A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs.

Introduction: Penicillin allergy labels (PAL) are common in the hospital setting and are associated with worse clinical outcomes. Desensitization can be a useful strategy for allergic patients when alternative options are suboptimal or not available. The aim was to compare clinical outcomes of patients with PAL managed with antibiotic desensitization vs. those who received alternative non-beta-lactam antibiotic treatments. Methods: A retrospective 3:1 case-control study was performed between 2015-2022. Cases were adult PAL patients with infection who required antibiotic desensitization; controls were PAL patients with infection managed with an alternative antibiotic treatment. Cases and controls were adjusted for age, sex, infection source, and critical or non-critical medical services. Results: Fifty-six patients were included: 14 in the desensitization group, 42 in the control group. Compared to the control group, desensitized PAL patients had more comorbidities, with a higher Charlson index (7.4 vs. 5; p = 0.00) and more infections caused by multidrug-resistant (MDR) pathogens (57.1% vs. 28.6%; p = 0.05). Thirty-day mortality was 14.3% in the desensitized group, 28.6% in the control group (p = 0.24). Clinical cure occurred in 71.4% cases and 54.8% controls (p = 0.22). Four control patients selected for MDR strains after alternative treatment; selection of MDR strains did not occur in desensitized patients. Five controls had antibiotic-related adverse events, including Clostridioides difficile or nephrotoxicity. No antibiotic-related adverse events were found in the study group. In multivariate analysis, no differences between groups were observed for main variables. Conclusion: Desensitization was not associated with worse clinical outcomes, despite more severe patients in this group. Our study suggests that antibiotic desensitization may be a useful Antimicrobial Stewardship tool for the management of selected PAL patients.

Medidas de prevención de la infección de localización quirúrgica en cirugía general. Documento de posicionamiento de la Sección de Infección Quirúrgica de la Asociación Española de Cirujanos / Surgical site infection prevention measures in General Surgery: Position statement by the Surgical Infections Division of the Spanish Association of Surgery

La infección de localización quirúrgica se asocia a prolongación de la estancia hospitalaria, aumento de la morbilidad, mortalidad y gasto sanitario. La adherencia a paquetes sistematizados que incluyan medidas de prevención validadas científicamente consigue disminuir la tasa de infección postoperatoria. La Sección de Infección Quirúrgica de la Asociación Española de Cirujanos ha realizado una revisión crítica de la evidencia científica y las más recientes guías internacionales, para seleccionar las medidas con mayor grado de evidencia a fin de facilitar su aplicación en los servicios de cirugía españoles. Cuentan con mayor grado de evidencia: no eliminación del vello del campo quirúrgico o eliminación con maquinilla eléctrica, descontaminación de la piel con soluciones alcohólicas, profilaxis antibiótica sistémica adecuada (inicio 30-60 minutos antes de la incisión, uso preferente en monodosis, administración de dosis intraoperatoria si indicada), mantenimiento de la normotermia y el control de la glucemia perioperatoria

Surgical site infection is associated with prolonged hospital stay and increased morbidity, mortality and healthcare costs, as well as a poorer patient quality of life. Many hospitals have adopted scientifically-validated guidelines for the prevention of surgical site infection. Most of these protocols have resulted in improved postoperative results. The Surgical Infection Division of the Spanish Association of Surgery conducted a critical review of the scientific evidence and the most recent international guidelines in order to select measures with the highest degree of evidence to be applied in Spanish surgical services. The best measures are: no removal or clipping of hair from the surgical field, skin decontamination with alcohol solutions, adequate systemic antibiotic prophylaxis (administration within 30-60 minutes before the incision in a single preoperative dose; intraoperative re-dosing when indicated), maintenance of normothermia and perioperative maintenance of glucose levels

Surgical site infection prevention measures in General Surgery: Position statement by the Surgical Infections Division of the Spanish Association of Surgery. / Medidas de prevención de la infección de localización quirúrgica en cirugía general. Documento de posicionamiento de la Sección de Infección Quirúrgica de la Asociación Española de Cirujanos.

Surgical site infection is associated with prolonged hospital stay and increased morbidity, mortality and healthcare costs, as well as a poorer patient quality of life. Many hospitals have adopted scientifically-validated guidelines for the prevention of surgical site infection. Most of these protocols have resulted in improved postoperative results. The Surgical Infection Division of the Spanish Association of Surgery conducted a critical review of the scientific evidence and the most recent international guidelines in order to select measures with the highest degree of evidence to be applied in Spanish surgical services. The best measures are: no removal or clipping of hair from the surgical field, skin decontamination with alcohol solutions, adequate systemic antibiotic prophylaxis (administration within 30-60minutes before the incision in a single preoperative dose; intraoperative re-dosing when indicated), maintenance of normothermia and perioperative maintenance of glucose levels.

