European Journal of Clinical Microbiology & Infectious Diseases, Aug 15, 2010
Artigo Original | Original article INTRODUCTION Microbial keratitis is commonly diagnosed worldwi... more Artigo Original | Original article INTRODUCTION Microbial keratitis is commonly diagnosed worldwide, and continues to cause significant ocular morbidity, requiring prompt and appropriate treatment (1,2). A large retrospective cohort recently reported an incidence of ulcerative keratitis of 27.6/100,000 person-years (95% confidence interval, 24.6-30.9) (3). Predisposing factors for microbial keratitis described in the literature, include: previous ocular surgery, contact lens use, trauma and metal fo reign body, surgical sutures, ocular surface disease, topical corticosteroid use, herpetic keratitis, lid misalignment, and systemic diseases such as diabetes and smoking (4-16). Predictive factors for outcome such as initial visual acuity at admission have not been widely described in previous studies. Previous reports describe a variability of etiological agents in dif erent centers around the world (2,4,5,7,8,13,14,16). Empirical, broadspectrum treatment of keratitis is a strategy selected by many ophthalmologists (17-21). However the increased resistence of the causative mi croorganism to currently available anti-infective drugs requires ongoing assessment of the trends of clinical and microbiological evaluation of the patients (22). Clinical characteristics and outcomes of patients admitted with presumed microbial keratitis to a tertiary medical center in Israel Características clínicas e desfechos dos pacientes internados com diagnóstico de ceratite microbiana em um centro terciário em Israel
European Journal of Clinical Microbiology & Infectious Diseases, Dec 24, 2009
Multidrug-resistant strains of Pseudomonas aeruginosa (MDRPA) have been increasing in some hospit... more Multidrug-resistant strains of Pseudomonas aeruginosa (MDRPA) have been increasing in some hospitals [1] and may become a public health problem [2]. The emergence of MDRPA has been related to exposure to antibiotics against P. aeruginosa [3, 4]. Most of these studies have focussed on particular environments such as the intensive care unit (ICU) [5] or particular antibiotic resistances, mainly quinolone-resistant P. aeruginosa and carbapenem-resistant P. aeruginosa or specific infection sites such ventilator-associated pneumonia or bacteraemia [6, 7]. Most studies have used case-control methodology or have investigated outbreaks, and the case-control studies have usually compared susceptibility to resistant microorganisms. This methodology may overestimate the association between the resistance-defining antibiotic or may be falsely implicated as a potential risk factor for the acquisition of this pattern of susceptibility [8, 9]. The aim of this study was to assess the factors related to MDRPA acquisition, especially previous antibiotic exposure, using a double case-control methodology [10], analysing all types of infections and all hospital wards during a long period of follow-up. We conducted a double case-control epidemiological study, exploring the risk factors (host characteristics, invasive procedures and, especially, previous antibiotic exposure) associated with the acquisition of MDRPA in hospitalised patients from 1 January 2001 to 31 December 2006 in a University Hospital with 450 beds. P. aeruginosa was isolated and identified by the microbiology laboratory by means of routine techniques. The susceptibility of
Intensive care medicine Conclusion(s): There is augmented pro-inflammatory response after trauma ... more Intensive care medicine Conclusion(s): There is augmented pro-inflammatory response after trauma with secondary sepsis. High concentrations of IL-8 and TNF-alpha indicated higher severity (MODS). But, fatal outcome was predicted with high concentrations of IL-8 only; survivors had higher concentrations of TNF-alpha and IL-12. Therefore, pro-inflammatory response was partly beneficial and partly detrimental to the host. References:
Background and Goal of Study: The risk of central venous catheter-related bloodstream infection (... more Background and Goal of Study: The risk of central venous catheter-related bloodstream infection (CVC-BSI) is closely related to insertion conditions (1). The ultrasound-guided technique (UST) of fers several advantatges over the landmark technique (LT) (2), but in turn, it requires additional devices and manipulation, which could increase the incidence of CVC-BSI. Our hypothesis is that placement of short duration central venous catheters (CVC) using the UST does not increase the risk of CVC-BSI. Materials and Methods: Prospective, non randomized study, including CVC placed by our service in surgical patients (May 2010-May 2011). Calculation of the sample size was realized from a CVC-BSI study performed in our center. Data collected: patient sex, insertion technique, CVC's insertion site, place of insertion, use of parenteral nutrition and incidence of CVC-BSI. Chi square and Fisher exact test were used for statistical analysis. Results and Discussion: 546 cases were included. 367 CVC were inserted using LT and 179 using UST. Most of them were placed in the operating room (85.7%). Internal jugular vein was the most common site of insertion (69.8%). Average duration of CVC was 6.6 days. No significant dif ferences were found in demographic data, duration or insertion site between LT group and UST group. The incidence of CVC-BSI was 1.3% (7 cases), without significant differences between the two groups (1 case in UST group and 6 cases in LT group). The incidence of CVC-BSI in patients with parenteral nutrition was statistically significant higher (5% of incidence, p 0.03). Conclusion(s): The UST for placement of short duration CVC does not increase the risk of CVC-BSI. Its use can be recommended in surgical and critical patients, since it decreases mechanical complications (1)(2) without increasing infectious complications. The need of parenteral nutrition is a risk factor related to the increase of CVC-BSI. References: 1.Naomi P. O'Grady, M.D., et al. Guidelines for the prevention of intravascular catheter-related infections, 2011. 2.Karakitsos D, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care. 2006;10(6):R162.
