Mycobacterium chimaera in heater-cooler devices: an experience in a tertiary hospital in Spain.

The aim of the study was to describe the Mycobacterium chimaera contamination in heater-cooler devices after the application of a protocol of cleaning and disinfection in a tertiary hospital. It was an observational study at the La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain. Seven heater-cooler devices are used in our hospital: five 3T Sorin (LivaNova) and two Maquet. We followed the manufacturers' instructions for cleaning and disinfection of the different heater-cooler devices. Environmental testing was developed monthly from January 2017 to July 2019. Samples were obtained from both cardioplegia and patient circuits and before and after the disinfection process and were cultured in appropriate media for non-tuberculous mycobacteria and heterotrophic bacteria (coliforms and Pseudomonas aeruginosa). A total of 320 samples were taken. Mycobacterium chimaera grew in four water samples (1.25%) from three different heater-cooler devices, with two positive results occurring after disinfection. The heterotrophic bacteria Delftia acidovorans and Stenotrophomonas maltophilia were also found. There has not been a case of M. chimaera infection in patients after cardiac surgery in our hospital. In March 2019, we decided to move the heater-cooler device outside the operating room. Mycobacterium chimaera contamination is not always eradicated by disinfection processes. We believe that placing 3T heater-cooler devices outside the operating room is the best option in preventing M. chimaera infection during cardiac surgery.

Enterobacterias productoras de carbapenemasas en un hospital pediátrico / Carbapenem-resistant enterobacteriaceae in a pediatric hospital

Introducción: El aumento en la incidencia de enterobacterias productoras de carbapenemasas (EPC) experimentado en todo el mundo en los últimos años constituye un importante problema de salud pública, dado que las infecciones provocadas por dichas bacterias se asocian a elevadas tasas de mortalidad y tienen gran capacidad de diseminación. Los estudios sobre infecciones por EPC en población pediátrica son muy escasos en la literatura científica. El presente estudio realiza una descripción de una serie de pacientes ingresados en un centro de referencia nacional pediátrico. Material y métodos: Se ha realizado un estudio retrospectivo descriptivo. Se describen las características clínicas y epidemiológicas de los pacientes infectados o colonizados por EPC entre junio de 2013 y noviembre de 2015. Resultados: Durante el periodo de estudio se han detectado 12 pacientes infectados o colonizados por EPC. La mayoría de los pacientes presentaba comorbilidades (el 58,3% eran pacientes oncológicos). Ha habido 3 casos de infección (25%) y 9 de colonización (75%). La evolución de los 3 pacientes con infección ha sido favorable. El principal mecanismo de resistencia detectado en nuestro estudio ha sido la producción de carbapenemasas tipo VIM. No ha habido transmisión cruzada de EPC entre pacientes durante el periodo de estudio. Conclusiones: Las infecciones por EPC en población pediátrica se dan fundamentalmente en niños con comorbilidades, sobre todo con patología oncológica. La detección precoz de los casos mediante vigilancia epidemiológica es un aspecto clave para prevenir la diseminación de estos microorganismos en el medio hospitalario (AU)

Introduction: Infections with carbapenem-resistant enterobacteriaceae (CRE) have become a major threat to public health because they are associated with significant mortality and they can spread rapidly in health-care settings. There are few studies of pediatric infections due to CRE. Here we describe clinical and microbiological features of infections caused by CRE at a national referral pediatric center. Methods: Retrospective descriptive study. We describe the clinical and epidemiological characteristics of patients infected or colonized with CRE between June 2013 and November 2015. Results: Twelve patients were identified with CRE during the study period. Underlying medical conditions were noted in most patients (58.3% had an oncologic process). Three were patients with clinical infection (25%), whereas 9 were colonized by CRE. The evolution of the three patients with infection has been favourable. Production of VIM was the prevalent mechanism conferring carbapenem resistance. There has been no EPC transmission between patients during the period of study. Conclusions: CRE infections are more common among children with underlying conditions, especially malignancy. Early detection is a key aspect to prevent the spread of CRE infection in hospitals (AU)

