Josep Vaqué

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.

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.

Nosocomial transmission of hepatitis C virus during contrast-enhanced computed tomography scanning.

We have investigated two cases of acute hepatitis C that occurred in patients who underwent digestive endoscopy and contrast-enhanced computed tomography (CT) scanning at two different centers. Investigations to identify the sources of infection included an on-site review of diagnostic procedures, interview of the involved healthcare staff, serological testing of the patients who underwent the procedures before and after the index cases and a molecular analysis of viral isolates from the patients and from potential viremic sources. In both cases, the epidemiological investigation identified a chronic hepatitis C virus (HCV) carrier who had been subjected to CT-scanning immediately before the index patient. Genetic distance and molecular phylogenetic analyzes of HCV sequences showed a close relationship between the isolates from these carriers and those from the acute-hepatitis patients, strongly suggesting that patient-to-patient transmission had occurred during CT. This is the first report describing two well documented cases of HCV nosocomial patient-to-patient transmission during contrast-enhanced CT scanning.

Funciones, actividades y estructuras de salud pública: el papel de los municipios grandes y medianos

Objetivo: Este trabajo pretende analizar como se cubren las funciones de salud publica en los municipios grandes y medianos de Catalunya, valorando el papel de los servicios de titularidad municipal, las actividades que desarrollan y su estructura. Metodos: Se utilizo un cuestionario como instrumento para la recogida de datos, con preguntas referidas a las funciones y actividades de salud publica, asi como a aspectos estructurales de los servicios municipales. El universo fueron los 43 municipios de mas de 25.000 habitantes de Catalunya (el 3% de los municipios y el 70% de la poblacion). Se obtuvieron respuestas de 28 municipios (65%), que cubren al 60% de la poblacion de Catalunya, e incluyen a todos los de mas de 50.000 habitantes. Resultados: La funcion de salud publica en la que los municipios asumen menor protagonismo es la de valoracion de necesidades, mientras que en las de desarrollo de politicas y de garantia de servicios el papel de los municipios es mayor. Respecto a las actividades, el papel de los municipios es preponderante en aspectos de proteccion de la salud, pero pocos municipios mantienen una actividad importante en vigilancia epidemiologica y sustancias adictivas. Se estima un gasto municipal en salud publica por habitante y ano de 1.063 ptas. El 72% del personal de los servicios municipales de salud publica mantiene dedicacion plena y el resto solo parcial (fundamentalmente son miembros de los cuerpos de sanitarios titulares al servicio de la administracion local). Los municipios con frecuencia agrupan las estructuras de salud publica con otras, habitualmente de consumo, de medio ambiente o de servicios sociales. Conclusiones: Se comprueba la persistencia de una notable actividad municipal en materia de salud publica. El volumen de recursos identificados y la capacidad de gestion parecen notables. Para algunos municipios hay actividades basicas en materia de salud publica que no parecen cubiertas, al menos en la percepcion de los responsables locales.

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.

Microbiología de las infecciones del sitio quirúrgico en pacientes intervenidos del tracto digestivo

INTRODUCTION Knowledge of the microbiology of surgical infections after abdominal surgery can be of use when prescribing effective empirical antibiotic treatments. METHOD Analysis of surgical infections after abdominal surgery in patients enrolled in the Prevalence of Infections in Spanish Hospitals (EPINE) corresponding to the years 1999-2006. RESULTS During the period of the study, 2,280 patients who were subjected to upper or lower abdominal tract surgery were diagnosed with an infection at the surgical site (SSI). Eight hundred and eighty three patients (37%) had an operation of the upper abdominal tract (gastric, hepatobiliary, and pancreatic surgery) and 1,447 patients (63%) lower abdominal tract surgery (appendectomy and colon surgery). A total of 2,617 bacterial species were isolated in the 2,280 patients included in the analysis. The most frequent microorganisms isolated were, Escherichia coli (28%), Enterococcus spp. (15%), Streptococcus spp. (8%), Pseudomonas aeruginosa (7%), and Staphylococcus aureus (5%, resistant to methicillin 2%). In the surgical infections after upper abdominal tract procedures, there were a higher proportion of isolations of staphylococci, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp. and Candida albicans and less Escherichia coli, Bacteroides fragilis and Clostridium spp. CONCLUSION The microbiology of SSI produced after upper abdominal tract surgery did not show any significant differences compared to those of the lower tract. However, more cases of SSI were detected due to staphylococci, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp. and Candida albicans and less caused by Escherichia coli, Bacteroides fragilis and Clostridium spp.

