BACKGROUND:In early 2018, we detected an increase in surgical site infections (SSI) after total knee arthroplasty in a tertiary hospital in Barcelona. We implemented an infection prevention and control (IPC) intervention reinforcing preventive bundles and reorganizing surgical schedules for high-risk patients and senior surgeons. We aimed to identify SSI-associated factors and evaluate the IPC intervention's impact. METHODS:We conducted a retrospective cohort study in 2018 with 90-day follow-up. SSI rates were compared pre- and post-intervention. Preintervention risk factors were assessed using Cox models. Differences in associated factor distributions were estimated. Kaplan-Meier and log-rank tests evaluated incidence, and a sensitivity analysis was stratified by American Society of Anesthesiologists (ASA) and National Nosocomial Infection Surveillance (NNIS) risk. RESULTS:Among 463 patients, overall SSI incidence was 0.52 per 1,000 patient-days. Incidence significantly declined postintervention (pre: 0.75; post: 0.26; P = .030). Obesity (HR: 3.63; 95% CI: 1.02-12.86) and afternoon surgery (HR: 3.02; 95% CI: 1.02-8.92) were associated. High ASA, NNIS risk, and inadequate prophylaxis significantly decreased (P < .001). The intervention reduced SSI risk by 66% (HR: 0.34; 95% CI: 0.13-0.94; P = .037). A nonsignificant reduction was seen in high-risk strata. CONCLUSIONS:Our study showed the impact of an IPC intervention addressing associated factors and significantly reducing SSI incidence rates.

Background Manual surveillance of surgical site infections (SSIs) after colorectal surgery is resource-intensive, limiting scalability. Semiautomated algorithms based on structured electronic health record (EHR) data may maintain high case-finding sensitivity while reducing workload. Methods A retrospective diagnostic-accuracy study was conducted in a teaching hospital participating in a nationwide SSI surveillance programme. All elective colorectal procedures performed between January 2010 and December 2023 were included. SSIs were classified according to CDC-NHSN/ECDC criteria. Eight binary EHR-derived “alerts” were combined into a composite rule (any alert positive). Manual surveillance served as the reference standard. Performance was assessed overall, by SSI depth (superficial, deep, organ/space), and by procedure type (colon vs rectal). Discrimination (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with 95% confidence intervals (CIs). Results A total of 1,213 patients (1,085 colon; 128 rectal) were included. The overall SSI incidence was 11.2% (3.1% superficial, 1.2% deep, 6.8% organ/space). The composite alert achieved an AUC of 0.859 (95% CI 0.838–0.878) for any SSI, with sensitivity 0.721, specificity 0.876, PPV 0.424, and NPV 0.961. At this operating point, 19% of procedures would be flagged for manual verification, corresponding to an estimated 81% reduction in full chart reviews. Discrimination was highest for organ/space infections (AUC 0.919; sensitivity 0.831; specificity 0.911). Performance for deep SSI was intermediate (AUC 0.805), and for superficial SSI, more limited (AUC 0.571). Sensitivity was higher for colon surgery (AUC 0.853) and specificity higher for rectal surgery (AUC 0.881). Conclusions The structured-data algorithm demonstrated strong overall discrimination and excellent performance for organ/space infections, supporting the feasibility of semiautomated surveillance without compromising detection quality. External and prospective validation, definition of diagnostic safety thresholds, and workload-reduction analyses are required to optimise implementation. Exploration of NLP add-ons may be considered where resources permit. ClinicalTrials.gov: NCT07130656.

