Trends in yearly prevalence of third-generation cephalosporin and fluoroquinolone resistant Enterobacteriaceae infections and antimicrobial use in Spanish hospitals, Spain, 1999 to 2010

Escherichia coli, Klebsiella pneumoniae, and Enterobacter spp. are a major cause of infections in hospitalised patients. The aim of our study was to evaluate rates and trends of resistance to third-generation cephalosporins and fluoroquinolones in infected patients, the trends in use for these antimicrobials, and to assess the potential correlation between both trends. The database of national point prevalence study series of infections and antimicrobial use among patients hospitalised in Spain over the period from 1999 to 2010 was analysed. On average 265 hospitals and 60,000 patients were surveyed per year yielding a total of 19,801 E. coli, 3,004 K. pneumoniae and 3,205 Enterobacter isolates. During the twelve years period, we observed significant increases for the use of fluoroquinolones (5.8%–10.2%, p<0.001), but not for third-generation cephalosporins (6.4%–5.9%, p=NS). Resistance to third-generation cephalosporins increased significantly for E. coli (5%–15%, p<0.01) and for K. pneumoniae infections (4%–21%, p<0.01) but not for Enterobacter spp. (24%). Resistance to fluoroquinolones increased significantly for E. coli (16%– 30%, p<0.01), for K. pneumoniae (5%–22%, p<0.01), and for Enterobacter spp. (6%–15%, p<0.01). We found strong correlations between the rate of fluoroquinolone use and the resistance to fluoroquinolones, third-generation cephalosporins, or co-resistance to both, for E. coli (R=0.97, p<0.01, R=0.94, p<0.01, and R=0.96, p<0.01, respectively), and for K. pneumoniae (R=0.92, p<0.01, R=0.91, p<0.01, and R=0.92, p<0.01, the use of third-generation cephalosporins and resistance to any of the latter antimicrobials. No significant correlations could be found for Enterobacter spp.. Knowledge of the trends in antimicrobial resistance and use of antimicrobials in the hospitalised population at the national level can help to develop prevention strategiesSupported by the Fondo para la investigación, Spanish Ministry of Health, grant PI07/90255

Adequacy of hospital admissions and stays of patients with uncomplicated inguinal hernia

BACKGROUND: Inguinal hernia uncomplicated in patients aged over 17 years, diagnosis-related group (DRG) 162, generates a substantial number of hospital stays due its high frequency in our country. These stays may not be necessary, and present an important temporal and geographical variability. MATERIAL AND METHODS: We have analyzed a total of 612 days of stay belonging to the 124 admissions codified as DRG 162 during the first quarter of 1993 and 1994, using the "Appropriateness Evaluation Protocol". RESULTS: The overall mean stay of the DRG 162 was 5.0 days (2.3 days of inadequate stay and 2.7 days of clinically necessary stay). The mean stay in 1993, 5.6 days, was higher than the mean stay in 1994, 4.1 days (p = 0.006). The percentage of inappropriate admission was higher in 1993 than in 1994 (33.8% versus 18.9%; p = 0.06). Similarly, the percentage of inappropriate stay was higher in 1993 than in 1994 (46.9% versus 41.9%; p = 0.06). The more frequent reasons of inappropriate admission was premature admission (88.2%) and for the stay was delay in the discharge medical order (33.3%). CONCLUSIONS: The mean stay of DRG 162, as well as the percentage of inadequate stay and admission, has decreased from 1993 to 1994 in our hospital. According to the observed trend, the mean stay is approaching the adequate mean stay for this DRG.S

A pilot validation in 10 European Union member states of a point prevalence survey of healthcare-associated infections and antimicrobial use in acute hospitals in Europe, 2011

We present a pilot validation study performed on 10 European Union (EU) Member States, of a point prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in Europe in 2011 involving 29 EU/European Economic Area (EEA) countries and Croatia. A total of 20 acute hospitals and 1,950 patient records were included in the pilot study, which consisted of validation and inter-rater reliablity (IRR) testing using an in-hospital observation approach. In the validation, a sensitivity of 83% (95% confidence interval (CI): 79\u201387%) and a specificity of 98% (95% CI: 98\u201399%) were found for HAIs. The level of agreement between the primary PPS and validation results were very good for HAIs overall (Cohen\u2019s \u3baappa (\u3ba): 0.81) and across all the types of HAIs (range: 0.83 for bloodstream infections to 1.00 for lower respiratory tract infections). Antimicrobial use had a sensitivity of 94% (95% CI: 93\u201395%) and specificity of 97% (95% CI: 96\u201398%) with a very good level of agreement (\u3ba: 0.91). Agreement on other demographic items ranged from moderate to very good (\u3ba: 0.57\u20130.95): age (\u3ba: 0.95), sex (\u3ba: 0.93), specialty of physician (\u3ba: 0.87) and McCabe score (\u3ba: 0.57). IRR showed a very good level of agreement (\u3ba: 0.92) for both the presence of HAIs and antimicrobial use. This pilot study suggested valid and reliable reporting of HAIs and antimicrobial use in the PPS dataset. The lower level of sensitivity with respect to reporting of HAIs reinforces the importance of training data collectors and including validation studies as part of a PPS in order for the burden of HAIs to be better estimated