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Biomedical subjects

C Gimeno

Publications and source records attributed to C Gimeno.

At least 19 recordsLinked to original sources
PubMed2006

Automatic detection of patients with nosocomial infection by a computer-based surveillance system: a validation study in a general hospital.

OBJECTIVE: To validate an automated system for the detection of patients with nosocomial infection (NI) in an intensive care unit (ICU). DESIGN: Retrospective analysis of data from the hospital information system. We applied 3 different NI suspicion criteria (positive microbiology reports, antibiotic administration, and diagnosis of clinical infection) and compared the results to those of a prospective NI incidence study done in the ICU during the same period (1999-2002). SETTING: A 250-bed general hospital in Barcelona, Spain. PATIENTS: From April 15, 1999, through June 30, 2002, 1380 patients were admitted to the ICU. Of these, 1043 had an ICU stay of more than 24 hours and were included in the study. RESULTS: At least one NI suspicion criterion was present for 242 patients (23.2%); 2 criteria were present for 184 patients (17.6%); and all 3 criteria were present for 112 (11.7%). Comparison of hospital information system data to the results of the prospective study indicated that the combination of 2 criteria demonstrated the most satisfactory sensitivity (94.3%; 95% confidence interval [CI], 79.5%-99.0%) and specificity (83.6%; 95% CI, 76.8%-88.9%). The positive predictive value was 55.9% (95% CI, 42.5%-68.6%); the negative predictive value was 98.5% (95% CI, 94.2%-99.7%). The system could assign a site of infection for 90.4% of the NIs detected. CONCLUSION: The hospital information system was a useful tool for retrospectively detecting patients with an NI during the ICU stay. Given its high sensitivity, it may be useful as an alert for the NI team.

Aged↗
PubMed2005

Prophylaxis of early bacterial infections after autologous peripheral blood stem cell transplantation (PBSCT): a matched-pair study comparing oral fluoroquinolones and intravenous piperacillin-tazobactam.

The safety and efficacy of early bacterial prophylaxis with piperacillin-tazobactam were prospectively evaluated in 51 autologous peripheral blood stem cell transplantation (PBSCT) recipients. The results were compared with those obtained in 51 control patients receiving oral fluoroquinolones in a retrospective matched-pair control study. Overall, 76% of the study group and 98% of the control group developed at least one febrile episode during neutropenia (P=0.002). Time from neutropenia to the first febrile episode (FFE) was significantly longer in the study group than in the control group (P=0.04). Once a febrile episode appeared, the duration of fever was significantly longer in cases than in controls (median of 5 and 2 days respectively, P<0.001), and led to a more frequent use of empirical amphotericin B (AmB), not statistically significant (P=0.13). However, the total time of antibiotic administration was significantly greater in the control than in the study group (P=0.05). The duration of AmB treatment shows a trend toward a longer duration in the control than in study group (P=0.2). Overall, 86% of the Gram-positive bacteremia and 85% of the Gram-negative bacteria were susceptible to the tested antibiotics. Our study suggests that a subgroup of patients could benefit from prophylaxis with piperacillin-tazobactam without increasing toxicity or bacterial resistance.

Adolescent↗
PubMed2005

[Prevalence of chronic kidney disease in community-dwelling elderly and associated cardiovascular risk factors].