BACKGROUND:The VINCat programme focuses on monitoring surgical site infections (SSI) in caesarean sections (CS) performed across affiliated hospitals. METHODS:The study included CS performed from 2008 to 2022, with a follow-up of 30 days after the intervention. The analysis of cumulative incidence rate of SSI was stratified into three 5-year periods (Periods 1-3). SSI was defined according to the National Healthcare Safety Network (NHSN) classification. SSI surveillance was carried out in accordance with the methodology established by the VINCat programme. RESULTS:From 2008 to 2022, 36,387 CS were surveyed at 34 hospitals: 13,502 in Period 1, 12,985 in Period 2 and 9900 in Period 3. The mean age was 33 years. Overall, SSI incidence fell from 3.81% in Period 1 to 2.66% in Period 3 (rho=-0.838; p<0.001). Superficial SSI decreased from 3.1% in Period 1 to 2.15% in Period 3 (rho=-0.795; p<0.001). The rate of organ-space SSI remained consistent across all three periods, maintaining a rate of 0.27 (rho=-0.092; p=0.745). Culture was performed in 58.9% of infections. The microorganisms most frequently identified were Staphylococcus aureus (20.64%), Coagulase-negative staphylococci (CoNS) (13.52%), and Escherichia coli (11.27%). Antibiotic prophylaxis was appropriate in 73.76% of the procedures. CONCLUSIONS:Appropriate monitoring of post-CS SSI rates allows the implementation of preventive measures to reduce their incidence.

BACKGROUND:Catheter-related bacteremia (CRB) is one of the most frequent infections acquired during hospitalization. We summarize the results of CRB surveillance conducted by the Catalan Program of Surveillance of Nosocomial Infections (VINCat) over the past fifteen years. METHODS:All episodes of hospital-acquired CRB diagnosed in the 55 Catalan hospitals participating in the VINCat program (2008-2023) were recorded. Annual incidence rates per 1000 patient-days were calculated. Analyses were stratified into three relevant five-year periods: 2008-2012, 2013-2017, and 2018-2022. Incidence rate ratios (IRRs) were used to compare infection rates. RESULTS:During the study period, 10,212 episodes of nosocomial CRB were diagnosed. The global incidence rate was 0.21 episodes per 1000 patient-days (intensive care units (ICUs): 1.13; medical wards: 0.16; surgical wards: 0.15). Gram-positive bacteria caused 68.3% of the episodes. The incidence rate of CRB acquired in ICUs and that of CRB associated with central venous catheters decreased during the study period, while episodes associated with peripheral venous catheters (PVCs) and peripherally-inserted central venous catheters (PICVCs) significantly increased (p<0.001). CONCLUSIONS:The current study underscores the necessity for interventional programs targeting PVCs, particularly in non-ICU wards.

INTRODUCTION:Antimicrobial stewardship programs (ASPs) monitor antimicrobial consumption and implement interventions in order to improve their use. Here, we analyze the trends in antimicrobial consumption at hospitals participating in the VINCat Program over a 15-year period in Catalonia, Spain. METHODS:We conducted a time-series analysis of systemic antimicrobial consumption in both adult and pediatric populations across 72 acute care centers. The annual measurement of systemic antibiotic and antifungal use was conducted using defined daily dose (DDD) in adults and days of therapy (DOT) in children. To analyze trends in antimicrobial use, we considered the annual consumption defined in DDD or DOT per 100 patient-days. RESULTS:Overall adult consumption (2008-2022) of antimicrobials, antibiotics, and antifungals averaged 73.54, 70.08, and 3.46 DDD/100 patient-days respectively. There was a significant increase in overall antimicrobial (rho=0.554; p=0.035) and also in antifungal (rho=0.657; p=0.01) consumption during the study period. Antibiotic consumption showed an upward trend in the first period followed by an unchanged consumption in the following years (rho=0.482; p=0.071). Penicillins were the most frequently used (33.5%), followed by cephalosporins (18.2%), quinolones (13.9%), and other systemic antibacterials (10.8%) and antifungals (4.7%). Pediatric consumption was analyzed between 2020 and 2022. Overall, antimicrobial, antibiotic, and antifungal use in this population averaged 60.04, 53.47, and 6.57DOT/100 patient-days respectively. As in adults, in children penicillins were the most used family (34.3%); within this group, penicillin combinations with beta-lactamase inhibitors (21.1%) were the most used, followed by cephalosporins (19.3%). CONCLUSIONS:Participation on the VINCat Program was high at both adult and pediatric hospitals. Fifteen-year trends showed a significant increase in overall antimicrobial consumption in adults.