A principios de 1980 la irrupción del VIH / sida generó miedos, discriminación y estigmatización ... more A principios de 1980 la irrupción del VIH / sida generó miedos, discriminación y estigmatización hacia personas y colectivos afectados. Como respuesta, aparecieron movimientos activistas para defender los derechos de las personas con VIH / sida y promover la introducción de tratamientos efectivos y accesibles. Tras más de tres décadas de epidemia, se han filmado varias películas sobre dichos movimientos. Sin embargo, son escasos los estudios que analicen el valor de la participación ciudadana en la lucha del VIH / sida dentro del cine. El objetivo del artículo es describir y analizar las películas más representativas de este fenómeno. Se analizan How to survive a plague, Larry Kramer In Love and Anger, The Normal Heart, 120 battements par minute y Dallas Buyers Club y se discuten con otras relacionadas. Estas películas nos muestran la fuerza de los movimientos activistas para promover la implicación de los gobiernos, las farmacéuticas y los profesionales en la lucha del VIH / sida. Por ello, se proponen unos objetivos para su debate en entornos docentes de las ciencias sociales y de la salud, para continuar apoyando el compromiso y las estrategias de la sociedad civil en los avances de la investigación, los autocuidados y los tratamientos del VIH / sida. Palabras clave: sida; activismo político; investigación cualitativa; estigma social; docencia. Summary Early 80´s the emergence of VIH generated popular fear coupled with discrimination and stigmatization for patients. In this context, HIV / AIDS activist movements emerged to establish and protect patients´ rights and foster the development of effective and affordable treatments.
Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection i... more Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit
Introduction: Enterococci are responsible for severe infections, such as endocarditis and bactere... more Introduction: Enterococci are responsible for severe infections, such as endocarditis and bacteremia. During recent decades, enterococcal infections have grown in importance because of the increasing number of cases. Knowledge of the factors predisposing to acquisition of infection by E. faecalis or E. faecium may be useful to improve the empirical treatment. Methods: Retrospective study of patients diagnosed with enterococcal bacteremia and hospitalized over a 7-year period (January 2000–December 2006), analyzing demographic data, clinical and microbiological characteristics, antibiotic exposure, treatment, and outcome. To identify the predisposing factors for isolation of E. faecalis or E. faecium in a clinical specimen, we performed univariate comparisons between the 2 groups, and subsequently, multivariate logistic regression analysis. Results: A total of 228 episodes of bacteremia were recorded, 168 caused by E. faecalis and 60 by E. faecium. All E. faecalis isolates were susce...