Indicadores de infección nosocomial

Los indicadores de infeccion nosocomial (IN) son una expresion de la calidad asistencial asi como de la seguridad de los pacientes durante su estancia en el hospital. La cuantificacion de los indicadores de infeccion se realiza mediante la aplicacion de sistemas y/o programas de vigilancia. Los sistemas actuales de vigilancia de IN se basan tanto en estudios de prevalencia como de incidencia. En Espana se realiza desde el ano 1990 el estudio de prevalencia EPINE, promovido por la Sociedad Espanola de Medicina Preventiva, Salud Publica e Higiene, que ha desarrollado 25 indicadores relacionados con IN en el conjunto de pacientes hospitalizados. Asimismo, desde el ano 1994, se realiza el estudio de incidencia ENVIN-HELICS promovido por el Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Espanola de Medicina Intensiva, Critica y Unidades Coronarias que ha desarrollado 9 indicadores relacionados con infeccion adquirida en unidades de cuidados intensivos (UCI) en pacientes criticos. La participacion en ambos sistemas de vigilancia es voluntaria y ha crecido de forma progresiva ano tras ano. Los dos sistemas de vigilancia ofrecen resultados de diferentes realidades en el entorno de la IN son complementarios entre si y han contribuido a crear una formacion y una sensibilizacion del personal sanitario ante la IN y la seguridad del paciente. Este articulo muestra los indicadores correspondientes al ano 2007 obtenidos por ambos programas, asi como los estandares de referencia.

Prevention and control of nosocomial infections in Spain : Current problems and future trends

Spain is a state member of the European Union, with more than 180,000 hospital beds and 800 public and private institutions. Only 6.9% of our gross national product is devoted to health expenditures. All citizens receive free health care through the National Health System. This system has given increasing attention to the prevention and control of nosocomial infections since 1986. In this article, results of serial prevalence surveys of antibiotic use and resistance patterns of microorganisms isolated from nosocomial infections are discussed. The needs for future development of infection control and quality assurance training programs in Spain also are discussed. Overall, a clinically and epidemiologically oriented approach to infection control is preferred, with greater emphasis in the role of infection control practitioners and infection control committees.

Etiología de las infecciones quirúrgicas en pacientes sometidos a craneotomía

BACKGROUND Postoperative infections in patients undergoing craniotomy constitute significant complications associated with increased hospital stay and patient morbidity and mortality. Knowing the aetiology of surgical infections after craniotomy may contribute to improving antibiotic prophylaxis and empirical treatment. METHOD Information relating to surgical infections in patients undergoing craniotomy was obtained from a series of annual surveys on prevalence of infections in Spanish hospitals (EPINE) during the period 1999-2006. The study protocol collected relevant clinical information on patients with infection. Presence of infection was determined according to the Centres for Disease Control infection criteria. RESULTS During the time period considered, 107 cases of surgical infections in patients undergoing craniotomy were diagnosed. Forty patients were women (37%) and 67 were male (63%). The mean age was 51.7 years (median 55, range 6-86 years). The duration of the intervention was over 180minutes in 49 patients (45.8%).Thirty-eight patients (35.5%) underwent emergency surgery. Seventy-eight patients (73%) received surgical prophylaxis. Thirty-eight patients (35.5%) had superficial infection of the surgical wound, 38 patients (35.5%) had deep wound infection (including bone flap) and 31 patients (29%), postoperative infections of organ or space (meningitis, subdural empyema or brain abscess). The most common aetiology corresponded to staphylococci (50%), mainly S. aureus (one third of them methicillin-resistant), Pseudomonas aeruginosa (11%), Enterobacter spp (10%) and Acinetobacter baumannii (9%). CONCLUSION Empirical treatment of these infections should include a glycopeptide such as vancomycin and a beta-lactam with coverage against non-fermenting gram-negative bacilli.

Investigación clínicaEtiología de las infecciones quirúrgicas en pacientes sometidos a craneotomíaAetiology of surgical infections in patients undergoing craniotomy

BACKGROUND Postoperative infections in patients undergoing craniotomy constitute significant complications associated with increased hospital stay and patient morbidity and mortality. Knowing the aetiology of surgical infections after craniotomy may contribute to improving antibiotic prophylaxis and empirical treatment. METHOD Information relating to surgical infections in patients undergoing craniotomy was obtained from a series of annual surveys on prevalence of infections in Spanish hospitals (EPINE) during the period 1999-2006. The study protocol collected relevant clinical information on patients with infection. Presence of infection was determined according to the Centres for Disease Control infection criteria. RESULTS During the time period considered, 107 cases of surgical infections in patients undergoing craniotomy were diagnosed. Forty patients were women (37%) and 67 were male (63%). The mean age was 51.7 years (median 55, range 6-86 years). The duration of the intervention was over 180minutes in 49 patients (45.8%).Thirty-eight patients (35.5%) underwent emergency surgery. Seventy-eight patients (73%) received surgical prophylaxis. Thirty-eight patients (35.5%) had superficial infection of the surgical wound, 38 patients (35.5%) had deep wound infection (including bone flap) and 31 patients (29%), postoperative infections of organ or space (meningitis, subdural empyema or brain abscess). The most common aetiology corresponded to staphylococci (50%), mainly S. aureus (one third of them methicillin-resistant), Pseudomonas aeruginosa (11%), Enterobacter spp (10%) and Acinetobacter baumannii (9%). CONCLUSION Empirical treatment of these infections should include a glycopeptide such as vancomycin and a beta-lactam with coverage against non-fermenting gram-negative bacilli.