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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The current issue of <span class="elsevierStyleItalic">Medicina Intensiva</span> publishes the analysis of results of a nationwide multimodal initiative known as the Zero Resistance &#40;ZR&#41; program<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> intended to reduce the acquisition of multidrug-resistant &#40;MDR&#41; bacteria in patients admitted to intensive care units &#40;ICU&#41;&#46; The problem with infections following MDR bacteria is a significant and pressing problem of gram-negative infections with new patterns of resistance and treatment difficulties&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The objective of the project was to analyze the impact of a set of 10 recommendations given between 2014 and 2016 on ICU-acquired MDR bacteria&#46; These were a set of recommendations on preventive isolation based on risk factors&#46; We should mention the significant effort made in training during the project and its association with a safety program at the ICU setting &#40;implicit in the different infection control and management projects derived from the ENVIN registry&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The project included a total of 103 ICUs&#44; 130<span class="elsevierStyleHsp" style=""></span>000 patients&#44; and over 800<span class="elsevierStyleHsp" style=""></span>000 stay days at the ICU setting&#46; Besides these spectacular numbers&#44; I believe that the following results are relevant&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Gradual increase in the number of patients in whom MDR bacteria colonization&#47;infection is detected at ICU admission &#40;a 32&#37; increase&#41;&#46; This piece of information <span class="elsevierStyleItalic">per se</span> is extremely relevant&#44; changes completely the concept of acquisition of MDR bacteria at the ICU setting&#44; and focuses on the previous colonization of patients from different hospital settings or admitted directly from the community&#46; <span class="elsevierStyleItalic">Per se</span>&#44; this finding confirms the significance of monitoring colonizations at ICU admission with a higher rate of positivity in relation to running tests&#44; which is something that we may have not done before&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Lower rate of MDR bacteria acquired at the ICU setting &#40;around 25&#37;&#41;&#46; Although this result is not significant in the study statistical analysis&#44; there is no doubt that it is an important and clinically relevant finding&#46; Also&#44; at the ICU setting&#44; the acquisition MDR bacteria is associated with colonizations rather than infections&#46; By the way&#44; fewer infections &#40;46&#37;&#41; were reported during the project&#46;</p></li></ul></p><p id="par0030" class="elsevierStylePara elsevierViewall">The project has some limitations the authors have made public in the manuscript&#46; Distinguishing infection from colonization is always controversial and requires unequivocal definitions to make sure we are talking about the same thing in all the cases&#46; In the study it was difficult to measure reliably the compliance of the different ICUs to the measures proposed&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">However&#44; we should mention how important this type of collaborative projects among different health professionals really is&#46; Undoubtedly&#44; the ENVIN registry&#44; in general&#44; and the ZR program&#44; in particular&#44; lay the foundations for new collective efforts like the ones made to assess cancer patients admitted to the ICU &#40;Onco-ENVIN&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> or recommendations made during the COVID-19 pandemic<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> based on previous experiences&#46; During the COVID-19 pandemic the issue of MDR bacterial infections has experienced setbacks that should make us rethink strategies<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and analyze the impact of different measures like preventive isolations&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Undoubtedly&#44; this project is part of a monitorization and prevention strategy regarding the appearance of infections at the ICU setting&#44; which is a great advancement and a total heads-up to improve preventive activities in critically ill patients&#46; This type of collective efforts is hard to make and even harder to keep across time&#46; Only through individual and collective coordination efforts from all the investigators involved&#44; and institutional support from scientific societies like different health agencies &#40;both the ministry of health and autonomous communities&#41; this type of collective efforts can become a reality&#46; Both the fields of medicine and critical care nursing are associated with two different activities not fully recognized &#40;early detection and prevention&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">I would not want to end this editorial without mentioning Dr&#46; Alvarez Lerma&#46; Without his leadership&#8212;and knowing that this is a collective effort&#8212;it may have been impossible to conduct nationwide initiatives like this one&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Knowledge&#44; leadership&#44; and collaboration are key in today&#8217;s medicine&#44; not only for infection control and management&#46;</p></span>"
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Editorial
Knowledge, collaboration, and leadership in the battle against infection and the appearance of resistances
Conocimiento, colaboración y liderazgo en la batalla contra la infección y aparición de resistencias