Sepsis grave por absceso cervical profundo tras agranulocitosis por metamizol / Severe sepsis due to cervical abscess after agranulocytosis associated with metamizole

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Prophylactic synthetic mesh can be safely used to close emergency laparotomies, even in peritonitis.

BACKGROUND: This study was conducted to determine the efficacy and safety of the use of a partially absorbable large pore synthetic prophylactic mesh in emergent midline laparotomies for the prevention of evisceration and incisional hernia. METHODS: Retrospective analysis of all patients who underwent an emergency midline laparotomy between January of 2009 and July of 2010 was performed. Patients with complicated ventral hernia repair, postoperative death, and lack of follow-up were excluded. RESULTS: A total of 266 patients were included. Laparotomies were closed with a running suture of slow-reabsorbable material in 190 patients (Group S), and 50 patients within this group (26.3%) received additional retention sutures. In 76 patients (Group M), an additional partially absorbable lightweight mesh was placed in the Supra-aponeurotic space. Both groups presented similar complication rates (71.1% Group S vs 80.3% Group M, P = .97). There were no differences regarding surgical-site infection rates (17.9% Group S vs 26.3% Group M; P = .13) or postoperative mortality (13.7% Group S vs 18.3% Group M; P = .346). A total of 150 patients completed the follow-up (99 Group S; 51 Group M) at a mean time of 16.7 months. During follow-up, 36 cases of incisional hernia (24%) were diagnosed: 33 (33%) in Group S, whereas there were only three cases (5.9%) in Group M (P = .0001). Mesh removal for chronic infection was not required in any case. CONCLUSION: The use of a partially absorbable, lightweight large pore prophylactic mesh in the closure of emergency midline laparotomies is feasible for the prevention of incisional hernia without adding a substantial rate of morbidity to the procedure, even if high contamination or infections are present.

Resultados del abordaje laparoscópico en el tratamiento de la obstrucción aguda del intestino delgado por adherencias y hernias internas / Results of a laparoscopic approach for the treatment of acute small bowel obstruction due to adhesions and internal hernias

Introducción La laparotomía suele ser la vía de abordaje de elección en los casos de intervención quirúrgica por obstrucción aguda de intestino delgado (OAID).Pacientes y métodos De febrero 2007 hasta mayo 2012 se registraron prospectivamente los pacientes intervenidos de urgencias en nuestro centro vía laparoscópica por OAID por adherencias (27 casos) y/o hernia interna (6 casos). Todos disponían de una TC preoperatoria. Se excluyeron del abordaje laparoscópico aquellos con peritonitis y/o sepsis. En caso de requerir resección intestinal se convirtió a laparotomía. Resultados La edad media de los 33 pacientes operados fue de 61,1 ± 17,6 años. El 64% tenían antecedentes de cirugía abdominal previa. El 72% de los casos fue operado por un cirujano experto en laparoscopia. La tasa de conversión fue del 21%. El tiempo operatorio y estancia postoperatoria medios fueron de 83 ± 44 min y 7,8 ± 11,2 días, respectivamente. El tiempo operatorio (72 ± 30 vs 123 ± 63 min), día de inicio de ingesta oral (1,8 ± 0,9 vs 5,7 ± 3,3 día) y estancia postoperatoria (4,7 ± 2,5 vs 19,4 ± 21 días) fueron significativamente menores en el grupo laparoscopia respecto al de conversión, si bien los pacientes convertidos presentaron mayor gravedad clínica (2 resecciones intestinales). Hubo 2 complicaciones graves (Clavien-Dindo III y V ) en el grupo de conversión. Conclusiones El abordaje laparoscópico, en casos seleccionados de OIDA por adherencias y hernias internas, cuando es realizado por cirujanos entrenados en laparoscopia, presenta una alta probabilidad de éxito (baja tasa de conversión, corta estancia postoperatoria y baja morbilidad), por lo que su uso estaría plenamente justificado en estos casos (AU)