AIM:Hand hygiene is regarded as the cornerstone for preventing healthcare-associated infections. This study assesses trends in alcohol-based hand rub (ABHR) consumption for hand hygiene and availability of dispensers at the point of care (POC) in acute care hospitals in Catalonia, as part of the VINCat program. METHODS:Data were collected from 2014 to 2022 in 69 hospitals, categorized by size and type, including large, medium, small, and specialized facilities. ABHR consumption was measured in liters per 1000 patient-days, with data segmented into intensive care units (ICUs) and non-ICU wards. Hospital infection control personnel determined the availability of ABHR solutions at the POC through yearly point prevalence surveys. RESULTS:The study found a significant increase in ABHR consumption over time, with usage rising from 22.8L/1000 patient-days in the 2014-2017 period to 39.9L in 2018-2022, representing a 75% increase. The most significant growth was observed in ICUs, where ABHR use nearly doubled. ABHR consumption also spiked during the COVID-19 pandemic in 2020, with large hospitals showing the highest levels of usage. Additionally, the availability of ABHR dispensers at the POC increased, particularly in non-ICU wards and small hospitals. CONCLUSIONS:The findings underscore the role of sustained hand hygiene efforts, including increased ABHR availability at the POC, as essential components of infection prevention. These efforts are especially crucial in high-risk units such as ICUs and in smaller hospitals, where resources and compliance may be limited.

INTRODUCTION:Colorectal surgery has the highest surgical site infection (SSI) rates of all abdominal surgeries. Epidemiological surveillance is an excellent instrument to reduce SSI rates, but its effects may be time-limited and need to be monitored periodically. This study analyses the effectiveness of an interventional surveillance programme with regard to reducing SSI rates after elective colorectal surgery. METHODS:Cohort study analysing a SSI surveillance programme in elective colorectal surgery over a 15-year period. Prospectively collected data were stratified by 5-year periods (Periods 1, 2 and 3), and SSI rates, length of stay, readmission, mortality and microbiological aetiology were investigated. RESULTS:A total of 64,074 operations were included (42,665 colon surgery and 21,409 rectal surgery). Overall SSI incidence in colon surgery fell from 19.6% in Period 1 to 7.6% in Period 3 (rho=-0.961). Organ-space SSI (O/S-SSI) was 8.3% in Period 1 and 4.7% in Period 3 (rho=-0.815). In rectal surgery, overall SSI fell from 20.6% to 12.8% (rho=-0.839), and O/S-SSI from 8.5% to 8.3%, the latter difference being non-significant. The intervention that achieved the greatest SSI reduction was a preventive bundle comprising six measures. Hospital stay and mortality rates decreased, while SSIs after discharge and readmissions increased. An increase in Gram-positive cocci and fungi, and reductions in Gram-negative bacteria and anaerobes were detected for both incisional and O/S-SSI. CONCLUSIONS:Detailed analysis of SSI rates allows the design of strategies for reducing their incidence. An interventional surveillance programme was effective in decreasing SSI rates in colorectal surgery.