Federico Gordo Vidala,b
a Intensive Care Unit, Hospital Universitario del Henares, Madrid, Spain
b Critical Care Working Group, Universidad Francisco de Vitoria, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The current issue of <span class="elsevierStyleItalic">Medicina Intensiva</span> publishes the analysis of results of a nationwide multimodal initiative known as the Zero Resistance &#40;ZR&#41; program<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> intended to reduce the acquisition of multidrug-resistant &#40;MDR&#41; bacteria in patients admitted to intensive care units &#40;ICU&#41;&#46; The problem with infections following MDR bacteria is a significant and pressing problem of gram-negative infections with new patterns of resistance and treatment difficulties&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The objective of the project was to analyze the impact of a set of 10 recommendations given between 2014 and 2016 on ICU-acquired MDR bacteria&#46; These were a set of recommendations on preventive isolation based on risk factors&#46; We should mention the significant effort made in training during the project and its association with a safety program at the ICU setting &#40;implicit in the different infection control and management projects derived from the ENVIN registry&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The project included a total of 103 ICUs&#44; 130<span class="elsevierStyleHsp" style=""></span>000 patients&#44; and over 800<span class="elsevierStyleHsp" style=""></span>000 stay days at the ICU setting&#46; Besides these spectacular numbers&#44; I believe that the following results are relevant&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Gradual increase in the number of patients in whom MDR bacteria colonization&#47;infection is detected at ICU admission &#40;a 32&#37; increase&#41;&#46; This piece of information <span class="elsevierStyleItalic">per se</span> is extremely relevant&#44; changes completely the concept of acquisition of MDR bacteria at the ICU setting&#44; and focuses on the previous colonization of patients from different hospital settings or admitted directly from the community&#46; <span class="elsevierStyleItalic">Per se</span>&#44; this finding confirms the significance of monitoring colonizations at ICU admission with a higher rate of positivity in relation to running tests&#44; which is something that we may have not done before&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Lower rate of MDR bacteria acquired at the ICU setting &#40;around 25&#37;&#41;&#46; Although this result is not significant in the study statistical analysis&#44; there is no doubt that it is an important and clinically relevant finding&#46; Also&#44; at the ICU setting&#44; the acquisition MDR bacteria is associated with colonizations rather than infections&#46; By the way&#44; fewer infections &#40;46&#37;&#41; were reported during the project&#46;</p></li></ul></p><p id="par0030" class="elsevierStylePara elsevierViewall">The project has some limitations the authors have made public in the manuscript&#46; Distinguishing infection from colonization is always controversial and requires unequivocal definitions to make sure we are talking about the same thing in all the cases&#46; In the study it was difficult to measure reliably the compliance of the different ICUs to the measures proposed&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">However&#44; we should mention how important this type of collaborative projects among different health professionals really is&#46; Undoubtedly&#44; the ENVIN registry&#44; in general&#44; and the ZR program&#44; in particular&#44; lay the foundations for new collective efforts like the ones made to assess cancer patients admitted to the ICU &#40;Onco-ENVIN&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> or recommendations made during the COVID-19 pandemic<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> based on previous experiences&#46; During the COVID-19 pandemic the issue of MDR bacterial infections has experienced setbacks that should make us rethink strategies<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and analyze the impact of different measures like preventive isolations&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Undoubtedly&#44; this project is part of a monitorization and prevention strategy regarding the appearance of infections at the ICU setting&#44; which is a great advancement and a total heads-up to improve preventive activities in critically ill patients&#46; This type of collective efforts is hard to make and even harder to keep across time&#46; Only through individual and collective coordination efforts from all the investigators involved&#44; and institutional support from scientific societies like different health agencies &#40;both the ministry of health and autonomous communities&#41; this type of collective efforts can become a reality&#46; Both the fields of medicine and critical care nursing are associated with two different activities not fully recognized &#40;early detection and prevention&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">I would not want to end this editorial without mentioning Dr&#46; Alvarez Lerma&#46; Without his leadership&#8212;and knowing that this is a collective effort&#8212;it may have been impossible to conduct nationwide initiatives like this one&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Knowledge&#44; leadership&#44; and collaboration are key in today&#8217;s medicine&#44; not only for infection control and management&#46;</p></span>"
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ISSN: 21735727
Original language: English
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