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Lina Marcela Parra,1 Mireia Cantero,1 Ignacio Morrás,2 Alberto Vallejo,1 Itziar Diego,2 Elena Jiménez-Tejero,1 Elena Múñez,3 Ángel Asensio,1 Ana Fermández-Cruz,3,4 Antonio Ramos-Martinez3,4 On behalf of Puerta de Hierro Hospital Admission Study Group1Servicio de Medicina Preventiva, HU Puerta de Hierro-Majadahonda, Madrid, Spain; 2Servicio de Medicina Interna, HU Puerta de Hierro-Majadahonda, Madrid, Spain; 3Servicio de Medicina Interna, HU Puerta de Hierro-Majadahonda, Unidad de Enfermedades Infecciosas, UAM, Madrid, Spain; 4Instituto Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHSA), Madrid, SpainCorrespondence: Antonio Ramos-MartinezServicio de Medicina Interna, HU Puerta de Hierro-Majadahonda, Unidad de Enfermedades Infecciosas, Calle Joaquín Rodrigo 2, Majadahonda, Madrid 28222, SpainTel +34 638 211 120Fax +34 91191 6807Email aramos2202@gmail.comObjective: To analyse the rate of occurrence and the clinical variables associated with readmission of patients who had previously been discharged after admission for COVID-19.Setting: University hospital in Madrid (Spain).Participants: Sixty-one patients (74% male) who presented COVID-19 were readmitted during the 3 weeks after discharge from hospital.Interventions: Nested case–control study paired (1:1 ratio) by age, sex and period of admission.Outcome Measures: Rate of readmission rate of patients discharged after suffering COVID-19 and identification of the clinical variables associated with it.Results: Out of 1368 patients who were discharged during the study period, 61 patients (4.4%) were readmitted. Immunocompromised patients (N=10.2%) were at increased risk for readmission (p=0.04). There was also a trend towards a higher probability of readmission in hypertensive patients (p=0.07). Cases had had a shorter hospital stay and a higher prevalence of fever during the 48 hours prior to discharge. There were no significant differences in oxygen levels measured at admission and discharge by pulse oximetry intra-subject or between the groups. Neutrophil-to-lymphocyte ratio at hospital admission tended to be higher in cases than in controls (p=0.06). Neither glucocorticoids nor anticoagulants prescribed at hospital discharge were associated with a lower readmission rate. Patients who were readmitted due to a thrombotic event (8 patients, 13.1%) presented a higher level of D-dimer at discharge of initial admission.Conclusion: The rate of readmission after discharge from hospital for COVID-19 was low. Immunocompromised patients and those presenting with fever during the 48 hours prior to discharge were at greater risk of readmission to hospital.Keywords: coronavirus, pneumonia, viral, patient readmission, pulmonary embolism, heparin

Bacterial infections may complicate the course of COVID-19 patients. The rate and predictors of bacterial infections were examined in patients consecutively admitted with COVID-19 at one tertiary hospital in Madrid between March 1st and April 30th, 2020. Among 1594 hospitalized patients with COVID-19, 135 (8.5%) experienced bacterial infectious events, distributed as follows: urinary tract infections (32.6%), bacteremia (31.9%), pneumonia (31.8%), intra-abdominal infections (6.7%) and skin and soft tissue infections (6.7%). Independent predictors of bacterial infections were older age, neurological disease, prior immunosuppression and ICU admission (p < 0.05). Patients with bacterial infections who more frequently received steroids and tocilizumab, progressed to lower Sap02/FiO2 ratios, and experienced more severe ARDS (p < 0.001). The mortality rate was significantly higher in patients with bacterial infections as compared to the rest (25% vs 6.7%, respectively; p < 0.001). In multivariate analyses, older age, prior neurological or kidney disease, immunosuppression and ARDS severity were associated with an increased mortality (p < 0.05) while bacterial infections were not. Conversely, the use of steroids or steroids plus tocilizumab did not confer a higher risk of bacterial infections and improved survival rates. Bacterial infections occurred in 8.5% of patients hospitalized with COVID-19 during the first wave of the pandemic. They were not independently associated with increased mortality rates. Baseline COVID-19 severity rather than the incidence of bacterial infections seems to contribute to mortality. When indicated, the use of steroids or steroids plus tocilizumab might improve survival in this population. [ABSTRACT FROM AUTHOR]

