F. Álvarez-Lerma

Estudio Nacional de Vigilancia de Infección Nosocomial en Unidades de Cuidados Intensivos. Informe evolutivo de los años 2003-2005

Objetivo Describir las tasas nacionales de las infecciones adquiridas en Unidades de Cuidados Intensivos (UCI) relacionadas con dispositivos invasores durante 2003, 2004 y 2005, su etiologia y la evolucion de los marcadores de multirresistencia. Diseno Estudio prospectivo observacional. Ambito UCI u otras unidades donde ingresan pacientes criticos. Pacientes Un total de 21.608 pacientes ingresados durante mas de 24 horas en las UCI participantes. Principales variables de interes Infecciones relacionadas con dispositivos: neumonias relacionadas con ventilacion mecanica (N-VM), infecciones urinarias relacionadas con sonda uretral (IU-SU) y bacteriemias primarias (BP) y/o relacionadas con cateteres vasculares de riesgo (BCV). Resultados En 2.279 (10,5%) pacientes se han detectado 3.151 infecciones: 1.469 N-VM, 808 IU-SU y 874 BP/BCV. Las tasas de incidencia han oscilado desde 15,5 a 17,5 N-VM por 1.000 dias de ventilacion mecanica, 5,0 a 6,7 IU-SU por 1.000 dias de sonda uretral y 4,0 a 4,7 BP/BCV por 1.000 dias de cateter vascular. La etiologia predominante en las N-VM ha sido Staphylococcus aureus sensible a meticilina, Pseudomonas aeruginosa y Acinetobacter baumannii . Las IU-SU han estado originadas predominantemente por Escherichia coli, Candida albicans y Enterococcus faecalis . A. baumannii y E. coli han aumentado su resistencia a imipenem y ciprofloxacino o cefotaxima, respectivamente, en el ultimo ano controlado. Conclusiones Persisten tasas elevadas en todas las infecciones controladas, sin cambio en la etiologia y aumento de la resistencia de bacilos gramnegativos.

Recomendaciones para el diagnóstico de la neumonía asociada a ventilación mecánica

Francisco Alvarez-Lerma, Antonio Torres, Felipe Rodriguez de Castro y la Comision de Expertos del Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Espanola de Medicina Intensiva, Critica y Unidades Coronarias (GTEI-SEMICYUC ), Area de Trabajo de Tuberculosis e Infecciones Respiratorias de la Sociedad Espanola de Patologia del Aparato Respiratorio (SEPAR) y Grupo de Estudio de Infeccion Hospitalaria de la Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica (GEIH-SEIMC)

Estudio nacional de vigilancia de infección nosocomial en unidades de cuidados intensivos. Informe del año 2001

Fundamento. El Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Espanola de Medicina Intensiva, Critica y Unidades Coronarias (GTEI-SEMICYUC) ha elaborado un programa de vigilancia de infeccion nosocomial para ser aplicado en las UCI de Espana. En este estudio se presentan los resultados correspondientes al ano 2001.nnMetodos. Se han incluido de forma prospectiva los pacientes ingresados durante mas de 24 horas en las UCI participantes, que fueron seguidos hasta su alta de UCI o hasta un maximo de 60 dias. Se han controlado las infecciones relacionadas con dispositivos: neumonias relacionadas con ventilacion mecanica (N-VM), infecciones urinarias relacionadas con sonda uretral (IU-SU), bacteriemias primarias (BP) y relacionadas con cateteres venosos centrales (B-CVC) y bacteriemias secundarias.nnResultados. Se ha incluido a 5.045 pacientes ingresados en 67 UCI pertenecientes a 63 hospitales distintos. En 485 (9,6%) pacientes se han detectado 694 infecciones, 311 N-VM (44,8%), 155 IU-SU (22,3%), 82 BP (11,8%), 68 B-CVC (9,8%) y 78 bacteriemias secundarias (11,2%).nnLas densidades de incidencia en relacion con los dias de exposicion al factor de riesgo han sido 16,1 N-VM por 1.000 dias de ventilacion mecanica, 5,5 IU-SU por 1.000 dias de sonda uretral y 3,7 BP-CVC por 1.000 dias de cateter venoso central. La etiologia predominante en las N-VM tempranas ha sido Staphylococcus aureus sensible a meticilina y Haemophilus influenzae, y en las N-VM tardias Pseudomonas aeruginosa y Acinetobacter baumannii. Las IU-SU han sido originadas predominantemente por Escherichia coli y Enterococcus faecalis, y las BP-CVC por S. epidermidis y Staphylococcus coagulasa negativo.nnEntre los marcadores de resistencia destacan por su frecuencia: P. aeruginosa resistente a ceftazidima (35,7%), S. aureus resistente a meticilina (29,2%), A. baumannii resistente a imipenem (23,1%) y E. coli resistente a ciprofloxacino (19,2%). A diferencia de otros anos, se han detectado una cepa de Enterococcus spp. y otra de Staphylococcus aureus, ambas resistentes a vancomicina.nnConclusiones. Se han identificado, para el ano 2001, las tasas nacionales de las infecciones nosocomiales relacionadas con ventilacion mecanica, sonda uretral y cateter venoso central, asi como los agentes patogenos que predominan en cada una de ellas y el estado de los marcadores de multirresistencia.

