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Introducción: La tasa de infección del sitio quirúrgico es un buen indicador de la calidad asistencial en los servicios quirúrgicos. La profilaxis antibiótica representa una medida de eficacia probada en la prevención de la infección del sitio quirúrgico y su cumplimiento constituye un objetivo en los contratos de gestión de los servicios de salud. La eficacia de esta medida preventiva requiere la existencia de protocolos de actuación actualizados y la evaluación de los mismos. Objetivo: Evaluar el cumplimiento de ese protocolo antibiótico en nuestro Servicio analizando las causas de profilaxis inadecuada de forma global y por procedimientos. Material y métodos: El servicio de Medicina Preventiva, como observador externo, por medio de un estudio retrospectivo analizó 695 intervenciones quirúrgicas (en pacientes ingresados y ambulantes) realizadas por el servicio de Urología durante los años 2003 al 2006 para su evaluación anual del cumplimiento del protocolo de profilaxis antibiótica. Se considera profilaxis inadecuada la administrada no estando indicada, la no administrada estando indicada y la administrada con pauta incorrecta. Resultados: El cumplimiento del protocolo es adecuado en el 83,16% de las intervenciones. La causa de inadecuación más frecuente fue la pauta incorrecta en el 15,3 %. Dentro de esta pauta incorrecta la causa principal fue el momento de administración tardío del antibiótico profiláctico y en menor medida una duración incorrecta de la pauta antibiótica. Conclusiones: El porcentaje de cumplimento del protocolo antibiótico en nuestro servicio de Urología es alto. La evaluación detectó dos problemas de diferente índole y solución: El adecuar el momento de administración del antibiótico es un problema funcional, estructural y organizativo a resolver junto al servicio de Anestesiología; El número de dosis de antibiótico en cirugía abierta de próstata requiere el conocimiento y cumplimiento estricto de la pauta por parte de los cirujanos. La efectividad de la profilaxis antibiótica requiere la existencia de protocolos adecuados y actualizados para la unificación de criterios entre los profesionales, para detectar nuevos problemas, así como para buscar soluciones para un correcto cumplimiento del mismo.

The rate of surgical site infection is a good indicator of the quality of care in surgical departments. Antibiotic prophylaxis represents a measure of proven efficiency in preventing the infection in a surgical site, and its fulfilment is a main goal in management contracts of health services. The efficiency of this preventive measure requires the existence of updated protocols and performance evaluation.To evaluate the compliance of this antibiotic protocol in our Urology Department with the global analysis of the causes of inadequate prophylaxis and by procedures.The Department of Preventive Medicine as an outside observer, through a retrospective study, analyzed 695 urological surgical procedures (inpatient and outpatient) during the years 2003 and 2006 for its annual assessment of compliance with the antibiotic prophylaxis protocol. Administration of non-indicated prophylaxis, non-administration of indicated prophylaxis and incorrect dosage are considered as inappropriate prophylaxis.The compliance of the protocol was appropriate in 83.16% of the operations. The cause of the most frequent inadequacy was an incorrect pattern in 15.3%. Within this incorrect pattern the main reason was the delay of administration of prophylactic antibiotic and to a lesser extent an incorrect length of the antibiotic regime.The percentage of compliance with the antibiotic protocol in our Urology Department is high. The evaluation detected two problems of a different nature and solution: to adapt the timing of antibiotics is a functional, structural and organizational problem to be resolved in accordance with the Anaesthesiology Department. The number of doses of antibiotics in open prostate surgery requires knowledge and strict adherence to the guidelines by the surgeons. The efficiency of antibiotic prophylaxis requires the existence of appropriated and updated protocols for the unifications of criteria among professionals to detect new problems as well as to find solutions for its adequate compliance.