BACKGROUND: Chronic kidney disease is a major public health problem in developed countries. The incidence of patients on dialysis is increasing progressively in the last years. The ageing population and increasing incidence of diabetes and hypertension are the main causes. Moreover, the level of kidney function is now recognised as a major risk factor for cardiovascular disease, even in mild cases. There is a great unaware about the prevalence of mild to moderate chronic kidney disease in the general population. The aim of the present study was to know the kidney function level in our general population over 64 years old, and the associated cardiovascular risk. METHODS: This is an epidemiological descriptive cross-sectional study, obtained by a representative random sampling of the population over 64 years living in the reference area of our Hospital. The glomerular filtration rate was estimated by the Cockroft-Gault formula and the MDRD equations. Kidney function has been classified by the K/DOQI stages. We examined the univariate and multivariate association between the estimated glomerular filtration rate and the presence of cardiovascular events. RESULTS: We analysed 253 subjects aged 65 to 93 years (mean 72 +/- 5.4). Present comorbidities were: HTA 64%, dislipemia 29%, diabetes 14%, active smokers: 10% of men, 1,5% of women. A previous cardiovascular event was present in 11% of patients (15% of men; 6,8% of women). A serum creatinin level over 1,3 and 1,5 mg/dl was present in 3,8% of women and 8% of men respectively. Nevertheless, chronic kidney insufficiency (estimated clreatinie clearance less than 60 mix') was present in 31-49% relying on the utilised formula. In addition to age, sex, and diabetes, an independent graded association was observed between reduced glomerular filtration rate and the existence of cardiovascular events. CONCLUSIONS: We have confirmed a high prevalence of renal insufficiency among elderly people, usually not detected by the isolated plasma creatinin concentration This aspect is important for cardiovascular stratification risk and medical decisions (diagnostic and/or therapeutic). The level of glomerular filtration rate is independently associated with cardiovascular events.

Aged↗
PubMed2002

Atmospheric nitrogen deposition on the east coast of Spain: relevance of dry deposition in semi-arid Mediterranean regions.

Bulk deposition composition and pine branch washing were measured from April 1999 to March 2000 on the east coast of Spain. The main objective was to characterise N deposition patterns with special emphasis on dry deposition. Bulk deposition in the region is dominated by neutralisation processes by Ca2+ and HCO3-, ClNa of marine origin and a high correlation between NO3- and SO4(2-). SO4(2-) concentrations show a decrease with respect to previous studies in the region in agreement with generalized sulfur emission decreases while the remaining ions, including NO3-, are higher due to their general increase as well as to the inclusion of dry deposition in bulk collectors in the present study. An enrichment in NO3- has been observed in dry deposition composition branch washing) with respect to bulk deposition, while an impoverishment has been observed in the case of NH4+. Annual bulk deposition varies between 7.22-3.1 and 3.5-1.8 Kg ha(-1) year(-1) for S- SO4(2-) and N- NO3-, respectively. N total deposition goes from 9.78 to 6.8 Kg ha(-1) year(-1) at most stations, with the lowest deposition at the control station and Alcoi. The relative dry deposition with respect to the total was over 40% at most stations, going up to 75% at the southern station. N-deposition is expected to be higher considering that N-NH4+ deposition has been underestimated in this study.

Air Pollutants↗
PubMed2002

Susceptibility patterns of bacteria causing community-acquired respiratory infections in Spain: the SAUCE project.

Multicentre surveillance is essential in order to monitor the prevalence of certain resistance phenotypes and to identify rapidly the emergence of new ones. However, many surveillance studies are based either on a relatively small number of isolates from a single country, or on a large number of isolates from many different countries and so are not equally meaningful. Extensive national multicentre surveillance would provide a more reliable strategy for assessing the extent of antimicrobial resistance in individual countries. This article describes Spanish experience with the surveillance network SAUCE, and summarizes the main results on antimicrobial resistance in the three key bacterial pathogens involved in community-acquired respiratory tract infections in Spain: Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes.

Anti-Bacterial Agents↗
PubMed2002

[Incidence and risk factors for hepatitis A in the province of Guadalajara (Spain)].

BACKGROUND: The decrease in the prevalence of hepatitis A in Spain may modify the characteristics of this infection because of the rise in the susceptible adult population. The aim of this study was to determine the incidence of this disease, as well as the epidemiological characteristics and the complications of patients diagnosed in the province of Guadalajara between 1991 and 1999. PATIENTS AND METHODS: The inclusion criterion was the presence of specific IgM together with an increase in alanine aminotransferase concentrations and/or symptoms compatible with acute hepatitis. RESULTS: The mean incidence was 7.13 cases/105 inhabitants. Considerable differences were found between years due to the presence of an outbreak. Most cases occurred in children and young adults. The most frequent risk factor found overall was contact with an infected individual but the distribution of risk factors differed between children and adults. CONCLUSIONS: The decrease in the prevalence of hepatitis A in Spain entails an increase in the susceptible adult population. Consequently, hepatitis A may cease to be a typically pediatric disease and may become one that also affects young adults in whom it may have different characteristics. This consideration should be borne in mind when designing a vaccination strategy.

