Prevalencia de los eventos adversos relacionados con la medicación en los hospitales de la Comunitat Valenciana. Estudio Epidea 2005-2013

La seguridad del paciente es hoy una prioridad para las organizaciones sanitarias y su compromiso es proporcionar una atención sanitaria de calidad y minimizar los eventos adversos relacionados con la asistencia. Los eventos adversos relacionados con la medicación constituyen un tipo de evento adverso muy importante, siendo su evitabilidad relevante alrededor del 40% de los casos. Diferentes organizaciones, nacionales e internacionales, trabajan para mejorar la seguridad en el uso de medicamentos, definiendo y promoviendo la implantación de prácticas seguras. Los eventos adversos relacionados con la medicación pueden ocurrir en cualquiera de las etapas del proceso de utilización de los medicamentos (y tipos de medicamento), en el que participan diferentes profesionales por lo que existen diversas posibilidades de prevenirlos siendo muy relevante conocer los datos al respecto. La hipótesis de este trabajo es que los eventos adversos relacionados con la medicación es uno de los puntos relevantes a considerar en la seguridad clínica tanto por su prevalencia como por su evitabilidad. El objetivo principal de este trabajo consiste en determinar la prevalencia de los acontecimientos adversos relacionados con la medicación en los hospitales de la Comunitat Valenciana en el periodo de estudio 2005-2013. Los objetivos secundarios del estudio fueron conocer los factores de riesgo asociados a los acontecimientos adversos relacionados con la medicación, valorar el impacto de los acontecimientos adversos relacionados con la medicación: gravedad y evitabilidad, identificar los fármacos más frecuentemente implicados en los acontecimientos adversos relacionados con la medicación, determinar los servicios hospitalarios más frecuentemente implicados en los acontecimientos adversos relacionados con la medicación

Estudio de la situación actual de la infección por Schistosoma haematobium en la Unión Europea. Una aproximación al posible riesgo en España

ABSTRACT Background. In Europe, urogenital schistosomiasis was not endemic, however in 2014 the first cases of a European autochthonous infection outbreak appeared in Corsica (France). In this work a search and description of cases, both import and native urogenital schistosomiasis, published in the European Union (EU) during the last 20 years was made. In addition, a qualitative risk assessment in Spain was carried out. Methods. A bibliographic search of European Union published cases over the last 20 years (1997-2017) was performed using PubMed. Works that evidenced the presence of intermediate hosts Bulinus truncatus and Planorbarius metidjensis in our country were searched in PubMed, ResearchGate and Google Scholar. Finally, a risk assessment of urogenital schistosomiasis in Spain using the 2011 ECDC guide was made. Results. 481 cases in the EU were found. 328 were imported and 152 autochthonous. All from the autochthonous cases were focused in Corsica, where people from different nationalities got sicked. The presence of two potential host species was documented in different locations of our geography. The result of the risk assessment in Spain was low risk. Conclusions. Although the risk assessment in Spain was low risk, several factors as the presence of intermediate hosts in Spain, the increase on migratory flows, and the role that the S. haematobium-bovis hybrid had in the outbreak of Corsica, must alert community and health authorities about the possibility that autochthonous cases in our country appear.RESUMEN Fundamentos. En Europa no era endémica la esquistosomiasis urogenital, sin embargo en 2014 aparecieron en Francia los primeros casos de un brote de infección autóctona europea. En este trabajo se hace una búsqueda y descripción de casos de esquistosomiasis urogenital, tanto importados como autóctonos, publicados en la Unión Europea (UE) durante los últimos 20 años. Además se realiza una evaluación cualitativa del riesgo en España. Métodos. Se realizó una búsqueda bibliográfica en PubMed de casos publicados en la UE durante los últimos 20 años (1997-2017). Se buscaron trabajos en PubMed, ResearchGate y Google Académico que evidenciasen la presencia hospedadores intermediarios Bulinus truncatus y Planorbarius metidjensis en nuestro país. Finalmente se evaluó el riesgo de esquistosomiasis urogenital en España aplicando la guía del ECDC de 2011. Resultados. Se hallaron 481 casos en la UE, 328 eran importados y 152 autóctonos. En todos los casos autóctonos el foco se localizó en Córcega, donde enfermaron personas de diversas nacionalidades. Se documentó la presencia de dos especies hospedadores potenciales en diversas localizaciones de nuestra geografía. El resultado de la evaluación de riesgo en España fue bajo riesgo. Conclusiones. Si bien el resultado de la evaluación de riesgo en España fue bajo riesgo, factores como la presencia de hospedadores intermediarios, el aumento de los flujos migratorios, y el papel que tuvo el híbrido S. haematobium-bovis en el brote de Córcega, deben poner en sobre aviso a la comunidad médica y las autoridades sanitarias ante la posibilidad de que aparezcan casos autóctonos en nuestro país

