Gil Rodríguez-Caravaca

Effectiveness of intracameral cefuroxime in preventing endophthalmitis after cataract surgery Ten-year comparative study.

PURPOSE: To determine the differences in the endophthalmitis rates in cataract surgery before and after prophylactic use of intracameral cefuroxime. SETTING: University Hospital Fundación Alcorcón, Madrid, Spain. METHODS: This prospective study evaluated patients who had cataract surgery at a university eye center over a 10‐year period (1999 to 2008). Since the protocols approval by the Hospital Board in October 2005 to the end of the 10‐year period, cataract patients were routinely treated with prophylactic intracameral cefuroxime. A database was used to measure the occurrence of endophthalmitis postoperatively. Then, the incidence of endophthalmitis before and after generalized use of prophylactic cefuroxime was compared. The effect of cefuroxime was evaluated by the relative risk. RESULTS: From January 1999 to December 2008, 13 652 patients had cataract surgery. Forty‐two cases of postoperative bacterial endophthalmitis were reported. The endophthalmitis rate was 0.30% (95% confidence interval [CI], 0.26%‐0.35%) overall, 0.59% (95% CI, 0.50%‐0.70%) from January 1999 to September 2005, and 0.043% (95% CI, 0.02%‐0.06%) from October 2005 to December 2008. The relative risk was 0.07 (range 0.022 to 0.231; P<.05). CONCLUSION: Intracameral cefuroxime proved to be effective in reducing the risk for acute‐onset endophthalmitis after cataract surgery. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Incidence of endophthalmitis and impact of prophylaxis with cefuroxime on cataract surgery

Purpose To evaluate the clinical and economic impact of prophylactic administration of intracameral cefuroxime on cataract surgery. Setting Hospital Universitario Fundación Alcorcón, Madrid, Spain. Design Quasi‐experimental study with before and after analysis. Methods The evolution of the cumulative incidence of endophthalmitis before and after (October 2005) administration of intracameral cefuroxime as endophthalmitis prophylaxis in cataract surgery was studied. The annual incidence adjusting to a Poisson distribution was compared. The effectiveness of the prophylaxis was evaluated with the relative risk (RR). The impact of cefuroxime was evaluated with the attributable risk fraction and the number of patients needed to treat to avoid a case of endophthalmitis. Results Cataract surgery was performed in 19 463 patients, 6595 patients before and 12 868 patients after October 2005. Endophthalmitis was diagnosed in 44 cases (39 before and 5 after). Positive microbiology cultures were obtained in 29 patients (66%). The overall cumulative incidence was 0.23 cases per 100 patients. Cefuroxime protected against endophthalmitis (RR = 0.06; P<.05; 95% confidence interval [CI], 0.03‐0.17); the impact or number needed to treat was 182, and the attributable risk fraction was −0.93% (P<.05; 95% CI, −0.82 to −0.97). The cost of a dose of cefuroxime was &U20AC;1, and the cost of a case of endophthalmitis was &U20AC;1358. The potential saving with cefuroxime was &U20AC;1177 for every 182 patients treated. Conclusion Intracameral cefuroxime reduced the incidence of endophthalmitis in cataract surgery and had a high clinical and economic impact on its prevention. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Endoftalmitis tras cirugía de cataratas: epidemiología, aspectos clínicos y profilaxis antibiótica

PURPOSE To estimate the incidence of endophthalmitis after cataract surgery and to describe the main epidemiological and clinical data, as well as the role of intracameral antibiotics. METHODS A cross-sectional descriptive study was conducted on patients who underwent cataract surgery in a public hospital over an 11-year period. An ocular infection database was used to report endophthalmitis occurrences and to collect the clinical features. Qualitative variables are described with their frequency distribution and qualitative variables, with the mean and the standard deviation. RESULTS From January 1999 to December 2009, 15.173 patients underwent cataract surgery. A total of 43 patients suffered from postoperative endophthalmitis, giving an overall infection rate of 0.28% (95% CI: 0.20-0.36%). Among the 43 cases, there were 19 men and 24 women with a mean age of 78.5. Other clinical parameters evaluated were as follows: 25.58% were diabetic, 44.18% had some degree of immunosuppression and there were complications with posterior capsular tears in 18.6%. As regards antibiotic prophylaxis, 2 groups were considered: the first one did not receive intracameral antibiotic (8,099 patients) and the second group received intracameral cefuroxime (7,074 patients). There were 39 endophthalmitis in the first group with an infection incidence of 0.48% and 4 endophthalmitis in the second group with an infection incidence of 0.056%. The relative risk (RR) after-before cefuroxime was 0.12 (0.04-0.33) with P<0.05. CONCLUSIONS The incidence of endophthalmitis after cataract surgery in an 11-year period was lower than 0.3%. Almost half of the patients had a higher systemic risk. Intracameral cefuroxime resulted in nearly a 9-fold reduction in the rate of infection.

