Background The global crisis of bacterial resistance urges the scientific community to implement intervention programs in healthcare facilities to promote an appropriate use of antibiotics. However, the clinical benefits or the impact on resistance of these interventions has not been definitively proved. Methods We designed a quasi-experimental intervention study with an interrupted time-series analysis. A multidisciplinary team conducted a multifaceted educational intervention in our tertiary-care hospital over a 5-year period. The main activity of the program consisted of peer-to-peer educational interviews between counselors and prescribers from all departments to reinforce the principles of the proper use of antibiotics. We assessed antibiotic consumption, incidence density of Candida and multidrug-resistant (MDR) bacteria bloodstream infections (BSIs) and their crude death rate per 1000 occupied bed days (OBDs). Results A quick and intense reduction in antibiotic consumption occurred 6 months after the implementation of the intervention (change in level, −216.8 defined daily doses per 1000 OBDs; 95% confidence interval, −347.5 to −86.1), and was sustained during subsequent years (average reduction, −19,9%). In addition, the increasing trend observed in the preintervention period for the incidence density of candidemia and MDR BSI (+0.018 cases per 1000 OBDs per quarter; 95% confidence interval, −.003 to .039) reverted toward a decreasing trend of −0.130 per quarter (change in slope, −0.029; −.051 to −.008), and so did the mortality rate (change in slope, −0.015; −.021 to −.008). Conclusions This education-based antimicrobial stewardship program was effective in decreasing the incidence and mortality rate of hospital-acquired candidemia and MDR BSI through sustained reduction in antibiotic use.

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The aetiological diagnosis of nosocomial pneumonia in intensive care unit (ICU) patients requires a valid, cheap and safe method. This method should be suitable for all mechanically-ventilated patients and all ICUs. The aim of this study was to assess the diagnostic yields of three methods: "blind" bronchial brushing (Accu-Cath)(protective specimen brush-nonbronchofibroscopic (PSB-non BF)); bronchofibroscopic protected specimen brushing (PSB-BF) and bronchoalveolar lavage (BAL).We prospectively studied the diagnostic values of the three methods as well as the agreement between microbiological results in 74 patients with 88 episodes of clinically suspected ventilator-associated pneumonia (VAP) and 22 control subjects. VAP episodes were also divided into those with (n=24) and without antibiotic pretreatment (n=64), and into those with (n=78) and without (n=10) right lower lobe infiltrates on chest radiography.No differences were found as regards the bacteriological yield of the three techniques. Furthermore, the rate of concordant results was high; 92% for PSB-BF and BAL; 84% for PSB-nonBF and BAL; 85% for PSB-nonBF and PSB-BF; and 85% for PSB-nonBF combined with both bronchoscopic techniques. The diagnostic yields in suspected VAP were 66, 59 and 56% for PSB-nonBF, PSB-BF and BAL, respectively.We conclude that "blind" bronchial brushing has similar accuracy to bronchoscopic techniques commonly used in the diagnosis of ventilator-associated pneumonia, constituting an interesting alternative in hospitals where fibreoptic bronchoscopy is not available.

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Antecedentes y objetivo La pandemia por SARS-CoV-2 (COVID-19) ha sido un desafío diagnóstico en el que la radiografía de tórax ha tenido un papel muy relevante. El objetivo de este estudio es determinar si la escala radiológica de valoración de ingreso hospitalario (ERVI), aplicada a las radiografías de tórax de pacientes con COVID-19 a su llegada al servicio de urgencias, se relaciona con la gravedad de la COVID-19 en términos de necesidad de ingreso hospitalario, ingreso en unidad de cuidados intensivos (UCI) o la mortalidad. Materiales y métodos Se ha realizado un estudio retrospectivo a 292 pacientes enfermos de COVID-19 que consultaron en el servicio de urgencias, en un período de mes y medio (del 16 de marzo al 30 de abril de 2020). Para estandarizar los patrones radiológicos, hemos utilizado la escala ERVI, categorizando el patrón radiológico en leve, moderado y grave. Se ha analizado la relación entre la gravedad radiológica según la escala ERVI y la necesidad de ingreso hospitalario, en UCI y la mortalidad. Resultados El 91,4% de los pacientes precisaron ingreso. Existe una asociación estadísticamente significativa entre la escala ERVI y la necesidad de ingreso hospitalario ( p = 0,03). El ingreso en UCI presenta una asociación significativa con la escala ERVI ( p < 0,001). Han fallecido 51 (17,5%) pacientes, de los cuales el 57% presentaba una escala ERVI grave. Cuando estudiamos la mortalidad agrupando a los pacientes según su resultado en la escala ERVI y su rango de edad, el porcentaje de fallecidos aumenta a partir de los 70 años en los pacientes con una escala ERVI moderada y grave. Conclusiones La radiografía de tórax en pacientes con COVID-19 a su llegada al servicio de urgencias es una herramienta pronóstica en cuanto a la decisión de ingreso hospitalario, en UCI y mortalidad, de manera que las escalas ERVI graves tienen una mayor mortalidad e ingreso en UCI con una diferencia estadísticamente significativa.