An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital

Multidrug-resistant Candida auris has emerged as a cause of insidious hospital outbreaks and complicated infections. We present the analysis of an ongoing C. auris outbreak including the largest published series of C. auris bloodstream infection. All C. auris-positive patients from April-2016 to January-2017 were included. Environmental, clinical and microbiological data were recorded. Definitive isolate identification was performed by ITS-rDNA sequencing, and typing by amplified fragment length polymorphism fingerprinting. One hundred and forty patients were colonised by C. auris during the studied period (68% from surgical intensive care). Although control measures were implemented, we were not able to control the outbreak. Forty-one invasive bloodstream infections (87.8% from surgical intensive care) were included. Clinical management included prompt intravascular catheter removal and antifungal therapy with echinocandins. All isolates were fluconazole- and voriconazole-resistant, but echinocandin- and amphotericin B-susceptible. Thirty-day mortality rate was 41.4%, and severe septic metastasis as spondylodiscitis and endocarditis were observed in 5 patients (12%). C. auris was also recovered from inanimate patient surroundings and medical equipment. Despite antifungal treatment, high mortality and late complication rates were recorded. Molecular typing suggested a clonal outbreak different from those previously published

Influenza Vaccine Effectiveness in Preventing Influenza A(H3N2)-Related Hospitalizations in Adults Targeted for Vaccination by Type of Vaccine: A Hospital-Based Test-Negative Study, 2011–2012 A(H3N2) Predominant Influenza Season, Valencia, Spain

<div><p>Background</p><p>Most evidence of the effectiveness of influenza vaccines comes from studies conducted in primary care, but less is known about their effectiveness in preventing serious complications. Here, we examined the influenza vaccine effectiveness (IVE) against hospitalization with PCR-confirmed influenza in the predominant A(H3N2) 2011–2012 influenza season.</p><p>Methods</p><p>A hospital-based, test-negative study was conducted in nine hospitals in Valencia, Spain. All emergency admissions with a predefined subset of symptoms were eligible. We enrolled consenting adults age 18 and over, targeted for influenza vaccination because of comorbidity, with symptoms of influenza-like-illness within seven days of admission. We estimated IVE as (1-adjusted vaccination odds ratio)*100 after accounting for major confounders, calendar time and recruitment hospital.</p><p>Results</p><p>The subjects included 544 positive for influenza A(H3N2) and 1,370 negative for influenza admissions. Age was an IVE modifying factor. Regardless of vaccine administration, IVE was 72% (38 to 88%) in subjects aged under 65 and 21% (−5% to 40%) in subjects aged 65 and over. By type of vaccine, the IVE of classical intramuscular split-influenza vaccine, used in subjects 18 to 64, was 68% (12% to 88%). The IVE for intradermal and virosomal influenza vaccines, used in subjects aged 65 and over, was 39% (11% to 58%) and 16% (−39% to 49%), respectively.</p><p>Conclusions</p><p>The split-influenza vaccine was effective in preventing influenza-associated hospitalizations in adults aged under 65. The intradermal vaccine was moderately effective in those aged 65 and over.</p></div

Admissions by epidemiological week and laboratory result.

<p>Admissions by epidemiological week and laboratory result.</p

Main complaint at admission, influenza-like-illness symptoms within seven days to admission and clinical outcomes in influenza positive compared to influenza negative admissions

<p>CI Confidence Interval. LR Likelihood ratio. SD (standard deviation).</p><p>SIRS: Systemic inflammatory response syndrome.</p><p>Metabolic failure: hyperglycemic or hypoglycemic commas, acute renal failure, and disorders of fluid, electrolyte and acid-base balance.</p><p>Main complaint at admission, influenza-like-illness symptoms within seven days to admission and clinical outcomes in influenza positive compared to influenza negative admissions</p

Influenza vaccines recorded as administered by type of vaccine, age group, and PCR result.

<p>PCR real-time reverse transcription-polymerase chain reaction.</p>a.<p>Recorded vaccinations in the Vaccine Information System only (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0112294#pone-0112294-t004" target="_blank">Table 4</a> for the percentage of patients included in the Vaccine Information System). The percentages reported over all participants included in the Vaccine Information System and with any vaccination ever recorded in the Vaccine Information System.</p>b.<p>Encompassing epidemiological weeks 52 to 12, with influenza related admissions identified in> = 65 years subjects. This was the age group targeted to receive this type of vaccine.</p>c.<p>Encompassing epidemiological weeks 4 to 10, with influenza related admissions identified in <65 years old subjects. This was the age group targeted to receive this type of vaccine.</p><p>Influenza vaccines recorded as administered by type of vaccine, age group, and PCR result.</p

Sensitivity analysis of adjusted influenza vaccine effectiveness.

<p>Adjusted influenza vaccine effectiveness (IVE) assessed for all ages, <65 and> = 65, and by: a) vaccination ascertainment method: Vaccine Information System (VIS), as reported by the patient (recall) and both combined; b) days to swab: seven or less, four or less. Reference category for all analyses includes all patients irrespective of time elapsed to swab and vaccination according to VIS or recall. OR: adjusted odds ratio. OR adjusted as reported in footnotes in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0112294#pone-0112294-t006" target="_blank">Table 6</a>.</p

Flow diagram of study subjects.

<p>Flow diagram of study subjects.</p