INTRODUCTION:From 2013 to 2022, annual point-prevalence studies (PPS) of healthcare-associated infections (HAIs) were conducted in 97 long-term care facilities (LTCF) within the VINCat Program in Catalonia, Spain. The objective was to analyze trends in HAIs and antibiotic use to evaluate the burden of HAIs in this setting. METHODS:We compare PPS data from two 5-year periods. Period 1 (2013-2017) involving 50,378 residents and period 2 (2018-2022) involving 65,997 residents. Variables included demographic characteristics, patient conditions, medical devices on the day of PPS and recent surgery. Source of HAI, causative microorganisms, antibiotics and indication were recorded. HAIs were defined according to ECDC criteria. RESULTS:A total of 116,375 residents were included, median age of 82 years (range: 73-88), 56.7% female. Although severe dependency was more common in period 1, the presence of vascular and urinary catheters increased in period 2. Overall, 9943 (8.5%) residents had one or more HAIs. The HAI prevalence rate significantly decreased from 9.3% in period 1 to 8% in period 2, being urinary tract infections the most prevalent HAI in both periods, followed by respiratory tract infections. Escherichia coli was the most frequently identified microorganism. No significant differences in the prevalence of antibiotic use between periods (11.8 vs 12.1 respectively) were found, although there was a shift toward more targeted prescriptions. CONCLUSION:Despite a significant reduction over the study period, the prevalence of HAIs remains high in LTCFs of Catalonia, affecting 8% of residents. Implementation of infection prevention and control interventions are highly required.

INTRODUCTION:Central line-associated bloodstream infections (CLABSI) are among the most common and preventable hospital-acquired infections in pediatric and neonatal intensive care units (PICU-NICU). CLABSI is a common etiology of late-onset sepsis and is associated with high morbidity and mortality. The aim of this study was to describe the incidence of CLABSI in PICUs and NICUs in our geographical setting. METHODS:Descriptive study conducted as part of the VINCat program, investigating the incidence of CLABSI in NICUs and PICUs at acute care hospitals in Catalonia from 2013 to 2022. The annual CLABSI incidence rate was calculated by multiplying the total detected cases in a year by 1000 and dividing by the total patient-days with central venous catheter (CVC). RESULTS:NICU: The overall incidence rate was 5.59 per 1000 patient-days. Peripherally inserted CVC was involved in 59.8% of catheter-related infection, and an overall median duration of 7 days from catheter insertion to the onset of infection. PICU: The overall incidence rate was 3.62 per 1000 patient-days. Jugular venous access (44.1%) was the most common location of infections, with a median of 12 days to CLABSI. Gram-positive bacteria, especially coagulase-negative Staphylococci, were the most prevalent in both units. CONCLUSIONS:A standardized surveillance system based on the calculation of the incidence rate of CLABSI in PICUs and NICUs can broaden our understanding of this HAI and will guide the implementation of measures of infection control and prevention.

AimOral antibiotic prophylaxis (OAP) lowers rates of surgical site infection (SSI) and may aid anastomotic healing in colorectal surgery. The aim of this study was to analyse the understudied impact of OAP on SSI microbiology after colorectal surgery.MethodA post hoc analysis was performed on a previous prospective, multicentre study of elective colorectal surgery. For 1000 patients with SSI, this study compared the microbiology of SSIs in procedures without OAP (SSI/OAP-) and with OAP (SSI/OAP+).ResultsThere were 340 patients in the SSI/OAP- group and 660 in the SSI/OAP+ group. The use of OAP increased the presence of Gram-positive cocci (GPC) (OR 1.542, 95% CI 1.153-2.062) and fungi (OR 2.037, 95% CI 1.206-3.440), but reduced rates of Gram-negative bacteria (GNB) (OR 1.461, 95% CI 1.022-2.088) and anaerobe isolation (OR 0.331, 95% CI 0.158-0.696). Specifically, it led to increases in the isolation of Enterococcus faecium (OR 1.450, 95% CI 0.812-2.591), methicillin-resistant Staphylococcus aureus (OR 2.000, 95% CI 1.043-3.834) and Candida spp. (OR 2.037, 95% CI 1.206-3.440). In colon surgery with OAP, GPC infections were more likely (OR 1.461, 95% CI 1.022-2.088). In rectal surgery, organ/space SSIs had a higher risk of harbouring GPC (OR 1.860, 95% CI 1.153-2.999) and a lower risk of GNB (OR 0.321, 95% CI 0.200-0.515).ConclusionOAP reduced the presence of anaerobes and GNB in SSIs, but increased the isolation of GPCs and fungi, with E. faecium and Candida being of particular concern. This information should guide empirical antibiotic therapy for postoperative colorectal SSIs in patients who have received preoperative OAP.