Nosocomial infection rates constitute an indicator of welfare quality, permitting to adopt measures of prevention and control. It has been developed a surveillance plan of the nosocomial infection in hospitals, showing to be an efficient method to diminish its incident.To know the indicators and characteristics of the nosocomial infection and of the infection of the site surgical particularly, in a urology service in a global form and by procedures.Prospective study by means of the epidemiological surveillance system from 2002 to 2005 in 4.618 patients hospitalised at least 24 hours, with a total of 3.096 surgical.The overall incidence of nosocomial infection was 6,10%, 3.42% for urinary infection and 2,81% for the infection of the chirurgical site. For procedures, the incidence of the infection of the surgical site for cistectomy was 22,8%, 6,6% for surgery of kidney and ureter and 4,36% for open surgery of prostate. Eschericia Coli (43,6%) was the most frequently isolated organism, accounting for 43,6% of the causative organisms in the infection of the surgical site and 43,6% in the urinary infection. Pseudomonas aeruginosa is the next organism in frequency with a 15% in both infections.Our nosocomial infection rates are lower than the published standard values. The main infection rate of the surgical sites present in the most complex surgical techniques, whereas Escherichia Coli is the most frecuently isolated ethiological agent. The surveillance of the infection of the surgical site and related factors permit to incorporate improvements in the clinical-surgical practice which will be an indicator of reference in subsequent analysis.

Resumen Introduccion La medida de las tasas de infeccion nosocomial constituye un indicador de calidad asistencial, permitiendo adoptar medidas de prevencion y control. Se ha desarrollado un plan de vigilancia de infeccion nosocomial en los hospitales, demostrando ser un metodo eficaz para disminuir su incidencia. Objetivo Conocer los indicadores y caracteristicas de la infeccion nosocomial en general y de la infeccion del sitio quirurgico en particular en un servicio de Urologia de forma global y por procedimientos. Material y Metodos Estudio prospectivo mediante el sistema de vigilancia epidemiologica entre 2002-2005 en 4.618 pacientes ingresados al menos 24 horas, practicandose un total de 3.096 intervenciones. Resultados Se observo una tasa global de infeccion nosocomial del 6,10%, de infeccion urinaria del 3,42% y de infeccion del sitio quirurgico del 2,81%. De esta ultima por procedimientos, la cistectomia se situa en el 22,8%, seguido de la cirugia del rinon y ureter (6,6%) y de la cirugia abierta de prostata (4,36%). Los germenes mas frecuentemente aislados en la infeccion del sitio quirurgico son Escherichia Coli (43,6%) y Pseudomonas aeruginosa (15%). En la infeccion urinaria los germenes mas frecuentes son Escherichia Coli (43,6%) y Pseudomonas aeruginosa (15%) Conclusion Las tasas de infeccion nosocomial son inferiores a los valores estandares publicados. La mayor tasa de infeccion del sitio quirurgico se presenta en las cirugias mas complejas tecnicamente, siendo Escherichia Coli, el agente etiologico mas frecuente. La vigilancia de la infeccion del sitio quirurgico y factores relacionados permiten incorporar elementos de mejora en la practica clinico-quirurgica, aportando un indicador de referencia en analisis posteriores.

The goal of this work tries to evaluate the utility of the qualitative determination of NMP-22 in the evaluation of the superficial bladder carcinoma in asymptomatic patients, comparing it with its quantitative determination, the cytology and the cystoscopy.A simple of urine just voided was taken in 88 asymptomatic patient follow-up for superficial bladder cell carcinoma. This dose was distributed in 3 parts, for performed cytology, for determination of NMP-22, and 4 drops of the third part are added to device bladder chek. Later, we performed cystoscopy and transurethral resection in patients with a suspicion of bladder cancer.26 patients had tumor relapse and 62 patients were free of disease. The sensitivity for the bladder chek was of 28%, 34.62% for NMP-22, 34.62% for cytology and 100% for cystoscopy. The specificity was of 93.55%, 80.33%, 87.10% and 87.10% respectively. The sensitivity by degree was 25 in G1, 28.57 in G2 and 50 in G3 for Bladder chek; 29.41, 42.86 and 50 for NMP-22; 23.53, 71.43 and 0 for cytology. The sensitivity by stages was 27.7 in Ta-1 and 50 in T2 for Bladder chek; 34.78 and 50 for NMP-22; 39.13 and 0 for the cytology.The low sensitivity of bladder chek invalidates it like alternative method to the cystoscopy in the follow-up of the superficial asymptomatic bladder cell carcinoma.

