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Answer to the article: “Serratia marcescens bacteraemia outbreak in hemodialysis”. Comment on “Serratia marcescens bacteraemia outbreak in haemodialysis patients with tunnelled catheters due to colonisation of antiseptic solution. Experience at 4 hospitals”
Respuesta al artículo: «Brote de bacteriemia por Serratia marcescens en hemodiálisis». Comentarios al artículo: «Brote de bacteriemia por Serratia marcescens en pacientes portadores de catéteres tunelizados en hemodiálisis secundario a colonización de la solución antiséptica. Experiencia en 4 centros»
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Comment on “<span class="elsevierStyleItalic">Serratia marcescens</span> bacteraemia outbreak in haemodialysis patients with tunnelled catheters due to colonisation of antiseptic solution. Experience at 4 hospitals”" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "103" "paginaFinal" => "104" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jose L. Merino, Hanane Bouarich, M. José Pita, Vicente Paraíso" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Jose L." "apellidos" => "Merino" "email" => array:1 [ 0 => "jluis.merino@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Hanane" "apellidos" => "Bouarich" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M. José" "apellidos" => "Pita" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Vicente" "apellidos" => "Paraíso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Nefrología, Hospital Universitario del Henares, Coslada, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Medicina Preventiva, Hospital Universitario del Henares, Coslada, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta al artículo: «Brote de bacteriemia por <span class="elsevierStyleItalic">Serratia marcescens</span> en hemodiálisis». Comentarios al artículo: «Brote de bacteriemia por <span class="elsevierStyleItalic">Serratia marcescens</span> en pacientes portadores de catéteres tunelizados en hemodiálisis secundario a colonización de la solución antiséptica. Experiencia en 4 centros»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We appreciate the interest generated by the publication of the event that occurred in our hospitals. Although our article mentions the findings from only 4 sites, we are aware that it was a situation experienced at national level.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Even within the same region of Madrid, other hospitals have also presented their experience.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleItalic">Nefrología</span>, González Sanchidrián et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> describe the progress of their patients, showing outcomes similar to ours. As they rightly explain, the most critical aspect was the rapid detection of the presence of an atypical microorganism as the cause of the complication. This set in motion the safety mechanisms present in all hospitals, with special emphasis on the importance of the involvement of the preventive medicine departments.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This type of microorganism – although described as an agent of epidemic outbreaks – is rare in the colonisation of dialysis catheters.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5,6</span></a> The presence of more than one patient affected in such a short period of time should be considered as potentially high risk, and a common origin must be investigated. All the affected hospitals made reasonable efforts to detect the origin of the microorganism, and the problem was solved once the focus had been confirmed. The presence of the antiseptic (source of infection) in all cases and its verification in the samples sent for examination enabled the correct identification of the focus.</p><p id="par0020" class="elsevierStylePara elsevierViewall">From a practical point of view, most centres started empirical treatment with broad spectrum antibiotic cover, readjusting the final treatment according to the antibiotic susceptibility testing results. In general, the sealing of the catheter was a common procedure to eliminate the possibility of the biofilm acting as a reservoir.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In our experience, the need to catheter removal was minimal, despite a high rate of occurrence. Current guidelines on vascular access establish risk factors that indicate catheter removal, in some patients this decision is critical since it, may be the last vascular access available.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7,8</span></a> With the different treatment regimens adopted in our hospitals, none of the catheters had to be removed, no major complications were observed, and there were no deaths for this reason during follow-up. The rate of catheter removal was greater in other hospitals, probably determined by the severity of symptoms and difficulty in identifying the focus of infection.