INTRODUCTION:This study aimed to describe the epidemiological trends of methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae, carbapenem-resistant Enterobacteriaceae (CRE), and Clostridioides difficile in Catalonia, Spain. METHODS:We analyzed data from hospitals participating in the VINCat Program from 2008 to 2022. The study analyzed antimicrobial susceptibility data from isolates collected in acute care hospital settings. Key metrics: annual MRSA rate, incidence density of new MRSA cases, MRSA bacteremia, and hospital-acquired MRSA cases. We assessed the rate of ESBL-producing K. pneumoniae and carbapenemase-resistant (CR)-K. pneumoniae, CR-Enterobacter cloacae, and CR-Escherichia coli. For C. difficile infections (CDI), the incidence density was determined. RESULTS:While MRSA rate slightly decreased over the study period, the incidence of MRSA bacteremia increased. Global hospital-acquired MRSA incidence decreased but increased in small hospitals. Among patients with bacteremia, the rate of ESBL-producing K. pneumoniae remained stable; in contrast, the rate of CR-K. pneumoniae rose in large centers as well as did the rates of CR-E. cloacae and CR-E. coli. CDI incidence rose substantially over the study period. CONCLUSION:VINCat's hospital surveillance system has provided valuable insights into the evolving incidence of key multidrug-resistant organisms and CDI. These findings highlight the need for targeted interventions, particularly for MRSA in smaller hospitals and for CR-Enterobacteriaceae and CDI across all hospital sizes.

Background This study presents comprehensive data on antimicrobial susceptibility across healthcare settings and age groups in Catalonia, Spain. Methods Susceptibility data were collected from 37 microbiology laboratories between 2020 and 2022 for community-acquired infections (CAIs), and 2021 and 2022 for hospital and long-term care facilities (LTCFs). Susceptibility was calculated based on the proportion of susceptible strains among the total strains. Results Pediatrics: Community-acquired infections (CAIs): in urinary tract infections (UTIs), extended-spectrum beta-lactamase production (ESBL-P) Escherichia coli was 3.8%. Streptococcus pneumoniae was highly susceptible to penicillins (97.5%). Community-acquired methicillin-resistant Staphylococcus aureus was 6.8%. Hospital-acquired infections (HAIs): ESBL-P in E. coli and Klebsiella pneumoniae were 6.7% and 9.4%. Carbapenem resistance in Enterobacter cloacae complex was less than 1%. Extremely drug-resistant Pseudomonas aeruginosa was 1.6%. Adults CAIs: In UTIs, E. coli showed high susceptibility to fosfomycin (>95%) and 9% of ESBL-P. In respiratory tract infections, Streptococcus pyogenes exhibited reduced susceptibility to macrolides (67%) and clindamycin (75.1%), while Haemophilus influenzae and S. pneumoniae remained susceptible to penicillins (78% and 96%). HAIs: E. coli showed 12.8% of ESBL-P and K. pneumoniae 20%. Carbapenem resistance was mainly identified in E. cloacae (2.8%) and K. pneumoniae (2.2%). P. aeruginosa showed high susceptibility to meropenem (87%). Methicillin-resistance was detected in 22% of S. aureus.Long-term care facilities (LTCFs): E. coli causing UTI was highly susceptible to carbapenems (99%), nitrofurantoin (96%), and fosfomycin (93%) with 25.8% of ESBL-P. K. pneumoniae showed 40% ESBL-P and 2.9% of carbapenem resistance. P. aeruginosa exhibited decreased susceptibility to quinolones (69.5%) and highly susceptibility to meropenem (88.5%). Conclusion The data underscore the necessity of stratified susceptibility reports by setting, type of infection, and age.

