An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital.

Multidrug-resistant Candida auris has emerged as a cause of insidious hospital outbreaks and complicated infections. We present the analysis of an ongoing C. auris outbreak including the largest published series of C. auris bloodstream infection. All C. auris-positive patients from April-2016 to January-2017 were included. Environmental, clinical and microbiological data were recorded. Definitive isolate identification was performed by ITS-rDNA sequencing, and typing by amplified fragment length polymorphism fingerprinting. One hundred and forty patients were colonised by C. auris during the studied period (68% from surgical intensive care). Although control measures were implemented, we were not able to control the outbreak. Forty-one invasive bloodstream infections (87.8% from surgical intensive care) were included. Clinical management included prompt intravascular catheter removal and antifungal therapy with echinocandins. All isolates were fluconazole- and voriconazole-resistant, but echinocandin- and amphotericin B-susceptible. Thirty-day mortality rate was 41.4%, and severe septic metastasis as spondylodiscitis and endocarditis were observed in 5 patients (12%). C. auris was also recovered from inanimate patient surroundings and medical equipment. Despite antifungal treatment, high mortality and late complication rates were recorded. Molecular typing suggested a clonal outbreak different from those previously published.

Eventos adversos relacionados con la medicación en los hospitales de la Comunidad Valenciana. Estudio EPIDEA 2005-2013 / Adverse events related to medication in hospitals from the Valencian Community. EPIDEA Study 2005-2013

Introducción. Determinar la prevalencia de eventos adversos relacionados con la medicación (EAM) en los hospitales de la Comunidad Valenciana en el periodo de estudio 2005-2013. Conocer los factores de riesgo asociados, su análisis e impacto. Material y métodos. El trabajo está basado en los datos y metodología del Estudio de Prevalencia de Eventos Adversos en los hospitales de la Comunidad Valenciana (EPIDEA), desde 2005 hasta 2013. Se analizaron los EAM producidos en cada año. Resultados. Se identificaron 344 EAM que ocurrieron a 337 pacientes, entre 35.103 pacientes estudiados, lo cual constituye una prevalencia de EAM de 0,96% (IC95% 0,89-1,07). Los factores de riesgo intrínseco para EAM más prevalentes fueron hipertensión, diabetes y neoplasia. Los factores de riesgo extrínseco más prevalentes fueron catéter venoso periférico, sonda urinaria cerrada y catéter venoso central. Los grupos terapéuticos más implicados fueron antibióticos sistémicos, fármacos cardiovasculares, y antineoplásicos. El 61,17% de los EAM fue clasificado como moderado, un 27,18% como leve y un 11,65 % como grave. El 33,99% de los EAM prolongaron la estancia del paciente y un 39,90% fueron causa de reingreso del paciente. Globalmente, el 58,5% de los EAM fueron evitables. Según gravedad, fueron evitables el 46.3% de los EAM leves, el 60.3% de los EAM moderados, y el 75% de los EAM graves (p=0.013). Conclusiones. La prevalencia de pacientes con EAM en la Comunidad Valenciana durante el periodo 2005-2013 fue de 0,96%. Más de la mitad de EAM fueron evitables, observándose una relación directa significativa entre la evitabilidad de los EAM con la gravedad de los mismos (AU)

Introduction. To determine the prevalence of Adverse Events related to Medication (AEM) in hospitals of the Valencian Community in the 2005-2013 study period, and to describe the associated risk factors and their impact. Material and methods. This study is based on data and methodology of the Study of Prevalence of Adverse Events in hospitals (EPIDEA), since its inception in 2005 until 2013. AEM produced in each year were analyzed. Results. We identified 344 AEM that occurred in 337 patients, among 35,103 patients studied, giving a prevalence of patients with AEM of 0.96% (IC95% 0.89-1.07). The most prevalent intrinsic risk factors for AEM were hypertension, diabetes and cancer. The most prevalent extrinsic risk factors were peripheral venous catheter, urinary catheter and central venous catheter. Therapeutic groups most frequently involved were systemic antibiotics, cardiovascular drugs and antineoplastics. The 61.17% of AEM was classified as moderate, followed by 27.18% as mild and 11.65% as severe. The 33.99% of EAM caused increase of the patient’s stay and 39.90% of EAM caused the re-entry of patient. The 58.5% of AEM were avoidable. Mild AEM were avoidable in 46.3%, moderate AEM were avoidable in 60.3% and severe AEM were in 75% (p = 0.013). Conclusions. The prevalence of patients with AEM in hospitals of the Community of Valencia for the period 2005- 2013 was 0.96%. More than half of AEM were preventable, and preventability increases significantly with the severity of the event (AU)