Adolescent↗
PubMed2002

Epidemiology of invasive streptococcus pneumoniae infections in children in Spain, 1996-1998.

BACKGROUND: Streptococcus pneumoniae is a significant cause of meningitis and septicemia in early infancy, being associated to a high case-fatality rates and serious sequelae. OBJECTIVE: To investigate the burden of invasive disease caused by S. pneumoniae in Valencia, Spain, during a three-year period (1996-1998). METHODS: Hospital-based prospective active surveillance program for invasive bacterial diseases in children < or = 15 years of age in Valencia, from December 1, 1995 to January 1999. RESULTS: A total of 94 cases of invasive pneumococcal disease were detected in patients < or = 15 years of age. The overall annual incidence of invasive pneumococcal disease was 4.6/100,000 persons, < or = 15 years of age. The incidence of invasive disease and meningitis was higher among children younger than 2 years of age (16.8 and 3.8, respectively). Serotypes 19, 14 and 6 accounted for 83% of the isolates. CONCLUSIONS: The age distribution of invasive pneumococcal disease and meningitis shows a peak in the first two years of life and a decline thereafter. Serotypes 19, 14 and 6 are those primarily responsible for invasive pneumococcal disease in children of this region of Spain.

Adolescent↗
PubMed2001

[The prevalence of hepatitis A in the Guadalajara province. Is Spain a country with low endemia?].

BACKGROUND: Spain, together with the other southern European countries, was considered to be an area with a moderate degree of endemia. This fact has consequences for tourists that visit these areas and for vaccination strategies. A prevalence study was proposed in order to get to know the situation of this infection in the Guadalajara province. METHODS: 284 specimens of serum were taken from patients who were classified according to their age, sex and place of residence (with more or less than 10.000 inhabitants). In these specimens the presence of hepatitis A antibodies were studied, using a Microparticule Enzyme Immunoassay (MEIA) (Abbott). RESULTS: An increase in the prevalence was observed in older people, there is a low prevalence population (</= 5%) in people aged between 0-29 years and a high prevalence population (>80%) in adults aged between 30 and 74 years. No differences were observed related to sex. In the stratified analysis according to age, differences were observed between the groups from rural and urban origins. CONCLUSIONS: The low prevalence of hepatitis A was found among the younger population, as seen in other studies carried out on a national level, and this together with a decrease in the frequency, means that Spain is included among the countries with low endemia. This fact has consequences for tourists who visit our country and for vaccination strategies, due to the increase in the number of adults who are susceptible to the infection.

Adolescent↗
PubMed2001

Impact of non-routine vaccination on the incidence of invasive Haemophilus influenzae type b (Hib) disease: experience in the autonomous region of Valencia, Spain.

OBJECTIVE: This study assessed the impact of non-routine vaccination against invasive Haemophilus influenzae (Hib)disease before the introduction of universal childhood Hib vaccination. METHODS: Data were obtained from a prospective surveillance program for invasive bacterial diseases in children <15 years of age that was begun in the Autonomous Region of Valencia on 1 December 1995. RESULTS: An incidence of 15.5 cases of invasive Hib disease per 100,000 children <5 years of age was reported in the first year of the surveillance program (from 1 December 1995 to 30 November 1996), when Hib vaccination coverage was estimated to be 32.5%. An increase in vaccination coverage to 44% in the second year (1 December 1996 to 30 November 1997) was associated with a reduction in disease incidence to 3.3 cases per 100,000. After the initiation of universal vaccination in December 1998, only two cases were reported. The effectiveness of non-routine vaccination was 71% in 1997. CONCLUSIONS: These results show that before the introduction of routine childhood Hib vaccination, widespread use of the vaccine can dramatically reduce the occurrence of invasive Hib disease.

