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Colorectal surgery; Postoperative infection; Cohort studies Cirugía colorrectal; Infección postoperatoria; Estudios de cohortes Cirurgia colorectal; Infecció postoperatòria; Estudis de cohorts Background: Colorectal surgery is associated with the highest rate of surgical site infection (SSI). This study analyses the effectiveness of an interventional surveillance program on SSI rates after elective colorectal surgery. Material and methods: Cohort study showing temporal trends of SSI rates and Standardized Infection Ratio (SIR) in elective colorectal surgery over a 12-year period. Prospectively collected data of a national SSI surveillance program was analysed and the effect of specific interventions was evaluated. Patient and procedure characteristics, as well as SIR and SSI rates were stratified by risk categories and type of SSI analysed using stepwise multivariate logistic regression models. Results: In a cohort of 42,330 operations, overall cumulative SSI incidence was 16.31%, and organ-space SSI (O/S-SSI) was 8.59%. There was a 61.63% relative decrease in SSI rates (rho = -0.95804). The intervention which achieved the greatest SSI reduction was a bundle of 6 measures. SSI in pre-bundle period was 19.73% vs. 11.10% in post-bundle period (OR 1.969; IC 95% 1.860-2.085; p < 0.0001). O/S-SSI were 9.08% vs. 6.06%, respectively (OR 1.547; IC 95% 1.433-1.670; p < 0.0001). Median length of stay was 7 days, with a significant decrease over the studied period (rho = -0.98414). Mortality of the series was 1.08%, ranging from 0.35% to 2.0%, but a highly significant decrease was observed (rho = -0.67133). Conclusions: Detailed analysis of risk factors and postoperative infection in colorectal surgery allows strategies for reducing SSI incidence to be designed. An interventional surveillance program has been effective in decreasing SIR and SSI rates.

Background Catheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death. Aim To analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat). Methods A cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007–2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000 patient days. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000 patient days and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported. Results During the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate: 0.20 episodes/1,000 patient days). Patients’ median age was 64.1 years; 36.6% (3,403/9,290) were female. In total, 73.7% (n = 6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n = 5,822) were related to central venous catheter (CVC), 24.1% (n = 2,236) to peripheral venous catheters (PVC) and 13.3% (n = 1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR: 0.94; 95%CI: 0.93–0.96), especially in the ICU (IRR: 0.88; 95%CI: 0.87–0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR: 0.88; 95%CI: 0.87–0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC: 1.08; 95%CI: 1.05–1.11; IRR PVC: 1.03; 95% 1.00-1.05). Conclusions Over the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards.

Introduction: During the last three decades, the surveillance of healthcare associated infections (HAIs) has been recognized as the cornerstone of an effective program of prevention and control of HAIs. Catheter-related bloodstream infections (CRBSIs) are one of the most common types of HAIs. In 2018, the VINCat program (vigilància de les infeccions nosocomials als hospitals de Catalunya) conducted a national validation of CRBSIs´ data to validate the actual recorded rates and assess the data concordance between VINCat and the participating hospitals. Objectives: To validate the declared CRBSIs data of the hospitals participating in the VINCat program Methods: This validation included 44 participating hospitals divided into 3 main groups according to bed number. All hospitals were asked to submit microbilogical data lists of all registered cases of CRBSIs with Staphylococcus aureus (S.aureus) and Coagulase-negative staphylococci (CoNS) reported to the VINCat during the cut period (March to December) and were subject for validation. Main outcomes were false negative cases of CRBSIs that should have been declared to VINCat and false positive cases that do not comply VINCat criteria for a CRBSI.To evaluate the agreement between the two validators statistically, the Cohen's Kappa value is used with '1' being the highest value of concordance. Results: The total number of validated cases of bacteremia was 2327, of which 585 were cases of CRBSIs. In total, 89 (5%) were discordant cases of which 2 cases (2%) were not declared, 4 cases (5%) did not meet the VINCat criteria and 83 cases (93%) were not shown in the list of microbiology provided by hospitals. The Kappa value between the two validators was 0.92. Conclusion: This validation shows a high level of concordance between the CRBSIs´data declared to the VINCat program and the participating hospitals up to 96% (almost perfect). Therefore, the CRBSIs ´data within the VINCat program are reliable and eligible for the benchmarking and for public declaration.

Supplemental Digital Content is available in the text, In cancer patients, who are frequently immunocompromised, bacterial meningitis (BM) can be a severe complication, with a different presentation, etiology, and course, compared to patients without cancer. Our objective is to compare the characteristics and outcomes of BM in patients with and without cancer. A single-center, prospective observational cohort study, conducted between 1982 and 2012, in a tertiary university hospital in Barcelona (Spain). The main outcome measure is in-hospital mortality. We evaluated 659 episodes of BM; 97 (15%) had active cancer. Patients with malignancies were older (median 63 (interquartile range [IQR] 24) vs 52 [IQR 42] years, P

Este artículo, se relaciona con Recuerdos de una alumna de las colonias, de Carmen López Contreras, (BILE, número 55 del 2004) La Fundación Sierra Pambley ayudó a la Institución Libre de la Enseñanza a poner en marcha otra vez la educación de adultos y las colonias. Madrid Biblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5; 28014 Madrid; Tel. +34917748000; biblioteca@mecd.es ESP