To estimate the incremental cost of nosocomial bacteremia according to the causative focus and cl... more To estimate the incremental cost of nosocomial bacteremia according to the causative focus and classified by the antibiotic sensitivity of the microorganism. Patients admitted to Hospital del Mar in Barcelona from 2005 to 2012 were included. We analyzed the total hospital costs of patients with nosocomial bacteremia caused by microorganisms with a high prevalence and, often, with multidrug-resistance. A control group was defined by selecting patients without bacteremia in the same diagnosis-related group. Our hospital has a cost accounting system (full-costing) that uses activity-based criteria to estimate per-patient costs. A logistic regression was fitted to estimate the probability of developing bacteremia (propensity score) and was used for propensity-score matching adjustment. This propensity score was included in an econometric model to adjust the incremental cost of patients with bacteremia with differentiation of the causative focus and antibiotic sensitivity. The mean incremental cost was estimated at €15,526. The lowest incremental cost corresponded to bacteremia caused by multidrug-sensitive urinary infection (€6786) and the highest to primary or unknown sources of bacteremia caused by multidrugresistant microorganisms (€29,186). This is one of the first analyses to include all episodes of bacteremia produced during hospital stays in a single study. The study included accurate information about the focus and antibiotic sensitivity of the causative organism and actual hospital costs. It provides information that could be useful to improve, establish, and prioritize prevention strategies for nosocomial infections. Abbreviations: APR-DRG = all-patient refined-diagnosis-related group, ICU = intensive care unit, UTI = urinary tract infection.
Enfermedades infecciosas y microbiologia clinica, Jan 4, 2016
To describe a clonal outbreak due to vancomycin-resistant Enterococcus faecium (VREF) in the neph... more To describe a clonal outbreak due to vancomycin-resistant Enterococcus faecium (VREF) in the nephrology and renal transplant unit of a tertiary teaching hospital in Barcelona, Spain, and to highlight how active patient and environment surveillance cultures, as well as prompt and directed intervention strategies, mainly environmental, helped to successfully bring it under control. A study was conducted on patients admitted to the nephrology ward with any culture positive for VREF over a 6-month period (August 2012-January 2013). Based on the identification of a clonal link between the isolates, weekly rectal screening using swabs was implemented for all patients, as well as environmental cultures and cleaning of medical equipment and the ward. VREF isolates were identified by MicroScan and confirmed by Etest. Bacterial identification was confirmed by MALDI-TOF MS. The presence of van genes, and esp and hyl virulence genes was determined using PCR. The clonal relationship between the ...
To calculate the incremental cost of nosocomial bacteremia caused by the most common organisms, c... more To calculate the incremental cost of nosocomial bacteremia caused by the most common organisms, classified by their antimicrobial susceptibility. We selected patients who developed nosocomial bacteremia caused by Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa. These microorganisms were analyzed because of their high prevalence and they frequently present multidrug resistance. A control group consisted of patients classified within the same all-patient refined-diagnosis related group without bacteremia. Our hospital has an established cost accounting system (full-costing) that uses activity-based criteria to analyze cost distribution. A logistic regression model was fitted to estimate the probability of developing bacteremia for each admission (propensity score) and was used for propensity score matching adjustment. Subsequently, the propensity score was included in an econometric model to adjust the incremental cost of patients who develope...
To develop a prediction rule to describe the risk of death as a result of enterococcal bloodstrea... more To develop a prediction rule to describe the risk of death as a result of enterococcal bloodstream infection. A prediction rule was developed by analysing data collected from 122 patients diagnosed with enterococcal BSI admitted to the Clínica Universidad de Navarra (Pamplona, Spain); and validated by confirming its accuracy with the data of an external population (Hospital del Mar, Barcelona). According to this model, independent significant predictors for the risk of death were being diabetic, have received appropriate treatment, severe prognosis of the underlying diseases, have renal failure, received solid organ transplant, malignancy, source of the bloodstream infection and be immunosuppressed. The prediction rule showed a very good calibration (Hosmer-Lemeshow statistic, P = 0.93) and discrimination for both training and testing sets (area under ROC curve = 0.84 and 0.83 respectively). The predictive rule was able to predict risk of death as a result of enterococcal bloodstrea...
Enfermedades Infecciosas y Microbiología Clínica, 2016
Se analizaron 640 hospitalizaciones con BN y 28.459 sin BN; el coste medio observado fue de 24.51... more Se analizaron 640 hospitalizaciones con BN y 28.459 sin BN; el coste medio observado fue de 24.515€ y 4.851,6€, respectivamente. En la estratificación por patología, el coste incremental medio estimado fue de 14.735€; el grupo de microorganismos que ocasionó menor coste incremental fue el de Gram positivos, con 10.051€. En el MLG el coste incremental medio estimado fue de 20.922€, mientras que utilizando PSM se estimó un coste incremental medio de 11.916€. En las tres estimaciones hay diferencias importantes según el grupo de microorganismos. Conclusiones Utilizar metodologías más elaboradas mejora el ajuste en este tipo de estudios e incrementa el valor de los resultados obtenidos.