Incidencia de infección nosocomial en cirugía abierta de próstata

OBJECTIVES To know the rate of nosocomial infections in open prostate surgery and to assess the application of pre-surgery preparation and preoperative antibiotic prophylaxis protocols at three public hospitals in the Autonomous Community of Madrid. MATERIALS AND METHODS Prospective observational and multicentre study, including all the patients operated on at the services monitored and admitted for more than 48 hours between 1 January and 31 December 2009. They were monitored from admittance until their discharge. RESULTS The rate of hospital infection observed was 3.38%. The most frequent infection was surgical localization, with an incidence rate of 2.77% (superficial=1.23%; deep=0.31%; organ-space=1.23%). The percentage of appropriate surgical prophylaxis, both in the indication and in the selection of antibiotics, initiation and duration, with respect to all those patients that received it, was 47.42%. According to the data obtained from their clinical records, the percentage of patients in which the pre-surgery preparation protocol was correctly complied with, was 92%. CONCLUSIONS The results obtained in this multicentre study can serve not only as a reference to other public hospitals, but they are also comparable to other international monitoring systems. Monitoring and controlling infections associated with healthcare must be a key aspect in Patient Care and Safety programmes.

Incidence of Surgical Site Infection in Colon Surgery: Comparison with Regional, National Spanish, and United States Standards

BACKGROUND The high prevalence of surgical site infection (SSI) in colon surgery, and the clinical and economic impacts of such infections, make its monitoring and prevention a priority. METHODS We conducted a prospective cohort study to estimate the rate of SSI in colon surgery and the degree of compliance with antibiotic prophylaxis and pre-operative preparation protocols. The study population comprised patients who underwent colon surgery at the University Hospital of the Alcorcon Foundation in Alcorcon, Spain, from October 2007 to December 2009. Risk factors, the observance of antibiotic prophylaxis, and compliance with pre-operative preparation protocols were monitored; and their influence on SSIs was followed for 30 days after surgery. The main outcome measure was comparisons of the rates of SSI in patients undergoing colon surgery in Madrid and across the whole of Spain and in the United States, as determined in accordance with the surveillance parameters of the National Nosocomial Infections Surveillance (NNIS) index. RESULTS Among a total of 132 patients, we found a 10.6% rate of SSI. The indirect standardization rate at our hospital was 1.75-fold for the United States and 0.64-fold and 0.61-fold, respectively, the rates for Madrid and all of Spain. The rates of compliance with antibiotic prophylaxis and pre-operative preparation protocols were 93.6% and 56.8%, respectively. No relation could be established between these data and the rate of infection. The risk factors for SSI found in a multivariable analysis were the degree of contamination in surgery and the presence of chronic obstructive pulmonary disease (COPD; p<0.05). CONCLUSIONS The rate of SSI in our study population was below that for Madrid and Spain but higher than that for the United States. Thorough adherence to the monitoring system was essential for obtaining these results.

Surgical Wound Infection Rates and Risk Factors in Spinal Fusion in a University Teaching Hospital in Madrid, Spain.

Study Design. Prospective cohort study. Objective. To study risk factors linked to spinal fusion surgical wound infection (SWI) incidence and compare the incidence with rates in Madrid Region, Spain and United States as a whole. Summary of Background Data. SWI is one of the complications posed by spinal surgery. Indeed, spinal surgery has a higher infection rate than do other orthopedic surgeries such as total hip or knee arthroplasty. The study of risk factors that are susceptible to be modified will enable both the incidence of SWI and, by extension, related morbidity, mortality, and costs to be reduced. Methods. All patients undergoing spinal fusion at a tertiary hospital from June 2011 to June 2014 were included. Infection rate was calculated, and the association between risk factors and SWI incidence was assessed by reference to odds ratio (OR) with univariate and multivariate analysis. Results. The study population (n = 892) had a SWI rate of 3.9%. The standardized infection ratio of our hospital was 0.58 with respect to the Madrid Region, 0.76 with respect to Spains national rate and 2.05 with respect to the US NHSN/CDC. The multivariate analysis showed that predictive factors of SWI were diabetes mellitus (OR 2.81, 95% confidence interval, CI: 1.18–6.72, P < 0.05), chronic obstructive pulmonary disease (COPD) (OR 5.16, 95% CI: 2.04–13.08, P < 0.05), duration of surgery higher than the 75th percentile (OR 5.39, 95% CI: 1.77–110.84, P < 0.05) and dirty surgery (OR 14.01, 95% CI: 1.01–28.88, P < 0.05). Conclusion. Independent risk factors for SWI in spinal fusion are existence of diabetes mellitus, COPD, duration of surgery higher than the 75th percentile and dirty surgery. Knowing these risk factors enables action to be taken to reduce the SWI rate. Level of Evidence: 3