Introduction Laparotomy is the standard approach for the surgical treatment of acute small bowel obstruction (ASBO).Patients and methods From February 2007 to May 2012 we prospectively recorded all patients operated by laparoscopy in our hospital because of ASBO due to adhesions (27 cases) and/or internal hernia (6 cases). A preoperative abdominal CT was performed in all cases. Patients suffering from peritonitis and/or sepsis were excluded from the laparoscopic approach. It was decided to convert to laparotomy if intestinal resection was required. Results The mean age of the 33 patients who underwent surgery was 61.1±17.6 years. 64% had previous history of abdominal surgery. 72% of the cases were operated by surgeons highly skilled in laparoscopy. Conversion rate was 21%. Operative time and postoperative length of stay were 83±44 min and 7.8±11.2 days, respectively. Operative time (72±30 vs 123±63 min.), tolerance to oral intake (1.8±0.9 vs 5.7±3.3 days) and length of postoperative stay (4.7±2.5 vs 19.4±21 days) were significantly lower in the laparoscopy group compared with the conversion group, although converted patients had greater clinical severity (2 bowel resections). There were two severe complications (Clavien-Dindo III and V) in the conversion group. Conclusions In selected cases of ASBO caused by adhesions and internal hernias and when performed by surgeons highly skilled in laparoscopy, a laparoscopic approach has a high probability of success (low conversion rate, short stay in hospital and low morbidity); its use would be fully justified in these cases (AU)

Results of a laparoscopic approach for the treatment of acute small bowel obstruction due to adhesions and internal hernias.

INTRODUCTION: Laparotomy is the standard approach for the surgical treatment of acute small bowel obstruction (ASBO). PATIENTS AND METHODS: From February 2007 to May 2012 we prospectively recorded all patients operated by laparoscopy in our hospital because of ASBO due to adhesions (27 cases) and/or internal hernia (6 cases). A preoperative abdominal CT was performed in all cases. Patients suffering from peritonitis and/or sepsis were excluded from the laparoscopic approach. It was decided to convert to laparotomy if intestinal resection was required. RESULTS: The mean age of the 33 patients who underwent surgery was 61.1 ± 17.6 years. 64% had previous history of abdominal surgery. 72% of the cases were operated by surgeons highly skilled in laparoscopy. Conversion rate was 21%. Operative time and postoperative length of stay were 83 ± 44 min. and 7.8 ± 11.2 days, respectively. Operative time (72 ± 30 vs 123 ± 63 min.), tolerance to oral intake (1.8 ± 0.9 vs 5.7 ± 3.3 days) and length of postoperative stay (4.7 ± 2.5 vs 19.4 ± 21 days) were significantly lower in the laparoscopy group compared with the conversion group, although converted patients had greater clinical severity (2 bowel resections). There were two severe complications (Clavien-Dindo III and V) in the conversion group. CONCLUSIONS: In selected cases of ASBO caused by adhesions and internal hernias and when performed by surgeons highly skilled in laparoscopy, a laparoscopic approach has a high probability of success (low conversion rate, short hospital length of stay and low morbidity); its use would be fully justified in these cases.

Ritmo nodal secundario a descarga eléctrica de alto voltaje: Report of one case / Transient high frequency nodal rhythm after a high voltage electric shock

Electrical shock can cause a direct myocardial damage and different types of arrhythmias, which are uncommon and occur more often when there is a high voltage exposure. We report a 19-year-old male that received a high voltage shock, falling thereafter from an altitude of four meters. On admission to the emergency room, he had second and third degree burns in the right hand and the left thigh. The electrocardiogram showed a nodal rhythm of 72 beats per minute. After four hours of monitoring, sinus rhythm returned spontaneously.

Tratamiento quirúrgico de la úlcera péptica perforada: comparación entre los abordajes laparoscópico y abierto / A comparison of laparoscopic versus open repair for the surgical treatment of perforated peptic ulcers

Objetivo Analizar los resultados del abordaje quirúrgico laparoscópico frente al abierto en el tratamiento de las úlceras pépticas perforadas (UPP).Pacientes y métodos Estudio retrospectivo de todos los pacientes operados de una UPP durante el periodo enero de 2002-marzo de 2012. Se analizaron datos demográficos, tiempo operatorio, complicaciones y estancia hospitalaria. Resultados Se incluyó a 112 pacientes (mediana, 49 años), 60 en el grupo laparoscópico y 52 en el grupo abierto. Los pacientes operados por vía laparoscópica eran significativamente más jóvenes y tenían un mayor consumo de tabaco, alcohol y cannabis. La mediana de duración de los síntomas agudos fue menor en los pacientes del grupo laparoscópico (6 h) en comparación con los del grupo abierto (12 h). La mediana del tiempo operatorio fue significativamente mayor en los pacientes del grupo laparoscópico (104,5 vs. 76 min; p = 0,025). El porcentaje de conversión a cirugía abierta fue del 25%. La morbilidad fue similar en ambos grupos, pero 3 pacientes fallecieron en el grupo abierto. La mediana de estancia hospitalaria fue significativamente menor en el grupo laparoscópico (6 vs. 8 días; p = 0,041).Conclusión El abordaje por vía laparoscópica es una técnica segura y comparable a la cirugía abierta en el tratamiento de la UPP, con la que el paciente se beneficia de una estancia hospitalaria más corta (AU)

