Comorbilidad y factores de riesgo asociados a la infección de localización quirúrgica en artroplastia de rodilla

Las infecciones relacionadas con la asistencia sanitaria (IRAS) representan un problema que amenaza la seguridad de los pacientes, tanto por su importancia clínica como por su epidemiología, ya que aumentan las tasas de morbilidad y mortalidad, originan una mayor duración de las estancias hospitalarias, promueven la resistencia a los antibióticos y generan un aumento de los costes1 . La infección de localización quirúrgica (ILQ) es la más frecuente de las infecciones asociadas a cuidados sanitarios en los pacientes sometidos a un procedimiento quirúrgico, y ocupa el segundo lugar dentro de las infecciones nosocomiales que afectan a los pacientes ingresados en centros hospitalarios 2. La ILQ en artroplastia de rodilla constituye actualmente un problema de salud pública de primera magnitud en la mayoría de países desarrollados. La práctica de una artroplastia ha supuesto uno de los avances sanitarios más significativos en las últimas décadas. El desarrollo tecnológico, el envejecimiento progresivo de la población y la prolongación de la vida de enfermos con patología subyacente han propiciado un incremento exponencial en el número de pacientes sometidos a esta práctica3. En España se implantan anualmente alrededor de 30.000 prótesis articulares, la mayoría de rodilla y cadera, y en todo el mundo más de un millon4. Sin embargo, no es una intervención exenta de complicaciones, de las cuales una de las más temidas es la infección, con una incidencia media del 1,5% en prótesis de cadera y el 2,5% en las de rodilla5. La presencia de infección supone una importante disminución de la calidad de vida de los pacientes y sus familias, y un elevado coste económico para el sistema sanitario y la sociedad en general..

Effect of vaccination, comorbidities and age on mortality and severe disease associated with influenza during the season 2016-2017 in a Spanish tertiary hospital.

Identifying risk factors for complications or death associated with influenza remains crucial to target preventive interventions. Scores like the Charlson comorbidity index (CCI) may be of help. The aims of this study were to assess the effect of vaccination and comorbidities on severe influenza disease and influenza-related death among hospitalized patients during the season 2016/17; and to evaluate the validity of the CCI to predict death among these patients. Data from adult patients (≥18 years old) with influenza infection admitted to La Paz University Hospital (LPUH) were recorded during the 2016/17 epidemic. The effect of influenza vaccine to prevent severe influenza or death was evaluated using multivariate logistic regression models. The area under the curve of the CCI and the age-adjusted CCI were compared to assess the predictive effect on mortality. A total of 342 adult patients with influenza infection were admitted, of which 83 developed severe influenza and 25 died during hospitalization. There were no differences between patients who survived and those who died concerning the CCI, but the age-adjusted CCI was higher in fatal cases (p-value=0.005). Influenza vaccine had no statistically significant effect on the risk of mortality (p-value=0.162) while age (OR: 1.12, p-value<0.001) and dementia (OR: 3.05, p-value=0.016) proved to be independent predictors for mortality. The seasonal vaccine was found to be protective for severe infection (OR: 0.54, p-value=0.019). The age-adjusted CCI was a better predictor of mortality than the crude CCI. Age and dementia are significant independent risk factors for mortality associated with influenza among hospitalized patients. The age-adjusted CCI seems to be a better predictor of mortality than the crude CCI. Influenza vaccine has shown to be effective in preventing severe influenza in the season 2016/17 among hospitalized patients and should be promoted in population at risk.S

First wave of COVID-19 pandemic in Madrid: handling the unexpected in a tertiary hospital

The COVID-19 pandemic was declared on March 11th, 2020. By the end of January, the first imported cases were detected in Spain and, by March, the number of cases was growing exponentially, causing the implementation of a national lockdown. Madrid has been one of the most affected regions in terms of both cases and deaths. The aim of this study is to describe the epidemic curve and the epidemiological features and outcomes of COVID-19 patients hospitalized in La Paz University Hospital, a tertiary hospital located in Madrid. We included confirmed and probable COVID-19 cases admitted to our centre from February 26th to June 1st, 2020. We studied trends in hospitalization and ICU admissions using joinpoint regression analysis. A sample of 2970 patients was obtained. Median age was 70 years old (IQR 55 – 82) and 54.8% of them were male. ICU admission rate was 8.7% with a mortality rate of 45.7%. Global CFR was 21.8%. Median time from symptom onset to death was 14 days (IQR 9 – 22). We detected an admissions peak on March 21st followed by a descending trend, matching national and regional data. Age and sex distribution were comparable to further series nationally and in western countries