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Iglesies-Torrent J, Garrido M, Morales J, Pitart C, Vergara A, Fernández-Pittol M. Enhancing pneumococcal bacteraemia diagnosis: A comparative assessment of culture-independent assays (MALDI-TOF-MS Sepsityper® module and a lateral flow inmunochromatography test). Enferm Infecc Microbiol Clin (Engl Ed) 2024:S2529-993X(24)00114-X. [PMID: 38705749 DOI: 10.1016/j.eimce.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/12/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Pneumococcal bacteraemia is a major contributor to global morbidity and mortality. Traditional culture-based methods lack sensitivity and are time-consuming. This study aimed to assess the effectiveness of two culture-independent assays, the MALDI-TOF-MS Sepsityper® module and the lateral flow inmunochromatography test (LFICT) with the Standard F® Streptococcus pneumoniae, directly from positive blood culture (BC) bottles. METHODS A prospective study was conducted from December 2021 to July 2022. For all BC positives for S. pneumoniae a double centrifugation protocol was implemented. The resulting pellet was subsequently processed using both techniques. RESULTS The LFICT showed exceptional performance with 100% sensitivity and specificity, outperforming the MALDI-TOF-MS Sepsityper® module, which achieved 85.2% sensitivity and 100% specificity. Nevertheless, the combination of these assays offers a robust and comprehensive approach to diagnosis. CONCLUSIONS The simultaneous use of both techniques offers a promising alternative that can be integrated into routine practices directly from BC samples.
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Affiliation(s)
| | - Míriam Garrido
- Department of Microbiology, Hospital Clínic, Barcelona, Spain
| | - Javier Morales
- Department of Microbiology, Hospital Clínic, Barcelona, Spain
| | - Cristina Pitart
- Department of Microbiology, Hospital Clínic, Barcelona, Spain; Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Andrea Vergara
- Department of Microbiology, Hospital Clínic, Barcelona, Spain; Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Mariana Fernández-Pittol
- Department of Microbiology, Hospital Clínic, Barcelona, Spain; Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
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2
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Caso JM, Recio R, Ruiz-Ruigómez M, Orellana MÁ, Fernández-Ruiz M. Bacteremia due to Leuconostoc species: A 13-year single-center case series. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:149-151. [PMID: 37088690 DOI: 10.1016/j.eimce.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/10/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Leuconostoc spp. are facultatively anaerobic Gram-positive cocci involved in cases of hospital-acquired bacteremia, mainly in immunocompromised hosts. The available data is scarce due to its uncommon presentation. METHODS We describe all the episodes of Leuconostoc spp. bacteremia in a third level hospital in a 13-year period (2008-2021). RESULTS Four cases of clinically relevant bacteremia were detected. All cases were categorized as catheter-related. The following risk factors were found: previous glycopeptide therapy (75%), use of parenteral nutrition (100%) and cancer (75%). All isolates showed susceptibility to beta-lactams. Catheter removal was performed and wide spectrum antimicrobials were administered, with clinical response in all cases except one. DISCUSSION Apart from cancer and glycopeptide exposure, disruption of skin barrier and gastrointestinal conditions were identified as risk factors, as it was concordantly underlined in other case series. Susceptibility to beta-lactams is usually maintained. Catheter removal and administration of an active antibacterial therapy seem to be the best approach for Leuconostoc spp. catheter-related bacteremia.
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Affiliation(s)
- José María Caso
- Department of Internal Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain.
| | - Raúl Recio
- Department of Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - María Ruiz-Ruigómez
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - María Ángeles Orellana
- Department of Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Spain
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Chessa S, Belfiori E, Mandis G, Urru E, Manconi G, Scuteri A. Bacteremia from streptococcus constellatus revealing a gastrointestinal stromal tumor. Gut Pathog 2024; 16:1. [PMID: 38178146 PMCID: PMC10765689 DOI: 10.1186/s13099-023-00593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Pyogenic Liver Abscesses (PLA) are the most common type of visceral abscess. They generally develop in a context of biliary disease or hematogenous seeding, but a complete diagnostic work-up is always required in order not to miss other important causes, including above all malignancies of the gastro-intestinal tract. CASE PRESENTATION Herein, we report a particular case of a 80 years-old immunocompetent woman hospitalized for sepsis. At the end of the diagnostic process, Streptococcus constellatus (Sc) was identified as the cause of sepsis, multiple PLA were found together with a previous unknown ileal malignancy. We speculated about a possible correlation among these three entities (i.e. sepsis from Sc, PLA and tumors). CONCLUSIONS Detection of Sc in blood should raise red flags in clinicians as aggressive clinical presentation are possible.
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Affiliation(s)
- Salvatore Chessa
- Post-Graduate Medical School of Internal Medicine, University of Cagliari, Cagliari, Italy
| | - Elena Belfiori
- Post-Graduate Medical School of Internal Medicine, University of Cagliari, Cagliari, Italy
| | - Giulia Mandis
- Post-Graduate Medical School of Internal Medicine, University of Cagliari, Cagliari, Italy
| | - Enrico Urru
- Division of Internal Medicine, University Hospital Monserrato (AOU), Cagliari, Italy
| | - Giovanna Manconi
- Division of Internal Medicine, University Hospital Monserrato (AOU), Cagliari, Italy
| | - Angelo Scuteri
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
- Division of Internal Medicine, University Hospital Monserrato (AOU), Cagliari, Italy.
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Maldonado-Barrueco A, Bloise I, Cendejas-Bueno E, López-Rodrigo F, García-Rodríguez J, Lázaro-Perona F. Epidemiological changes in invasive Streptococcus pyogenes infection during the UK alert period: A molecular comparative analysis from a tertiary Spanish hospital in 2023. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:34-37. [PMID: 38176845 DOI: 10.1016/j.eimce.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/14/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES To study the genomic epidemiology of Streptococcus pyogenes causing bloodstream infections (GAS-BSI) in a Spanish tertiary hospital during the United Kingdom invasive S. pyogenes outbreak alert. METHODS Retrospective epidemiological analysis of GAS-BSI during the January-May 2017-2023 period. WGS was performed using Ion torrent GeneStudio™ S5 system for emm typing and identification of superantigen genes in S. pyogenes isolated during the 2022-2023 UK outbreak alert. RESULTS During 2023, there were more cases of GAS-BSI compared to the same period of previous year with a non-significant increase in children. Fourteen isolates were sequenced. The emm1 (6/14, 42.9%) and emm12 (2/14, 14.3%) types predominated; 5 of 6 (75%) emm1 isolates were from the M1UK clone. The most detected superantigen genes were speG (12/14, 85.7%), speC (10/14, 71.4%), speJ (7/14, 50%), and speA (5/15, 33.3%). speA and speJ were predominant in M1UK clone. CONCLUSIONS Our genomic epidemiology in 2023 is similar to the reported data from the UK outbreak alert in the same period and different from previous national S. pyogenes surveillance reports.
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Affiliation(s)
| | - Iván Bloise
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Emilio Cendejas-Bueno
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco López-Rodrigo
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Julio García-Rodríguez
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Lázaro-Perona
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain.
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Corral L, de Los Santos I, Quereda C, Acebrón F, Ruíz-Garbajosa P, Muriel A, Corral Í. Non-perinatal listeriosis: Changes in frequency, clinical spectrum and prognostic factors. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:24-29. [PMID: 36646589 DOI: 10.1016/j.eimce.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Listeria monocytogenes infection is a severe disease affecting mainly aged people and patients with immune depression. The incidence of listeriosis seems to be increasing. In the present study cases of listeriosis from two hospitals are analyzed with the aims of studying changes in its incidence, clinical forms of presentation and possible factors associated with mortality. METHODS Retrospective multicentric study of patients with culture-proven listeriosis in two university hospitals in Madrid between 1977 and 2021. Epidemiological and clinical variables, as well as factors for immune depression, complementary studies and treatments were registered. Factors associated with mortality were analyzed. RESULTS A total of 194 cases of listeriosis were analyzed. The incidence of listeriosis among in-patients increased through the study period, with a significant drop in the number of cases in 2020. The most common clinical presentations were isolated bacteriemia (37.1%) and central nervous system involvement (CNS) (36.6%). Symptoms of gastroenteritis occurred in 21% of cases. Other focal infections were present in 16.5% of patients, the most frequent were spontaneous bacterial peritonitis (8.2%), cholecystitis (2.1%), respiratory infection (1.5%) and vascular prothesis infection (1.5%). In-hospital mortality was 24.7%. Independent factors associated with mortality at admission were age (Odds Ratio [OR] 1.027, 95% confidence interval [IC95%] 1.003-1.056) and a diagnosis of a solid tumor (OR 3.525, IC95% 1.652-7.524). CONCLUSIONS This study confirms an increasing incidence of listeriosis in our millieu. The most common clinical presentations were isolated bacteriemia and central nervous system involvement. In-hospital mortality was associated with age and the diagnosis of a solid tumor.
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Affiliation(s)
- Luis Corral
- Servicio de Medicina Interna-Infecciosas, Hospital Universitario de La Princesa, Madrid, Spain
| | - Ignacio de Los Santos
- Servicio de Medicina Interna-Infecciosas, Hospital Universitario de La Princesa, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Quereda
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Fernando Acebrón
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal e IRYCIS, CIBERESP, Madrid, Spain; Universidad de Alcalá de Henares, Madrid, Spain
| | - Íñigo Corral
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá de Henares, Madrid, Spain.
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Cernada M, De Alba Romero C, Fernández-Colomer B, González-Pacheco N, González M, Couce ML. Health care-associated infections in neonatology. An Pediatr (Barc) 2024; 100:46-56. [PMID: 38177038 DOI: 10.1016/j.anpede.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Health care-associated infections are common in neonatology, but there is no consensus on their definitions. This makes it difficult to compare their incidence or assess the effectiveness of prevention bundles. This is why we think it is very important to achieve a consensus on the definitions and diagnostic criteria for one of the most frequent causes of morbidity in hospitalised neonates. This document aims to standardise the definitions for the most frequent health care-associated infections, such as catheter-associated bloodstream infection, ventilator-associated pneumonia and surgical wound infection, as well as the approach to their diagnosis and treatment.
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Affiliation(s)
- María Cernada
- Servicio de Neonatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | - María González
- Servicio de Neonatología, Hospital Materno-Infantil Regional Málaga, Málaga, Spain
| | - María Luz Couce
- Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, Universidad de Santiago, Santiago de Compostela, Spain.