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally, although it is not the aim of the study, it is important to emphasise the importance of tunnelled catheter as a clearly differentiated risk factor of morbidity and mortality. Although their use may be unavoidable in a significant number of patients, due to different conditions, this should not be an impediment for initiating all possible strategies to minimise their use. Collaboration between radiology, vascular surgery and nephrology departments is crucial so that tunnelled catheters are used only when strictly necessary.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">These atypical situations challenge our safety protocols and measures in our routine clinical practice. Vigilance and re-evaluation of our protocols are key for minimising the consequences of unexpected complications. The initiative to recruit the experience of all the national centres affected would be particularly relevant, and it could help to understand an exceptional, but potentially significant, phenomenon.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Merino JL, Bouarich H, Pita MJ, Paraíso V. Respuesta al artículo: «Brote de bacteriemia por <span class="elsevierStyleItalic">Serratia marcescens</span> en hemodiálisis». Comentarios al artículo: «Brote de bacteriemia por <span class="elsevierStyleItalic">Serratia marcescens</span> en pacientes portadores de catéteres tunelizados en hemodiálisis secundario a colonización de la solución antiséptica. Experiencia en 4 centros». Nefrologia. 2018;38:103–104.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brote de bacteriemias por <span class="elsevierStyleItalic">Serratia marcescens</span> en pacientes portadores de catéteres tunelizados en hemodiálisis secundario a colonización de la solución antiséptica. Experiencia en 4 centros" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Merino" 1 => "H. Bouarich" 2 => "M.J. Pita" 3 => "P. Martínez" 4 => "B. Bueno" 5 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 11 | 17 |
| 2024 October | 53 | 39 | 92 |
| 2024 September | 52 | 31 | 83 |
| 2024 August | 59 | 66 | 125 |
| 2024 July | 50 | 25 | 75 |
| 2024 June | 59 | 38 | 97 |
| 2024 May | 54 | 38 | 92 |
| 2024 April | 51 | 33 | 84 |
| 2024 March | 77 | 19 | 96 |
| 2024 February | 37 | 32 | 69 |
| 2024 January | 25 | 25 | 50 |
| 2023 December | 27 | 23 | 50 |
| 2023 November | 37 | 40 | 77 |
| 2023 October | 34 | 32 | 66 |
| 2023 September | 46 | 26 | 72 |
| 2023 August | 39 | 32 | 71 |
| 2023 July | 48 | 30 | 78 |
| 2023 June | 36 | 24 | 60 |
| 2023 May | 57 | 41 | 98 |
| 2023 April | 30 | 28 | 58 |
| 2023 March | 70 | 22 | 92 |
| 2023 February | 48 | 27 | 75 |
| 2023 January | 42 | 37 | 79 |
| 2022 December | 47 | 34 | 81 |
| 2022 November | 77 | 37 | 114 |
| 2022 October | 55 | 49 | 104 |
| 2022 September | 57 | 35 | 92 |
| 2022 August | 71 | 46 | 117 |
| 2022 July | 31 | 54 | 85 |
| 2022 June | 38 | 41 | 79 |
| 2022 May | 48 | 29 | 77 |
| 2022 April | 37 | 56 | 93 |
| 2022 March | 51 | 66 | 117 |
| 2022 February | 30 | 43 | 73 |
| 2022 January | 32 | 40 | 72 |
| 2021 December | 39 | 38 | 77 |
| 2021 November | 50 | 46 | 96 |
| 2021 October | 48 | 42 | 90 |
| 2021 September | 32 | 40 | 72 |
| 2021 August | 26 | 41 | 67 |
| 2021 July | 44 | 32 | 76 |
| 2021 June | 30 | 26 | 56 |
| 2021 May | 30 | 38 | 68 |
| 2021 April | 87 | 47 | 134 |
| 2021 March | 53 | 42 | 95 |
| 2021 February | 32 | 33 | 65 |
| 2021 January | 31 | 19 | 50 |
| 2020 December | 28 | 20 | 48 |
| 2020 November | 35 | 11 | 46 |
| 2020 October | 30 | 21 | 51 |
| 2020 September | 25 | 23 | 48 |
| 2020 August | 48 | 19 | 67 |
| 2020 July | 40 | 16 | 56 |
| 2020 June | 39 | 26 | 65 |
| 2020 May | 46 | 17 | 63 |
| 2020 April | 35 | 16 | 51 |
| 2020 March | 29 | 20 | 49 |
| 2020 February | 36 | 23 | 59 |
| 2020 January | 57 | 28 | 85 |
| 2019 December | 35 | 20 | 55 |
| 2019 November | 33 | 23 | 56 |
| 2019 October | 29 | 16 | 45 |
| 2019 September | 32 | 15 | 47 |
| 2019 August | 23 | 17 | 40 |
| 2019 July | 34 | 31 | 65 |
| 2019 June | 36 | 18 | 54 |
| 2019 May | 36 | 19 | 55 |
| 2019 April | 64 | 33 | 97 |
| 2019 March | 43 | 22 | 65 |
| 2019 February | 27 | 16 | 43 |
| 2019 January | 27 | 23 | 50 |
| 2018 December | 144 | 44 | 188 |
| 2018 November | 283 | 25 | 308 |
| 2018 October | 276 | 19 | 295 |
| 2018 September | 127 | 23 | 150 |
| 2018 August | 102 | 15 | 117 |
| 2018 July | 116 | 22 | 138 |
| 2018 June | 103 | 15 | 118 |
| 2018 May | 143 | 20 | 163 |
| 2018 April | 81 | 11 | 92 |
| 2018 March | 110 | 16 | 126 |
| 2018 February | 74 | 5 | 79 |
| 2018 January | 72 | 9 | 81 |
| 2017 December | 55 | 6 | 61 |
| 2017 November | 28 | 3 | 31 |
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