Objectives: The prognosis of bone and joint infections (BJI) caused by Gram-negative bacilli (GNB) worsens significantly in the face of fluoroquinolone-resistance. In this setting, scarce pre-clinical and clinical reports suggest that intravenous beta-lactams plus colistin may improve outcome. Our aim was to assess the efficacy and safety of this treatment in a well-characterized prospective cohort., Methods: Observational, prospective, non-comparative, multicenter (14 hospitals) study of adults with BJI caused by fluoroquinolone-resistant GNB treated with surgery and intravenous beta-lactams plus colistin for ≥ 21 days. The primary endpoint was the cure rate., Results: Of the 44 cases included (median age 72 years [IQR 50-81], 22 [50%] women), 32 (73%) had an orthopedic device-related infection, including 17 (39%) prosthetic joints. Enterobacterales were responsible for 27 (61%) episodes, and Pseudomonas spp for 17 (39%), with an overall rate of MDR/XDR GNB infections of 27/44 (61%). Patients were treated with colistin plus intravenous beta-lactam for 28 days (IQR 22-37), followed by intravenous beta-lactam alone for 19 days (IQR 5-35). The cure rate (intention-to-treat analysis; median follow-up = 24 months, IQR 19-30) was 82% (95% CI 68%-90%) and particularly, 80% (95% CI 55%-93%) among patients managed with implant retention. Adverse events (AEs) leading to antimicrobial withdrawal occurred in 10 (23%) cases, all of which were reversible. Colistin AEs were associated with higher plasma drug concentrations (2.8 mg/L vs. 0.9 mg/L, p = 0.0001)., Conclusions: Combination therapy with intravenous beta-lactams plus colistin is an effective regimen for BJI caused by fluoroquinolone-resistant GNB. AEs were reversible and potentially preventable by close therapeutic drug monitoring., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Recurrent acute cholangitis (RAC) is a relatively uncommon entity that presents significant management difficulties. We present the case of a patient with RAC in whom the number of episodes was reduced after a novel therapeutic procedure., Case Report: A 93-year-old male who in June 2019 was admitted for chills without fever, shivering, epigastric abdominal pain and moderate jaundice. Both abdominal ultrasound and CT scan showed intrahepatic and extrahepatic duct dilatation up to the papilla with no evidence of mass at that level. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and abundant biliary sludge was removed. E. coli was identified as the cause of several of the episodes. Some isolates were shown to produce extended spectrum beta-lactamase (ESBL). Papillotomy was performed and plastic prosthesis and later a metallic prosthesis were implanted. Several months later a surgical bypass of the biliary tract was performed due to persistent episodes of cholangitis. When the chronic suppressive antibiotic treatment subsequently instituted to prevent new episodes of cholangitis failed, it was decided to perform a fecal microbiota transplant from a healthy donor and to suspend the chronic suppressive treatment. Since then, she has not presented new episodes of RAC for more than 10 months of clinical follow-up. BLEE-producing E. coli in the gastrointestinal tract could not be eradicated., Comment: Chronic colonization of the biliary tract by certain enterobacteria such as E. coli has been identified as a relevant pathogenic factor in cases of RAC. FMT may be a promising tool to improve the clinical course of patients with RAC., Competing Interests: All authors are free of conflicts of interest., (© 2024 The Authors.)