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Carrion NA, Quiroz RE, Asenzo C, Gamarra M, Flores AE, Garcia M, Soloaga RN, Grigioni J, Mastroianni M, Margari A, Molina F, Procopio AN, Reijtman V, Ratti MS, Mamani V, Vazquez M, Viale D, Perez G. [Optimization in the detection of bacteremia: Integrated use of FilmArray (BCID2) and MALDI-TOF]. Rev Argent Microbiol 2023; 55:332-336. [PMID: 37474389 DOI: 10.1016/j.ram.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 07/22/2023] Open
Abstract
The usefulness of the combined use of MALDI-TOF MS from a subculture with 3-5h of incubation and the BCID2 panel (FilmArray) for the identification of microorganisms from positive blood cultures and its importance in the adjustment of antimicrobial therapy was analyzed. Overall identification with BCID2 was 90.4% (142/157) and with Maldi-TOF MS 83.4% (131/157) (p=0.0858); in 23 polymicrobial episodes (47 strains), the BCID2 panel identified 45 (95.7%) and MALDI-TOF MS 24 (51.1%) (p<0.0000). BCID2 detected the presence of the resistance genes mecA/C (n=16), blaKPC (n=8); blaCTX-M (n=17), blaNDM (n=8), blaOXA-48 (n=1), and vanA/B (n=2). The median time to report a result was 2.0h for BCID2 and 4.0h for MALDI-TOF MS (p<0.0000). Of 124 episodes analyzed, the rapid result of BCID2 led to 82.3% (102/124) therapeutic changes.
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Affiliation(s)
| | | | | | | | | | - Maria Garcia
- Hospital de Pediatría Prof. Dr. J. P. Garrahan, CABA, Argentina
| | - Rolando N Soloaga
- Cátedra de Microbiología, Medicina, Universidad del Salvador, CABA, Argentina
| | | | | | | | | | | | - Vanesa Reijtman
- Hospital de Pediatría Prof. Dr. J. P. Garrahan, CABA, Argentina
| | | | | | | | - Diana Viale
- Hospital de Pediatría Prof. Dr. J. P. Garrahan, CABA, Argentina
| | - Guadalupe Perez
- Hospital de Pediatría Prof. Dr. J. P. Garrahan, CABA, Argentina
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Alejo-Cancho I, Gual-de-Torrella A, Vielba Postigo R, Perez Abraguin I, Redondo Farias L, Lopez de Goikoetxea MJ. [Solobacterium moorei bacteriemia in a patient with sinusitis]. Rev Esp Quimioter 2023; 36:432-433. [PMID: 37192438 PMCID: PMC10336307 DOI: 10.37201/req/141.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 05/18/2023]
Affiliation(s)
- I Alejo-Cancho
- Izaskun Alejo-Cancho, Servicio de Microbiología, Hospital de Galdakao, Barrio Labeaga, 46 A, 48960, Galdakao, Spain.
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Martínez de Victoria Carazo J, Vinuesa García D, Serrano-Conde Sánchez E, Peregrina Rivas JA, Ruíz Rodríguez AJ, Hernández Quero J. Ruminococcus gnavus bacteremia: Literature review and a case report associated with acute flare of ulcerative colitis in an immunocompromised patient. Anaerobe 2023; 82:102762. [PMID: 37481231 DOI: 10.1016/j.anaerobe.2023.102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
We present a case of bacteremia caused by Ruminococcus gnavus in an immunocompromised patient. R. gnavus is a Gram-positive strict anaerobe bacterium that forms chains. The bacteremia has been associated with an acute flare of ulcerative colitis. Anaerobic bacteremia is becoming increasingly frequent in patients with compromised gastrointestinal barrier. The role of the human microbiota and its alterations in the pathogenesis of immune-related diseases is an expanding area of interest. R. gnavus has been identified as a microorganism that may be responsible for the development of these diseases. The contribution of anaerobic bacteria to the pathogenesis of inflammatory bowel disease (IBD) is discussed, and cases reported up until 2023 were reviewed.
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Affiliation(s)
| | - David Vinuesa García
- Infectious Diseases Service, Hospital Universitario Clínico San Cecilio, Av. del Conocimiento, 18016, Granada, Spain
| | - Esther Serrano-Conde Sánchez
- Microbiology and Parasitology Service, Hospital Universitario Clínico San Cecilio, Av. del Conocimiento, 18016, Granada, Spain
| | - José Antonio Peregrina Rivas
- Infectious Diseases Service, Hospital Universitario Clínico San Cecilio, Av. del Conocimiento, 18016, Granada, Spain
| | - Antonio José Ruíz Rodríguez
- Gastroenterology and Hepatology Service, Hospital Universitario Clínico San Cecilio, Av. del Conocimiento, 18016, Granada, Spain
| | - José Hernández Quero
- Infectious Diseases Service, Hospital Universitario Clínico San Cecilio, Av. del Conocimiento, 18016, Granada, Spain
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Corredoira J, Miguez E, Mateo LM, Fernández-Rodríguez R, García-Rodríguez JF, Pérez-González A, Sanjurjo A, Pulian MV, Ayuso-García B. The interaction between liver cirrhosis, infection by Streptococcus bovis, and colon cancer. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04618-5. [PMID: 37145237 DOI: 10.1007/s10096-023-04618-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
Whether cirrhotic patients with Streptococcus bovis bacteremia have an increased risk of colorectal neoplasm is uncertain. A multicentric retrospective cohort study was conducted investigating associations between S. bovis biotype and species, cirrhosis, and colorectal neoplasm. Out of 779 patients with S. bovis bacteremia, 69 (8.7%) had cirrhosis. No differences were found in the prevalence of colorectal neoplasm between cirrhotic and non-cirrhotic patients undergoing colonoscopy. Among cirrhotic patients, prevalence of colorectal neoplasms was higher in S. bovis biotype I (S. gallolyticus) bacteremia (80%) than in S. bovis biotype II (33.3%; p < 0.007). In conclusion, risk of colorectal neoplasm is high among cirrhotic patients with S. gallolyticus bacteremia.
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Affiliation(s)
- Juan Corredoira
- Infectious Diseases Unit, University Hospital Lucus Augusti, Lugo, Spain
| | - Enrique Miguez
- Infectious Diseases Unit, A Coruña University Hospital Complex, A Coruña, Spain
| | - Lara María Mateo
- Internal Medicine Department, Santiago de Compostela University Hospital Complex, Santiago de Compostela, Spain
| | | | | | | | - Ana Sanjurjo
- Internal Medicine Department, POVISA Hospital, Vigo, Spain
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Ferreira M, Santos M, Rodrigues J, Diogo C, Resende C, Baptista C, Faria C. Epidemiology of bacteremia in a pediatric population - A 10-year study. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:85-91. [PMID: 36759058 DOI: 10.1016/j.eimce.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/05/2021] [Indexed: 02/09/2023]
Abstract
INTRODUCTION With the widespread introduction of conjugate meningococcal and pneumococcal vaccines, the prevalence and etiology of invasive bacterial infections have changed. We aimed to review all cases of bacteremia in a level II pediatric department over a ten-year period in the post-pneumococcal conjugate vaccine era. METHODS We reviewed all positive blood cultures (BC) obtained in our department between 2007 and 2016. Results were classified as contaminants, potential pathogens or confirmed pathogens, based on species, number of positive BC in the episode and the patients' medical history. Demographic and clinical data were collected for patients with identified pathogens. RESULTS A total of 638 positive BC were identified (6.6% of total BC); 120 (1.2%) were considered to represent true bacteremia. The most frequently identified microorganism was Streptococcus pneumoniae (29.2%), with a decrease in the number of cases between 2008 and 2015. Staphylococcus aureus was the second most common organism (19.2%) being 21.7% of these methicillin-resistant. Escherichia coli was the most common isolate in children aged less than three months. CONCLUSION We found a rate of true bacteremia in children similar to recent studies. Although Streptococcus pneumoniae remains the most common microorganism, its prevalence may be declining. Monitoring microbiological data in children has implications in practice, particularly in local antibiotic prescription.
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Affiliation(s)
- Mariana Ferreira
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
| | - Mafalda Santos
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Jorge Rodrigues
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Clara Diogo
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Catarina Resende
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Cristina Baptista
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Cristina Faria
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
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Falces-Romero I, Bloise I, García-Rodríguez J, Cendejas-Bueno E. Staphylococcus aureus bacteremia in patients with SARS-CoV-2 infection. Med Clin (Barc) 2023:S0025-7753(23)00029-5. [PMID: 36841646 PMCID: PMC9884619 DOI: 10.1016/j.medcli.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim was to compare the incidence of Staphylococcus aureus bacteremia in COVID-19 and non-COVID-19 adult patients during the pandemic period versus the previous two years. Also, we described the characteristics of both cohorts of patients in pandemic period to find differences. MATERIAL AND METHODS Retrospective study in our tertiary-care centre reviewing S. aureus bacteremia episodes in COVID-19 and non-COVID-19 patients through clinical records and the Microbiology Department database. RESULTS In 2018 and 2019, the incidence of S. aureus bacteremia episodes was 1.95 and 1.63 per 1000 admissions respectively. In the pandemic period, global incidence was 1.96 episodes per 1000 non-COVID-19 admissions and 10.59 episodes per 1000 COVID-19 admissions. A total of 241 bacteremia was registered during this pandemic period in 74 COVID-19 patients and in 167 non-COVID-19 patients. Methicillin resistance was detected in 32.4% and 13.8% of isolates from COVID-19 and non-COVID-19 patients respectively. In COVID-19 patients, mortality rates were significantly higher. CONCLUSIONS We showed a significantly high rates of S. aureus bacteremia incidence in COVID-19 patients and higher methicillin resistance and 15-day mortality rates than in non-COVID-19 patients.
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Affiliation(s)
- Iker Falces-Romero
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Iván Bloise
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Julio García-Rodríguez
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Emilio Cendejas-Bueno
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Méndez-Cruz AR, Félix-Bermúdez GE, Aguilar-Escobar DV, Vega-Vega L, Morales-Estrada AI, Contreras-Rodríguez A. Bloodstream infection by Rhodococcus corynebacterioides in a pediatric patient diagnosed with high-risk retinoblastoma. Rev Argent Microbiol 2023; 55:68-72. [PMID: 35988003 DOI: 10.1016/j.ram.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/19/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Rhodococcus is a pathogen that is known to cause infections in animals and humans, mainly in cases of immunocompromised patients. A case of a pediatric cancer patient suffering from a bloodstream infection caused by Rhodococcus corynebacterioides was described in this work. Gram positive rods were isolated from blood cultures. The target bacterium was identified using a combination of biochemical tests, the MALDI-TOF mass spectrometry technique, and the analysis of the 16S rRNA sequence. Moreover, an antimicrobial susceptibility test was performed using the E-test. The isolated bacterium was identified as R. corynebacterioides. The 3-year-old patient was successfully treated with vancomycin and meropenem. This is the first published report of R. corynebacterioides in a pediatric patient diagnosed with retinoblastoma that developed a bloodstream infection. R. corynebacterioides should be considered among the opportunistic infectious agents affecting pediatric cancer patients.