To identify risk factors for mortality in patients with bloodstream infection by extended-spectru... more To identify risk factors for mortality in patients with bloodstream infection by extended-spectrum beta-lactamase (ESBL)-producing microorganisms. A retrospective study in patients with bloodstream infection by ESBL-producing microorganisms from January 2000 to December 2006 was carried out. A total of 4,172 bloodstream infections were identified, 1,218 (29.2%) and 226 (5.4%) of which were caused by Escherichia coli and Klebsiella pneumoniae, respectively. The overall mortality rate was 50.9% in patients with bacteriema due to ESBL-producing strains. The binomial logistic regression model, adjusted for age and severity, identified admission to an intensive care unit (OR 38,631; 95%CI:3,375-424,618; P=.002) and a SAPS II severity index score >30 in the 24-48 h before obtaining blood culture (OR 17,980; 95% CI:2,193-170,439; P=.010) as factors associated to mortality, while the urinary tract as primary site of infection was an independent determinant for non-mortality (OR 0.184; 95...
The patients with bacteremia usually require hospital admission. In occasions they are remitted t... more The patients with bacteremia usually require hospital admission. In occasions they are remitted to their home, due to inappropriate diagnosis or rapid clinical improvement. The study describes the evolution and the interventions carried out in patients with community bacteremia that were remitted to their home. Prospective observational study carried out in a university hospital, of 450 beds, from March of 2000 until December of 2003. The hospital has a team that daily evaluated all blood cultures practiced; the patients with bacteremia remitted to home from the Emergency Department with inappropriate antibiotic were identified. During the period of study 1,172 episodes of true bacteremia were diagnosed, of these 247 (21.1%) were remitted to their home. In 50 cases (20.2%) it was considered necessary to contact with the patient: 36 for inappropriate empiric antibiotic treatment, 12 without antibiotic treatment and 2 for lack of information. Antibiotic treatment was initiated or modi...
Description of a situation of incidence increase of bronchial secretions with positive cultures f... more Description of a situation of incidence increase of bronchial secretions with positive cultures for Aspergillus fumigatus, and analysis of the related risk factors in the invasive aspergillosis. Between January 1999 and February 2000, a prospective study of the patients was conducted with culture of bronchial secretions and with positive result for A. fumigatus. age, sex, primary diagnosis, type of cultivated sample, clinical interpretation (colonization/infection), probable source (community/nosocomial), situation of the patient after discharge, and risk factors for opportunistic infection. The results were compared among the colonized and infected patients. Fifty-two patients showed positive cultures of bronchial secretions to A. fumigatus, 43 (82.6%) colonized and 9 (17.3%) infected. Cultivated sputum sample on 30 occasions (57.6%) and bronchial aspiration in 22 (42.3%). Median age: 70 years (31-84). Sex: 40 men (76.9%). Probable source of infection/colonization: nosocomial in 18...
Introduction: There is scarce evidence on the use of eosinophil count as a marker of outcome in p... more Introduction: There is scarce evidence on the use of eosinophil count as a marker of outcome in patients with infection. The aim of this study was to evaluate whether changes in eosinophil count, as well as the neutrophil-lymphocyte count ratio (NLCR), could be used as clinical markers of outcome in patients with bacteremia. Methods: We performed a retrospective study of patients with a first episode of community-acquired or healthcare-related bacteremia during hospital admission between 2004 and 2009. A total of 2,311 patients were included. Cox regression was used to analyze the behaviour of eosinophil count and the NLCR in survivors and non-survivors. Results: In the adjusted analysis, the main independent risk factor for mortality was persistence of an eosinophil count below 0.0454?10 3 /uL (HR = 4.20; 95% CI 2.66-6.62). An NLCR value .7 was also an independent risk factor but was of lesser importance. The mean eosinophil count in survivors showed a tendency to increase rapidly and to achieve normal values between the second and third day. In these patients, the NLCR was ,7 between the second and third day. Conclusion: Both sustained eosinopenia and persistence of an NLCR .7 were independent markers of mortality in patients with bacteremia.