Epidemiología de «Staphylococcus aureus» resistente a la meticilina (SAMR): experiencia en un hospital infantil / Epidemiology of methicilin-resistant Staphylococcus aureus (MRSA) experience in a children’s hospital

En las últimas dos décadas la prevalencia de Staphylococcus aureus resistente a la meticilina (SAMR) ha aumentado de forma notoria. El SAMR infecta frecuentemente a niños. Tradicionalmente, las infecciones por SAMR se limitaban a niños con factores de riesgo subyacentes o a niños que frecuentaban las instituciones sanitarias; sin embargo, está aumentando la prevalencia en niños sanos de la comunidad. El objetivo de este trabajo es realizar un estudio descriptivo de las características de los pacientes que han tenido una infección por SAMR en el Hospital Infantil Niño Jesús de Madrid entre octubre de 2009 y diciembre de 2011. Los datos analizados demuestran la utilidad del sistema de vigilancia epidemiológica y de las medidas de aislamiento. La mayoría de los niños incluidos en este estudio con infección por SAMR comunitaria adquirieron la infección durante algún contacto con el sistema sanitario (AU)

During the past two decades, the prevalence of methicilin-resistant Staphylococcus aureus (MRSA) has significantly increased. MRSA frequently infects children. Traditionally, MRSA infections were confined to those with predisposing healthcare-associated risk factor or those who frequented healthcare facilities but its prevalence is increasing between healthy children in the community. The objective of this study was to describe the demographic and clinical data of the patients with a MRSA infection at our centre between October 2009 and December 2011. Analyzed data demonstrate the utility of infection control surveillance program and the isolation precautions to prevent the transmission of MRSA. Most patients with community-acquired MRSA infection acquired MRSA during contact with the health care system (AU)

[Perception of clinical practice derived risks compared to adverse effects detected in an internal medicine service]. / Percepción de riesgos derivados de la práctica clínica frente a los efectos adversos detectados en un servicio de medicina interna.

BACKGROUND AND OBJECTIVE: To know how the health care workers perceive the risks derived from the care practice. To estimate the most frequent adverse effects (AE) and establish differences and similarities between the perception of risks and the AE produced. MATERIAL AND METHOD: A self-administered questionnaire was applied to all the workers of an Internal Medicine Department of a General University Hospital on perception of risks and safety of the patient. After, and by using the screening guide of the IDEA project, edition 1, the clinical histories of the patients selected were analyzed by medical residents of preventive Medicine and Internal Medicine. RESULTS: Questionnaire. Fifty questionnaires we sent with a 42% response rate. Risks prioritized by obtaining a lower mean score: there is not action plan against catastrophes (2.79/10) and lack of spaces to report (3/10); those having greater percentage of open questions: long maintenance of urinary probes (47.61%) and inadequate prescription of antibiotics (33.33%). Study of AE. Incidence of patients with AE: 25% (95% CI 11.06-38.9). Incidence of AE: 26.6% (95% CI 12.6-40.6). 41.6% of AE was related to medication, 25% to nosocomial infection, 16.66% to technical problems in procedures and 16.66% were related to nursing cares. CONCLUSIONS: The perception of the health care workers on health care practice derived risks is different from the adverse events that really appear. The professionals are concerned about the information to patients than about scientific and technical quality. The most frequent adverse events produced are those related with medication. The only common point is concern for nosocomial infection.

Percepción de riesgos derivados de la práctica clínica frente a los efectos adversos detectados en un servicio de medicina interna / Perception of clinical practice derived risks compared to adverse effects detected in an internal medicine service