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Affiliation(s)
| | | | | | | | | | - Araceli Contreras-Rodríguez
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
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Julián-Jiménez A, Rubio-Díaz R, González Del Castillo J, Jorge García-Lamberechts E, Huarte Sanz I, Navarro Bustos C, Candel González FJ. Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with urinary tract infections in the emergency department. Actas Urol Esp 2022; 46:629-639. [PMID: 36273760 DOI: 10.1016/j.acuroe.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/28/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED). METHODS Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of ≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value. CONCLUSION The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED.
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Affiliation(s)
- A Julián-Jiménez
- Servicio de Urgencias, Complejo Hospitalario Universitario de Toledo, Universidad de Castilla La Mancha, Toledo, Spain.
| | - R Rubio-Díaz
- Servicio de Urgencias, Complejo Hospitalario Universitario de Toledo, Universidad de Castilla La Mancha, Toledo, Spain
| | | | | | - I Huarte Sanz
- Servicio de Urgencias, Hospital Universitario de Donosti, San Sebastián, Spain
| | - C Navarro Bustos
- Servicio de Urgencias, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - F J Candel González
- Servicio de Microbiología Clínica, Hospital Universitario Clínico San Carlos, IDISSC, Madrid, Spain
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Alonso B, Pérez-Granda MJ, Latorre MC, Sánchez-Carrillo C, Bouza E, Muñoz P, Guembe M. Production of biofilm by Staphylococcus aureus: Association with infective endocarditis? Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:418-422. [PMID: 36195405 DOI: 10.1016/j.eimce.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/11/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Staphylococcus aureus is a well-known biofilm-producing pathogen that is capable of causing chronic infections owing to its ability to resist antibiotic treatment and obstruct the immune response. However, the possible association between high biofilm production and infective endocarditis (IE) has not been assessed. Our objective was to compare production of biofilm by S. aureus strains isolated from patients with bacteremia and IE, catheter-related bloodstream infection (C-RBSI), or non-device associated bacteremia. METHODS We isolated 260 S. aureus strains from the blood of patients with bacteremia who were diagnosed during hospital admission between 2012 and 2015. Patients were divided into 3 groups according to whether they had IE, C-RBSI, or non-device associated bacteremia. Biofilm production was measured in terms of biomass and metabolic activity using the crystal violet and XTT assays, respectively. High biomass and metabolic activity rates (based on tertile ranks classification) were compared between the 3 groups. RESULTS The high biomass and metabolic activity rates of each group were 41.9% and 37.2% for IE, 32.5% and 35.0%, for C-RBSI, and 29.0% and 33.3% for non-device associated bacteremia (p=0.325 and p=0.885, respectively). CONCLUSIONS High biomass and metabolic activity levels for S. aureus isolates from IE were similar to those of S. aureus isolates from C-RBSI or non-device associated bacteremia.
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Affiliation(s)
- Beatriz Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Jesús Pérez-Granda
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - María Consuelo Latorre
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - María Guembe
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Uva A, Gernone F, Cavalera MA, Carelli G, Cordisco M, Trotta A, Donghia R, Corrente M, Zatelli A. Prevalence of bacteriuria in cats with neurogenic bladder. Vet Res Commun 2022. [PMID: 35835971 DOI: 10.1007/s11259-022-09973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
Urinary tract infections are defined as the adherence, multiplication, and persistence of an infectious agent within the urogenital system, causing an associated inflammatory response and clinical signs; instead, the presence of bacteria in urine as determined by positive bacterial culture (PUC) from a properly collected urine specimen, in the absence of clinical signs, is defined subclinical bacteriuria. Limited information on the prevalence of PUC in spinal cord injury cats affected by neurogenic bladder (NB) is available. On contrary, in NB dogs and humans the prevalence of bacteriuria is well documented. Moreover, while in humans information about bacteriemia associated with NB is already available, this aspect has never been studied in NB cats. The aim of this prospective study was to determine the prevalence of PUC in cats with NB, compared to animals affected by chronic kidney disease (CKD) and healthy cats. Furthermore, the prevalence of bacteriemia in cats with NB was evaluated. Fifty-one cats met the inclusion criteria: 12 cats were affected by NB, 22 had CKD and 17 were healthy. The prevalence of PUC was 58.33% and 18% in NB and CKD cat populations, respectively. All blood cultures were negative. The incomplete bladder emptying and the decreased resistance in the bladder wall could be considered predisposing elements to PUC in the NB feline population. The results of this study highlight, for the first time, an high prevalence of PUC in cats affected by NB, which was not found to be associated with bacteriemia.
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Fernández-Galilea A, Estella A, García-Garmendia JL, Loza A, Palacios-García I, Sierra-Camerino R, Seller G, Rodríguez-Delgado M, Rodriguez-Higueras I, Garnacho-Montero J. Clindamycin but not Intravenous Immunoglobulins reduces mortality in a retrospective cohort of critically ill patients with bacteremic Group A Streptococcal infections. Rev Esp Quimioter 2022; 35:475-481. [PMID: 35796693 PMCID: PMC9548074 DOI: 10.37201/req/030.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objectives Mortality of patients requiring Intensive Care Unit (ICU) admission for an invasive group A streptococcal (GAS) infection continues being high. In critically ill patients with bacteremic GAS infection we aimed at determining risk factors for mortality. Patients and methods Retrospective multicentre study carried out in nine ICU in Southern Spain. All adult patients admitted to the participant ICUs from January 2014 to June 2019 with one positive blood culture for S. pyogenes were included in this study. Patient characteristics, infection-related variables, therapeutic interventions, failure of organs, and outcomes were registered. Risk factors independently associated with ICU and in-hospital mortalities were determined by multivariate regression analyses. Results Fifty-seven patients were included: median age was 63 (45-73) years, median SOFA score at admission was 11 (7-13). The most frequent source was skin and soft tissue infection (n=32) followed by unknown origin of bacteremia (n=12). In the multivariate analysis, age (OR 1.079; 95% CI 1.016-1.145), SOFA score (OR 2.129; 95% CI 1.339-3.383) were the risk factors for ICU mortality and the use of clindamycin was identified as a protective factor (OR 0.049; 95% CI 0.003-0.737). Age and SOFA were the independent factors associated with hospital mortality however the use of clindamycin showed a strong trend but without reaching statistical significance (OR 0.085; 95% CI 0.007-1.095). Conclusion In this cohort of critically ill patients the use of intravenous immunoglobulin was not identified as a protective factor for ICU or hospital mortality treatment with clindamycin significantly reduced mortality after controlling for confounders.
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Affiliation(s)
| | - A Estella
- Ángel Estella, Hospital Universitario de Jerez. Departamento de Medicina Universidad de Cádiz, INiBICA, Carretera Nacional IV s/n. Jerez de la Frontera. 11407, Jerez de la Frontera (Cádiz), Spain.
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Abu El-Ella SS, El-Mekkawy MS, Mohamed Selim A. Stress ulcer prophylaxis for critically ill children: routine use needs to be re-examined. An Pediatr (Engl Ed) 2022; 96:402-409. [PMID: 35701033 DOI: 10.1016/j.anpede.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/11/2020] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Stress ulcer prophylaxis (SUP) is commonly used in Paediatric Intensive Care Units (PICUs). However, strong evidence for this practice is lacking and there is a dire need for paediatric randomized controlled trials (RCTs). Our aim was to assess the usefulness of SUP with omeprazole in critically ill children. PATIENTS AND METHODS We conducted a randomized, controlled open-label trial, including 144 children admitted into a PICU with a paediatric Sequential Organ Failure Assessment (pSOFA) score of less than 16. We randomly allocated patients to SUP with omeprazole or no SUP. The primary outcome was development of upper gastrointestinal bleeding or nosocomial infection. RESULTS The incidence of gastrointestinal bleeding was 27.1%, but clinically significant bleeding developed in only 5.6% of patients. We did not find a significant difference in the incidence of bleeding between the prophylaxis and control groups (27.8% vs 26.4%; P = .85). We also did not find a significant difference between the groups in the incidence of ventilator-associated pneumonia (VAP) (9.6% vs 8.3%; P = .77). The incidence of central line-associated bloodstream infection (CLABSI) was higher in the prophylaxis group compared to the control group (30.6% vs 12.5%; P = .014). None of the patients developed Clostridium difficile-associated diarrhoea. We did not find significant differences in mortality, length of PICU stay or duration of mechanical ventilation. Mechanical ventilation was an independent predictor of bleeding (OR, 6.4; 95%CI, 2.73-14.9). CONCLUSION In PICU patients with mild to moderate organ dysfunction, omeprazole does not seem to be useful for prevention of gastrointestinal bleeding while at the same time increasing the risk of CLABSI. Thus, we recommend restricting SUP to mechanically ventilated children.
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Affiliation(s)
| | | | - Ali Mohamed Selim
- Departamento de Pediatría, Facultad de Medicina, Universidad de Menufia, Shibin el-Kom, Egypt
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Julián-Jiménez A, García-Lamberechts EJ, González Del Castillo J, Navarro Bustos C, Llopis-Roca F, Martínez-Ortiz de Zarate M, Salmerón PP, Guardiola Tey JM, Álvarez-Manzanares J, Rio JJGD, Sanz IH, Díaz RR, Alonso MÁ, Ordoñez BM, López OÁ, Romero MDMO, Candel González FJ. Validation of a predictive model for bacteraemia (MPB5-Toledo) in the patients seen in emergency departments due to infections. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:102-112. [PMID: 34992000 DOI: 10.1016/j.eimce.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/12/2020] [Accepted: 12/25/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To validate a simple risk score to predict bacteremia (MPB5-Toledo) in patients seen in the emergency departments (ED) due to infections. METHODS Prospective and multicenter observational cohort study of the blood cultures (BC) ordered in 74 Spanish ED for adults (aged 18 or older) seen from October 1, 2019, to February 29, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the cut-off values chosen for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS A total of 3.843 blood samples wered cultured. True cases of bacteremia were confirmed in 839 (21.83%). The remaining 3.004 cultures (78.17%) were negative. Among the negative, 172 (4.47%) were judged to be contaminated. Low risk for bacteremia was indicated by a score of 0-2 points, intermediate risk by 3-5 points, and high risk by 6-8 points. Bacteremia in these 3 risk groups was predicted for 1.5%, 16.8%, and 81.6%, respectively. The model's area under the receiver operating characteristic curve was 0.930 (95% CI, 0.916-0.948). The prognostic performance with a model's cut-off value of ≥5 points achieved 94.76% (95% CI: 92.97-96.12) sensitivity, 81.56% (95% CI: 80.11-82.92) specificity, and negative predictive value of 98.24% (95% CI: 97.62-98.70). CONCLUSION The 5MPB-Toledo score is useful for predicting bacteremia in patients attended in hospital emergency departments for infection.
