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Objetivos. Determinar y analizar la relación entre la arteriografía inguinal preoperatoria (AIP) y la infección quirúrgica inguinal homolateral en cirugía arterial. Material y métodos. Se incluyeron en el estudio 867 abordajes quirúrgicos inguinales realizados en un período de 5 años, comparando la incidencia de infección quirúrgica según la realización o ausencia de arteriografía previa homolateral al sector intervenido. El período de seguimiento para diagnosticar la infección varió desde 2 días a 7,5 años. Se realizaron un estudio descriptivo y un análisis univariante. Resultados. La tasa de incidencia de infección quirúrgica global fue del 2,65 por ciento (n = 23). En 156 casos (18 por ciento) se había realizado una arteriografía homolateral previa. La frecuencia de infección en los casos con arteriografía homolateral fue del 6,41 por ciento, mientras que en los que no se realizó la misma homolateralmente fue del 1,83 por ciento, objetivándose una relación estadísticamente significativa entre la arteriografía inguinal preoperatoria homolateral y la infección quirúrgica (p = 0,003).Conclusiones. La relación significativa entre la AIP y la infección inguinal confirma la necesidad de adoptar medidas preventivas específicas para evitar la elevada morbimortalidad de esta complicación inherente a la cirugía vascular (AU)

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From 1990, a study on the prevalence of nosocomial infections has been carried out yearly in Spanish hospitals. Acute care hospitals with more than 50 beds were involved on a voluntary basis. In 1990, 123 hospitals participated and by 1997 the number of hospitals had reached 214. The objective of the study is to examine the situation in each hospital, and to collect data across the country, by means of a common protocol. The overall prevalence of nosocomial infections has significantly decreased in Spain. The prevalence of infected patients has been about 7% in the three last studies. The prevalences for urinary tract infections and surgical wound infections have decreased, while prevalences for lower respiratory tract infections and bacteraemia have increased. Urinary tract infections have occupied the first position over the eight surveys. Second place was taken by surgical wound infections from 1990 to 1995, and by lower respiratory tract infections in 1996-1997. With the exception of Intensive Care Units, the prevalence of nosocomial infections has been decreasing in all hospital areas. The mean age of hospitalized patients has increased, so has the proportion of patients with one or more intrinsic risk factors and the proportion of those with one or more instrumentations. The proportions of patients with a short or a very long hospital stay have increased, revealing a change that no doubt reduces nosocomial infection rates. The use of antimicrobial drugs has shown a significant increase, from 33.8% of patients in 1990 to 35.8% in 1997.

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OBJECTIVE: To determine trends in rates of nosocomial infections in Spanish hospitals. DESIGN: Prospective prevalence studies, performed yearly from 1990 through 1994. SETTING: A convenience sample of acute-care Spanish hospitals. PARTICIPANTS AND PATIENTS: The number of hospitals and patients included were as follows: 1990, 125 hospitals and 38,489 patients; 1991, 136 and 42,185; 1992, 163 and 44,343; 1993, 171 and 46,983; 1994, 186 and 49,689. A core sample of 74 hospitals, which participated in all five surveys and included a mean of 23,871 patients per year, was analyzed separately. RESULTS: The overall prevalence rate of patients with nosocomial infections in the five studies was as follows: 1990, 8.5%; 1991, 7.8%; 1992, 7.3%; 1993, 7.1%; and 1994, 7.2%. The prevalence rate of patients with nosocomial infection in the core sample of 74 hospitals was 8.9%, 8.0%, 7.4%, 7.6%, and 7.6%, respectively (test for trend, P = .0001). Patients admitted to intensive-care units had a 22.8% prevalence rate of nosocomial infection in 1994. The most common nosocomial infections by primary site were urinary tract infection and surgical site infections, followed by respiratory tract infections and bacteremia. More than 60% of all infections were supported by a microbiological diagnosis. CONCLUSIONS: The EPINE project provides a uniform tool for performing limited surveillance of nosocomial infections in most Spanish acute-care hospitals. Its use helps to spread an accepted set of definitions and methods for nosocomial infection control in the Spanish healthcare system. The surveys indicated that the prevalence of nosocomial infections has been reduced over the last 5 years in a core sample of Spanish hospitals.

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BACKGROUND: The aim of the present study was to know the incidence, etiology, prognostic factors and rate of mortality of bacterial meningitis in Aragón (Spain). METHODS: The clinical records of all the patients with bacterial meningitis seen in the hospitals in Aragón (Spain), from 1985 to 1988 inclusive were reviewed. RESULTS: The mean of the annual rates of incidence for Aragón (Spain) was 7.52/100,000 inhabitants. In patients under the age of 15 years the most frequent etiologies were Neisseria meningitidis (59.0%), Haemophilus influenzae (13.7%) and Streptococcus pneumoniae (9.4%); the global rate of mortality was 3.5% similar to that of sequelae. In those over the age of 14 years, the most frequent etiologies were N. meningitidis (33%), S. pneumoniae (18.4%) and Staphylococcus spp. (13.6%); the rate of global mortality was 19.5% and that of sequelae 10.8% with resistance of S. pneumoniae to penicillin and/or ampicillin in 45.5% of the cases in children and in 26.3% in adults. No significant evolutive differences related with the existence of resistances or the administration of antibiotics prior to lumbar punction were observed in any of the age groups. CONCLUSIONS: N. meningitidis is the main etiologic agent in Aragón in both children and adults. The greatest rates of mortality and sequelae were observed in the youngest and oldest age groups with a similar relation being seen in infection by gramnegative bacilli and S. pneumoniae, thus making these patients to be considered as being at high risk.