Coagulase-negative staphylococci (CoNS) are currently considered typical microorganisms causing infective endocarditis (IE) in patients with prosthetic valves. The objective was to determine variables associated with IE in patients with CoNS bacteremia. We performed an analysis of the clinical characteristics of patients with CoNS bacteremia admitted to a university hospital in Madrid (Spain) from 2021 to December 2022 according to the occurrence of IE. This study is an evaluation of a bacteremia registry. During the study period, 106 patients with CoNS bacteremia were detected. In 85 patients an echocardiogram was performed during hospital admission to rule out IE. Among them, 12 episodes were detected that met IE criteria (14.2%). Of the 6 patients with heart valve prostheses, 5 patients (83.3%) had IE (p < 0.001). Patients with IE more frequently had positive blood cultures more than 12 h after the first draw (58.3% versus 13.4%; p < 0.001). There was a tendency to associate community-acquired bacteremia and to that all blood culture bottles obtained were positive with an increased risk of IE (p = 0.091 and p = 0,057, respectively). Attributable mortality to infection was higher in patients with IE relative to all other patients (16.7% vs. 0%; p = 0.033). The multivariable analysis included having valve prosthesis and persistent bacteremia for more than 12 h. Both were independently associated with IE: valve prosthesis OR 38.6 (95% CI 5.8-258; p < 0.001) and persistent bacteremia OR 2.6 (95% CI 1.1-6.8; p = 0.046). In conclusion, a high percentage of cases of CoNS bacteremia may be due to IE. Some of the variables related to a higher risk of IE, such as having a valvular prosthesis or presenting positive blood cultures for more than 12 h, should lead to rule out or confirm the presence of IE by performing echocardiography., (© 2023. Springer Nature Limited.)

Introduction: Whole-body autopsies may be crucial to understand coronavirus disease 2019 (COVID-19) pathophysiology. We aimed to analyze pathological findings in a large series of full-body autopsies, with a special focus on superinfections., Methods: This was a prospective multicenter study that included 70 COVID-19 autopsies performed between April 2020 and February 2021. Epidemiological, clinical and pathological information was collected using a standardized case report form., Results: Median (IQR) age was 70 (range 63.75-74.25) years and 76% of cases were males. Most patients (90%,) had at least one comorbidity prior to COVID-19 diagnosis, with vascular risk factors being the most frequent. Infectious complications were developed by 65.71% of the patients during their follow-up. Mechanical ventilation was required in most patients (75.71%) and was mainly invasive. In multivariate analyses, length of hospital stay and invasive mechanical ventilation were significantly associated with infections ( p  = 0.036 and p  = 0.013, respectively). Necropsy findings revealed diffuse alveolar damage in the lungs, left ventricular hypertrophy in the heart, liver steatosis and pre-infection arteriosclerosis in the heart and kidneys., Conclusion: Our study confirms the main necropsy histopathological findings attributed to COVID-19 in a large patient series, while underlining the importance of both comorbid conditions and superinfections in the pathology., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ruiz-Cáceres, Hermida Romero, Guerra Merino, Portu Zapirain, Pérez-Mies, Sánchez-Conde, Riaño, Rubio, Fortés Alen, Vidal González, Salas Antón, Múñez, Sánchez Sánchez, Corona-Mata, Aldecoa Ansorregui, Miró, Beloqui Pérez de Obanos, Ibero, Gómez-Román, Fariñas, Tabuyo Bello, de Alava, Cisneros, Matías-Guiu and Rivero.)