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Affiliation(s)
| | | | | | | | - Ferrán Llopis-Roca
- Servicio de Urgencias, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | | | | | | | | | - Itziar Huarte Sanz
- Servicio de Urgencias, Hospital Universitario de Donosti, Donostia-San Sebastián, Guipúzcoa, Spain
| | - Rafael Rubio Díaz
- Servicio de Urgencias, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Marta Álvarez Alonso
- Servicio de Urgencias, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | | - Oscar Álvarez López
- Servicio de Urgencias, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
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Gallo R, Tamborini AL, Di Bella H, Scarone N, Morante M, Prieto M, Casabona LM. [Actinotignum schaalii: Report of two cases of bacteremia in Argentina]. Rev Argent Microbiol 2021; 54:110-113. [PMID: 34903428 DOI: 10.1016/j.ram.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/01/2021] [Accepted: 10/03/2021] [Indexed: 10/19/2022] Open
Abstract
Actinotignum schaalii is an emerging pathogen in elderly patients with urinary tract pathologies. Two cases of A. schaalii bacteremia are described. Case 1: 79-year-old patient with a history of benign prostatic hyperplasia. He was admitted to the ward for febrile syndrome, abdominal pain, and dysuria. Case 2: 95-year-old patient with prostatic adenomectomy, urethrostomy due to urethral stricture, and benign prostatic hyperplasia. He was admitted due to febrile syndrome, productive cough, bilateral infiltrates with right paracardiac image, and pleural effusion. In both patients, A. schaalii was isolated in blood cultures, identified by MALDITOF-MS mass spectrometry. Only in case 1 was it confirmed that the focus of bacteremia was urinary. It is important to suspect this emerging pathogen in urinary infections with pathological sediment without developing in traditional culture media to ensure adequate empirical treatment. Since most of the isolates show resistance to ciprofloxacin and trimethoprim-sulfamethoxazole.
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Affiliation(s)
- Romina Gallo
- Servicio de Bacteriología, Hospital Dr. Lucio Molas, Santa Rosa, La Pampa, Argentina.
| | - Ana Lis Tamborini
- Servicio de Bacteriología, Hospital Dr. Lucio Molas, Santa Rosa, La Pampa, Argentina
| | - Horacio Di Bella
- Servicio de Bacteriología, Hospital Dr. Lucio Molas, Santa Rosa, La Pampa, Argentina
| | - Nahuel Scarone
- Servicio de Bacteriología, Hospital Dr. Lucio Molas, Santa Rosa, La Pampa, Argentina
| | - Martín Morante
- Grupo Integral Clínico Cardiológico (GICC prevención), Santa Rosa, La Pampa, Argentina
| | - Mónica Prieto
- Servicio de Bacteriología Especial, INEI-ANLIS «Dr. Carlos G. Malbrán», Buenos Aires, Argentina
| | - Luis Marcelo Casabona
- Servicio de Bacteriología, Hospital Dr. Lucio Molas, Santa Rosa, La Pampa, Argentina
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Julián-Jiménez A, Iqbal-Mirza SZ, de Rafael González E, Estévez-González R, Serrano-Romero de Ávila V, Heredero-Gálvez E, Rubio Díaz R, Nieto Rojas I, Canabal Berlanga R. Predicting bacteremia in patients attended for infections in an emergency department: the 5MPB-Toledo model. Emergencias 2021; 32:81-89. [PMID: 32125106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To develop a simple risk score to predict bacteremia in patients in our hospital emergency department for infection. MATERIAL AND METHODS Retrospective observational cohort study of all blood cultures ordered in the emergency department for adults (aged 18 or older) from July 1, 2018, to March 31, 2019. We gathered data on 38 independent variables (demographic, comorbidity, functional status, and laboratory findings) that might predict bacteremia. Univariate and multiple logistic regression analyses were applied to the data and a risk scale was developed. RESULTS A total of 2181 blood samples were cultured. True cases of bacteremia were confirmed in 262 (12%). The remaining 1919 cultures (88%) were negative. No growth was observed in 1755 (80.5%) of the negative cultures, and 164 (7.5%) were judged to be contaminated. The 5MPB-Toledo model identified 5 predictors of bacteremia: temperature higher than 38.3°C (1 point), a Charlson comorbidity index of 3 or more (1 point), respiratory frequency of at least 22 breaths/min (1 point), leukocyte count greater than 12 000/mm3 (1 point), and procalcitonin concentration of 0.51 ng/mL or higher (4 points). Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.1%, 10.5%, and 77%, respectively. The model's area under the receiver operating characteristic curve was 0.946 (95% CI, 0.922-0.969). CONCLUSION The 5MPB-Toledo score could be useful for predicting bacteremia in patients attended in hospital emergency departments for infection.
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Affiliation(s)
- Agustín Julián-Jiménez
- Servicio de Urgencias - Área de Medicina Interna, Complejo Hospitalario Universitario de Toledo, Toledo, España. Universidad de Castilla La Mancha, Toledo, España
| | - Sadaf Zafar Iqbal-Mirza
- Servicio de Urgencias - Área de Medicina Interna, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - Elena de Rafael González
- Servicio de Análisis Clínicos y Bioquímica, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - Raquel Estévez-González
- Servicio de Urgencias - Área de Medicina Interna, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | | | - Eva Heredero-Gálvez
- Servicio de Microbiología y Parasitología, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - Rafael Rubio Díaz
- Servicio de Urgencias - Área de Medicina Interna, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - Isabel Nieto Rojas
- Servicio de Urgencias - Área de Medicina Interna, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - Raúl Canabal Berlanga
- Servicio de Urgencias - Área de Medicina Interna, Complejo Hospitalario Universitario de Toledo, Toledo, España
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Ferreira M, Santos M, Rodrigues J, Diogo C, Resende C, Baptista C, Faria C. Epidemiology of bacteremia in a pediatric population - A 10-year study. Enferm Infecc Microbiol Clin 2021; 41:S0213-005X(21)00207-X. [PMID: 34275687 DOI: 10.1016/j.eimc.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/28/2021] [Accepted: 06/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION With the widespread introduction of conjugate meningococcal and pneumococcal vaccines, the prevalence and etiology of invasive bacterial infections have changed. We aimed to review all cases of bacteremia in a level II pediatric department over a ten-year period in the post-pneumococcal conjugate vaccine era. METHODS We reviewed all positive blood cultures (BC) obtained in our department between 2007 and 2016. Results were classified as contaminants, potential pathogens or confirmed pathogens, based on species, number of positive BC in the episode and the patients' medical history. Demographic and clinical data were collected for patients with identified pathogens. RESULTS A total of 638 positive BC were identified (6.6% of total BC); 120 (1.2%) were considered to represent true bacteremia. The most frequently identified microorganism was Streptococcus pneumoniae (29.2%), with a decrease in the number of cases between 2008 and 2015. Staphylococcus aureus was the second most common organism (19.2%) being 21.7% of these methicillin-resistant. Escherichia coli was the most common isolate in children aged less than three months. CONCLUSION We found a rate of true bacteremia in children similar to recent studies. Although Streptococcus pneumoniae remains the most common microorganism, its prevalence may be declining. Monitoring microbiological data in children has implications in practice, particularly in local antibiotic prescription.
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Affiliation(s)
- Mariana Ferreira
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
| | - Mafalda Santos
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Jorge Rodrigues
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Clara Diogo
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Catarina Resende
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Cristina Baptista
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Cristina Faria
- Department of Pediatrics, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
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Álvarez-Artero E, Campo-Nuñez A, García-García I, García-Bravo M, Cores-Calvo O, Galindo-Pérez I, Pendones-Ulerio J, López-Bernus A, Belhassen-García M, Pardo-Lledías J. Urinary tract infection caused by Enterococcus spp.: Risk factors and mortality. An observational study. Rev Clin Esp 2021; 221:375-383. [PMID: 34074626 DOI: 10.1016/j.rceng.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Urinary tract infections (UTIs) are frequently caused by Enterococcus spp. This work aims to define the risk factors associated with UTIs caused by Enterococci and to determine its overall mortality and predictive risk factors. MATERIALS AND METHODS A retrospective study was conducted on bacteremic UTIs caused by Enterococcus spp. among inpatients. We compared 106 inpatients with bacteremic UTIs caused by Enterococcus spp. vs. a random sample of 100 inpatients with bacteremic UTIs caused by other enterobacteria. RESULTS A total of 106 inpatients with UTIs caused by Enterococcus spp. were analyzed, 51 of whom had concomitant positive blood cultures. Distribution by species was 83% E. faecalis and 17% E. faecium. The mean Charlson Comorbidity Index score was 5.9±2.9. Upon comparing bacteremic UTIs caused by Enterococcus spp. vs. bacteremic UTIs caused by others enterobacteria, we found the following independent predictors of bacteremic UTI by Enterococcus: male sex, obstructive uropathy, nosocomial infection, cancers of the urinary system, and previous antimicrobial treatment. Overall, inpatient mortality was 16.5% and was associated with a higher Sequential Organ Failure Assessment (SOFA) score (>4); severe comorbidities such as immunosuppression, malignant hemopathy, and nephrostomy; and Enterococcus faecium species and its pattern of resistance to ampicillin or vancomycin (p<0.05). Appropriate empiric antibiotic therapy was not associated with a better prognosis (p>0.05). CONCLUSIONS Enterococcus spp. is a frequent cause of complicated UTI in patients with risk factors. High mortality secondary to a severe clinical condition and high comorbidity may be sufficient for justifying the implementation of empiric treatment of at-risk patients.
