Programa de vigilància de les infeccions relacionades amb l’accés vascular en pacients en hemodiàlisi crònica ambulatòria: programa VINCat

Diàlisi; Bacterièmia de catèter vascular; Accés vascular; Infecció local punt d'accés vascularDiálisis; Bacteriemia de catéter vascular; Acceso vascular; Infección local punto de acceso vascularDialysis; Vascular catheter bacteremia; Vascular access; Local infection vascular access pointEl nombre de pacients amb hemodiàlisi crònica ambulatòria ha augmentat de forma significativa en els darrers anys per la supervivència perllongada de pacients amb malaltia renal terminal. Les infeccions representen la segona causa de mortalitat i ocasionen elevats costos pel sistema sanitari. Diferents guies recomanen la vigilància sistemàtica d’esdeveniments adversos relacionats amb la infecció sistèmica o local de l’accés vascular i l’establiment de mesures de prevenció. El principal objectiu és establir un programa de vigilància sobre esdeveniments relacionats amb la infecció sistèmica o local de l’accés vascular en pacients en hemodiàlisi crònica ambulatòria i conèixer les taxes d’incidència dels següents esdeveniments sentinelles: -Bacterièmia relacionada amb l’accés vascular (Catèter/Fístula/Empelt). -Infecció local del punt d’accés vascular

An interventional nationwide surveillance program lowers postoperative infection rates in elective colorectal surgery: a cohort study (2008–2019)

Colorectal surgery; Postoperative infection; Cohort studiesCirugía colorrectal; Infección postoperatoria; Estudios de cohortesCirurgia colorectal; Infecció postoperatòria; Estudis de cohortsBackground: Colorectal surgery is associated with the highest rate of surgical site infection (SSI). This study analyses the effectiveness of an interventional surveillance program on SSI rates after elective colorectal surgery. Material and methods: Cohort study showing temporal trends of SSI rates and Standardized Infection Ratio (SIR) in elective colorectal surgery over a 12-year period. Prospectively collected data of a national SSI surveillance program was analysed and the effect of specific interventions was evaluated. Patient and procedure characteristics, as well as SIR and SSI rates were stratified by risk categories and type of SSI analysed using stepwise multivariate logistic regression models. Results: In a cohort of 42,330 operations, overall cumulative SSI incidence was 16.31%, and organ-space SSI (O/S-SSI) was 8.59%. There was a 61.63% relative decrease in SSI rates (rho = -0.95804). The intervention which achieved the greatest SSI reduction was a bundle of 6 measures. SSI in pre-bundle period was 19.73% vs. 11.10% in post-bundle period (OR 1.969; IC 95% 1.860-2.085; p < 0.0001). O/S-SSI were 9.08% vs. 6.06%, respectively (OR 1.547; IC 95% 1.433-1.670; p < 0.0001). Median length of stay was 7 days, with a significant decrease over the studied period (rho = -0.98414). Mortality of the series was 1.08%, ranging from 0.35% to 2.0%, but a highly significant decrease was observed (rho = -0.67133). Conclusions: Detailed analysis of risk factors and postoperative infection in colorectal surgery allows strategies for reducing SSI incidence to be designed. An interventional surveillance program has been effective in decreasing SIR and SSI rates

Impact of changes in the WHO's 2019 update of DDDs on the measurement of adult hospital antibacterial consumption in Catalonia (Spain), 2008-18

In 2019 the WHO fully adopted new DDD values. The objective of this study is to analyse their impact on the measurement of consumption of antibacterials in hospitals participating in the Catalan Infection Control and Antimicrobial Stewardship National Program (VINCat-PROA) in Catalonia (Spain) between 2008 and 2018. The anatomical therapeutic chemical/DDD system was used to monitor adult hospital antibacterial consumption expressed in DDD/100 bed-days. Consumption from 2008 to 2018 was calculated using both pre- and post-update DDD values. Differences were calculated as the percentage variation in DDD/100 bed-days and analysed with Student's t -test. Simple linear regressions were performed to evaluate the trends in adult antimicrobial consumption over the study period. The overall consumption according to post-update DDD values decreased by 12.2% (P < 0.001) compared with the pre-update DDD values. Penicillins (−19.6.%; P < 0.001) and carbapenems (−19.0%; P = 0.023) showed the greatest reduction, followed by cephalosporins (−7.7%; P = 0.021) and quinolone antibacterials (−7.7%; P = 0.017). ICU services showed the greatest overall reduction (−13.1%; P < 0.001). From 2008 to 2018 there was a statistically significant decrease in consumption of penicillins and quinolone antibacterials and a statistically significant increase in cephalosporin and carbapenem consumption with both pre- and post-update DDD values. There were no variations in the ranking of consumption between the pre- and post-update DDD values. The WHO's updates of DDDs have had a significant impact on the measurement of antibacterial consumption. In our region, they have corrected an overestimation of penicillin and carbapenem consumption amounting to 19%. It is essential to bear these findings in mind for an accurate assessment of temporal trends and benchmarking