European Journal of Clinical Microbiology & Infectious Diseases, Aug 15, 2010
Artigo Original | Original article INTRODUCTION Microbial keratitis is commonly diagnosed worldwi... more Artigo Original | Original article INTRODUCTION Microbial keratitis is commonly diagnosed worldwide, and continues to cause significant ocular morbidity, requiring prompt and appropriate treatment (1,2). A large retrospective cohort recently reported an incidence of ulcerative keratitis of 27.6/100,000 person-years (95% confidence interval, 24.6-30.9) (3). Predisposing factors for microbial keratitis described in the literature, include: previous ocular surgery, contact lens use, trauma and metal fo reign body, surgical sutures, ocular surface disease, topical corticosteroid use, herpetic keratitis, lid misalignment, and systemic diseases such as diabetes and smoking (4-16). Predictive factors for outcome such as initial visual acuity at admission have not been widely described in previous studies. Previous reports describe a variability of etiological agents in dif erent centers around the world (2,4,5,7,8,13,14,16). Empirical, broadspectrum treatment of keratitis is a strategy selected by many ophthalmologists (17-21). However the increased resistence of the causative mi croorganism to currently available anti-infective drugs requires ongoing assessment of the trends of clinical and microbiological evaluation of the patients (22). Clinical characteristics and outcomes of patients admitted with presumed microbial keratitis to a tertiary medical center in Israel Características clínicas e desfechos dos pacientes internados com diagnóstico de ceratite microbiana em um centro terciário em Israel
European Journal of Clinical Microbiology & Infectious Diseases, Dec 24, 2009
Multidrug-resistant strains of Pseudomonas aeruginosa (MDRPA) have been increasing in some hospit... more Multidrug-resistant strains of Pseudomonas aeruginosa (MDRPA) have been increasing in some hospitals [1] and may become a public health problem [2]. The emergence of MDRPA has been related to exposure to antibiotics against P. aeruginosa [3, 4]. Most of these studies have focussed on particular environments such as the intensive care unit (ICU) [5] or particular antibiotic resistances, mainly quinolone-resistant P. aeruginosa and carbapenem-resistant P. aeruginosa or specific infection sites such ventilator-associated pneumonia or bacteraemia [6, 7]. Most studies have used case-control methodology or have investigated outbreaks, and the case-control studies have usually compared susceptibility to resistant microorganisms. This methodology may overestimate the association between the resistance-defining antibiotic or may be falsely implicated as a potential risk factor for the acquisition of this pattern of susceptibility [8, 9]. The aim of this study was to assess the factors related to MDRPA acquisition, especially previous antibiotic exposure, using a double case-control methodology [10], analysing all types of infections and all hospital wards during a long period of follow-up. We conducted a double case-control epidemiological study, exploring the risk factors (host characteristics, invasive procedures and, especially, previous antibiotic exposure) associated with the acquisition of MDRPA in hospitalised patients from 1 January 2001 to 31 December 2006 in a University Hospital with 450 beds. P. aeruginosa was isolated and identified by the microbiology laboratory by means of routine techniques. The susceptibility of
Intensive care medicine Conclusion(s): There is augmented pro-inflammatory response after trauma ... more Intensive care medicine Conclusion(s): There is augmented pro-inflammatory response after trauma with secondary sepsis. High concentrations of IL-8 and TNF-alpha indicated higher severity (MODS). But, fatal outcome was predicted with high concentrations of IL-8 only; survivors had higher concentrations of TNF-alpha and IL-12. Therefore, pro-inflammatory response was partly beneficial and partly detrimental to the host. References:
Background and Goal of Study: The risk of central venous catheter-related bloodstream infection (... more Background and Goal of Study: The risk of central venous catheter-related bloodstream infection (CVC-BSI) is closely related to insertion conditions (1). The ultrasound-guided technique (UST) of fers several advantatges over the landmark technique (LT) (2), but in turn, it requires additional devices and manipulation, which could increase the incidence of CVC-BSI. Our hypothesis is that placement of short duration central venous catheters (CVC) using the UST does not increase the risk of CVC-BSI. Materials and Methods: Prospective, non randomized study, including CVC placed by our service in surgical patients (May 2010-May 2011). Calculation of the sample size was realized from a CVC-BSI study performed in our center. Data collected: patient sex, insertion technique, CVC's insertion site, place of insertion, use of parenteral nutrition and incidence of CVC-BSI. Chi square and Fisher exact test were used for statistical analysis. Results and Discussion: 546 cases were included. 367 CVC were inserted using LT and 179 using UST. Most of them were placed in the operating room (85.7%). Internal jugular vein was the most common site of insertion (69.8%). Average duration of CVC was 6.6 days. No significant dif ferences were found in demographic data, duration or insertion site between LT group and UST group. The incidence of CVC-BSI was 1.3% (7 cases), without significant differences between the two groups (1 case in UST group and 6 cases in LT group). The incidence of CVC-BSI in patients with parenteral nutrition was statistically significant higher (5% of incidence, p 0.03). Conclusion(s): The UST for placement of short duration CVC does not increase the risk of CVC-BSI. Its use can be recommended in surgical and critical patients, since it decreases mechanical complications (1)(2) without increasing infectious complications. The need of parenteral nutrition is a risk factor related to the increase of CVC-BSI. References: 1.Naomi P. O'Grady, M.D., et al. Guidelines for the prevention of intravascular catheter-related infections, 2011. 2.Karakitsos D, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care. 2006;10(6):R162.