Child, Preschool↗
PubMed2001

Epidemiological pattern of meningococcal disease in Valencia, Spain. Impact of a mass immunization campaign with meningococcal C polysaccharide vaccine.

The objective of this study was to define the epidemiological pattern of meningococcal disease in the autonomous region of Valencia, Spain, and the impact of a mass immunization campaign against serogroup C meningococcus. Data were obtained from a prospective surveillance program for invasive bacterial diseases in children < 15 y of age that began in the Valencia region on 1 December, 1995. During the period 1996-98, 213 cases of meningococcal disease were detected, representing an annual incidence of 11.3/100,000 children < 15 y. Serogroup C accounted for 31% and 38.5% of cases in 1996 and 1997, respectively (annual incidences of 2.9 and 5.4 cases/100,000 children < 15 y). An immunization campaign with the meningococcal C polysaccharide vaccine, which included all persons between 18 months and 19 y of age, began in late 1997 (vaccination coverage of 86%). In 1998, the annual incidence of meningococcal C disease fell to 1.4 cases per 100,000 children < 15 y of age. These results mirror the increase in the reported incidence of serogroup C meningococcal disease in Spain in the 1990s, a trend that was reversed after the introduction of the mass vaccination campaign. Meningococcal polysaccharide vaccine seems to be an effective public health tool for the management of this serious communicable disease.

Adolescent↗
PubMed2001

Qualitative plasma PCR assay (AMPLICOR CMV test) versus pp65 antigenemia assay for monitoring cytomegalovirus viremia and guiding preemptive ganciclovir therapy in allogeneic stem cell transplantation.

The performances of a commercially available qualitative plasma PCR assay (AMPLICOR CMV test; Roche Diagnostics) and the pp65 antigenemia assay (AG) were evaluated for the monitoring of cytomegalovirus (CMV) viremia in 43 allogeneic stem cell transplant recipients. In addition, the suitabilities of both assays for triggering the initiation of preemptive ganciclovir therapy were assessed. A total of 37 CMV viremic episodes were detected in 28 patients. Positivity of plasma PCR testing in one or more consecutive specimens was the only marker of CMV viremia in 18 of the 37 episodes (PCR positive and AG negative, n = 50 specimens). Five episodes were diagnosed on the basis of a single positive AG result (AG positive and PCR negative, n = 5 specimens); both assays were eventually positive (PCR positive and AG positive, n = 27 specimens) for 14 viremic episodes; for these episodes, conversion of the PCR assay result to a positive result occurred an average of 1 week before conversion of the AG result. Overall, the concordance between the two methods was 90%, and the sensitivities of the plasma PCR assay and AG for the detection of CMV viremic episodes were 86.5 and 51.3%, respectively. Two patients who tested positive by both assays simultaneously progressed to CMV end-stage organ disease, despite the initiation of preemptive ganciclovir therapy. Conversion of the AG result to a negative result upon administration of preemptive ganciclovir therapy occurred a median of 7.5 days earlier than conversion of the plasma PCR assay result. Nineteen of the 28 patients with CMV viremia received AG-guided preemptive ganciclovir therapy; had the positivity of the plasma PCR assay triggered the initiation of preemptive therapy, 9 additional patients would have been unnecessarily treated since none of them developed CMV end-stage organ disease. Although the AMPLICOR CMV assay is more sensitive than AG, the latter appears to be more suitable both for guiding the initiation of preemptive therapy and for monitoring a patient's response to antiviral therapy.

Antiviral Agents↗
PubMed2001

Lack of association between the kinetics of human cytomegalovirus (HCMV) glycoprotein B (gB)-specific and neutralizing serum antibodies and development or recovery from HCMV active infection in patients undergoing allogeneic stem cell transplant.