Oral antibiotic prophylaxis lowers surgical site infection in elective colorectal surgery: results of a pragmatic cohort study in Catalonia

Background: The role of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP) in the prevention of surgical site infection (SSI) after colorectal surgery is still controversial. The aim of this study was to analyze the effect of a bundle including both measures in a National Infection Surveillance Network in Catalonia. Methods: Pragmatic cohort study to assess the effect of OAP and MBP in reducing SSI rate in 65 hospitals, comparing baseline phase (BP: 2007-2015) with implementation phase (IP: 2016-2019). To compare the results, a logistic regression model was established. Results: Out of 34,421 colorectal operations, 5180 had SSIs (15.05%). Overall SSI rate decreased from 18.81% to 11.10% in BP and IP, respectively (OR 0.539, CI95 0.507-0.573, p < 0.0001). Information about bundle implementation was complete in 61.7% of cases. In a univariate analysis, OAP and MBP were independent factors in decreasing overall SSI, with OR 0.555, CI95 0.483-0.638, and OR 0.686, CI95 0.589-0.798, respectively; and similarly, organ/space SSI (O/S-SSI) (OR 0.592, CI95 0.494-0.710, and OR 0.771, CI95 0.630-0.944, respectively). However, only OAP retained its protective effect at both levels at multivariate analyses. Conclusions: oral antibiotic prophylaxis decreased the rates of SSI and O/S-SSI in a large series of elective colorectal surger

Programa de vigilància de les infeccions nosocomials als hospitals de Catalunya (programa VINCat): document de competències dels equips de control d’infeccions

Infeccions nosocomials; Equips de control d'infeccions; ECI; Competències professionalsInfecciones nosocomiales; Equipos de control de infecciones; ECI; Competencias profesionalesNosocomial infections; Infection control equipment; ECI; Professional skillsThis document sets out the professional competencies of the infection control teams to carry out their work, with the intention of: Standardizing the infection control competencies in the hospitals participating in the VINCat program; Be a guide to designing infection control training courses; Contribute to self-assessment of ECI performance; Provide a professional planning and development model and Orient the centers on the appropriate needs and resources to carry out daily infection control activities.Aquest document recull les competències professionals dels equips de control d'infeccions per desenvolupar la seva tasca amb la intenció de: Estandarditzar les competències de control d’infecció als hospitals que participen en el programa VINCat; Ser una guia per dissenyar cursos de formació en control d’infeccions; Contribuir a l’autoavaluació del rendiment dels ECI; Proporcionar un model de planificació i desenvolupament professional i Orientar els centres sobre les necessitats i els recursos adients per portar a terme les activitats de control d’infeccions diària.Este documento recoge las competencias profesionales de los equipos de control de infecciones para desarrollar su tarea con la intención de: Estandarizar las competencias de control de infección en los hospitales que participan en el programa VINCat; Ser una guía para diseñar cursos de formación en control de infecciones; Contribuir a la autoevaluación del rendimiento de los ECI; Proporcionar un modelo de planificación y desarrollo profesional y Orientar a los centros sobre las necesidades y los recursos adecuados para llevar a cabo las actividades de control de infecciones diarias

The induction and function of the anti-inflammatory fate of TH17 cells

TH17 cells exemplify environmental immune adaptation: they can acquire both a pathogenic and an anti-inflammatory fate. However, it is not known whether the anti-inflammatory fate is merely a vestigial trait, or whether it serves to preserve the integrity of the host tissues. Here we show that the capacity of TH17 cells to acquire an anti-inflammatory fate is necessary to sustain immunological tolerance, yet it impairs immune protection against S. aureus. Additionally, we find that TGF-β signalling via Smad3/Smad4 is sufficient for the expression of the anti-inflammatory cytokine, IL-10, in TH17 cells. Our data thus indicate a key function of TH17 cell plasticity in maintaining immune homeostasis, and dissect the molecular mechanisms explaining the functional flexibility of TH17 cells with regard to environmental changes.Fil: Xu, Hao. University of Yale. School of Medicine; Estados UnidosFil: Agalioti, Theodora. University Medical Center Hamburg-Eppendorf; AlemaniaFil: Zhao, Jun. University of Yale. School of Medicine; Estados UnidosFil: Steglich, Babett. University Medical Center Hamburg-Eppendorf; AlemaniaFil: Wahib, Ramez. University Medical Center Hamburg-Eppendorf; AlemaniaFil: Amezcua Vesely, Maria Carolina. University of Yale. School of Medicine; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Bielecki, Piotr. University of Yale. School of Medicine; Estados UnidosFil: Bailis, Will. University of Yale. School of Medicine; Estados UnidosFil: Jackson, Ruaidhri. University of Yale. School of Medicine; Estados UnidosFil: Perez, Daniel. University Medical Center Hamburg-Eppendorf; AlemaniaFil: Izbicki, Jakob. University Medical Center Hamburg-Eppendorf; AlemaniaFil: Licona-Limón, Paula. University of Yale. School of Medicine; Estados UnidosFil: Kaartinen, Vesa. University Medical Center Hamburg-Eppendorf; AlemaniaFil: Geginat, Jens. University Medical Center Hamburg-Eppendorf; AlemaniaFil: Esplugues, Enric. University of Yale. School of Medicine; Estados UnidosFil: Tolosa, Eva. University of Yale. School of Medicine; Estados UnidosFil: Huber, Samuel. University of Yale. School of Medicine; Estados UnidosFil: Flavell, Richard A.. University of Yale. School of Medicine; Estados UnidosFil: Gagliani, Nicola. University Medical Center Hamburg-Eppendorf; Alemani

