José Rosselló

Nosocomial Infections in Spain: Results of Five Nationwide Serial Prevalence Surveys (EPINE Project, 1990 to 1994)

OBJECTIVE To determine trends in rates of nosocomial infections in Spanish hospitals. DESIGN Prospective prevalence studies, performed yearly from 1990 through 1994. SETTING A convenience sample of acute-care Spanish hospitals. PARTICIPANTS AND PATIENTS The number of hospitals and patients included were as follows: 1990, 125 hospitals and 38,489 patients; 1991, 136 and 42,185; 1992, 163 and 44,343; 1993, 171 and 46,983; 1994, 186 and 49,689. A core sample of 74 hospitals, which participated in all five surveys and included a mean of 23,871 patients per year, was analyzed separately. RESULTS The overall prevalence rate of patients with nosocomial infections in the five studies was as follows: 1990, 8.5%; 1991, 7.8%; 1992, 7.3%; 1993, 7.1%; and 1994, 7.2%. The prevalence rate of patients with nosocomial infection in the core sample of 74 hospitals was 8.9%, 8.0%, 7.4%, 7.6%, and 7.6%, respectively (test for trend, P = .0001). Patients admitted to intensive-care units had a 22.8% prevalence rate of nosocomial infection in 1994. The most common nosocomial infections by primary site were urinary tract infection and surgical site infections, followed by respiratory tract infections and bacteremia. More than 60% of all infections were supported by a microbiological diagnosis. CONCLUSIONS The EPINE project provides a uniform tool for performing limited surveillance of nosocomial infections in most Spanish acute-care hospitals. Its use helps to spread an accepted set of definitions and methods for nosocomial infection control in the Spanish healthcare system. The surveys indicated that the prevalence of nosocomial infections has been reduced over the last 5 years in a core sample of Spanish hospitals.

Cytomegalovirus Disease as a Risk Factor for Graft Loss and Death After Orthotopic Liver Transplantation

To determine whether cytomegalovirus (CMV) disease is an independent risk factor for graft loss and death after orthotopic liver transplantation, we performed a 3-year follow-up study of 143 consecutive liver transplant recipients and six patients who underwent retransplantation. Thirty-seven patients (25%) had had CMV disease and were alive after treatment. Fifty-two deaths and eight graft losses occurred. The cumulative incidence of graft failure at 1 and 3 years of follow-up were 40% and 63%, respectively, for patients with CMV disease, compared with 22% and 33%, respectively, for those without CMV disease (P < .05, logrank test). Cumulative probabilities of survival for patients with and without CMV disease were 64% and 82%, respectively, at 1 year and 46% and 69%, respectively, after 3 years (P < .05, logrank test). Multivariate analysis with use of a time-dependent Cox model showed that previous CMV disease was an independent risk factor for graft loss at 1 and 3 years of follow-up (P = .04 and P = .007) and for patient survival (P = .04 and P = .01). Our results indicate that CMV disease is a significant independent risk factor for graft loss and patient survival after liver transplantation.

Etiología de las infecciones hospitalarias en España (EPINE, 1990-1999)

BACKGROUND: Clinical and demographic characteristics of patients, their interaction with pathogens and antimicrobial therapies are prompting changes in the epidemiology of hospital-acquired infections (HI). The knowledge of the etiology of hospital-acquired infections is valuable for the treatment of infected patients and for the prevention of HI. PATIENTS AND METHOD: We analyzed a series of 10 annual prevalence studies during the period 1990-1999 (EPINE project) in Spanish hospitals. Estimate of prevalence of infection was calculated by means of the percent distribution of every organism regarding overall identified organisms and infections. RESULTS: 40,550 HI were identified among 484,013 patients (HI prevalence = 8.4%; 95% CI, 8.3-8.5%). Gram-positive organism predominated steadily in bloodstream and surgical wound infections, while gram-negative bacilli predominated in respiratory and urinary tract infections. There was an increase in HI infections by Acinetobacter baumannii (from 1.9% in 1990 to 3.6% in 1999; P < 0.001) and Candida albicans (from 2.4 to 3.2%; P < 0.001), as well as an increase in both HI and community-acquired infections by methicillin-resistant Staphylococcus aureus [HI: from 4.7 to 40.2% (P < 0.001); community-acquired: from 2.7 to 15.6% (P < 0.001)]. CONCLUSIONS: We observed some changes in the etiology of infections over the last decade: rates of methicillin-resistant S. aureus hospital-acquired and community-acquired infections increased steadily and their initial rates multiplied by 8 and 6, respectively. Rates of HI caused by yeasts and A. baumannii increased also.

Two grams daily of oral acyclovir reduces the incidence of cytomegalovirus disease in CMV-seropositive liver transplant recipients

Abstract. Our objective in this study was to determine the efficacy of 2 grams a day of oral acyclovir administered for 16 weeks after transplantation for the prevention of cytomegalovirus (CMV) infection and disease in CMV‐seropositive liver transplant recipients. Seventy‐three adult liver transplant recipients, seropositive for CMV, were randomized to receive either 2 grams a day of oral acyclovir for 16 weeks after transplantation or no prophylaxis. The incidence of CMV disease was significantly lower in the acyclovir group (5 %) than in the control group (27 %; P < 0.05). By log‐rank analysis, the differences in the probability of presenting CMV disease over the first 16 weeks and over the 1st year were also significant (P < 0.05). We conclude that 2 grams a day of oral acyclovir provides effective prophylaxis against CMV disease in CMV‐seropositive liver transplant recipients.

Utilización de los antimicrobianos en los hospitales españoles (EPINE, 1990–1999)

Fundamento Entre las estrategias recomendadas para la contencion de la resistencia a los antimicrobianosen el ambito hospitalario se encuentran la monitorizacion del consumo de antimicrobianosy el estudio de los habitos de prescripcion. Metodo Serie de 10 estudios anuales de prevalencia durante el periodo 1990–1999, en hospitalesespanoles. La estimacion de la utilizacion de antimicrobianos se calculo mediante la distribucionporcentual de cada antimicrobiano sobre el total de antimicrobianos prescritos. Secalculo la prueba de la χ 2 para tendencias. Resultados De los 484.013 pacientes hospitalizados, entre un 34 y un 36% estaban recibiendoantimicrobianos, de los cuales los antibioticos representaban mas del 90% de todos ellos.El uso de amoxicilina-acido clavulanico aumento desde un 3,8% en 1990 hasta un 14,8% en1999 (p Conclusiones Aunque la utilizacion de los antimicrobianos se ha incrementado durante estos10 anos, las cifras actuales se situan en los intervalos observados en otros paises. El perfil deutilizacion de antibioticos se modifico a lo largo de este periodo; disminuyo el uso de aminoglucosidosy se incremento el consumo de las asociaciones de β-lactamicos e inhibidores de β-lactamasas, fluoroquinolonas y carbapenemes.