A principios de 1980 la irrupción del VIH / sida generó miedos, discriminación y estigmatización ... more A principios de 1980 la irrupción del VIH / sida generó miedos, discriminación y estigmatización hacia personas y colectivos afectados. Como respuesta, aparecieron movimientos activistas para defender los derechos de las personas con VIH / sida y promover la introducción de tratamientos efectivos y accesibles. Tras más de tres décadas de epidemia, se han filmado varias películas sobre dichos movimientos. Sin embargo, son escasos los estudios que analicen el valor de la participación ciudadana en la lucha del VIH / sida dentro del cine. El objetivo del artículo es describir y analizar las películas más representativas de este fenómeno. Se analizan How to survive a plague, Larry Kramer In Love and Anger, The Normal Heart, 120 battements par minute y Dallas Buyers Club y se discuten con otras relacionadas. Estas películas nos muestran la fuerza de los movimientos activistas para promover la implicación de los gobiernos, las farmacéuticas y los profesionales en la lucha del VIH / sida. Por ello, se proponen unos objetivos para su debate en entornos docentes de las ciencias sociales y de la salud, para continuar apoyando el compromiso y las estrategias de la sociedad civil en los avances de la investigación, los autocuidados y los tratamientos del VIH / sida. Palabras clave: sida; activismo político; investigación cualitativa; estigma social; docencia. Summary Early 80´s the emergence of VIH generated popular fear coupled with discrimination and stigmatization for patients. In this context, HIV / AIDS activist movements emerged to establish and protect patients´ rights and foster the development of effective and affordable treatments.
Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection i... more Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit
Introduction: Enterococci are responsible for severe infections, such as endocarditis and bactere... more Introduction: Enterococci are responsible for severe infections, such as endocarditis and bacteremia. During recent decades, enterococcal infections have grown in importance because of the increasing number of cases. Knowledge of the factors predisposing to acquisition of infection by E. faecalis or E. faecium may be useful to improve the empirical treatment. Methods: Retrospective study of patients diagnosed with enterococcal bacteremia and hospitalized over a 7-year period (January 2000–December 2006), analyzing demographic data, clinical and microbiological characteristics, antibiotic exposure, treatment, and outcome. To identify the predisposing factors for isolation of E. faecalis or E. faecium in a clinical specimen, we performed univariate comparisons between the 2 groups, and subsequently, multivariate logistic regression analysis. Results: A total of 228 episodes of bacteremia were recorded, 168 caused by E. faecalis and 60 by E. faecium. All E. faecalis isolates were susce...