The kinetics of the gB-specific and neutralizing antibody responses to human cytomegalovirus (HCMV) were analyzed in 26 allogeneic stem-cell transplant recipients who either did (n = 20) or did not (n = 6) develop asymptomatic HCMV active infection during the study period. Antibody response profiles varied widely among individuals in both groups, irrespective of whether HCMV active infection did or did not occur. Development of HCMV active infection was not preceded by a decline in functional serum antibody levels. Neither the absence nor the presence of HCMV active infection correlated with either high or low serum levels of gB-specific and neutralizing antibodies, respectively. In most patients, episodes of HCMV replication were not followed by a marked increment in functional serum antibody titers. Therefore, resolution of an ongoing HCMV active infection was not associated with a vigorous antibody response to viral replication. In addition, this study supports previous data indicating that passive transfer of human immunoglobulins may result in an increment in gB-specific and neutralizing serum antibody levels, the magnitude of which varies among recipients; however, both patients with and without measurable increments in serum antibody levels developed HCMV active infections with comparable frequency.

Adult↗
PubMed2000

[Costs of a low payment maintenance treatment with methadone].

BACKGROUND: Little is known about the cost of methadone maintenance treatments in opioid-dependent individuals. PATIENTS AND METHODS: Calculation of cost was achieved by applying an activity-based costing and management method from Conselleria de Sanitat of Catalonia, Spain (1997). RESULTS: The cost of each methadone dose was 76 ptas. First medical visits cost 4,517 ptas. Urine tests cost 760 ptas. Transportation amounted to 18,895 ptas. CONCLUSION: Such a costing method is applicable and reveals the low cost of this methadone maintenance treatment in opioid-dependent subjects.

Costs and Cost Analysis↗
PubMed2000

[Urinary infection caused by non typhi Salmonella].

BACKGROUND: The aim of this study was to know the frequency and the clinical characteristics of urinary infection by non typhi Salmonella in our area in Spain. PATIENTS AND METHODS: The clinical histories of patients with urinary infection by non typhi Salmonella diagnosed in the Hospital General del Guadalajara from January 1990 to July 1999 were reviewed. RESULTS: During the period studied nine patients with urinary infection by non typhi Salmonella were diagnosed, representing 0.056% of the urinary infection diagnosed in our hospital over the same period. All the patients presented underlying disease and five were undergoing immunosuppressor treatment. Four patients presented urological disease. The most frequent serogroup was Salmonella enteritidis (7 cases). All the episodes were symptomatic. The same microorganism was isolated in stools in four patients. The evolution was favorable in five of the nine cases. Recurrence was observed in two patients and secondary bacteremia in one. Six patients required antibiotic treatment over two or more weeks. The mean length of treatment was of 2.5 weeks. CONCLUSIONS: Urinary infection by non typhi Salmonella is predominantly observed in patients undergoing immunosuppression or with urological disease. Prolonged antibiotic treatment is recommended due to its bad evolution.

Adolescent↗
PubMed1999

[Haemophilus influenza type b invasive disease in the Community of Valencia. Study Group on Invasive Diseases].

The objective of this study was to estimate the incidence of systemic Haemophilus influenzae type b (Hib) disease in the Valencian Community, Spain, and to study the microbiological characteristics of the strains. Prospective, active surveillance of children in the Valencian Community. Data were obtained from microbiology laboratories and paediatricians. A case was considered when a child younger than 15 years of age had clinical invasive disease and a Haemophilus influenzae (Hi) was isolated from a normally sterile site, or when a positive capsular antigen was identified with a compatible Gram strain. In the first year of surveillance, starting on December 1, 24 cases were identified. Of the 20 strains studied in our laboratory, 19 were serotype b and one non typable. 75% of the strains were beta-lactamase positive. Meningitis was the most frequent clinical presentation. All children were less than five, and 51.2% were less than one year of age. The mortality was 8.3%. For unvaccinated children less than 5 years the estimated incidence of invasive disease was 18.2/100,000 and of meningitis 14.0/100,000. The incidence of Hib invasive disease in unvaccinated children justifies the universal Hib vaccine programme in the Valencian Community.

Adolescent↗