Background Anastomotic leak and subsequent organ/space surgical site infection (O/S-SSI) after colorectal cancer surgery are associated with poor short-term outcomes; however, the evidence regarding long-term outcomes is inconclusive. This population-based retrospective cohort study aimed to evaluate the association between O/S-SSI and both tumour recurrence and long-term survival after curative rectal cancer surgery. Methods Data was obtained for all adults who underwent curative oncological resection of the rectum in the periods 2011-2012 and 2015-2016 (n = 2208) in Spain. Multivariable analysis (Cox proportional hazards model) was used to evaluate the effects of clinical and pathological characteristics, as well as the occurrence of O/S-SSI, on recurrence and survival. Results In all, 2208 adults underwent curative rectal cancer resection, 1464 of whom were male (66.3%); the median patient age was 69.1 years. O/S-SSI occurred in 291 patients (13%). Independent predictors of recurrence included tumour stage III (hazard ratio (HR) 1.95, 95% confidence interval (c.i.) 1.06 to 3.58; P = 0.032), a positive resection margin (HR 4.03, 95% c.i. 2.58 to 6.29; P < 0.001), and poor quality mesorectal excision (HR 1.81, 95% c.i. 1.11 to 2.95; P = 0.018), but not O/S-SSI (HR 1.02, 95% c.i. 0.78 to 1.34; P = 0.888). However, O/S-SSI was independently associated with reduced overall survival at 1 year (HR 2.20, 95% c.i. 1.39 to 3.48; P < 0.001), 2 years (HR 1.75, 95% c.i. 1.25 to 2.43; P < 0.001), and 5 years (HR 1.33, 95% c.i. 1.05 to 1.68; P = 0.017). Conclusion In this study, O/S-SSI had a negative impact on the long-term survival of patients who underwent rectal cancer surgery, but was not associated with increased tumour recurrence.

INTRODUCTION:Surveillance is an essential part of the control of device-related nosocomial infections (NI) in intensive care units (UCIs). The aim of this study was to analyze the evolution of device-related infection rates in ICUs over the last 13 years, including ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI). MATERIAL AND METHODS:Patients admitted to the 44 ICUs at 43 participating hospitals of the VINCat Program from 2010 to 2022 were included, taking into account three periods: first period (2010-2013), second period (2014-2017) and third period (2018-2022). Hospitals were classified into three groups according to their size: small (<200 beds), medium (200-500 beds) and large (>500 beds). Complexity was assessed based on the use of invasive mechanical ventilation. The incidence rate of VAP, CRBSI and CAUTI was recorded at least during three consecutive months/year in each unit by an intensivist with extensive experience. RESULTS:The device utilization ratio (DUR) of mechanical ventilation was 0.39, varying between 0.38 in large hospitals and 0.42 in small hospitals. The DUR of central venous catheter was 0.6, ranging from 0.59 (large hospitals) to 0.64 (small). The DUR of urinary catheter was 0.66, with a range of 0.65 (large hospitals) to 0.68 (small). The complexity of the different ICUs influenced the DUR of the different devices and the infections associated with them. The average rates of VAP, CRBSI, and CAUTI were 6.4, 1.9, and 3.4 episodes per 1000 device days respectively. CONCLUSIONS:Surveillance systems provide information on intra-ICU infections. ICU complexity, measured in terms of the use of mechanical ventilation, influences device-associated infections.