To estimate the incremental cost of nosocomial bacteremia according to the causative focus and cl... more To estimate the incremental cost of nosocomial bacteremia according to the causative focus and classified by the antibiotic sensitivity of the microorganism. Patients admitted to Hospital del Mar in Barcelona from 2005 to 2012 were included. We analyzed the total hospital costs of patients with nosocomial bacteremia caused by microorganisms with a high prevalence and, often, with multidrug-resistance. A control group was defined by selecting patients without bacteremia in the same diagnosis-related group. Our hospital has a cost accounting system (full-costing) that uses activity-based criteria to estimate per-patient costs. A logistic regression was fitted to estimate the probability of developing bacteremia (propensity score) and was used for propensity-score matching adjustment. This propensity score was included in an econometric model to adjust the incremental cost of patients with bacteremia with differentiation of the causative focus and antibiotic sensitivity. The mean incremental cost was estimated at €15,526. The lowest incremental cost corresponded to bacteremia caused by multidrug-sensitive urinary infection (€6786) and the highest to primary or unknown sources of bacteremia caused by multidrugresistant microorganisms (€29,186). This is one of the first analyses to include all episodes of bacteremia produced during hospital stays in a single study. The study included accurate information about the focus and antibiotic sensitivity of the causative organism and actual hospital costs. It provides information that could be useful to improve, establish, and prioritize prevention strategies for nosocomial infections. Abbreviations: APR-DRG = all-patient refined-diagnosis-related group, ICU = intensive care unit, UTI = urinary tract infection.
Enfermedades infecciosas y microbiologia clinica, Jan 4, 2016
To describe a clonal outbreak due to vancomycin-resistant Enterococcus faecium (VREF) in the neph... more To describe a clonal outbreak due to vancomycin-resistant Enterococcus faecium (VREF) in the nephrology and renal transplant unit of a tertiary teaching hospital in Barcelona, Spain, and to highlight how active patient and environment surveillance cultures, as well as prompt and directed intervention strategies, mainly environmental, helped to successfully bring it under control. A study was conducted on patients admitted to the nephrology ward with any culture positive for VREF over a 6-month period (August 2012-January 2013). Based on the identification of a clonal link between the isolates, weekly rectal screening using swabs was implemented for all patients, as well as environmental cultures and cleaning of medical equipment and the ward. VREF isolates were identified by MicroScan and confirmed by Etest. Bacterial identification was confirmed by MALDI-TOF MS. The presence of van genes, and esp and hyl virulence genes was determined using PCR. The clonal relationship between the ...
To calculate the incremental cost of nosocomial bacteremia caused by the most common organisms, c... more To calculate the incremental cost of nosocomial bacteremia caused by the most common organisms, classified by their antimicrobial susceptibility. We selected patients who developed nosocomial bacteremia caused by Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa. These microorganisms were analyzed because of their high prevalence and they frequently present multidrug resistance. A control group consisted of patients classified within the same all-patient refined-diagnosis related group without bacteremia. Our hospital has an established cost accounting system (full-costing) that uses activity-based criteria to analyze cost distribution. A logistic regression model was fitted to estimate the probability of developing bacteremia for each admission (propensity score) and was used for propensity score matching adjustment. Subsequently, the propensity score was included in an econometric model to adjust the incremental cost of patients who develope...
To develop a prediction rule to describe the risk of death as a result of enterococcal bloodstrea... more To develop a prediction rule to describe the risk of death as a result of enterococcal bloodstream infection. A prediction rule was developed by analysing data collected from 122 patients diagnosed with enterococcal BSI admitted to the Clínica Universidad de Navarra (Pamplona, Spain); and validated by confirming its accuracy with the data of an external population (Hospital del Mar, Barcelona). According to this model, independent significant predictors for the risk of death were being diabetic, have received appropriate treatment, severe prognosis of the underlying diseases, have renal failure, received solid organ transplant, malignancy, source of the bloodstream infection and be immunosuppressed. The prediction rule showed a very good calibration (Hosmer-Lemeshow statistic, P = 0.93) and discrimination for both training and testing sets (area under ROC curve = 0.84 and 0.83 respectively). The predictive rule was able to predict risk of death as a result of enterococcal bloodstrea...
Enfermedades Infecciosas y Microbiología Clínica, 2016
Se analizaron 640 hospitalizaciones con BN y 28.459 sin BN; el coste medio observado fue de 24.51... more Se analizaron 640 hospitalizaciones con BN y 28.459 sin BN; el coste medio observado fue de 24.515€ y 4.851,6€, respectivamente. En la estratificación por patología, el coste incremental medio estimado fue de 14.735€; el grupo de microorganismos que ocasionó menor coste incremental fue el de Gram positivos, con 10.051€. En el MLG el coste incremental medio estimado fue de 20.922€, mientras que utilizando PSM se estimó un coste incremental medio de 11.916€. En las tres estimaciones hay diferencias importantes según el grupo de microorganismos. Conclusiones Utilizar metodologías más elaboradas mejora el ajuste en este tipo de estudios e incrementa el valor de los resultados obtenidos.