Introduction: The evaluation of staging and activity of invasive fungal infection (IFI) is used to adjust the type and duration of antifungal therapy (AT). Typically anatomy-based imaging is used. Positron emission tomography/CT with 18 F-fluorodeoxyglucose ( 18 F-FDG PET/CT) not only evaluates more than one body area in one session, but adds functional information to the anatomic data provided by usual imaging techniques and can potentially improve staging of IFI and monitoring of the response to therapy. Our objective is to analyse the impact of the systematic use of 18 F-FDG PET/CT in IFI diagnostic and therapeutic management., Methods and Analysis: Multicentre prospective cohort study of IFI with performance of systematic 18 F-FDG PET/CT at diagnosis and follow-up that will be carried out in 14 Spanish tertiary hospitals. It is planned to include 224 patients with IFI over a 2-year study period. Findings and changes in management before and after 18 F-FDG PET/CT will be compared. Additionally, the association of initial quantitative 18 F-FDG PET/CT parameters with response to therapy will be evaluated.The primary endpoint is to compare the yield of 18 F-FDG PET/CT with standard management without 18 F-FDG PET/CT in IFI at initial assessment (staging) and in monitoring the response to treatment.The impact of the results of 18 F-FDG PET/CT on the diagnostic-therapeutic management of patients with IFI (added value), as well as the prognostic ability of different quantification parameters of 18 F-FDG PET/CT will be secondary endpoints., Ethics and Dissemination: The Clinical Research Ethics Committee of Puerta de Hierro-Majadahonda University Hospital approved the protocol of the study at the primary site. We plan to publish the results in high-impact journals., Trial Registration Number: NCT05688592., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objectives: To compare the ability of qSOFA, NEWS2, SOFA, LODS, SIRS, APACHE-II and SAPS-II scores., Material and Methods: Analysis of in-hospital mortality of 203 patients admitted to the ICU because of sepsis. The scores were compared according to their application. Discrimination was evaluated with AUC-ROC curve and performance with the Akaike's (AIC) and Bayesian information criterion (BIC)., Results: In-hospital mortality was 31.53%. NEWS2 showed better mortality discrimination ability and better performance considering the AIC/BIC criterion for mortality tan qSOFA (AUC-ROC=.615 and .536; P=.039). SOFA presented higher performance and AUC-ROC tan LODS (.776 vs .693; P=.01) and both showed higher discrimination ability than SIRS (AUC-ROC=.521; P<.003). Finally, SAPS-II was able to predict mortality with better performance than APACHE-II and presented higher discrimination capacity but without statistical significance compared (AUROC=.738 for SAPS-II and AUROC=.673 for APACHE-II; P=.08)., Conclusion: NEWS2 is a better predictor of mortality than qSOFA and its implementation for the early recognition of the septic patient or the patient with higher risk in the emergency and hospitalization wards should be addressed. In addition, given that SOFA and SAPS-II showed better performance and are simpler than LODS and APACHE-II, respectively, both should be considered the scores of choice in this setting., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Severely ill COVID-19 patients are at high risk of nosocomial infections. The aim of the study was to describe the characteristics of candidemia during the pre-pandemic period (January 2019−February 2020) compared to the pandemic period (March 2020−September 2021). Antifungal susceptibilities were assessed using the EUCAST E.Def 7.3.2 broth dilution method. Fluconazole-resistant C. parapsilosis isolates (FRCP) were studied for sequencing of the ERG11 gene. The incidence of candidemia and C. parapsilosis bloodstream infection increased significantly in the pandemic period (p = 0.021). ICU admission, mechanical ventilation, parenteral nutrition and corticosteroids administration were more frequent in patients with candidemia who had been admitted due to COVID-19. Fifteen cases of FRCP fungemia were detected. The first case was recorded 10 months before the pandemic in a patient transferred from another hospital. The incidence of FRCP in patients admitted for COVID-19 was 1.34 and 0.16 in all other patients (p < 0.001). ICU admission, previous Candida spp. colonization, arterial catheter use, parenteral nutrition and renal function replacement therapy were more frequent in patients with candidemia due to FRCP. All FRCP isolates showed the Y132F mutation. In conclusion, the incidence of candidemia experienced an increase during the COVID-19 pandemic and FRCP fungemia was more frequent in patients admitted due to COVID-19.

