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Transmisión nosocomial comparada de los virus gripales
Comparative nosocomial transmission of influenza viruses
Víctor Quirós Gonzáleza,
Autor para correspondencia
victorquiros@saludcastillayleon.es

Autor para correspondencia.
, Paz Rodríguez-Péreza,1, José María Eiros Bouzab
a Servicio de Medicina Preventiva, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
b Área de Microbiología Clínica, Facultad de Medicina, Universidad de Valladolid, Valladolid, España
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534 pacientes ingresaron con gripe en nuestro centro&#46; Se estableci&#243; como caso a los pacientes con s&#237;ndrome gripal&#44; confirmado a trav&#233;s de la detecci&#243;n de ARN del virus en muestras respiratorias procesadas en el laboratorio de microbiolog&#237;a mediante la reacci&#243;n en cadena de la polimerasa &#40;PCR&#41; en tiempo real&#46; Se defini&#243; gripe de origen nosocomial a los casos que iniciaron el s&#237;ndrome gripal posterior a las 72<span class="elsevierStyleHsp" style=""></span>h tras el ingreso o que reingresaron con s&#237;ntomas gripales antes de 72<span class="elsevierStyleHsp" style=""></span>h tras su alta&#46; Las variables estudiadas fueron&#58; sexo&#44; edad&#44; vacunaci&#243;n para la T1718&#44; tiempo desde la vacunaci&#243;n hasta el resultado positivo en PCR&#44; tipo de infecci&#243;n &#40;nosocomial&#47;comunitaria&#41;&#44; ingreso en la UCI&#44; situaci&#243;n al alta &#40;mejor&#237;a&#47;&#233;xitus&#41; y estancia desde el diagn&#243;stico microbiol&#243;gico hasta el alta&#46; Las variables cuantitativas quedaron descritas a partir de su media y desviaci&#243;n t&#237;pica&#44; empleando la t de Student y la U de Mann-Whitney como pruebas de contraste de hip&#243;tesis&#46; Para las variables categ&#243;ricas se utilizaron porcentajes y los test de Chi-cuadrado y Fisher&#46; La significaci&#243;n estad&#237;stica se estableci&#243; en p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Del total de casos&#44; 307 &#40;57&#44;4&#37;&#41; correspondieron a gripe B y 227 &#40;42&#44;6&#37;&#41; a gripe A&#46; La curva epid&#233;mica alcanz&#243; el m&#225;ximo de notificaciones semanales &#40;89&#41; durante la 1&#46;&#170; semana epidemiol&#243;gica de 2018 &#40;1-7 de enero&#41;&#44; 2 semanas antes de la m&#225;xima incidencia en la curva epidemiol&#243;gica nacional<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46; De acuerdo con los criterios previamente definidos&#44; el 9&#44;7&#37; de los casos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; fueron de origen nosocomial&#46; La diferencia respecto al porcentaje expuesto por los autores &#40;23&#44;3&#37;&#41;&#44; podr&#237;a&#160;ser atribuible a la implementaci&#243;n de distintas precauciones de transmisi&#243;n en cada centro&#46; Pese a que la proporci&#243;n de transmisi&#243;n nosocomial result&#243; mayor en la gripe B que en la A &#40;11 frente al 7&#44;9&#37;&#41;&#44; dicha diferencia carece de significaci&#243;n estad&#237;stica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#41;&#46; La mortalidad asociada a las formas de gripe de transmisi&#243;n nosocomial &#40;13&#44;5&#37;&#41;&#44; fue superior a la asociada a la gripe comunitaria &#40;9&#44;3&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#46; Estudiando de manera aislada cada tipo de virus&#44; la mortalidad solo se vio incrementada en los casos con detecci&#243;n virol&#243;gica positiva para el virus B&#46; Estos datos explican que los autores no encontraran diferencias en mortalidad&#44; al disponer de una muestra exclusiva de casos de gripe A&#46; Las caracter&#237;sticas comparadas de los tipos de virus en funci&#243;n de su transmisi&#243;n &#40;nosocomial frente a la comunitaria&#41; se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Analizando el total de la muestra&#44; el 58&#44;9&#37; de los casos de gripe de adquisici&#243;n comunitaria se hab&#237;an vacunado&#44; frente al 32&#44;7&#37; de los nosocomiales &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Estas diferencias se acent&#250;an al categorizar la muestra en funci&#243;n del tipo de virus&#44; resultando especialmente ilustrativas para la gripe A&#44; con &#250;nicamente 3 pacientes vacunados entre los casos nosocomiales&#46; De esta manera se refuerza la idea de que&#44; aunque la efectividad de la vacuna pueda oscilar entre temporadas&#44; es innegable su capacidad para reducir muchas de las complicaciones asociadas a la gripe&#46; El periodo tras la vacunaci&#243;n hasta el resultado positivo en PCR&#44; mayor en el caso de la gripe A&#44; sugiere una mayor protecci&#243;n frente a este tipo de virus&#46; La conocida divergencia en m&#250;ltiples temporadas entre la cepa vacunal y el linaje de la cepa B circulante<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#44; pudo ocasionar una contenci&#243;n inicial del virus A que no se produjo para el virus B&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">De acuerdo con nuestros resultados&#44; parece oportuno reiterar la necesidad de apostar activamente por estrategias que reduzcan la transmisi&#243;n nosocomial de los virus gripales&#46; Sumado a la vacunaci&#243;n anual de pacientes y profesionales sanitarios<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a>&#44; son fundamentales las medidas de prevenci&#243;n y control desplegadas en nuestros hospitales e integradas en sistemas de vigilancia&#46;</p></span>"
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Nosocomial</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Comunitario</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p-valor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Nosocomial</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Comunitario</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p-valor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">7&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&#61;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">92&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">89&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">127&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;&#177;<span class="elsevierStyleHsp" style=""></span>26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">76&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">114&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">54&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">149&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">83&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">45&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">58&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">D&#237;as tras vacunaci&#243;n hasta diagn&#243;stico por PCR</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">115&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#177;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">112&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;&#177;<span class="elsevierStyleHsp" style=""></span>29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;&#177;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#177;<span class="elsevierStyleHsp" style=""></span>28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="11" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ingreso en la UVI</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">&#40;&#177;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#177;<span class="elsevierStyleHsp" style=""></span>4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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Información del artículo
ISSN: 00257753
Idioma original: Español
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