A quarter of patients waiting for kidney transplantation are patients with previous graft failure. Outcome of first and second renal transplant make these the gold standard for end renal stage disease, but this is not so clear in the case of third and further renal transplant, especially at the time of organ shortage. We revise our experience in patients with three or more kidney transplants focusing on surgical aspects and graft outcome.1364 renal transplants have been carried out in our centre since 1975 until December 2003. We have retrospectively revised the 34 patients with three renal transplants and the 5 with four. We analyse the surgical technique, surgical complications and graft outcome.Mean age was 42 years (21-65). Average mismatches between donor and recipient was 3.2. All kidneys, but one case of living donor, were harvested from cadaver donors, mostly in multiple organ-procurement. Average time from the last renal transplant was 5 years (3 days-17 years) and from the last transplant carried out in the iliac fossa reused until the new transplant was 9 years (3 days- 17.5 years). All implants were performed through an iterative lumboliliac incision (25 on the right side, 11 on the left one and in 3 cases where side was not registered). Mean average duration of the procedure was 166 minutes (100-300). Nephrectomy of previous graft at the moment of the implant was carried out in 13 patients (33%). Vascular anastomosis was made on the common iliac vessels (50%) or on the external ones (50%) in end to side way, Ureteroneocystostomy was performed in an extravesical way except in 1 patient with cutaneous diversion. Vascular complications were 4 haemorrages (1 patient died), 3 venous and 2 arterial thrombosis. We had an abscess secondary to intestinal fistulae. Other surgical complications were 4 lymphoceles, three of them needed surgical treatment, and one perirenal haematoma treated in a conservative way. No urological complications were seen. In total 6 grafts (15%) were lost due to surgical complications. Graft actuarial survival rate at 1 year was 65%, 40% at 5 and 28% at 10 years.Three and four renal transplant survival rates are shorter than first and second ones. Iterative access through lumboiliac incision is associated with a higher vascular complication rate, probably in these patients a transperitoneal access would be better. Multicentric studies with higher numbers of patients are needed to define more clearly which patients would benefit from multiple kidney retransplants.

Background Severe Respiratory Infections (SRI) are relative frequent complications of biologic therapy. The vaccines can reduce these complications. Objectives To assess the SRI in a prospective cohort of patients with rheumatic diseases who were immunized following a protocol of immunization. Methods A protocol of immunization agreed beforehand between preventive and rheumatology service was established. In the first visit they initiated immunization for Pneumococcal, Haemophylus and Influenza vaccines. Influenza vaccine was only administered during the seasonal period (from October to April yearly in our hospital). At May 2013, pneumococcal conjugate was added to pneumococcal polysaccharide. Cohort study of 374 patients consecutively evaluated at the first visit for the vaccine consultation from 1 October 2011 to 31 September 2013. They were followed for a minimum period of one month and a maximum of two years. Data about episodes of SRI were collected from patients seen at emergency departments and hospitalisation. Results The mean age of the 374 patients was 53.1±15.4 (62.2% women/37.8% men). 8 of 374 patients refused to be vaccinated and 1 died before been vaccinated. The most frequent underlying diseases were Rheumatoid Arthritis (38.9%), Psoriatic arthritis (23.6%) and Ankylosing spondylitis (8,8%). A total of 225 (61.6%) patients were taking a biological drug (adalimumab 49,3%, etanercept 18,2%, infliximab 17,3%, tocilizumab 5,3%, Golimumab 5,%, Rituximab 3,5%, abatacept 0,4% and belimumab 0,4%) at the first visit. Combined therapy with other synthetic DMARDs was observed in 41.7% (mainly methotrexate). The following vaccines were prescribed: Influenza (n=365 patients), Haemophylus influenzae (n=360), Pneumococcal polysaccharide (n=322), Pneumococcal conjugate (n=178). 26 of 50 patients that had been immunized previously for pneumococcal polysaccharide, did not receive another dose. Throughout the follow-up, only 4 of 365 patients (1.1%) had a SRI. All of them required to be hospitalized, one with a tuberculous necrotizing granulomatous pneumonia, two with a bacterial pneumonia (E coli and other unidentified) and one with a lower respiratory tract infection without pulmonary condensation. Conclusions Our immunized cohort of patients with inflammatory rheumatic diseases had a low incidence of SRI. It seems that vaccination following a protocol of immunization may be useful. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.4967