Effects of the COVID-19 Pandemic on Incidence and Epidemiology of Catheter-Related Bacteremia, Spain

We compared hospital-acquired catheter-related bacte-remia (CRB) episodes diagnosed at acute care hospitals in Catalonia, Spain, during the COVID-19 pandemic in 2020 with those detected during 2007-2019. We com-pared the annual observed and predicted CRB rates by using the negative binomial regression model and calcu-lated stratified annual root mean squared errors. A total of 10,030 episodes were diagnosed during 2007-2020. During 2020, the observed CRB incidence rate was 0.29/103 patient-days, whereas the predicted CRB rate was 0.14/103 patient-days. The root mean squared er-ror was 0.153. Thus, a substantial increase in hospital-acquired CRB cases was observed during the COVID-19 pandemic in 2020 compared with the rate predicted from 2007-2019. The incidence rate was expected to increase by 1.07 (95% CI 1-1.15) for every 1,000 COVID-19-re-lated hospital admissions. We recommend maintaining all CRB prevention efforts regardless of the coexistence of other challenges, such as the COVID-19 pandemic

Trends in the epidemiology of catheter-related bloodstream infections; towards a paradigm shift, Spain, 2007 to 2019

Altres ajuts: Departament de Salut. Generalitat de Catalunya ("Pla estratègic de recerca i innovació en salut (PERIS) 2019-2021"); Ministerio de Asuntos Económicos y Transformación Digital; Red Española de Investigación en Patología Infecciosa (REIPI).Background: Catheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death. Aim: To analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat). Methods: A cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007-2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000patientdays. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000patientdays and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported. Results: During the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate:0.20episodes/1,000patientdays). Patients' median age was 64.1years; 36.6% (3,403/9,290) were female. In total, 73.7% (n=6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n=5,822) were related to central venous catheter (CVC), 24.1% (n=2,236) to peripheral venous catheters (PVC) and 13.3% (n=1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR:0.94;95%CI:0.93-0.96), especially in the ICU (IRR:0.88;95%CI:0.87-0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR:0.88;95%CI:0.87-0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC:1.08;95%CI:1.05-1.11; IRR PVC: 1.03; 95% 1.00-1.05). Conclusions: Over the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards

{'en_US': '"From fear to resilience". Phenomenological study on the impact of the COVID-19 pandemic on caregivers of dependent hemodialysis patients', 'es_ES': '“Del miedo a la resiliencia”. Estudio fenomenológico sobre el impacto de la pandemia por COVID-19 en cuidadoras de pacientes dependientes en hemodiálisis'}

Objetivo: profundizar en el conocimiento sobre las vivencias y el soporte percibido en cuidadoras primarias que atendieron a pacientes dependientes en tratamiento con hemodiálisis durante el periodo de pandemia por COVID-19 en la ciudad de Madrid. Material y Método: estudio transversal efectuado con diez cuidadoras primarias de pacientes en tratamiento de hemodiálisis que habían proporcionado cuidados durante el periodo de marzo 2020 a junio 2021. La recolección de los datos se realizó mediante entrevistas semiestructuradas a distancia hasta conseguir la saturación de las unidades de significado. Se realizó un análisis cualitativo fenomenológico mediante el método de siete pasos de Colaizzi. Resultados: del análisis de los discursos emergieron dimensiones asociadas a diferentes subcategorías: miedo inicial sobre la enfermedad, pérdida de libertad, riesgo percibido durante el transporte, soporte percibido por parte de los centros de diálisis, capacidad de resiliencia, miedo a la muerte e impacto de la vacunación. Conclusiones: en la etapa álgida del brote epidémico las vivencias de las cuidadoras estuvieron muy influidas por el desconocimiento de la enfermedad y el miedo al contagio. Adaptaron medidas de auto prevención para mantener a salvo a su familiar. Apreciaron la seguridad proporcionada por los profesionales de los centros. Les preocupaba los riesgos inherentes a los traslados y la falta de soporte de los servicios sociales. Son conscientes de su propia fragilidad y la de la persona cuidada y no perciben grandes cambios ni en su forma de vida ni en su esperanza de futuro, pese a la vacunación y otros adelantos científicos