Background: Determination of the humoral response to Clostridioides difficile (CD) toxins could be of great value in the management of patients with CD infection (CDI)., Methods: A prospective study was conducted on the clinical characteristics and humoral response in patients with CDI. Determination of ELISA IgG CD anti-toxin B (tgcBiomics, Germany) was performed. The following dilutions were planned for each patient, 1:100, 1: 200, 1: 400, 1: 800: 1: 1600. A significant concentration of antibody was considered to be present in each dilution if an optical density 0.2 units higher than the negative control of the technique was evident., Results: Eighty-five patients were included during the study period, November 2018-February 2020. The median age was 73 years (interquartile range: 62.5-85 years), with female predominance (45 patients, 52.9%). Thirty-nine patients (45.9%) had a severe infection. Seven patients (8.2%) had suffered an episode of CDI in the previous three months. Seventeen patients (20%) had one or more recurrent episodes during the three-month follow-up: No patient died during admission or required surgery for severe-complicated infection. The incidence of recurrence in patients with no antibody detected at 1:400 dilution was 25.4% (16 patients) while it was 4.3% (one patient) in patients with antibody present at that dilution (p = 0.03). Liver cirrhosis was associated with higher humoral response against CD., Conclusions: Antibodies IgG CD anti-toxin B detection at a dilution of 1:400, using a B ELISA technique, effectively identified patients at increased risk of recurrence. This information could help assist in the management of patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Antonio Ramos-Martínez has received honoraria for lecturing activities and funding for conference attendance from MSD, Astellas, ERN and Angelini., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: There is limited knowledge about risk factors for Clostridioides difficile infection (CDI) and recurrent CDI in solid organ transplant (SOT) recipients., Methods: A case-control study of CDI in SOT recipients compared with controls (SOT recipients who did not present CDI)., Results: Sixty-seven patients from 1089 SOT recipients (6.2%) suffered at least one episode of CDI. The mean age was 55 ± 12 years and 20 cases (69%) were men. The accumulated incidence was 8% in liver transplantation, 6.2% in lung transplantation, 5.4% in heart transplantation, and 4.7% in kidney transplantation. Twenty-nine cases (43.3%) were diagnosed during the first 3 months after SOT. Forty-one cases (61.2%) were hospital acquired. Thirty-one patients with CDI presented with mild-moderate infection (46.3%), 30 patients with severe infection (44.8%), and 6 patients with severe-complicated disease (9%). Independent variables found to be related with CDI were hospitalization in the previous 3 months (odds ratio: 2.99; [95% confidence interval 1.21-7.37]) and the use of quinolones in the previous month (odds ratio: 3.71 [95% confidence interval 1.16-11.8]). Eleven patients (16.4%) had at least one recurrence of CDI. Previous treatment with amoxicillin-clavulanate, severe-complicated index episode, and high serum creatinine were associated with recurrent CDI in the univariant analysis CONCLUSIONS: Liver transplant recipients presented the highest incidence of CDI among SOT recipients. Risk factors for CDI were hospitalization in the previous 3 months and the use of quinolones in the previous month., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: liver enzyme elevation has been reported in SARS-CoV-2 disease (COVID-19) in heterogeneous cohorts, mainly from China. Comprehensive reports from other countries are needed. In this study, we dissect the pattern, evolution, and predictive value of such abnormalities in a cohort from Madrid, Spain., Methods: a retrospective study with a prospective 14-day follow-up of 373 patients with confirmed COVID-19 in five Madrid hospitals, including 50 outpatients. A COVID-19 severe course was defined as the need for mechanical ventilation., Results: a total of 33.1 % of hospitalized patients showed baseline AST elevation and 28.5 % showed ALT elevation, compared with 12 % and 8 % of outpatients (p ≤ 0.001). Baseline AST, ALT and GGT levels correlated with LDH and C-reactive protein (CRP) levels (r ≤ 0.598, p < 0.005). AST elevation was associated with other severity markers such as male sex, lymphopenia, and pneumonia on X-Ray (p < 0.05 for all). ALP and bilirubin levels were rarely increased. Patients with elevated baseline AST showed a progressive normalization of this enzyme and an increase in ALT and GGT levels. Patients with normal baseline AST showed a flattened evolution pattern with levels within the range. Patients with a severe course of COVID-19 more frequently showed elevated baseline AST than those with a milder evolution (54.2 % vs. 25.4 %, p < 0.001). Age, AST and CRP were independent risk factors for a severe course of COVID-19., Conclusion: mild liver enzyme elevation is associated with COVID-19 severity. Baseline AST is an independent predictor of severe COVID-19 course, and tends to normalize over time. ALT and GGT show a late elevation.