Fundamento y objetivos. Conocer la percepción que los profesionales sanitarios tienen sobre los riesgos derivados de la práctica asistencial, estimar los efectos adversos (EA) más frecuentes, y establecer las diferencias y similitudes entre la percepción de riesgos y los EA producidos. Material y método. Se realizó una encuesta autoadministrada sobre percepción de riesgos y seguridad del paciente a todo el personal de un servicio de medicina interna de un hospital general universitario. Posteriormente, y a través de la guía de cribado del proyecto IDEA 1ª edición, se analizaron las historias clínicas de los pacientes seleccionados por médicos residentes de medicina preventiva y de medicina interna. Resultados. Encuesta. Se enviaron 50 cuestionarios y se obtuvo una tasa de respuesta del 42%. Los riesgos priorizados por obtener una puntuación media más baja fueron la no existencia de plan de actuación frente a catástrofes (2,79 sobre 10) y la falta de espacios para informar (3 sobre 10.); y por mayor porcentaje en las preguntas abiertas, el mantenimiento prolongado de sondajes urinarios, con un 47.61% y la prescripción inadecuada de antibióticos (33,33%). Estudio sobre efectos adversos. Incidencia acumulada (IA) de pacientes con EA: 25% (intervalo de confianza [IC] 95% 11,06-38,9); IA de EA: 26,6% (IC 95% 12,6-40,6). El 41,6% de los EA estuvieron relacionados con la medicación, un 25% con la infección nosocomial, y con problemas técnicos de procedimientos y con fallos en los cuidados del paciente un 16,66% cada uno. Conclusiones. La percepción de los profesionales sanitarios sobre los riesgos derivados de la práctica asistencial es diferente a los sucesos adversos que realmente se terminan materializando. Los profesionales están más preocupados por la información a los pacientes y por la calidad científico-técnica. Los sucesos adversos más frecuentes que se producen son los relacionados con la medicación. El único punto común es la preocupación por la infección nosocomial (AU)

Background and objective. To know how the health care workers perceive the risks derived from the care practice. To estimate the most frequent adverse effects (AE) and establish differences and similarities between the perception of risks and the AE produced. Material and method. A self-administered questionnaire was applied to all the workers of an Internal Medicine Department of a General University Hospital on perception of risks and safety of the patient. After, and by using the screening guide of the IDEA project, edition 1, the clinical histories of the patients selected were analyzed by medical residents of preventive Medicine and Internal Medicine. Results. Questionnaire. Fifty questionnaires we sent with a 42% response rate. Risks prioritized by obtaining a lower mean score: there is not action plan against catastrophes (2.79/10) and lack of spaces to report (3/10); those having greater percentage of open questions: long maintenance of urinary probes (47.61%) and inadequate prescription of antibiotics (33.33%). Study of AE. Incidence of patients with AE: 25% (95% CI 11.06-38.9). Incidence of AE: 26.6% (95% CI 12.6-40.6). 41.6% of AE was related to medication, 25% to nosocomial infection, 16.66% to technical problems in procedures and 16.66% were related to nursing cares. Conclusions. The perception of the health care workers on health care practice derived risks is different from the adverse events that really appear. The professionals are concerned about the information to patients than about scientific and technical quality. The most frequent adverse events produced are those related with medication. The only common point is concern for nosocomial infection (AU)

[Epidemiological situation of prostate cancer in Spain]. / Situación epidemiológica del cáncer de próstata en España.

Prostate cancer is the third most frequent neoplasms in Spanish men and the third cause of cancer death. Incidence grows up with the increase of age. 90% of cases are diagnostic in people over 65 years old. Etiology is quite unknown and has been associated with environmental exposure, life style, family sign and genetic factors. In 2002 mortality rate was 21.5/ 100.000 (situated among the lowest in Europe), with more than 5.000 deaths. Trend of mortality has grown up until 1998, from this year it has decreased due to improve on diagnostic and treatment. In order to study prostate cancer incidence we find a difficulty due to shortage of population cancer register. Estimations have found incidence rates of 45.33/100.000 which are among the lowest in Europe. Annual incidence of prostatic cancer has grown up in all Spanish registers, not only improve in register systems explains it, but also the development of diagnosis tests with a higher survival from the beginning of 90s (86% the first year after diagnosis and 65,5% five years after diagnosis), similar to other European countries. Blow up the cancer register system is necessary to know the incidence and prevalence, to assess survival and effectiveness of screening programs and to improve the knowledge of risk factors.