Introduction Healthcare-associated urinary tract infections (HCA-UTIs) account for an important number of infections in acute care hospitals (ACH) and long-term care facilities (LTCF). Our objective was to evaluate the prevalence of HCA-UTIs in Catalonia. Methods Descriptive observational study in which we analyzed the prevalence of HCA-UTIs, including catheter-associated UTIs (CAUTIs) and non-CAUTIs, from point prevalence surveys conducted in 55 ACH (44,734 patients) and 97 LTCF (116,882 residents) between 2013 and 2022 as part of the VINCat program. Prevalence time trends were also assessed by using a Spearman correlation. Results In ACH, the overall prevalence of HCA-UTI was 1.6%. The prevalence of CAUTI was 3.9%, while the prevalence of non-CAUTI was 1%, with no significant changes over time. CAUTIs were more prevalent in large size and specialty hospitals. Among the 695 HCA-UTIs, 325 (46.8%) were CAUTIs and 370 (53.2%) non-CAUTIs. The overall prevalence of HCA-UTI in LTCF was 3.6%. The prevalence of CAUTI and non-CAUTI was 11% and 2.8%, respectively, with no significant changes over time. Among the 4190 HCA-UTIs, 1200 (28.6%) were CAUTIs and 2990 (71.4%) non-CAUTIs. Conclusion Most HCA-UTIs, in ACH and LTCF, were non-CAUTIs although patients with a urinary catheter had a higher risk of HCA-UTIs. HCA-UTIs surveillance programs are essential for identifying at risk patients and developing preventive strategies.

INTRODUCTION:Point prevalence surveys (PPS) offer valuable insights into the burden of healthcare-associated infections (HAIs) and antibiotic utilization. Our objective was to analyze trends of HAIs, medical device use, and antibiotic administration among hospitalized adult patients from 2008 to 2022, drawing on data from the VINCat Program in Catalonia, Spain. METHODS:The study compares aggregated data from PPS carried out over three 5-year periods (2008-2012, 2013-2017, and 2018-2022) gathered in a one-day survey carried out in May of each calendar year. Trained infection control personnel collected demographic and clinical data and information on device use and antibiotic administration. Criteria from the ECDC were used to define active HAI. RESULTS:Surveys were conducted at 56 acute care hospitals and included 59,454 patients: 14,914 (period 1), 19,916 (period 2) and 24,624 (period 3). Overall, 3986 patients (6.7%, 95% confidence interval: 6.5-6.9) had one or more HAIs. The trend of HAIs showed a U-shape, falling overall since 2008 but rising during the COVID-19 pandemic. Although there was a significant increase in the use of invasive devices, surgical site infections (SSI) were the most frequently reported HAIs across the three periods. The prevalence of antimicrobial therapy exhibited a significant rise from 33.3% of patients during period 1 to 39.2% in period 3. CONCLUSION:Although there was an overall downward trend in HAIs during the study period, there was also a significant increase in antibiotic consumption. The data showed that SSI was the most prevalent HAI. This information was used to reinforce prevention activities.

Background: There is controversy regarding the maximum number of elements that can be included in a surgical site infection prevention bundle. In addition, it is unclear whether a bundle of this type can be implemented at a multicentre level. Methods: A pragmatic, multicentre cohort study was designed to analyse surgical site infection rates in elective colorectal surgery after the sequential implementation of two preventive bundle protocols. Secondary outcomes were to determine compliance with individual measures and to establish their effectiveness, duration of stay, microbiology and 30-day mortality rate. Results: A total of 32 205 patients were included. A 50% reduction in surgical site infection was achieved after the implementation of two sequential sets of bundles: from 18.16% in the Baseline group to 10.03% with Bundle-1 and 8.19% with Bundle-2. Bundle-2 reduced superficial-surgical site infection (OR 0.74 (95% c.i. 0.58 to 0.95); P = 0.018) and deep-surgical site infection (OR 0.66 (95% c.i. 0.46 to 0.93); P = 0.018) but not organ/space-surgical site infection (OR 0.88 (95% c.i. 0.74 to 1.06); P = 0.172). Compliance increased after the addition of four measures to Bundle-2. In the multivariable analysis, for organ/space-surgical site infection, laparoscopy, oral antibiotic prophylaxis and mechanical bowel preparation were protective factors in colonic procedures, while no protective factors were found in rectal surgery. Duration of stay fell significantly over time, from 7 in the Baseline group to 6 and 5 days for Bundle-1 and Bundle-2 respectively (P < 0.001). The mortality rate fell from 1.4% in the Baseline group to 0.59% and 0.6% for Bundle-1 and Bundle-2 respectively (P < 0.001). There was an increase in Gram-positive bacteria and yeast isolation, and reduction in Gram-negative bacteria and anaerobes in organ/space-surgical site infection. Conclusions: The addition of measures to create a final 10-measure protocol had a cumulative protective effect on reducing surgical site infection. However, organ/space-surgical site infection did not benefit from the addition. No protective measures were found for organ/space-surgical site infection in rectal surgery. Compliance with preventive measures increased from Bundle-1 to Bundle-2.