Background: Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disease associated with neurological complications, including cerebral abscesses (CA). They tend to be unique, supratentorial and lobar. While the surgical intervention is a rule of thumb when treating and diagnosing the etiology of these lesions, this is not always possible due to dangerous or inaccessible locations. We report the case of a patient solely treated with empiric antibiotics without stereotaxic intervention and satisfactory results., Case Presentation: We present the case of a 21-year-old patient with a right thalamic abscess due to HHT and pulmonary arteriovenous malformations, previously embolized, treated solely with antibiotics. At first, we contemplated the possibility of a stereotaxic biopsy, but the high-risk location and the fact that our patient received a previous full course of antibiotic treatment (in another center), made us discard this intervention because of the low diagnostic yield. We started an empiric antibiotic regime. We followed up very closely the clinical and radiological evaluation the next weeks, adjusting our antibiotic treatment when necessary. The results were favorable from both the radiological and clinical aspects and 6 months after the diagnosis the images show its almost complete disappearance., Conclusion: Carefully tailored antibiotic-only regime and vigilance of its adverse effects and close radiological following is a good treatment approach when surgery is not an option.

Background: There is limited knowledge about specific risk factors for Clostridium difficile infection (CDI)., Method: A retrospective study comparing cases of CDI in solid organ transplant (SOT) recipients with controls (SOT recipients who did not present CDI)., Results: Thirty patients with SOT from 1340 transplantation recipients had at least 1 episode of CDI (2.23%). The accumulated incidence was 3.06% in liver transplantation, 2.78% in lung transplantation, 2.36% in kidney transplantation, and 0.33% in heart transplantation. Seven (23%) cases occurred during the first 2 months. Fifteen (50%) cases were community acquired. Colonoscopy was performed in 6 (20%) cases, but pseudomembranes were observed in only 1 (16%) case. Independent variables found to be related to CDI were previous treatment with proton pump inhibitors (PPIs; odds ratio [OR] 5.5; 95% confidence interval [CI] 1.2-32.0), immunosuppressive regimen including mycophenolate (OR 5.2; 95%CI 1.1-18), hospitalization during the previous 3 months (OR 5.1; 95%CI 1.1-17), and antibiotic treatment during the previous month (OR 6.7; 95%CI 1.4-23). Five (16.7%) patients did not respond to the initial treatment. Recurrences were noted in 6 (20%) patients., Conclusions: Liver transplant recipients presented the highest incidence. Risk factors for CDI were previous treatment with PPIs, immunosuppressive regimen containing mycophenolate, prior hospitalization, and prior antibiotic treatment., (© 2016, NATCO.)

A 59-year-old Caucasian male presented with progressive dyspnea, arthralgias and fever for three days. A diastolic regurgitation murmur was detected in the aortic area. A transesophageal echocardiograph showed several vegetations and severe aortic regurgitation. Blood cultures yielded Neisseria gonorrhoeae beta-lactamase negative. The patient had not noticed any urogenital discomfort or urethral discharge. The patient successfully underwent surgery for septal abscess debridement. The patient received ceftriaxone 2 g bid for eight weeks and the clinical follow-up was uneventful. The review of the literature revealed a total of the 38 additional cases reported between 1980 and the present. The majority of the patients were young, male and with native valve involvement. There has been a clear tendency for left-sided valve involvement (especially in the aortic valve). All valve cultures were reported negative despite, in most cases, the marked tissue destruction. Polymerase chain reaction was performed in two patients and positive results were shown in both. Cultures of exudates from other locations were negative in most cases. One striking fact is the high proportion of patients who underwent surgery (72 %). Information regarding antibiotic sensitivity was available in 28 cases, with penicillin resistance reported in six patients (21 %) and intermediate sensitivity in four patients (14 %). Resistance to ciprofloxacin was reported in two cases (7 %). A rapid increase and distribution of isolates resistant to third generation cephalosporins have been recently detected. The mortality is high, particularly taking into account that most were young patients who had not presented previous heart disease.

