIS=2-3), respectively. The risk factors identified for developing SSI included secondary arthroplasty, duration of urinary catheterization, and hip arthroplasty. Fifty percent of patients with arthroplasty infection had type I (early) or III (hematogenous) infection. Gram-positive cocci were the most frequent causes. Initial therapy consisted in debridement with preservation of the prosthesis (10 patients) or removal of the prosthesis (40 patients); surgery was not performed in 8 patients. After one year of follow up, 39 patients (67%) were considered cured, 12 (21%) had a recurrence or were under chronic suppressive antimicrobial therapy, and 7 (12%) had died. CONCLUSIONS: The incidence of SSI in our center is similar to that of other Spanish hospitals, but is higher than the notified incidence in the NNIS system. A modifiable risk factor (urinary catheterization) has been identified. Greater consensus for the management of these patients is desirable.

Infecciones relacionadas con las prótesis articulares: incidencia, factores de riesgo, características clínicas y pronóstico / Arthroplasty-related infection: incidence, risk factors, clinical features, and outcome

INTRODUCCIÓN. Existe escasa información acerca de la incidencia y factores de riesgo para las infecciones protésicas en España, así como sobre el tratamiento clínico global de estos pacientes. MÉTODOS. Estudio de incidencia de infección de localización quirúrgica (ILQ) en cirugía de prótesis de cadera y rodilla entre 2001 y 2005; estudio de factores de riesgo para ILQ mediante regresión logística multivariante en435 pacientes intervenidos. Descripción de una cohorte de 58 casos consecutivos de infección protésica. RESULTADOS. La incidencia de ILQ en función de los estratos del índice NNIS (National Nosocomial Infection Surveillance) en artroplastias de cadera y rodilla fue del1,86 y el 1,62% (NNIS 0); el 3,72 y el 2,02% (NNIS 1),y el 7,20 y el 6,71% (NNIS 2-3), respectivamente. Los factores de riesgo identificados para la ILQ fueron la artroplastia secundaria, la duración del sondaje urinario y la cirugía de la cadera. En la cohorte de casos de infección protésica, el 50% tenía infecciones tipo I (precoces) o III(hematógenas). Los cocos gram positivos fueron la causa más frecuente. El tratamiento quirúrgico inicial fue desbridamiento con conservación de la prótesis en 10 pacientes, retirada de ésta en 40 y no se intervinieron 8;al año de seguimiento habían curado 39 (67%), recidivado o en tratamiento supresor crónico estaban 12 (21%) y habían fallecido 7 (12%).CONCLUSIONES. La incidencia de infección protésica en nuestro país es similar a la de otros centros españoles, y superior a la del sistema NNIS. Hemos identificado un factor de riesgo de ILQ modificable (sondaje). Es deseable un mayor consenso para el tratamiento clínico de los pacientes(AU)

INTRODUCTION. There is little information about the overall incidence, risk factors, and clinical management of arthroplasty-related infection in Spain. METHODS. The incidence of surgical site infection (SSI)in hip and knee arthroplasty from 2001 to 2005 was determined. Risk factors for SSI were investigated in435 patients using multivariate logistic regression analysis. Clinical features and treatment were examined in a cohort of 58 consecutive patients with joint arthroplasty infection. RESULTS. The percentages of SSI in hip and knee arthroplastystratified according to the National Nosocomial Infection Surveillance (NNIS) index were 1.86% and 1.62%(NNIS 0), 3.72% and 2.02% (NNIS 1), and 7.20% and6.71% (NNIS 2-3), respectively. The risk factors identified for developing SSI included secondary arthroplasty, duration of urinary catheterization, and hip arthroplasty. Fifty percent of patients with arthroplasty infection had type I (early) or III (hematogenous) infection. Gram-positivecocci were the most frequent causes. Initial therapy consisted in debridement with preservation of the prosthesis (10 patients) or removal of the prosthesis(40 patients); surgery was not performed in 8 patients. After one year of follow up, 39 patients (67%) were considered cured, 12 (21%) had a recurrence or were under chronic suppressive antimicrobial therapy, and 7 (12%) had died. CONCLUSIONS. The incidence of SSI in our center is similar to that of other Spanish hospitals, but is higher than the notified incidence in the NNIS system. A modifiable risk factor (urinary catheterization) has been identified. Greater consensus for the management of these patientsis desirable (AU)