Situación epidemiológica del cáncer de próstata en España / Epidemiological situation of prostate cancer in Spain

El cáncer de próstata es el tercer tumor más frecuente en varones españoles y la tercera causa de muerte por cáncer. Su incidencia aumenta con la edad. Un 90% de casos se diagnostican en mayores de 65 años. La etiología es poco conocida relacionándose con exposiciones ambientales, estilos de vida, antecedentes familiares y factores genéticos. En el año 2002 la tasa de mortalidad (situada entre las más bajas de Europa) fue 21,5 casos por 100.000 habitantes, superándose las 5.000 defunciones. La tendencia de mortalidad ha ido en aumento hasta 1998, año en el que empieza a disminuir en relación con mejoras en el diagnóstico y tratamiento. Al estudiar la incidencia del cáncer de próstata nos encontramos con la dificultad debida a la escasez de registros poblacionales de cáncer. Se han realizado estimaciones a partir de los datos disponibles, detectándose una tasa de incidencia de 45,33 por 100.000 habitantes, también entre las más bajas de Europa. La incidencia anual de cáncer de próstata ha aumentado en todos los registros españoles debido a mejoras en los mismos, pero también al desarrollo de las pruebas diagnósticas, que han condicionado una mejor supervivencia desde principios de los 90 (86% al año del diagnóstico y 65,5% a los cinco años) comparable a la de otros países de nuestro entorno. Es necesario ampliar el sistema de registro de cáncer para conocer la incidencia y la prevalencia, evaluar la supervivencia y la eficacia de los programas de detección precoz y mejorar en el conocimiento de los factores de riesgo

Prostate cancer is the third most frequent neoplasms in Spanish men and the third cause of cancer death. Incidence grows up with the increase of age. 90% of cases are diagnostic in people over 65 years old. Etiology is quite unknown and has been associated with environmental exposure, life style, family sign and genetic factors. In 2002 mortality rate was 21.5/ 100.000 (situated among the lowest in Europe), with more than 5.000 deaths. Trend of mortality has grown up until 1998, from this year it has decreased due to improve on diagnostic and treatment. In order to study prostate cancer incidence we find a difficulty due to shortage of population cancer register. Estimations have found incidence rates of 45.33/100.000 which are among the lowest in Europe. Annual incidence of prostatic cancer has grown up in all Spanish registers, not only improve in register systems explains it, but also the development of diagnosis tests with a higher survival from the beginning of 90s (86% the first year after diagnosis and 65,5% five years after diagnosis), similar to other European countries. Blow up the cancer register system is necessary to know the incidence and prevalence, to assess survival and effectiveness of screening programs and to improve the knowledge of risk factors

Papel de las vacunas en la prevención de cáncer de cérvix / Prevention of cervical cancer with vaccines

Revisión sobre la situación actual de las vacunasfrente al papilomavirus humano (VPH). La infecciónpor papilomavirus humano es una infección frecuenteen todo el mundo. Existen más de 100 tipos distintosde VPH de los que al menos 15 son oncogénicos.La infección persistente por los tipos oncogénicosde VPH se relaciona con la mayor parte de loscasos de cáncer de cuello uterino y de las lesionesintraepiteliales precancerosas. Por tanto el desarrollode una vacuna frente al VPH supone una importantemedida de salud pública para prevenir las lesionescervicales precancerosas y el cáncer cervical.Actualmente hay dos vacunas basadas en viriones(partículas virus-like L1) que están en fasesavanzadas de desarrollo clínico y han sido presentadaspara registro. Una es tetravalente (VPH 6, 11,16, 18) y la otra es bivalente (VPH 16, 18)

This review focuses on the current situation of thehuman papilomavirus (HPV) vaccines. HPV infectionis a common infection worldwide. There are morethan 100 types of HPV of which approximately 15are oncogenic. Persistent infection with oncogenictypes of HPV may lead to cervical cancer and precancerouscervical lesions. Development of an HPVvaccine it is an important public health measure toprevent cervical cancer and precancerous cervicallesions.There are two HPV L1 virus-like-particle (VLP)vaccines that have been submitted to get their licence,one is a tetravalent (HPV 6, 11, 16, 18) vaccineand the other a bivalent (HPV 16, 18) one