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Affiliation(s)
- E Álvarez-Artero
- Servicio de Medicina Interna, Hospital Rio Carrión, Complejo Asistencial Universitario de Palencia (CAUPA), Palencia, Spain
| | - A Campo-Nuñez
- Servicio de Medicina Interna, Hospital Rio Carrión, Complejo Asistencial Universitario de Palencia (CAUPA), Palencia, Spain
| | - I García-García
- Servicio de Microbiología, Complejo Asistencial Universitario de Salamanca (CAUSA), Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación en Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Salamanca, Spain
| | - M García-Bravo
- Servicio de Medicina Interna, Hospital Rio Carrión, Complejo Asistencial Universitario de Palencia (CAUPA), Palencia, Spain
| | - O Cores-Calvo
- Servicio de Microbiología, Complejo Asistencial Universitario de Salamanca (CAUSA), Salamanca, Spain
| | - I Galindo-Pérez
- Centro de Atención Primaria, Puente San Miguel, Santander, Spain
| | - J Pendones-Ulerio
- Servicio de Microbiología, Complejo Asistencial Universitario de Salamanca (CAUSA), Salamanca, Spain
| | - A López-Bernus
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Salamanca, Spain
| | - M Belhassen-García
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Salamanca, Spain.
| | - J Pardo-Lledías
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla (HUMV), Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Alonso B, Pérez-Granda MJ, Latorre MC, Sánchez-Carrillo C, Bouza E, Muñoz P, Guembe M. Production of biofilm by Staphylococcus aureus: Association with infective endocarditis? Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00081-1. [PMID: 33867187 DOI: 10.1016/j.eimc.2021.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Staphylococcus aureus is a well-known biofilm-producing pathogen that is capable of causing chronic infections owing to its ability to resist antibiotic treatment and obstruct the immune response. However, the possible association between high biofilm production and infective endocarditis (IE) has not been assessed. Our objective was to compare production of biofilm by S. aureus strains isolated from patients with bacteremia and IE, catheter-related bloodstream infection (C-RBSI), or non-device associated bacteremia. METHODS We isolated 260 S. aureus strains from the blood of patients with bacteremia who were diagnosed during hospital admission between 2012 and 2015. Patients were divided into 3 groups according to whether they had IE, C-RBSI, or non-device associated bacteremia. Biofilm production was measured in terms of biomass and metabolic activity using the crystal violet and XTT assays, respectively. High biomass and metabolic activity rates (based on tertile ranks classification) were compared between the 3 groups. RESULTS The high biomass and metabolic activity rates of each group were 41.9% and 37.2% for IE, 32.5% and 35.0%, for C-RBSI, and 29.0% and 33.3% for non-device associated bacteremia (p=0.325 and p=0.885, respectively). CONCLUSIONS High biomass and metabolic activity levels for S. aureus isolates from IE were similar to those of S. aureus isolates from C-RBSI or non-device associated bacteremia.
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Affiliation(s)
- Beatriz Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Jesús Pérez-Granda
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - María Consuelo Latorre
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - María Guembe
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Abu El-Ella SS, Said El-Mekkawy M, Mohamed Selim A. [Stress ulcer prophylaxis for critically ill children: Routine use needs to be re-examined]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00130-2. [PMID: 33685825 DOI: 10.1016/j.anpedi.2020.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Stress ulcer prophylaxis (SUP) is commonly used in Paediatric Intensive Care Units (PICUs). However, strong evidence for this practice is lacking and there is a dire need for paediatric randomized controlled trials (RCTs). Our aim was to assess the usefulness of SUP with omeprazole in critically ill children. PATIENTS AND METHODS We conducted a randomized, controlled open-label trial, including 144 children admitted into a PICU with a paediatric Sequential Organ Failure Assessment (pSOFA) score of less than 16. We randomly allocated patients to SUP with omeprazole or no SUP. The primary outcome was development of upper gastrointestinal bleeding or nosocomial infection. RESULTS The incidence of gastrointestinal bleeding was 27.1%, but clinically significant bleeding developed in only 5.6% of patients. We did not find a significant difference in the incidence of bleeding between the prophylaxis and control groups (27.8 vs. 26.4%; p = 0.85). We also did not find a significant difference between the group in the incidence of ventilator-associated pneumonia (VAP) (9.6 vs. 8.3%; p = 0.77). The incidence of central line-associated bloodstream infection (CLABSI) was higher in the prophylaxis group compared to the control group (30.6% vs. 12.5%; p = 0.014). None of the patients developed Clostridium difficile-associated diarrhoea. We did not find significant differences in mortality, length of PICU stay or duration of mechanical ventilation. Mechanical ventilation was an independent predictor of bleeding (OR 6.4; 95% CI, 2.73-14.9). CONCLUSION In PICU patients with mild to moderate organ dysfunction, omeprazole does not seem to be useful for prevention of gastrointestinal bleeding while at the same time increasing the risk of CLABSI. Thus, we recommend restricting SUP to mechanically ventilated children.
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Affiliation(s)
| | | | - Ali Mohamed Selim
- Departamento de Pediatría, Facultad de Medicina, Universidad de Menufia, Shibin el-Kom, Egipto
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Mormeneo Bayo S, Palacián Ruíz MP, Moreno Hijazo M, Villuendas Usón MC. Bacteremia during COVID-19 pandemic in a tertiary hospital in Spain. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00037-9. [PMID: 33663873 PMCID: PMC7877218 DOI: 10.1016/j.eimc.2021.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The reasons for the decrease in blood cultures were investigated and the rate and aetiology of bacteremia and contaminated blood cultures collected from COVID and non-COVID patients were assessed. METHODS We performed a retrospective analysis in a tertiary hospital in Spain during the COVID period from 4th March 2020 to 21st June 2020. RESULTS The number of blood cultures processed was 5313, representing 22.7% and 18.8% of decrease compared to the same months of 2019 and 2018, respectively (p=0.173). The rate of bacteremia was 1.2% higher among COVID-patients than among non-COVID patients (p<0.001). COVID patients had a higher proportion of nosocomial bacteremia (95.5%) than non-COVID patients (30.5%) (p<0.001). In COVID-positive patients, the contamination rate was 12.3% vs 5.7% in non-COVID patients (p<0.001). CONCLUSION There was a decrease in the number of blood cultures collected during the COVID period compared to previous years. Bacteremia in COVID patients was mainly nosocomial and catheter-related.
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Affiliation(s)
- Saray Mormeneo Bayo
- Servicio de Microbiología, Hospital Universitario Miguel Servet Zaragoza, Spain.
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Julián-Jiménez A, García-Lamberechts EJ, González Del Castillo J, Navarro Bustos C, Llopis-Roca F, Martínez-Ortiz de Zarate M, Piñera Salmerón P, Guardiola Tey JM, Álvarez-Manzanares J, Gamazo-Del Rio JJ, Huarte Sanz I, Rubio Díaz R, Álvarez Alonso M, Mora Ordoñez B, Álvarez López O, Ortega Romero MDM, Candel González FJ. Validation of a predictive model for bacteraemia (MPB5-Toledo) in the patients seen in emergency departments due to infections. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00009-4. [PMID: 33581861 DOI: 10.1016/j.eimc.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/12/2020] [Accepted: 12/25/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To validate a simple risk score to predict bacteremia (MPB5-Toledo) in patients seen in the emergency departments (ED) due to infections. METHODS Prospective and multicenter observational cohort study of the blood cultures (BC) ordered in 74 Spanish ED for adults (aged 18 or older) seen from from October 1, 2019, to February 29, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the cut-off values chosen for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS A total of 3.843 blood samples wered cultured. True cases of bacteremia were confirmed in 839 (21.83%). The remaining 3.004 cultures (78.17%) were negative. Among the negative, 172 (4.47%) were judged to be contaminated. Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.5%, 16.8%, and 81.6%, respectively. The model's area under the receiver operating characteristic curve was 0.930 (95% CI, 0.916-0.948). The prognostic performance with a model's cut-off value of ≥ 5 points achieved 94.76% (95% CI: 92.97-96.12) sensitivity, 81.56% (95% CI: 80.11-82.92) specificity, and negative predictive value of 98.24% (95% CI: 97.62-98.70). CONCLUSION The 5MPB-Toledo score is useful for predicting bacteremia in patients attended in hospital emergency departments for infection.
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Affiliation(s)
| | | | | | - Carmen Navarro Bustos
- Servicio de Urgencias, Hospital Universitario Virgen de la Macarena, Sevilla, España
| | - Ferrán Llopis-Roca
- Servicio de Urgencias, Hospital Universitario de Bellvitge, Barcelona, España
| | | | | | | | | | | | - Itziar Huarte Sanz
- Servicio de Urgencias, Hospital Universitario de Donosti, Donostia-San Sebastián, Guipúzcoa, España
| | - Rafael Rubio Díaz
- Servicio de Urgencias, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - Marta Álvarez Alonso
- Servicio de Urgencias, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | | | - Oscar Álvarez López
- Servicio de Urgencias, Hospital Universitario de Móstoles, Móstoles, Madrid, España
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Finello M, Suasnabar DF, García MDJ, Díaz MV, Richetta L, Toranzo A, Hernández D, Cometto MA, Vázquez SM, Caeiro JP, Sierra J, Saad EJ. [Clinical and microbiological characteristics of bloodstream infections in adult neutropenic patients]. Rev Argent Microbiol 2021; 53:183-193. [PMID: 33388181 DOI: 10.1016/j.ram.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 09/07/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Bloodstream infections (BI) are relevant in neutropenic patients because they are associated with an increased number of complications and death. The objective was determinate the epidemiologic and microbiologic features of the BI in neutropenic patients with solid neoplasm (SN) and hematologic neoplasm (HN). Retrospective study in two third level hospitals between 2009 and 2016. They were included all the patients older than 18 years-old with active oncologic disease and neutropenia, who had BI. Patients with dermatologic cancer other than melanoma where excluded. A total of 143 BI in neutropenic were observed, of which 80.4% occurred in HN. Around 97.9% of the patients had a high-risk neutropenia without differences between both groups. The most frequent site of BI was primary bacteremia (46.9%) and catheter-associated infection (21%), without significant differences between the two groups. The gram negatives bacilli (GNB) predominated over the gram positive cocci (GPC) and they represented 74.1% of the isolated bacteria, being Escherichia coli the most frequent (32.8%). Among the gram positive cocci, Staphylococcus aureus (28.1%) was the most frequent isolated, followed by coagulase-negative Staphylococci (CNS). There were no differences in microbiological isolates between both groups. With regard to the antimicrobial susceptibility 67.5% of the CNS, 17.6% of the E. coli and 27.6% of the Klebsiella pneumoniae were multiresistant with no differences between both groups. Only 11.1% of S. aureus isolates were methicillin resistant. In conclusion BI of the neutropenic patients where most frequents within patients with HN, GNB were the main microbiological isolates. High mortality was observed in neutropenic patients with BI.
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Affiliation(s)
- Malena Finello
- Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | | | - Mercedes de Jesús García
- Servicio de Hematología y Oncología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - María Victoria Díaz
- Servicio de Hematología y Oncología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Luis Richetta
- Servicio de Anestesiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Agustín Toranzo
- Servicio de Diagnóstico por Imágenes, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Daniela Hernández
- Laboratorio de Microbiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - María Aldana Cometto
- Laboratorio de Microbiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Sofía Mariela Vázquez
- Laboratorio de Microbiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Juan Pablo Caeiro
- Servicio de Enfermedades Infecciosas, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Jeremías Sierra
- Servicio de Hematología y Oncología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Emanuel José Saad
- Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina.