Background: Postoperative infections in patients undergoing craniotomy constitute significant complications associated with increased hospital stay and patient morbidity and mortality. Knowing the aetiology of surgical infections after craniotomy may contribute to improving antibiotic prophylaxis and empirical treatment., Method: Information relating to surgical infections in patients undergoing craniotomy was obtained from a series of annual surveys on prevalence of infections in Spanish hospitals (EPINE) during the period 1999-2006. The study protocol collected relevant clinical information on patients with infection. Presence of infection was determined according to the Centres for Disease Control infection criteria., Results: During the time period considered, 107 cases of surgical infections in patients undergoing craniotomy were diagnosed. Forty patients were women (37%) and 67 were male (63%). The mean age was 51.7 years (median 55, range 6-86 years). The duration of the intervention was over 180minutes in 49 patients (45.8%).Thirty-eight patients (35.5%) underwent emergency surgery. Seventy-eight patients (73%) received surgical prophylaxis. Thirty-eight patients (35.5%) had superficial infection of the surgical wound, 38 patients (35.5%) had deep wound infection (including bone flap) and 31 patients (29%), postoperative infections of organ or space (meningitis, subdural empyema or brain abscess). The most common aetiology corresponded to staphylococci (50%), mainly S. aureus (one third of them methicillin-resistant), Pseudomonas aeruginosa (11%), Enterobacter spp (10%) and Acinetobacter baumannii (9%)., Conclusion: Empirical treatment of these infections should include a glycopeptide such as vancomycin and a beta-lactam with coverage against non-fermenting gram-negative bacilli., (Copyright © 2011 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.)

Introduction: Knowledge of the microbiology of surgical infections after abdominal surgery can be of use when prescribing effective empirical antibiotic treatments., Method: Analysis of surgical infections after abdominal surgery in patients enrolled in the Prevalence of Infections in Spanish Hospitals (EPINE) corresponding to the years 1999-2006., Results: During the period of the study, 2,280 patients who were subjected to upper or lower abdominal tract surgery were diagnosed with an infection at the surgical site (SSI). Eight hundred and eighty three patients (37%) had an operation of the upper abdominal tract (gastric, hepatobiliary, and pancreatic surgery) and 1,447 patients (63%) lower abdominal tract surgery (appendectomy and colon surgery). A total of 2,617 bacterial species were isolated in the 2,280 patients included in the analysis. The most frequent microorganisms isolated were, Escherichia coli (28%), Enterococcus spp. (15%), Streptococcus spp. (8%), Pseudomonas aeruginosa (7%), and Staphylococcus aureus (5%, resistant to methicillin 2%). In the surgical infections after upper abdominal tract procedures, there were a higher proportion of isolations of staphylococci, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp. and Candida albicans and less Escherichia coli, Bacteroides fragilis and Clostridium spp., Conclusion: The microbiology of SSI produced after upper abdominal tract surgery did not show any significant differences compared to those of the lower tract. However, more cases of SSI were detected due to staphylococci, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp. and Candida albicans and less caused by Escherichia coli, Bacteroides fragilis and Clostridium spp., (Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.)

Objective: To investigate the effect of preoperative initiation of low molecular weight heparin as prophylaxis for deep venous thrombosis in patients at risk of developing surgical-site infections after knee arthroplasty., Design: Case-control study nested in a cohort. The incidence of surgical-site infection in the cohort was calculated. With the use of data extracted from medical histories and after adjustment for other risk factors, the effect of preoperative heparinization on the risk of incisional and prosthetic infection among case-patients and control-patients (1:3 ratio) was assessed., Setting: Orthopedic department in a tertiary-care referral hospital., Patients: A cohort of 160 consecutive patients who had received prosthetic knee implants between October 1, 2001, and November 30, 2003., Results: Eighteen patients with surgical-site infections were identified, yielding an incidence of incisional and prosthetic infection of 6.9 (95% confidence interval [CI95], 3.5 to 12.0) and 4.4 (CI95, 1.8 to 8.8) cases per 100 patients undergoing surgery, respectively. Surgical-site infection was associated with preoperative use of low molecular weight heparin (odds ratio [OR], 6.2 after adjustment for medical and surgical factors; CI95 1.5 to 23). Prosthetic infection was strongly associated with preoperative use of prophylaxis (OR, undetermined [100% exposure in case-patients vs 35% exposure in control-patients]; P = .002), but incisional surgical-site infection was not., Conclusion: The use of low molecular weight heparins immediately before knee arthroplasty as prophylaxis for deep venous thrombosis should be questioned because of probable increased risk of prosthetic infection.