Joan Falcó Fagés

Bio: Joan Falcó Fagés is an academic researcher. The author has contributed to research in topics: Pseudoaneurysm & Arteriovenous fistula. The author has an hindex of 3, co-authored 5 publications receiving 12 citations.

Brote epidémico de bacteriemias por bacilos gram-negativos (BNG), especialmente enterobacter cloacae, en una unidad de hemodiálisis, en pacientes portadores de catéteres permanentes tunelizados

Abstract: : Vascular access through a venous catheter for haemodialysis is associated with increased risk of thrombosis, central venous stenosis, short access survival and inadequate dialysis. The most important catheter-related complications, which determine method survival, are infection and dysfunction. In particular, infectious episodes are in some studies the leading cause for untimely catheter removal and for catheter-related morbidity but also for morbidity in dialysis patients. Double-lumen central venous catheters used for haemodialysis, are common causes of septicaemia. Most cases are caused by staphylococci. Episodes of gram-negative bacteriemia have been traced to bacterial contamination of water and/or dialysate, errors in dialyzer reprocessing, and improper setup procedures. In this paper, we describe and outbreak of gram-negative bacteremia, firstly E. cloacae, in an outpatients haemodialysis unit, in the patients with long-term tunnelled haemodialysis catheters. We describe the epidemic investigation that we achieved to identify the source of contaminating bacteria and the route by which bacteria gained access to the bloodstream. We prove the contamination by gram-negative bacterium of the water-distribution lines and haemodialysis machines. Moreover, E. cloacae strains isolated from the lines and machines are genotypically identical to the isolated from the patients. Also, we prove that the hands of health care personnel are unintentional carriers. The outbreak was finished when decontamination of dialysis machines was enhanced and dialyzer-priming fluid was modified.

Monitorización sistemática del catéter permanente: una herramienta útil en el estudio de la tasa de infección y disfunción en dos tipos de catéteres tunelizados para hemodiálisis : XIV Premio IZASA, S.A. Accesos vasculares y nuevas tecnologías

Abstract: Los pacientes en hemodialisis son cada vez mas anosos, aumentando las complicaciones en su acceso vascular. Los cateteres permanentes (CP) tunelizados son una buena opcion, pero presentan disfunciones y/o infecciones, provocando una alta morbilidad. Enfermeria tiene un papel fundamental para minimizar este riesgo por lo que pensamos que su seguimiento y protocolizacion desde la multidisciplinaridad puede ser util. Nuestros objetivos fueron: valorar la utilidad del seguimiento sistematico del CPT, comparar tasa de infeccion y disfuncion entres dos tipos de CPT, identificar variables asociadas a la infeccion y valorar existencia de relacion entre infeccion y disfuncion. Estudiamos 52 CPT: 28 Opti-Flow y 24 Schon-Cath, colocados en 14 mujeres y 30 hombres con una media de edad de 72,3 anos en los pacientes con Schon-Cath y 73,6 en los pacientes con Opti-Flow. Las variables estudiadas son: complicaciones en la colocacion, problemas de funcionamiento e infeccion. Se recogieron datos en una base puesta en red e implementada on line por enfermeria, nefrologos y radiologos. Los resultados indicaron: 1. Una tasa global de 0,79 bacteriemias relacionadas con el cateter (BRC) / 1000 dias de cateter, presentando un mayor numero de casos de infeccion el Schon-Cath 2. Los Opti-Flow presentan una alta incidencia de intervenciones radiologicas y/o recambio y mas posibilidades de salida espontanea. 3. Observamos una relacion entre manipulacion e infeccion, mayor en el Schon-Cath, atribuible a mayores problemas de flujos arteriales y presiones venosas. 4. La supervivencia del cateter aumenta con la administracion de urokinasa (UK) e intervencion radiologica.