BackgroundAntimicrobial stewardship (AMS) programs have been differently implemented across Europe. This study primarily aimed to compare AMS in two European regions. Secondarily, the study explored the COVID-19 pandemic impact on surrogate outcome indicators of AMS.MethodsA retrospective observational study was conducted in Piedmont (Italy) and Catalonia (Spain). AMS programs were compared through structure and process indicators in 2021. Changes in surrogate outcome indicators (antimicrobial usage; alcohol-based sanitizer consumption; antimicrobial resistance, AMR) from 2017 to 2021 described the pandemic impact.ResultsSeventy-eight facilities provided structure and process indicators. Catalonia showed better structure scores (p<0.001) and less dispersion in both indicators. The greatest areas to improve were accountability (Piedmont) and diversification of strategies (Catalonia). Overall, the regions reported consistent changes in outcome indicators. Antimicrobial usage decreased in 2020, returning to near-pre-pandemic levels in 2021. Alcohol-based sanitizer consumption surged in 2020, then dipped remaining above pre-pandemic levels. AMR trends were minimally affected.ConclusionsThe centralized approach of Catalonia ensured consistent attainment of quality objectives across all facilities, but it may limit facility-specific strategies. In Piedmont, accountability remain one of the most critical factors as in previous years. The pandemic did not substantially disrupt surrogate outcome measures of AMS. However, the data on AMR suggest that maintaining vigilance against this issue remains paramount.

Abstract Background The Catalan Cancer Plan (CCP) undertakes periodic audits of cancer treatment outcomes, including organ/space surgical site infections (O/S-SSI) rates, while the Catalan Healthcare-associated Infections Surveillance Programme (VINCat) carries out standardized prospective surveillance of surgical site infections (SSI) in colorectal surgery. This cohort study aimed to assess the concordance between these two monitoring systems for O/S-SSI following primary rectal cancer surgery. Methods The study compared O/S-SSI incidence data from CCP clinical audits versus the VINCat Programme in patients undergoing surgery for primary rectal cancer, in 2011-12 and 2015-16, in publicly funded centres in Spain. The main outcome variable was the incidence of O/S-SSI in the first 30 days after surgery. Concordance between the two registers was analysed using Cohen’s kappa. Discordant cases were reviewed by an expert, and the main reasons for discrepancies evaluated. Results Pooling data from both databases generated a sample of 2867 patients. Of these, O/S-SSI was detected in 414 patients—235 were common to both registry systems, with satisfactory concordance (κ = 0.69, 95% confidence interval 0.65–0.73). The rate of discordance from the CCP (positive cases in VINCat and negative in CCP) was 2.7%, and from VINCat (positive in CCP and negative in VINCat) was 3.6%. External review confirmed O/S-SSI in 66.2% of the cases in the CCP registry and 52.9% in VINCat. Conclusions This type of synergy shows the potential of pooling data from two different information sources with a satisfactory level of agreement as a means to improving O/S-SSI detection. ClinicalTrials.gov Identifier: NCT06104579. Registered 30 November 2023.