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Ferreras Amez JM, Arribas Entrala B, Aspiroz C, Ezpeleta Galindo A, Boned Juliani B. Seasonality of bacteremia cases in an emergency department. Emergencias 2020; 31:399-403. [PMID: 31777211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess seasonal variation in episodes of bacteremia. MATERIAL AND METHODS Retrospective cohort study of cases of significant bacteremia found in blood cultures ordered in a hospital emergency department. The incidence, etiology, diagnostic and prognostic yield were analyzed for each season of the year. RESULTS A total of 4384 blood cultures were ordered in 4.1% of the emergency patients attended. The diagnostic yield was 12.2% (incidence, 490 cases per 100 000 cases attended). Cultures were ordered more often in winter (in 4.6% of the patients vs in 3.8% in the other seasons on average, P<.001). The diagnostic yield was lower in winter than in the other seasons (10.2% vs 13%, P=.01), and the contamination rate was higher (4.9% vs 3.8%, P=.02). Escherichia coli was isolated in fewer cultures in winter than in other seasons (36.4% vs 46.9%, P=.03), and Streptococcus pneumoniae was isolated in more (14.5% vs 5.9%, P=.001). CONCLUSION The microbiological profile of blood cultures, their diagnostic yield, and rate of contamination differ greatly in winter.
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Affiliation(s)
- José María Ferreras Amez
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza. Grupo INFURG-SEMES, Zaragoza, España
| | | | - Carmen Aspiroz
- Servicio de Microbiología, Hospital Royo Villanova, Zaragoza, España
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Vaquera-Aparicio DN, Mascareñas-De Los Santos AH, Casillas-Vega N, Riojas-Hernández P, Llaca-Díaz J, Herrera-Benavente I, Castillo-Bejarano JI. Bacteremia due to Weeksella virosa in a pediatric patient with embryonal rhabdomyosarcoma. Bol Med Hosp Infant Mex 2020; 77:149-152. [PMID: 32496471 DOI: 10.24875/bmhim.19000205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Weeksella virosa is one of the two species of the genus Weeksella. Clinical disease due to this bacterium in humans is rare, for which only nine cases have been reported in the literature. Case report A 4-year-old male patient was diagnosed with a left orbit rhabdomyosarcoma Stage III and was admitted to a northeast third level referral center in Mexico. Aerobic, non-pigmented, Gram-negative rod was isolated from a blood culture. W. virosa was identified by Sensititre™ ARIS. This organism has been described in cases of spontaneous bacterial peritonitis, sepsis, pneumonia, ventriculitis, and urinary tract infection. Conclusions Clinicians should consider the diagnosis of W. virosa bacteremia in cases involving immunocompromised patients with oral lesions, although it is infrequent. To the best of our knowledge, this is the first clinical report of W. virosa bacteremia described in an immunocompromised pediatric patient.
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Affiliation(s)
- Denisse N Vaquera-Aparicio
- Servicio de Enfermedades Infecciosas, Departmento de Pediatría, Hospital Universitario Dr. José Eleuterio González, Monterrey, Nuevo León, Mexico
| | - Abiel H Mascareñas-De Los Santos
- Servicio de Enfermedades Infecciosas, Departmento de Pediatría, Hospital Universitario Dr. José Eleuterio González, Monterrey, Nuevo León, Mexico
| | - Néstor Casillas-Vega
- Departmento de Patología Clínica, Departmento de Microbiología Clínica, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Patricia Riojas-Hernández
- Servicio de Enfermedades Infecciosas, Departmento de Pediatría, Hospital Universitario Dr. José Eleuterio González, Monterrey, Nuevo León, Mexico
| | - Jorge Llaca-Díaz
- Departmento de Patología Clínica, Departmento de Microbiología Clínica, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Ismael Herrera-Benavente
- Departmento de Microbiología, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí. Mexico
| | - José I Castillo-Bejarano
- Servicio de Enfermedades Infecciosas, Departmento de Pediatría, Hospital Universitario Dr. José Eleuterio González, Monterrey, Nuevo León, Mexico
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Fuentes-González MF, Ahumada-Topete VH. [Increase of antimicrobial resistance in bacteremias. Report of a reference center]. Rev Med Inst Mex Seguro Soc 2020; 58:284-291. [PMID: 34002987 DOI: 10.24875/rmimss.m20000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/06/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sepsis is a life-threatening organic dysfunction caused by an unregulated host response to infection. Management includes a prompt antibiotic treatment. Incorrect treatment can negatively influence in survival. OBJECTIVE To describe the pattern of antimicrobial resistance of the main isolated microorganisms in blood cultures of patients with sepsis in a reference center of Mexico City. MATERIAL AND METHODS Observational, retrospective, descriptive, cross-sectional study. Data from blood cultures performed in patients diagnosed with sepsis were analyzed during the period from January 1, 2015, to December 31, 2018. RESULTS 450 positive blood cultures were identified. Escherichia coli (34.5%) and Staphylococcus aureus (24.4%) were the most frequently isolated bacteria. E. coli and Klebsiella pneumoniae showed resistance to third generation cephalosporins of 75 and 80%, respectively. For K. pneumoniae it was reported resistance to carbapenems in 12.7%. For Enterococcus faecium it was reported a resistance to vancomycin in 60%. Multidrug resistance within the group of non-fermenting bacteria was reported in 88.1% for Acinetobacter baumannii and 48.8% in Pseudomonas aeruginosa. The resistance to methicillin in S. aureus was 23.6%. CONCLUSIONS A high proportion of beta-lactamase producing Enterobacteriaceae was observed, as well as a higher proportion of multidrug-resistant non-fermenting bacteria.
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Affiliation(s)
- María Fernanda Fuentes-González
- Secretaría de Salud de la Ciudad de México, Hospital de Especialidades de la Ciudad de México "Dr. Belisario Domínguez", Servicio de Medicina Interna
| | - Víctor Hugo Ahumada-Topete
- Secretaría de Salud, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Departamento de Investigación en Enfermedades Infecciosas. Ciudad de México, México
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Hernández-Aceituno A, Vega-Costa V, Ruiz-Álvarez M, Figuerola-Tejerina A, Méndez-Hernández R, Ramasco-Rueda F. Effectiveness of a bundle of measures for reducing central line-associated bloodstream infections. ACTA ACUST UNITED AC 2020; 67:227-236. [PMID: 32216956 DOI: 10.1016/j.redar.2019.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/21/2019] [Accepted: 11/08/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Catheter-associated infections are the main cause of nosocomial bacteremia. The main objective of this study was to demonstrate a possible decrease in CLABSI rates in perioperative environment after the implementation of a bundle of measures. Secondary objective was to determine which factors were associated with an increased risk of CLABSI, after the implementation of the bundle. METHODS Insertion bundle consisted of: subclavian vein as access of choice, disinfection with alcoholic 2% chlorhexidine, central-line full body drapes, sterile ultrasound probe-cable covers and insertion check-list. Cumulative Incidence (CI) and Incidence Density Rate (IR) of CLABSIs were compared before and after the intervention. Associations between patient or CVC characteristic and CLABSI were summarized with odds ratios and 95% confidence interval, obtained from multiple logistic regression, adjusting for age, sex, comorbidities and days with CVC. RESULTS Before implementing the bundle, from January to November 2016, CI of CLABSI was 5.05% and IR was 5.17 ‰. In the same period of 2018, CI of CLABSI was 2.28% and IR was 2.27 ‰, which means a reduction of 54.8% in CI (P=.072) and of 56% in IR (P=.068) In multivariable analyses, replacement of CVC was associated with a higher risk of CLABSI (OR 11.01, 95%CI 2.03-59.60, P=.005), as well as 2 or more catheterizations (OR 10.05, 95%CI 1.77-57.16, P=.009), and parenteral nutrition (OR 23.37, 95%CI 4.37-124.91, P<.001). CONCLUSIONS CLABSI rates decreased after the implementation of the insertion bundle. CVC replacement, 2 or more catheterizations and parenteral nutrition were associated with CLABSI after bundle implementation.
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Affiliation(s)
- A Hernández-Aceituno
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario de La Princesa, Madrid, España.
| | - V Vega-Costa
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de La Princesa, Madrid, España
| | - M Ruiz-Álvarez
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario de La Princesa, Madrid, España
| | - A Figuerola-Tejerina
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario de La Princesa, Madrid, España
| | - R Méndez-Hernández
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de La Princesa, Madrid, España
| | - F Ramasco-Rueda
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de La Princesa, Madrid, España
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Verona J, Dirialdi NC, Mutti MV, Scioli MC, Thougnon Islas FA, Curi Antún GE, Sgariglia LJ, Homar MG, Legato JA, Costa A, Maldonado ML, Di Conza JA, Litterio Bürki MR. Bacteremia and sepsis by Arcanobacterium haemolyticum in a young immunocompetent patient. Rev Argent Microbiol 2020; 52:283-7. [PMID: 32201068 DOI: 10.1016/j.ram.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/10/2019] [Accepted: 01/30/2020] [Indexed: 11/20/2022] Open
Abstract
We report the case of a twenty-year-old immunocompetent male patient presenting to the emergency room with pharyngitis and fever. Blood cultures were drawn and Arcanobacterium haemolyticum (rough biotype) was recovered. The presence of the arcanolysin gene was investigated at the molecular level and the upstream region was amplified and sequenced in order to correlate it with the smooth or rough biotype. Although the isolate was susceptible to penicillin, vancomycin and gentamicin, empirical treatments first with amoxicillin/clavulanic acid (1g/12h) and then with ceftriaxone (1g/12h) failed and the infection evolved to sepsis. Finally, treatment with vancomycin (1g/12h) plus piperacillin/tazobactam (4.5g/8h) was effective. Lemierre's syndrome was ruled out. To the best of our knowledge, this is the first case of bacteremia by A. haemolyticum reported in Argentina.