Epidemiología del sarampión en personas vacunadas, España 2003-2014

INTRODUCTION During the final phase of measles elimination rigorous investigation of each individual case becomes fundamental to confirm or discard cases, particularly among vaccinated people, since they experience a milder disease, and laboratory diagnosis is more complex. Our study focused in the epidemiology of measles in vaccinated people. METHODS Longitudinal study on measles cases in two dose vaccinated people in Spain from 2003 to 2014. RESULTS We confirmed 138 measles cases (90 of them, laboratory confirmed) in people with two doses of vaccine. The median of time from last vaccination to rash onset showed a lineal trend (P<.001), in parallel with the number of doses of vaccine received (0, 1, 2 doses). Among confirmed cases, the hospitalization risk decreased inversely proportional to the number of administered vaccine doses (linear trend, P<.001). Only in 23.9% of confirmed cases and 50% of discarded cases the guidelines about sample taking were fulfilled. 50% of samples in two dose vaccinated people were taken without fulfilling time delay criteria. 16.7% (36/215) of discarded cases with a negative IgM result did correspond to samples taken early (first 72h after rash) and could represent false negatives. CONCLUSION Our results highlight the importance of fulfilling properly the guidelines for laboratory diagnosis in order to confirm or discard every measles case, especially in two dose vaccinated people. When a negative IgM result is obtained in early samples a new IgM test should be practiced, as well as a PCR test, in order to avoid infra-detection of cases.

Surgical site infection incidence and risk factors in knee arthroplasty: A 9-year prospective cohort study at a university teaching hospital in Spain

Background: Surgical site infection (SSI) is one of the complications posed by knee replacement surgery. Hospital‐based infection surveillance systems may provide indicators of improvement and allow the characterization of risk factors critical to reduce infection. The aims of this study were to compare the incidence of SSI in our center with rates in the Madrid Region, Spain, and the United States, and to evaluate any possible SSI‐related risk factor in knee replacement surgery. Methods: All patients who underwent knee replacement surgery at a tertiary hospital in 2008–2016 were included. SSI was defined according to Centers for Disease Control and Prevention criteria. Infection rate was calculated. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR) with multivariate analysis. Results: The study population (n = 1969) had a global SSI risk of 1.0%. We found a declining trend in the follow‐up period, from an SSI risk of 1.8% in 2009 to 0.4% in 2016. Independent risk factors included hair removal (OR: 3.09, 95% confidence interval [CI]: 1.27–7.50) and National Healthcare Safety Network risk index ≥ 2 (OR: 9.37, 95% CI: 2.90–30.26). Conclusion: This study identified risk factors that showed the necessity to strictly comply with wound decontamination and patient preparation protocols, reduce surgery duration, and identify patients who require comprehensive monitoring.

Food poisoning caused by scombroids: A case-control study

The aim of this study is to report the epidemiological characteristics of a food poisoning outbreak due to scombroid fish in a hospital. A case-control study (1:4) was conducted. Patients either symptomatic of food poisoning (cases) or asymptomatic (controls) eating at the hospital cafeteria were included. To identify the source of the outbreak, sanitary control factors were assessed. Microbiological studies and the mast cell tryptase test were performed. All cases and controls received a questionnaire enquiring about symptoms and foods consumed. The odds ratios (OR) for all risk factors and their 95% confidence intervals (CI) were assessed. In total, 20 individuals (90% female) were included in the study: four cases and 16 controls. The overall mean age was 43 years (SD: 10.2). The most frequent symptom observed was facial and neck erythaema (100%). Microbiological cultures were negative, the mast cell tryptase test was normal and breakdown of the cold chain did not occur. The most likely source of the outbreak was fried anchovies (OR: 34.7; 95% CI: 1.50-809.6; p=0.02). Methods suitable to the rapid assessment of the outbreak allowed us to establish prompt preventive measures and identify the likely aetiology.

Utilidad de los parámetros analíticos en el manejo de los pacientes pediátricos con sospecha de pielonefritis aguda. ¿Es fiable la procalcitonina?

OBJECTIVE To investigate the usefulness of procalcitonin (PCT) and other analytical parameters (white blood cell count [WBC], C-reactive protein [CRP]) as markers of acute renal damage in children after a first febrile or afebrile urinary tract infection (UTI). METHODS A retrospective study was conducted on children with a first episode of UTI admitted between January 2009 to December 2011, and in whom serum PCT, CRP and white blood cell count were measured, as well as assessing the acute renal damage with renal scintigraphy with 99mTc-DMSA (DMSA) within the first 72h after referral. A descriptive study was performed and ROC curves were plotted, with optimal cut-off points calculated for each parameter. RESULTS The 101 enrolled patients were divided into two groups according to DMSA scintigraphy results, with 64 patients being classified with acute pyelonephritis (APN), and 37 with UTI. The mean WBC, CRP and PCT values were significantly higher in patients with APN with respect to normal acute DMSA. The area under the ROC curve was 0.862 for PCR, 0.774 for WBC, and 0.731 for PCT. The optimum statistical cut-off value for PCT was 0.285ng/ml (sensitivity 71.4% and specificity 75%). CONCLUSION Although the mean levels of fever, WBC, CRP, and PCT were significantly increased in patients with APN than in those who had UTI, the sensitivity and specificity of these analytical parameters are unable to predict the existence of acute renal damage, making the contribution by renal DMSA scintigraphy essential.