Impacto de la bacteriemia primaria y relacionada con catéter intravascular causada por Staphylococcus coagulasa negativo en pacientes críticos

OBJECTIVEnTo study the impact of coagulase-negative staphylococcal (CNS) primary and intravascular catheter-related bloodstream infection (PBSI/CRBSI) on mortality and morbidity in critically-ill patients.nnnDESIGNnWe performed a double analysis using data from the ENVIN-HELICS registry data (years 1997 to 2008): 1) We studied the clinical characteristics and outcomes of patients with CNS-induced PBSI/CRBSI and compared them with those of patients with PBSI/CRBSI caused by other pathogens; and 2) We analyzed the impact of CNS-induced PBSI/CRBSI using a case-control design (1:4) in patients without other nosocomial infections.nnnSETTINGn167 Spanish Intensive Care Units.nnnPATIENTSnPatients admitted to ICU for more than 24 hours.nnnRESULTSn2,252 patients developed PBSI/CRBSI, of which 1,133 were caused by CNS. The associated mortality for PBSI/CRBSI caused by non-CNS pathogens was higher than that of the CNS group (29.8% vs. 25.9%; P=.039) due exclusively to the mortality of patients with candidemia (mortality: 45.9%). In patients without other infections, PBSI/CRBSI caused by CNS (414 patients) is an independent risk factor for a higher than average length of ICU stay (OR: 5.81, 95% CI: 4.31-7.82; P<.001).nnnCONCLUSIONnCrude mortality of patients with CNS-induced BPSI/CRBSI is similar to that of patients with BPSI/CRBSI caused by other bacteria, but lower than that of patients with candidemia. Compared to patients without nosocomial infections, CNS-induced PBSI/CRBSI is associated with a significant increase in length of ICU stay.

Impact of primary and intravascular catheter-related bacteremia due to coagulase-negative staphylococci in critically ill patients

Abstract Objective To study the impact of coagulase-negative staphylococcal (CNS) primary and intravascular catheter-related bloodstream infection (PBSI/CRBSI) on mortality and morbidity in critically-ill patients. Design We performed a double analysis using data from the ENVIN-HELICS registry data (years 1997 to 2008): 1) We studied the clinical characteristics and outcomes of patients with CNSinduced PBSI/CRBSI and compared them with those of patients with PBSI/CRBSI caused by other pathogens; and 2) We analyzed the impact of CNS-induced PBSI/CRBSI using a case-control design (1:4) in patients without other nosocomial infections. Setting 167 Spanish Intensive Care Units. Patients Patients admitted to ICU for more than 24 hours. Results 2,252 patients developed PBSI/CRBSI, of which 1,133 were caused by CNS. The associated mortality for PBSI/CRBSI caused by non-CNS pathogens was higher than that of the CNS group (29.8% vs. 25.9%; P = .039) due exclusively to the mortality of patients with candidemia (mortality: 45.9%). In patients without other infections, PBSI/CRBSI caused by CNS (414 patients) is an independent risk factor for a higher than average length of ICU stay (OR: 5.81, 95% CI: 4.31–7.82; Pxa0 Conclusion Crude mortality of patients with CNS-induced BPSI/CRBSI is similar to that of patients with BPSI/CRBSI caused by other bacteria, but lower than that of patients with candidemia. Compared to patients without nosocomial infections, CNS-induced PBSI/CRBSI is associated with a significant increase in length of ICU stay

Guías para el manejo de la neumonía comunitaria del adulto que precisa ingreso en el hospital