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López-Cortés LE, Gálvez-Acebal J, Rodríguez-Baño J. Therapy of Staphylococcus aureus bacteremia: Evidences and challenges. Enferm Infecc Microbiol Clin 2020; 38:489-497. [PMID: 32169398 DOI: 10.1016/j.eimc.2020.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 10/24/2022]
Abstract
Staphylococcus aureus bacteremia (SAB) is still a daily challenge for clinicians. Despite all efforts, the associated mortality and morbidity has not significantly improved in the last 20 years. The available evidence suggests that adherence to some quality-of-care indicators with regard to clinical management is important in improving the outcome of patients, but it is lower than desired in many hospitals; as such, management of patients with SAB by infectious diseases specialists has been demonstrated to contribute in the reduction of the mortality rate of these patients. In this article, the most relevant clinical studies published over the last few years evaluating the efficacy and safety of alternative drugs for the treatment of SAB are reviewed. However, classic drugs are still used in a high proportion of patients because the promising results obtained from in vivo and in vivo studies with these alternative drugs have not translated as frequently as expected into evident superiority in clinical studies. Nevertheless, some data suggest that certain alternatives may offer advantages in specific situations. Overall, an individualised and expert approach is needed in order to decide the best treatment according to the source, severity, complications, patients' features and microbiological data.
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Affiliation(s)
- Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/CSIC/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Juan Gálvez-Acebal
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/CSIC/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/CSIC/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
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Ozkaya-Parlakay A, Gulhan B, Kanik-Yuksek S, Guney D, Gonulal D, Demirtas G, Tezer H, Unal S, Senel E. Tigecycline therapy in pediatric patients with multidrug resistant bacteremia. Enferm Infecc Microbiol Clin 2020; 38:471-473. [PMID: 32081452 DOI: 10.1016/j.eimc.2019.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Multidrug resistance among bacteria increases the need for new therapeutic options. Tigecycline is one candidate drug, due to property of a wider anti-bacterial spectrum to multi-drug resistant (MDR) pathogens. However, it has still not been approved for use in pediatric patients. METHODS In this study the effectiveness and safety of tigecycline in children was assessed retrospectively. RESULTS A total of 36 pediatric patients, received tigecycline therapy with a median of 13 days (2-32 days). Tigecycline was used as a combination therapy in all cases. Microbiological eradication was achieved in 27 patients (75%) and clinical response was observed in 30 patients (83%). There were six cases (17%) of relapse. CONCLUSION Our findings suggest that tigecycline may be an option for children with severe infections due to multidrug resistant bacteria.
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Affiliation(s)
- Aslinur Ozkaya-Parlakay
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Infectious Disease Department, Ankara, Turkey.
| | - Belgin Gulhan
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Infectious Disease Department, Ankara, Turkey
| | - Saliha Kanik-Yuksek
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Infectious Disease Department, Ankara, Turkey
| | - Dogus Guney
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Surgery and Burn Unit, Ankara, Turkey
| | - Deniz Gonulal
- Ankara Hematology Oncology Children's Training and Research Hospital, Neonatology Department, Ankara, Turkey
| | - Gokhan Demirtas
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Surgery and Burn Unit, Ankara, Turkey
| | - Hasan Tezer
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Infectious Disease Department, Ankara, Turkey
| | - Sevim Unal
- Ankara Hematology Oncology Children's Training and Research Hospital, Neonatology Department, Ankara, Turkey
| | - Emrah Senel
- Yıldırım Beyazıt University, Pediatric Surgery and Burn Unit, Ankara, Turkey
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Chaparro Tapias TA, Rangel Gualdron CM, Rodriguez HA, Rodriguez LM, Flores de Los Reyes L, Sánchez España JC. Bilateral enucleation due to multi-bacterial fulminant endogenous panophthalmitis. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:34-37. [PMID: 31767407 DOI: 10.1016/j.oftal.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae. To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae.
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Affiliation(s)
- T A Chaparro Tapias
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - C M Rangel Gualdron
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - H A Rodriguez
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia; Departamento de Oftalmología, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - L M Rodriguez
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - L Flores de Los Reyes
- Departamento de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, España.
| | - J C Sánchez España
- Departamento de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, España
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Acosta Pedemonte NB, Rocchetti NS, Villalba J, Lerman Tenenbaum D, Settecase CJ, Bagilet DH, Colombo LG, Gregorini ER. Bacillus cereus bacteremia in a patient with an abdominal stab wound. Rev Argent Microbiol 2020; 52:115-7. [PMID: 31791818 DOI: 10.1016/j.ram.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 07/14/2019] [Accepted: 07/19/2019] [Indexed: 11/20/2022] Open
Abstract
Bacillus cereus is a gram positive microorganism commonly involved in gastrointestinal infection but capable of causing severe infections and bacteremia. We describe here a case of bacteremia caused by B. cereus in a previously healthy young woman admitted to the intensive care unit following emergency surgery due to a penetrating abdominal stab wound and subsequent hepatic lesion. She developed fever during admission and cultures were taken. B. cereus was isolated in blood and hepatic fluid collection cultures. Treatment was adjusted according to the isolate, with good clinical results. It is important to highlight the pathogenic potential of this microorganism and not underestimate it as a contaminant when it is isolated from blood samples.
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Contenti J, Occelli C, Lemoel F, Ferrari P, Levraut J. Presepsin versus other biomarkers to predict sepsis and septic shock in patients with infection defined by Sepsis-3 criteria: the PREDI study of diagnostic accuracy. Emergencias 2019; 31:311-317. [PMID: 31625302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES An accurate diagnosis of sepsis in the emergency department must be made before appropriate treatment can be started. Many biomarkers that are potentially useful have been studied. The main aim of this study was to compare the diagnostic accuracy of blood levels of presepsin, lactate, C-reactive protein (CRP), and procalcitonin (PCT) for predicting sepsis as defined by the Sepsis-3 criteria. The secondary aim was to evaluate the diagnostic accuracy of these biomarkers for predicting bacteremia whether or not sepsis or septic shock was present. MATERIAL AND METHODS Single-center, prospective, observational cohort study in the emergency department of a university hospital. Consecutive patients suspected of having infection were enrolled prospectively if they had at least 2 criteria for systemic inflammatory response syndrome. We measured presepsin, PCT, CRP, and lactate in blood extracted on admission. RESULTS Blood samples from 359 patients were analyzed; 228 (63.5%) met the criteria for sepsis and 20 (5.6%) met the criteria for septic shock. PCT and presepsin levels were the best predictors of sepsis and septic shock with areas under the receiver operating characteristic curve (AUC) of 0.711 (95% CI, 0.660-0.758) and 0.709 (95% CI, 0.658- 0.756), respectively (P <.001, both comparisons). The AUCs for CRP and lactate concentrations were, respectively, 0.63 (95% CI, 0.58-0.69) and 0.61 (95% CI, 0.56-0.66) (P <.05, both comparisons). On applying the diagnostic cut points of 0.25 ng/mL for PCT and 500 pg/mL for presepsin, the odds ratios were 2.51 (95% CI, 1.53-4.12) for PCT and 3.19 (95% CI, 1.91-5.31) for presepsin. The diagnostic accuracy of the combination of presepsin and PCT results (AUC, 0.71; 95% CI 0.66-0.76; P <.001) was no better than the accuracy of PCT alone. The most accurate predictor of bacteremia was PCT (AUC, 0.835; 95% CI, 0.79-0.87; P <.001). CONCLUSION Presepsin and PCT seem to be the best predictors of a diagnosis of sepsis or septic shock in emergency department patients.
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Affiliation(s)
- Julie Contenti
- Department of Emergency Medicine (Pôle Urgences SAMU SMUR), Hopital Pasteur 2, Niza, Francia. Université Nice Côte D'Azur, Centre Méditerranéen de Médecine Moléculaire (C3M)- INSERM, Niza, Francia
| | - Céline Occelli
- Department of Emergency Medicine (Pôle Urgences SAMU SMUR), Hopital Pasteur 2, Niza, Francia. School of Medicine, University of Nice Sophia Antipolis, Niza, Francia
| | - Fabien Lemoel
- Department of Emergency Medicine (Pôle Urgences SAMU SMUR), Hopital Pasteur 2, Niza, Francia
| | - Patricia Ferrari
- Department of Emergency Medicine (Pôle Urgences SAMU SMUR), Hopital Pasteur 2, Niza, Francia
| | - Jacques Levraut
- Department of Emergency Medicine (Pôle Urgences SAMU SMUR), Hopital Pasteur 2, Niza, Francia. School of Medicine, University of Nice Sophia Antipolis, Niza, Francia
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Martín-Fortea MP, Lambán Ibor E, Cebollada Sánchez R, Monforte Cirac ML. [Bacteraemia due to L. monocytogenes: Description of cases and review of literature]. Rev Esp Geriatr Gerontol 2019; 55:50-53. [PMID: 31521408 DOI: 10.1016/j.regg.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
Abstract
Bacteraemia due to L. monocytogenes is a sporadic disease related to advanced age or neoplasms, and mortality associated with this disease is high. This study aims to describe the epidemiological, clinical, and therapeutics characteristics of this specific disease, through a retrospective descriptive analysis of cases with positive blood cultures from Calatayud Hospital, from 2008 to 2018. Four cases were detected, all of them occurred in the last 3 years analysed, and the age was greater than the age published in other papers. However, risk factors and mortality were similar. Prevention and early detection are essential to control the increase in this pathology.
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Affiliation(s)
| | - Elena Lambán Ibor
- Servicio de Medicina Interna, Hospital Ernest Lluch de Calatayud, Zaragoza, España
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Zafar Iqbal-Mirza S, Serrano Romero de Ávila V, Estévez-González R, Rodríguez-González D, Heredero-Gálvez E, Julián-Jiménez A. Ability of procalcitonin to differentiate true bacteraemia from contaminated blood cultures in an emergency department. Enferm Infecc Microbiol Clin 2019; 37:560-8. [PMID: 30904350 DOI: 10.1016/j.eimc.2019.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To analyse and compare the ability of procalcitonin (PCT), C-reactive protein (CRP) and leukocytes to differentiate true bacteraemia from contaminated blood cultures in patients seen in the emergency department (ED) for an episode of infectious disease. METHODS Observational, retrospective and descriptive analytical study of all blood cultures with positive growth extracted in an ED in adult patients (≥18 years) during 2016 and 2017. The follow-up was carried out over a 30-day period to calculate the predictive power and the prognostic performance for true bacteraemia. RESULTS A total of 266 blood cultures with positive growth were included in the study. Out of these, 154 (57.9%) were considered true bacteraemia and 112 (42.1%) were considered to be contaminated blood cultures. The area under the Receiver Operating Characteristic curve (AUC-ROC) for PCT to predict true bacteraemia was 0.983 (95% CI: 0.972-0.994; P<0.001) and, considering a cut-off value of≥0.43 ng/ml, PCT achieved 94% sensitivity, 91% specificity, positive predictive value of 94%, and negative predictive value of 92%. The AUC-ROC obtained for CRP was 0.639 (95% CI: 0.572-0.707, P<.001), for leukocytes of 0.693 (95% CI: 0.630-0.756, P<.001) and for immature leukocytes (>10% bands) of 0.614 (95% CI: 0.547-0.682, P<.001). The mean values for PCT were 3.44 (SD 6.30) ng/ml in true bacteraemia vs. 0.16 (SD 0.18) ng/ml in contaminated blood cultures (P<.001). CONCLUSIONS In blood cultures with positive growth extracted in an ED, PCT achieves the best prognostic performance of true bacteraemia vs. contaminated blood cultures, better than CRP and leukocytes.
