Hospital de Órbigo, Spain
Hospital de Órbigo, Spain

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Palacios-Baena Z.R.,Hospitales Universitarios Virgen Macarena y Virgen del Rocio | Oteo J.,Institute Salud Carlos III | Conejo C.,Hospitales Universitarios Virgen Macarena y Virgen del Rocio | Conejo C.,University of Seville | And 116 more authors.
Journal of Infection | Year: 2016

Background: Most available information on carbapenemase-producing Enterobacteriaceae (CPE) is usually associated with specific types of infection or patient or with descriptions of outbreaks. The aim of this study was to comprehensively analyse the clinical epidemiology, clinical features and outcomes of colonisation and infections due to CPE in Spain. Methods: A multicentre prospective cohort study was carried out in 34 Spanish hospitals from February to May 2013. All new patients testing positive for CPE in clinical samples were included. Logistic regression was used to identify predictors of mortality. Results: Overall, 245 cases were included. The most frequent organism was Klebsiella pneumoniae (74%) and the carbapenemases belonged to the OXA-48 (74%), metallo-β-lactamase (MBL) (24%) and KPC (2%) groups. Acquisition was nosocomial in 145 cases (60%) and healthcare-associated (HCA) in 91 (37%); 42% of the latter were nursing home residents, in whom OXA-48-producing K. pneumoniae ST405 predominated. MBLs and OXA-48 predominated in ICU and medical patients, respectively. Overall, 67% of patients had infections. The most frequent infections identified in this study were urinary tract (43%) and skin structure (21%) infections, and 10% of infections were bacteraemic. Crude mortality was 20%. Inappropriate antibiotic therapy was independently associated with an increased risk of death (OR = 3.30; 95% CI: 1.34-8.11). Conclusions: We found some differences in the epidemiology of CPE depending on the type of carbapenemase produced. Although a low proportion of CPE infections were bacteraemic, active antibiotic therapy was a protective factor for reducing mortality. © 2015 The British Infection Association.


Garcia Urena M.A.,Henares Hospital | Hidalgo M.,Clinica Nuestra Senora Del Rosario | Feliu X.,Hospital General Of Igualada | Velasco M.A.,Hospital Universitario Of Puerto Real | And 6 more authors.
Hernia | Year: 2011

Introduction: Investigation in the field of inguinal hernia surgery is now focused on postoperative pain. The extended use of lightweight meshes and alternative methods of fixation may play a relevant role in the reduction of pain. In this study, a new self-gripping lightweight polypropylene mesh is tested. Methods: A multicentric, observational study was scheduled to prospectively evaluate this new mesh. Ten centers agreed to participate. Only primary, type 1 or 2 uncomplicated hernias in adults were included. The mesh was placed as a Lichtenstein procedure without any fixation. A complete pain questionnaire was followed at 1 week, and at 1, 3 and 6 months postoperatively. The principal goal of the study was to evaluate maximum pain score at 6 months. Pain was assessed by a visual analog scale. A total of 256 patients were operated. Mean operative time was 35.6 min; 76.2% of patients were operated in an ambulatory setting. Results: There were a few postoperative complications: 2 wound infections, 17 seromas, 21 hematomas, 6 orchitis. The incidence of acute pain was 27.3% at week 1 and 7.5% at month 1. The incidence of chronic pain was 3.6% at month 3 and 2.8% at month 6. No recurrences or long-term complications were observed. Conclusion: This self-gripping mesh can be used safely in type 1 and 2 primary, uncomplicated inguinal hernia with minimal morbidity and most patients under ambulatory setting. The registered incidence of chronic pain is lower than 3%. © 2011 Springer-Verlag.

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