n n La neumonía adquirida en la comunidad (NAC) sigue siendo un problema sanitario de primer orden. En España, la incidencia de este tipo de infección es de 162 casos por cada 100.000 habitantes, lo que supone 53.000 hospitalizaciones al año y un coste de 115 millones de euros. Además, en los últimos años se han producido avances significativos en el conocimiento de la etiología y el diagnóstico de la enfermedad. Al mismo tiempo se está consiguiendo una mejor comprensión del problema derivado del aumento de las resistencias bacterianas, y han aparecido nuevas alternativas terapéuticas para el manejo de esta enfermedad. Por todo ello, un grupo de expertos pertenecientes a tres sociedades científicas de nuestro país (Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias - SEMICYUC; Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica - SEIMC; Sociedad Española de Neumología y Cirugía Torácica - SEPAR) se han reunido para, tras una revisión crítica de la literatura, elaborar las presentes Guías para el manejo de la NAC. En ellas se abordan aspectos de epidemiología, índices pronósticos, etiología, diagnóstico, tratamiento y prevención de la enfermedad. El objetivo que se persigue es ayudar a los clínicos en la toma de decisiones, sin olvidar destacar la importancia que tiene el conocer las características particulares de la NAC en cada zona.n n n n Community acquired pneumonia is still an important health problem. In Spain the year incidence is 162 cases per 100,000 inhabitants with 53,000 hospital admission costing 115 millions of euros per year. In the last years there have been significant advances in the knowledge of: aetiology, diagnostic tools, treatment alternatives and antibiotic resistance. The Spanish Societies of Intensive and Critical Care (SEMICYUC), Infectious Diseases and Clinical Microbiology (SEIMC) and Pulmonology and Thoracic Surgery (SEPAR) have produced these evidence-based Guidelines for the management of community acquired pneumonia in Adults. The main objective is to help physicians to make decisions about this disease. The different points that have been developed are: aetiology, diagnosis, treatment and prevention.n n

Pacientes con gripe por el virus influenza A (H1N1)pdm09 ingresados en la UCI. Impacto de las recomendaciones de la SEMICYUC

OBJECTIVESnTo evaluate the impact of the recommendations of the SEMICYUC (2012) on severe influenza A.nnnDESIGNnA prospective multicenter observational study was carried out.nnnSETTINGnICU.nnnPATIENTSnPatients infected with severe influenza A (H1N1) from the GETGAG/SEMICYUC registry.nnnINTERVENTIONSnAnalysis of 2 groups according to the epidemic period of the diagnosis (2009-2011; 2013-2015).nnnVARIABLESnDemographic, temporal, comorbidities, severity, treatments, mortality, late diagnosis and place of acquisition.nnnRESULTSnA total of 2,205 patients were included, 1,337 (60.6%) in the first period and 868 (39.4%) in the second one. Age and severity on admission were significantly greater in the second period, as well as co-infection. With regard to the impact of the recommendations, in the second period the diagnosis was established earlier (70.8 vs. 61.1%, P<.001), without changes in the start of treatment. Patients received less corticosteroid treatment (39.7 vs. 44.9%, P<.05), more NIMV was used (47.4 vs. 33.2%, P<.001) and more vaccination was made (11.1 vs. 1.7%, P<.001), without changes in mortality (24.2 vs. 20.7%). A decrease in nosocomial infection was also noted (9.8 vs. 16%, P<.001). Patients needed less MV with more days of ventilation, more vasopressor drug use and more ventral decubitus.nnnCONCLUSIONSnThe management of patients with severe influenza A (H1N1) has changed over the years, though without changes in mortality. The recommendations of the SEMICYUC (2012) have allowed earlier diagnosis and improved corticosteroid use. Pending challenges are the delay in treatment, the vaccination rate and the use of NIMV.

Infección urinaria relacionada con sonda uretral en pacientes críticos ingresados en UCI. Datos descriptivos del estudio ENVIN-UCI

OBJECTIVEnTo describe trends in national catheter-related urinary tract infection (CRUTI) rates, as well as etiologies and multiresistance markers.nnnDESIGNnAn observational, prospective, multicenter voluntary participation study was conducted from 1 April to 30 June in the period between 2005 and 2010.nnnSETTINGnIntensive Care Units (ICUs) that participated in the ENVIN-ICU registry during the study period.nnnPATIENTSnWe included all patients admitted to the participating ICUs and patients with urinary catheter placement for more than 24 hours (78,863 patients).nnnINTERVENTIONnPatient monitoring was continued until discharge from the ICU or up to 60 days.nnnVARIABLES OF INTERESTnCRUTIs were defined according to the CDC system, and frequency is expressed as incidence density (ID) in relation to the number of urinary catheter-patients days.nnnRESULTSnA total of 2329 patients (2.95%) developed one or more CRUTI. The ID decreased from 6.69 to 4.18 episodes per 1000 days of urinary catheter between 2005 and 2010 (p<0.001). In relation to the underlying etiology, gramnegative bacilli predominated (55.6 to 61.6%), followed by fungi (18.7 to 25.2%) and grampositive cocci (17.1 to 25.9%). In 2010, ciprofloxacin-resistant E. coli strains (37.1%) increased, as well as imipenem-resistant (36.4%) and ciprofloxacin-resistant (37.1%) strains of P. aeruginosa.nnnCONCLUSIONSnA decrease was observed in CRUTI rates, maintaining the same etiological distribution and showing increased resistances in gramnegative pathogens, especially E. coli and P. aeruginosa.