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A case of human subcutaneous dirofilariasis contracted in Ibiza, Spain is reported. An incomplete nematode extracted from the eyelid of a woman patient was identified on the basis of its anatomic and histologic characteristics as a nongravid adult female of the species Dirofilaria repens. The subcutaneous location of the worm, together with the epidemiologic data, support this finding.

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In Spain meningococcic meningitis is a disease of obligatory declaration which is declared under the name of "Meningococcic infection". In this section other process are also included with the declaration being made under suspicion, with no knowledge of the degree of fulfillment and the significance of the official data. To know this the clinical history of meningitis patients of all the hospitals in Aragon from January 1985 to December 1988 were reviewed comparing the results with those from the system of obligatory disease declaration. The degree of fulfillment for meningococcic meningitis was 90% with the annual rates of incidence of meningococcic meningitis being 1.11 to 2.13 fold higher, according to hospitalary data, higher than the rates of the obligatory disease declaration system.

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BACKGROUND: Years of potential life lost (YPLL) are a health indicator which allows to discriminate the main causes of premature mortality weighting up the deaths according to the age of dead person. METHODS: Premature mortality in Aragón during 1987 is analysed by means of the indicator YPLL between the ages 1 and 64 years. The information given by this indicator along with that supplied by the mortality rates is used to obtain a more complete information of the role and relative importance of each one of the main groups of diseases of the International Classification of Diseases (ICD-9th revision) within the mortality in Aragón during that whole year. RESULTS: The biggest rates of YPLL by one thousand population were due to tumours (9.87), traumatisms and poisonings (8.84), vascular diseases (5.65) and digestive diseases (1.96). Mortality and YPLL rates were higher for males than for females and statistically significant differences were also observed when comparing the provinces of Zaragoza and Huesca with the province of Teruel (higher rates in the first ones) and when comparing rural with urban areas (higher rates in the second case). CONCLUSIONS: According to this indicator the preventive programs in Aragón should lead to the prevention of tumors, traumatisms, vascular diseases and digestive diseases, without forgetting that these illnesses have a bigger effect on male population and on urban areas.

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The epidemiologic polls concerning 166 cases of brucellosis are retrospectively analyzed; the cases are registered by the Preventive Medicine Service of Miguel Servet Hospital for five years (1980-1985). Most of our cases are of recent evolution, although 55% began to give symptoms more of 2 weeks ago and 30% more of 1 month ago. A clear annual increase of the number of cases, fundamentally of the male sex and patients coming from the rural areas, is observed. The percentage of cases in men (73.5%) is almost three times as those in women (26.5%), and the most numerous groups are the 20-29 interval age group and olders above 60. There is a small percentage of people with a professional risk factor (30.1%), which rise, slightly, for the ones who told of contact with cattle (39.2%) and rose up to 53.6% for the ones who consumed non controlled dairy products. However, in 23% of men and 40.9% of women the existence of some risk factors was unknown.

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We tested the efficacy of a single daily dose of ceftriaxone (active ingredient of Rocephin) for the treatment of severe bacteremic infections in 125 non-neutropenic adult patients. A single daily dose of ceftriaxone ranging from 1 to 4 g was given. Surgical procedures were performed if needed. Seventy-six (60.8%) were males and bacteremia was nosocomially acquired in 45 (36%). Microbiologically proven bacteremia was demonstrated in all patients. The most common microorganisms isolated were Escherichia coli (46 episodes), Streptococcus pneumoniae (17 episodes), Klebsiella pneumoniae, and Haemophilus influenzae, Serratia marcescens, Salmonella sp., and Staphylococcus aureus (9, 7, 6, 6, respectively). The urinary tract was the source of the bacteremia in 45 cases (36%), and the lower respiratory tract in 33 (26.4%). Mean duration of treatment was 10.8 days (range 3-21 days). One hundred and six patients (84.8%) recovered completely, 11 (8.8%) improved, but needed an alternative antibiotic treatment. An alternative treatment was also given to a patient whose condition had initially deteriorated. Seven patients (5.6%) died. Death was directly related to the infection in 2 cases. Three patients (2.4%) developed a superinfection, and 5 (4%) a severe (1 case) or mild (4 cases) adverse effect. In summary, a single daily dose of ceftriaxone proved to be useful for the treatment of selected severe bacteremic infections.

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