To identify risk factors for mortality in patients with bloodstream infection by extended-spectru... more To identify risk factors for mortality in patients with bloodstream infection by extended-spectrum beta-lactamase (ESBL)-producing microorganisms. A retrospective study in patients with bloodstream infection by ESBL-producing microorganisms from January 2000 to December 2006 was carried out. A total of 4,172 bloodstream infections were identified, 1,218 (29.2%) and 226 (5.4%) of which were caused by Escherichia coli and Klebsiella pneumoniae, respectively. The overall mortality rate was 50.9% in patients with bacteriema due to ESBL-producing strains. The binomial logistic regression model, adjusted for age and severity, identified admission to an intensive care unit (OR 38,631; 95%CI:3,375-424,618; P=.002) and a SAPS II severity index score >30 in the 24-48 h before obtaining blood culture (OR 17,980; 95% CI:2,193-170,439; P=.010) as factors associated to mortality, while the urinary tract as primary site of infection was an independent determinant for non-mortality (OR 0.184; 95...
The patients with bacteremia usually require hospital admission. In occasions they are remitted t... more The patients with bacteremia usually require hospital admission. In occasions they are remitted to their home, due to inappropriate diagnosis or rapid clinical improvement. The study describes the evolution and the interventions carried out in patients with community bacteremia that were remitted to their home. Prospective observational study carried out in a university hospital, of 450 beds, from March of 2000 until December of 2003. The hospital has a team that daily evaluated all blood cultures practiced; the patients with bacteremia remitted to home from the Emergency Department with inappropriate antibiotic were identified. During the period of study 1,172 episodes of true bacteremia were diagnosed, of these 247 (21.1%) were remitted to their home. In 50 cases (20.2%) it was considered necessary to contact with the patient: 36 for inappropriate empiric antibiotic treatment, 12 without antibiotic treatment and 2 for lack of information. Antibiotic treatment was initiated or modi...
Description of a situation of incidence increase of bronchial secretions with positive cultures f... more Description of a situation of incidence increase of bronchial secretions with positive cultures for Aspergillus fumigatus, and analysis of the related risk factors in the invasive aspergillosis. Between January 1999 and February 2000, a prospective study of the patients was conducted with culture of bronchial secretions and with positive result for A. fumigatus. age, sex, primary diagnosis, type of cultivated sample, clinical interpretation (colonization/infection), probable source (community/nosocomial), situation of the patient after discharge, and risk factors for opportunistic infection. The results were compared among the colonized and infected patients. Fifty-two patients showed positive cultures of bronchial secretions to A. fumigatus, 43 (82.6%) colonized and 9 (17.3%) infected. Cultivated sputum sample on 30 occasions (57.6%) and bronchial aspiration in 22 (42.3%). Median age: 70 years (31-84). Sex: 40 men (76.9%). Probable source of infection/colonization: nosocomial in 18...
Introduction: There is scarce evidence on the use of eosinophil count as a marker of outcome in p... more Introduction: There is scarce evidence on the use of eosinophil count as a marker of outcome in patients with infection. The aim of this study was to evaluate whether changes in eosinophil count, as well as the neutrophil-lymphocyte count ratio (NLCR), could be used as clinical markers of outcome in patients with bacteremia. Methods: We performed a retrospective study of patients with a first episode of community-acquired or healthcare-related bacteremia during hospital admission between 2004 and 2009. A total of 2,311 patients were included. Cox regression was used to analyze the behaviour of eosinophil count and the NLCR in survivors and non-survivors. Results: In the adjusted analysis, the main independent risk factor for mortality was persistence of an eosinophil count below 0.0454?10 3 /uL (HR = 4.20; 95% CI 2.66-6.62). An NLCR value .7 was also an independent risk factor but was of lesser importance. The mean eosinophil count in survivors showed a tendency to increase rapidly and to achieve normal values between the second and third day. In these patients, the NLCR was ,7 between the second and third day. Conclusion: Both sustained eosinopenia and persistence of an NLCR .7 were independent markers of mortality in patients with bacteremia.
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