Objective To analyse the outcomes of laparoscopic versus open repair for perforated peptic ulcers (PPU).Methods All patients undergoing PPU repair between January 2002 and March 2012 were included in the study. Demographic characteristics, operation time, complications, and length of hospital stay were evaluated. Results Two hundred and twelve patients (median age, 49 years) were included, 60 in the laparoscopic group and 52 in the open group. Patients operated laparoscopically were significantly younger and had a higher consumption of tobacco, alcohol and cannabis. Median acute symptoms time was shorter in the laparoscopic group (6 h) compared to the open group (12 h; P=.025) Symptoms time was shorter in the laparoscopic group. Median operating time was significantly longer in the laparoscopic group (104.5 min vs. 76 min, P=.025). The percentage of conversion to open repair was 25%. There was no difference in morbidity between 2 groups, but there were 3 deaths in the open group. Median hospital stay was significantly shorter in patients treated laparoscopically when compared with the open group (6 days vs. 8 days; P=.041).Conclusion Laparoscopic and open repair are equally safe in the management of PPU. A shorter hospital stay can be achieved in the laparoscopic group (AU)

[A comparison of laparoscopic versus open repair for the surgical treatment of perforated peptic ulcers]. / Tratamiento quirúrgico de la úlcera péptica perforada: comparación entre los abordajes laparoscópico y abierto.

OBJECTIVE: To analyse the outcomes of laparoscopic versus open repair for perforated peptic ulcers (PPU). METHODS: All patients undergoing PPU repair between January 2002 and March 2012 were included in the study. Demographic characteristics, operation time, complications, and length of hospital stay were evaluated. RESULTS: Two hundred and twelve patients (median age, 49 years) were included, 60 in the laparoscopic group and 52 in the open group. Patients operated laparoscopically were significantly younger and had a higher consumption of tobacco, alcohol and cannabis. Median acute symptoms time was shorter in the laparoscopic group (6h) compared to the open group (12h; P=.025) Symptoms time was shorter in the laparoscopic group. Median operating time was significantly longer in the laparoscopic group (104.5min vs. 76min, P=.025). The percentage of conversion to open repair was 25%. There was no difference in morbidity between 2 groups, but there were 3 deaths in the open group. Median hospital stay was significantly shorter in patients treated laparoscopically when compared with the open group (6 days vs. 8 days; P=.041). CONCLUSION: Laparoscopic and open repair are equally safe in the management of PPU. A shorter hospital stay can be achieved in the laparoscopic group.

[Transient high frequency nodal rhythm after a high voltage electric shock. Report of one case]. / Ritmo nodal secundario a descarga eléctrica de alto voltaje.

Electrical shock can cause a direct myocardial damage and different types of arrhythmias, which are uncommon and occur more often when there is a high voltage exposure. We report a 19-year-old male that received a high voltage shock, falling thereafter from an altitude of four meters. On admission to the emergency room, he had second and third degree burns in the right hand and the left thigh. The electrocardiogram showed a nodal rhythm of 72 beats per minute. After four hours of monitoring, sinus rhythm returned spontaneously.

Inguinal syndrome secondary to Prevotella bivia after accidental bite in orogenital sex.

The authors report a case of an inguinal bubo in a young man caused by an anaerobe, Prevotella bivia, which was acquired during oral sexual intercourse. As far as the authors know, this is the first reported case of a sexually transmitted infection by Prevotella. Prevotella spp. inhabit the oral cavity and are highly prevalent in bacterial vaginosis, a polymicrobial syndrome resulting from replacement of the normal vaginal Lactobacillus spp. flora by high concentrations of anaerobic microorganisms such as Prevotella spp., Mobiluncus spp., Gardnerella vaginalis and other uncultivated anaerobes.

[Results of a multidisciplinary and multifocal project to reduce bacteraemia caused by central venous catheters in non critical patients in a university hospital]. / Resultados de un proyecto multidisciplinar y multifocal para la disminución de la bacteriemia causada por catéter venoso central, en pacientes no críticos, en un hospital universitario.

