RESUMEN
BACKGROUND: Nosocomial infection by enterococci is of growing importance and recognition. The risk factors, morbidity and prognosis of the same were investigated by a case and control study in a third level university hospital. METHODS: One hundred patients with nosocomial infection by enterococci were compared with 100 randomly selected control patients with non enterococcic nosocomial infection. Cases and controls were taken from a series of 10,926 patients examined in search of nosocomial infection by successive cut offs of prevalence. RESULTS: The prevalence of nosocomial infection by enterococci was found to be 9.9 per 1,000 admissions. Analysis among cases and controls by the odds ratio indicated a positive association for nosocomial infection by enterococci for the following risk factors: male sex (1.8), receipt of intensive care (3.6), predisposing diseases (3.1), urinary catheter (3), abdominal-genital surgery (2.4) or nephro-urologic surgery (4.6), other previous infections (1.9) and previous exposure to antibiotics (3.7), mainly aminoglucosides (4.2). Urinary infections and those of the surgical wound predominated, 15 patients had bacteremia, with mortality related with infection being 2%, preinfection hospital stay was 34.7 days and the mean stay was of 8.3 days but these data were not statistically different in the control group. The enterococcic infections were most frequently polymicrobian (odds ratio 5.5) received worse antibiotic coverage (5.1) and presented greater number of therapeutic failures or recurrences (2.5). CONCLUSIONS: Nosocomial infection by enterococci is relatively frequent and virulent. The risk factors identified in this study are in agreement with those found in most series. The previous use of aminoglucosides was specially capable of selecting enterococci but only 13% demonstrated high level resistance to gentamicin.
Asunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/epidemiología , Enterococcus , Infecciones por Bacterias Grampositivas/epidemiología , Premedicación , Adulto , Estudios de Casos y Controles , Infección Hospitalaria/prevención & control , Femenino , Infecciones por Bacterias Grampositivas/prevención & control , Humanos , Masculino , Prevalencia , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: The recent introduction of new antimicrobials allows important changes in the controversial field of their prescription. Longitudinal analysis of the quality and tendencies of the use of antibiotics constitutes one of the basic tools for adapting antibiotic policy. METHODS: This study was undertaken in a university hospital with antibiotic policy plans and institutional protocols of antibiotic prophylaxis. The use of antimicrobials with prophylactic and therapeutic aims has been analyzed by 12 prevalence studies over 6 years in a sample equivalent to 10.2% of the population admitted. A comparison between the first three counts (1986-1987) and the last three (1990-1991) was performed. RESULTS: A mean of 26.6% of the patients admitted used antibiotics. Nonetheless, while its use as treatment grew with progressive deterioration in the quality of use, its use for prophylaxis decreased and improved. Parallel, the use of restricted antibiotics grew from 12 to 19%. The comparison of the habits of prescription between the onset and the end of the study showed the following important changes: decrease in the use of aminopenicillins and cotrimoxazole and increase in the use of first and third generation cephalosporins, antifungal drugs, tobramycin, vancomycin, the group of urinary antiseptics and quinolones and the miscellaneous group of antimicrobials of minor use. CONCLUSIONS: Antibiotics for therapy have been used more and worse, despite the restrictive barriers. The control methods have been effective in prophylaxis with the exception of its excessive prolongation which remains the principal problem. Changes have been registered in the pattern of use of antibiotics in favor of new more effective drugs against multiresistant flora.
Asunto(s)
Antibacterianos , Utilización de Medicamentos , Hospitales Universitarios , Humanos , EspañaRESUMEN
From November 1986 to December 1987 we undertook 5 different counts of the prevalence of nosocomial infections (NI) in 4,572 patients (100% of the population). The following are the most important average values: NI overall, 14.4%, distributed as follows: urinary infections, 29.1%; surgical wounds, 21.6%; pneumonias 8.6%; phlebitis due to catheter insertion, 14.5%; and bacteremias, 5.2%. The most commonly found microorganisms were E. coli, S. aureus, Proteus mirabilis and Enterococcus. These studies reflect the need to decrease the prevalence of NI, mainly those coming from surgical wounds and from the urinary tract. These type counts are feasible with limited human resources. However, they are not appropriate for analyzing in detail the causes of the different types of NI nor in epidemic situations.