Contaminated Product Water as the Source of Phialemonium curvatum Bloodstream Infection among Patients Undergoing Hemodialysis

Abstract: objective. We investigated a cluster of cases of bloodstream infection (BSI) due to the mold Phialemonium at a hemodialysis center in Illinois and conducted a cohort study to identify risk factors. design. Environmental assessment and cohort study. setting. A hemodialysis center in a tertiary care hospital. methods. A case patient was defined as a person who underwent dialysis at the center and had a blood sample that tested positive for Phialemonium curvatum on culture. We reviewed microbiology and medical records and tested water, surface, and dialysate samples by culture. Molds isolated from environmental and clinical specimens were identified by their morphological features and confirmed by sequencing DNA. results. We identified 2 case patients with BSI due to P. curvatum. Both became febrile and hypotensive while undergoing dialysis on the same machine at the same treatment station, although on different days. Dialysis machines were equipped with waste handling option ports that are used to discard dialyzer priming fluid. We isolated P. curvatum from the product water (ie, water used for dialysis purposes) at 2 of 19 treatment stations, one of which was the implicated station. conclusion. The source of P. curvatum was likely the water distribution system. To our knowledge, this is the first report of patients acquiring a mold BSI from contaminated product water. The route of exposure in these cases of BSI due to P. curvatum may be related to the malfunction and improper maintenance of the waste handling option ports. Waste handling option ports have been previously implicated as the source of bacterial BSI due to the backflow of waste fluid into a patient’s blood line. No additional cases of infection were noted after remediation of the water distribution system and after discontinuing use of waste handling option ports at the facility. Infect Control Hosp Epidemiol 2009; 30:840-847

Enterobacter cloacae infection of an expanded polytetrafluoroethylene femoral-popliteal bypass graft: a case report

Abstract: Introduction Enterobacter cloacae infections are common among burn victims, immunocompromised patients, and patients with malignancy. Most commonly these infections are manifested as nosocomial urinary tract or pulmonary infections. Nosocomial outbreaks have also been associated with colonization of certain surgical equipment and operative cleaning solutions. Infections of an aortobifemoral prosthesis, an aortic graft, and arteriovenous fistulae are noted in the literature. To our knowledge, this is the first isolated account of an E. cloacae infection of a femoral-popliteal expanded polytetrafluoroethylene bypass graft.

Aneurisma cirsoide renal: una rara causa de hematuria severa

Abstract: OBJETIVOS Las fistulas arteriovenosas congenitas renales (aneurisma cirsoide) son una realidad clinica excepcional. Aunque con frecuencia son asintomaticas, su presentacion como hematuria grave suscita un excelente ejercicio diagnostico, y a menudo una actuacion terapeutica inmediata. METODOS Y RESULTADOS: Presentamos una paciente de 75 anos de edad con un cuadro de hematuria severa anemizante, hipertension arterial e insuficiencia cardiaca congestiva. EL diagnostico de imagen revelo una ureterohidronefrosis renal derecha con bloqueo vesical por coagulos. El estudio endoscopico (cistoscopia y ureterorenoscopia) alerto sobre el origen renal derecho de la hemorragia, precisando finalmente una nefrectomia resolutiva. El diagnostico histologico objetivo la presencia de una formacion redondeada de multiples canales vasculares arteriales y venosos en la submucosa pielocalicial con erosion focal epitelial, compatible con fistula arteriovenosa congenita renal (aneurisma cirsoide). Revisamos aspectos diagnosticos y terapeuticos en la literatura. CONCLUSIONES Las fistulas arteriovenosas congenitas renales representan un dilema diagnostico. Pueden presentarse de forma asintomatica o bien condicionar clinica derivada del shunt y alto gasto cardiaco (cardiopatia hipertensiva e insuficiencia cardiaca congestiva) o por erosion e infiltracion hemorragica aguda de la via urinaria (hematuria renal severa). El tratamiento debe ser conservador mediante la embolizacion o esclerosis supraselectiva. No obstante, ante fistulas voluminosas, repermeabilizacion postembolizacion o en situaciones de inestabilidad hemodinamica, la nefrectomia es una excelente alternativa.