OBJECTIVE: To evaluate a multidisciplinary and multifocal intervention in order to reduce catheter related bloodstream infections (CRBI), based on previously identified risk factors in non-critical patients. METHODS: A pre-post-intervention study, 2004-2006. POPULATION: patients with a central venous catheter (CVC). The primary endpoint was the CRBI. Other studied variables were patient characteristics, insertion, maintenance and removal of the catheter. The intervention consisted of baseline knowledge and identifying risk factors. In a second period, there was specific training on these identified risk factors and communication of the results, monitoring and evaluation of the CVC inserted. RESULTS: We analysed 175 and 200 CVC, respectively. The incidence of CRBI was 15.4% during the pre-intervention and 4.0% in the post-intervention period (P<.001). The incidence of BRC by CVC days in the first group was 8.8 infections 1.000 days of CVC and the second 2,3 (P=.0009). The multivariate analysis found an increased risk of CRBI during the first period (OR 4.32; 95% CI: 1.81-10.29) and the use of total parenteral nutrition (OR: 2.37; 95% CI: 1.10-5. 12). CONCLUSION: The application of specific measures directed at all non-critical patients in the entire hospital and involving a large number of professionals has achieved a decrease incidence of 73.9% of CRBI. An acceptable incidence of CRBI was obtained, and, with the completion of the project together with a new awareness, the situation will continue to improve.

Resultados de un proyecto multidisciplinar y multifocal para la disminución de la bacteriemia causada por catéter venoso central, en pacientes no críticos, en un hospital universitario / Results of a multidisciplinary and multifocal project to reduce bacteraemia caused by central venous catheters in non critical patients in a university hospital

Objetivo Evaluar una intervención multidisciplinar y multifocal en pacientes no críticos, para la reducción de bacteriemias relacionadas con los catéteres venosos centrales (BRC), basada en la corrección de factores de riesgo de la propia institución. Métodos Estudio pre-postintervención, 2004-2006. Población de estudio: pacientes portadores de catéter venoso central (CVC), la variable principal fue la BRC; otras variables fueron datos del paciente, de inserción, mantenimiento y retirada del catéter. La intervención consistió en conocer la situación basal e identificar factores de riesgo, y en el segundo período mejoras en el protocolo de inserción y mantenimiento de CVC, formación específica sobre los factores de riesgo, difusión de resultados, seguimiento y evaluación de los CVC insertados. Resultados Se analizaron 175 y 200 CVC respectivamente. Se observó una incidencia de BRC de 15,4% durante el periodo preintervención y de 4,0% en el período post-intervención (p<0,001). La incidencia de BRC por días de CVC en el primer grupo fue de 8,8 infecciones por 1.000 días de CVC y en el segundo 2,3 (p=0,009). En el análisis multivariado se encontró aumento del riesgo de BRC en los CVC insertados durante el primer periodo (OR:4,32; IC 95%:1,81-10,29), y en el uso de nutrición parenteral total, (OR:2,37; IC 95%:1,10-5,12).Conclusión La aplicación de medidas específicas dirigidas a todo el hospital e implicando a un gran número de profesionales, ha conseguido una disminución del 73,9% de BCR, situando la bacteriemia en cifras aceptables y creando una “cultura” responsable de que, una vez terminado el proyecto, las tasas de BRC siguieran mejorando (AU)

Objective To evaluate a multidisciplinary and multifocal intervention in order to reduce catheter related bloodstream infections (CRBI), based on previously identified risk factors in non-critical patients. MethodsA pre-post-intervention study, 2004-2006. Population: patients with a central venous catheter (CVC). The primary endpoint was the CRBI. Other studied variables were patient characteristics, insertion, maintenance and removal of the catheter. The intervention consisted of baseline knowledge and identifing risk factors. In a second period, there was specific training on these identified risk factors and communication of the results, monitoring and evaluation of the CVC inserted. Results We analysed 175 and 200 CVC, respectively. The incidence of CRBI was 15.4% during the pre-intervention and 4.0% in the post-intervention period (P<.001). The incidence of BRC by CVC days in the first group was 8.8 infections 1.000 days of CVC and the second 2,3 (P=.0009). The multivariate analysis found an increased risk of CRBI during the first period (OR 4.32; 95% CI: 1.81-10.29) and the use of total parenteral nutrition (OR: 2.37; 95% CI: 1.10-5. 12).Conclusion The application of specific measures directed at all non-critical patients in the entire hospital and involving a large number of professionals has achieved a decrease incidence of 73.9% of CRBI. An acceptable incidence of CRBI was obtained, and, with the completion of the project together with a new awareness, the situation will continue to improve (AU)

Esplenopancreatectomía radical modular anterógrada por laparoscopia / Laparoscopic radical antegrade modular pancreatosplenectomy

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