To evaluate the usefulness of the NMP-22 test in the diagnosis of bladder cancer; to calculate the ideal cutoff and to compare the results among NMP-22, voided urine cytology and cystoscopy.166 patients having clinical suspicious of bladder cancer or in follow-up due to a previous one. The exclusions criteria were: other urological conditions, radiotherapy in the last three months, systemic chemotherapy in the last month, recent vesical trauma or indwelling catheter. Prior cystoscopy a recent voided urinary sample was sent to the pathology and biochemistry laboratory to perform cytology and NMP-22. A TUR was performed in patients with bladder tumour. The cutoff was calculated with ROC curves. For each test we calculate sensitivity, specificity, positive and negative predictive value. We use the McNemar test to compare the results, all of which are expressed with a confidence interval of 95%.The ideal cutoff was 6 U/ml. We have a global sensitivity of 82.75% for NMP-22 and 67.9 for cytology (p = 0.0118); the specificity was 80% and 94.12% respectively (p = 0.0018). By grade the sensitivity was 72.22% G1, 70.97% G2 and 100% G3 for NMP-22 and 44.44%, 58.06% and 90.62% for cytology. By stage it was 68.42% Ta, 83.33% T1 and 100 T2 or more for NMP-22 and 36.84%, 75% and 85.71% for cytology. With the cystoscopy we obtained a 100% sensitivity and 89.41% specificity.The NMP-22 is a useful test for the diagnosis of bladder cancer; is more sensitive and less specific than cytology. We think it can replace the cytology in the diagnosis and follow-up of bladder cancer. The ideal cutoff is 6 U/ml.

To compare the sensitivity and specificity of the BTA stat test, NMP-22 and voided urine cytology in the diagnosis of bladder cancer.The study comprised 100 patients or follow-up or with a suspicion of bladder cancer. A voided urine sample was obtained and alliquoted in three samples for the BTA stat test, NMP-22 and cytology. The patients were subsequently evaluated by cystoscopy and TUR was performed when cancer was suspected. The bladder cancer was classified according to TNM stage and WHO grade. The McNemar test was utilized to compare the results. The cut-off level used for NMP-22 was 10 U/ml. ROC curves were plotted to determine the NMP-22 values for optimal sensitivity and specificity in our seires.Two patients were excluded from the study. The overall sensitivity was 76.47% for cytology, 78.43% for the BTA stat test and 84.31% for NMP-22 (p = n.s.). The specificity was 91.49%, 87.23% and 87.23% respectively (p = n.s.). By grade and stage, NMP-22 showed the best results followed by the BTA stat test and lastly cytology, although the differences were not significant. The ideal cut-off for NMP-22 in our series was 6 U/ml and not the generally recognized 10 U/ml.NMP-22 is superior to the BTA stat test and cytology in the diagnosis of bladder cancer, although the differences were not significant. The ideal cut-off in our series was 6 U/ml. The BTA stat test has the advantage of being easy to perform and provides the results in 5 minutes. In our view, NMP-22 and BTA stat test can replace cytology in the diagnosis of bladder cancer.