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Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M, Domínguez MÁ, Esteban J, Fernández-Hidalgo N, Fernández Sampedro M, Fortún J, Guembe M, Lorente L, Paño JR, Ramírez P, Salavert M, Sánchez M, Vallés J. Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). Enferm Infecc Microbiol Clin 2019; 36:112-119. [PMID: 29412895 DOI: 10.1016/j.eimc.2017.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/29/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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Affiliation(s)
- Fernando Chaves
- Servicio de Microbiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - José Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, España
| | - José Luis Del Pozo
- Área de Enfermedades Infecciosas, Servicio de Microbiología, Clínica Universidad de Navarra, Pamplona, España.
| | - Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid; CIBER de Enfermedades Respiratorias, CibeRes, Instituto de Salud Carlos III, Madrid; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | | | - Marina de Cueto
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Ángeles Domínguez
- Servicio de Microbiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Jaime Esteban
- Departamento de Microbiología Clínica, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
| | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Marta Fernández Sampedro
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Jesús Fortún
- Unidad de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Guembe
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Leonardo Lorente
- Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Jose Ramón Paño
- Unidad de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
| | - Paula Ramírez
- Unidad de Cuidados Intensivos, Hospital Universitari i Politècnic La Fe, Valencia; CIBER de Enfermedades Respiratorias (CibeRes), Instituto de Salud Carlos III, Madrid, España
| | - Miguel Salavert
- Unidad de Enfermedades Infecciosas, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Miguel Sánchez
- Servicio de Medicina Intensiva, Hospital Clínico San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Jordi Vallés
- Unidad de Cuidados Intensivos, Hospital Universitari Parc Taulí, Sabadell, Barcelona; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
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Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M, Domínguez MÁ, Esteban J, Fernández-Hidalgo N, Fernández Sampedro M, Fortún J, Guembe M, Lorente L, Paño JR, Ramírez P, Salavert M, Sánchez M, Vallés J. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2018; 42:5-36. [PMID: 29406956 DOI: 10.1016/j.medin.2017.09.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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Lorente L. Antiseptic measures during the insertion and manipulation of vascular catheters. Med Intensiva 2018; 43 Suppl 1:39-43. [PMID: 30409681 DOI: 10.1016/j.medin.2018.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/02/2018] [Accepted: 09/20/2018] [Indexed: 10/27/2022]
Abstract
Several measures related to asepsis for preventing catheter-related bloodstream infection have been proposed. The aseptic measures recommended by scientific societies include hand hygiene of the person who is inserting or manipulating the catheter; maximum sterile barrier precautions during catheter insertion; disinfection of catheter hubs; the use of needle-less connectors and injection ports; the avoidance of antibiotic ointments (except in hemodialysis catheters); change the dressing if it is soiled, loose or damp; and aseptic technique during dressing changes. Other measures only recommended by the most recently published guides (possibly due to the publication of recent studies reporting their beneficial effects) are the use of antimicrobial-impregnated dressings, changing transparent dressings every 7 days, and bathing of the patient with chlorhexidine. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Affiliation(s)
- L Lorente
- Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, La Laguna (Santa Cruz de Tenerife), España.
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Madrid-Aguilar M, López-Herrera MC, Pérez-López J, Escudero-Argaluza J, Santesteban-Otazu E, Piening B, Villate-Navarro JI, Pijoán-Zubizarreta JI; en colaboracion con el grupo NeoKissEs PI13 00587. [Implementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants]. An Pediatr (Barc) 2019; 91:3-12. [PMID: 30262156 DOI: 10.1016/j.anpedi.2018.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs. METHODS We assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process. RESULTS Out of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days. CONCLUSIONS The NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs.
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Lacostena-Pérez ME, Buesa-Escar AM, Gil-Alós AM. Complications related to the insertion and maintenance of peripheral venous access central venous catheter. Enferm Intensiva (Engl Ed) 2018; 30:116-126. [PMID: 30190250 DOI: 10.1016/j.enfi.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/11/2018] [Accepted: 05/21/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the rates and nature of the complications related to the Central Peripheral Access Catheter (CVCAP or PICC) from its insertion to its withdrawal. METHODS Prospective observational study. All patients older than 14 years of age with a PICC inserted in the polyvalent intensive care unit (ICU) during the period between May 1, 2015 and April 30, 2016 were included. Data collected included: demographic data, insertion details, reason for insertion and removal, maintenance unit, total dwell time, incidence of complications and related factors and infection rate. RESULTS 144 PICCs were inserted, of which 94 corresponded to the ICU group (65.28%) and 50 (34.72%) to the non-ICU group. The most important complication was the suspicion of infection: 17.36% (rate of 15.2 per 1000 days of PICC). The total number of confirmed infections was 6.25% (5.5 per 1000 days of PICC), 1.39% (1.2 per 1000 days) being in the ICU group and 4.86% (4.2 per 1000 days) in the non-ICU group. There were 5 bacteraemias, all in the non-ICU group (3 per 1000 days). The most frequent germ was Staphylococcus epidermidis (6 cases). Phlebitis had an incidence of 9.03% (7.9 per 1000 days of PICC). CONCLUSIONS PICC, effective device for central venous access due to the minimal incidence of risks in implantation and to its advantages with regard to the classic central venous catheters, is a further nursing technique.
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Affiliation(s)
| | - A M Buesa-Escar
- Unidad de Cuidados Intensivos, Hospital General San Jorge, Huesca, España
| | - A M Gil-Alós
- Unidad de Cuidados Intensivos, Hospital General San Jorge, Huesca, España
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Martín-Pujol O, Tosco-Nuñez T, de Miguel-Martinez I. Comparison of three procedures for the rapid identification of bacteraemia-causing microorganisms. Evaluation of their effectiveness and applicability to microbiology laboratories. Enferm Infecc Microbiol Clin 2019; 37:319-23. [PMID: 30072283 DOI: 10.1016/j.eimc.2018.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/24/2018] [Accepted: 06/01/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Three procedures for rapid identification of microorganisms in positive blood cultures were evaluated. METHODS We performed two methods based on direct extraction from a blood culture: Sepsityper® (Bruker Daltonics) (ST) and a non-commercial saponin method (MCS), and another method consisting of a short incubation subculture (SIC). Identification values obtained by spectrometry Matrix-Assisted Laser Desorption Ionization-Time of Flight (EM MALDI-TOF) were compared by applying the manufacturer's interpretation criteria and corrected cut-off points. RESULTS According to the manufacturer, 65.8%, 45.8% and 57.4% of microorganisms were identified at the species level by using ST, MCS and SIC, respectively. When applying corrected cut-off points, the values increased to 92.3%, 80.6% and 85.2%, respectively. ST offered significantly better results than MCS, and no significant differences were found between ST and SIC, except for with respect to yeast. CONCLUSIONS Better identification rates were obtained by using ST and SIC, which are easily applicable in any laboratory.
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Ferré Losa C, Llopis Roca F, Jacob Rodríguez J, Cabello Zamora I, Martínez Muñoz C, Bardés Robles I. [Factors associated with emergency department revisits for acute bacterial prostatitis]. Emergencias 2018; 29:105-108. [PMID: 28825252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To analyze factors associated with revisits by patients with acute bacterial prostatitis treated in a hospital emergency department. MATERIAL AND METHODS Descriptive analysis and prospective follow-up of a cohort of patients with acute bacterial prostatitis treated in an emergency department. RESULTS We included 241 episodes of acute bacterial prostatitis. The mean (SD) age was 63 (16) years. Seventy-three percent reported dysuria, 64% had fever, and between 15.4% and 22.4% had medical histories of cancer, urethral/bladder catheterization, or prostate adenoma. Positive urine cultures were obtained for 48.1% and positive blood cultures for 17.6%. Escherichia coli was the bacterium isolated most often, and 27.7% of the cultures showed resistance to ciprofloxacin and amoxicillin-clavulanic acid. Twenty-nine patients (12%) revisited within 30 days. The only factors associated with revisiting were performance of a rectal examination (odds ratio [OR], 9.23; 95% CI, 1.12-75.82) and bacteremia (OR, 3.81; 95% CI, 1.31-11.04) (P<.05). CONCLUSION Factors associated with revisiting for acute bacterial prostatitis were bacteremia and performance of a rectal examination.
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Affiliation(s)
- Carles Ferré Losa
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Ferran Llopis Roca
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Javier Jacob Rodríguez
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Irene Cabello Zamora
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Concepción Martínez Muñoz
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Ignasi Bardés Robles
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitari de Bellvitge, IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
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Coronado-Álvarez NM, Parra D, Parra-Ruiz J. Clinical efficacy of fosfomycin combinations against a variety of gram-positive cocci. Enferm Infecc Microbiol Clin 2018; 37:4-10. [PMID: 29907368 DOI: 10.1016/j.eimc.2018.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Over recent years we have witnessed an increase in the resistance of microorganisms to the available antimicrobials and a decrease in the number of new antimicrobials. Fosfomycin is a safe and cheap broad-spectrum antibiotic which has shown very promising results in combination therapy, mainly against gram-negative microorganisms. Little is known, however, about its clinical efficacy against gram-positive microorganisms. METHODS We performed a retrospective review of all patients with severe gram-positive infections who received fosfomycin as part of their treatment from 2011 to 2017. We also performed in vitro time-kill assays to study the behaviour of fosfomycin with different antimicrobials against two strains of methicillin-resistant Staphylococcus aureus (MRSA) and two strains of methicillin-susceptible S. aureus (MSSA). RESULTS Seventy-five patients were treated with different fosfomycin combinations. Among them, 61 (81%) were successfully treated. Daptomycin plus fosfomycin was the most effective combination. Overall, the treatment with fosfomycin was safe, and side effects were minor. There was only one major side effect that resolved after discontinuation of therapy. Time-kill studies demonstrated increased activity of fosfomycin combinations, with daptomycin-fosfomycin being the most active combination against both MRSA and MSSA strains. CONCLUSIONS Our results suggest that antimicrobial combinations including fosfomycin are an alternative and effective approach for gram-positive infections.
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Affiliation(s)
- Nieves M Coronado-Álvarez
- Laboratorio de Investigación Anti Microbiana LIAM, Hospital Inmaculada, Grupo HLA SLU, Granada, Spain
| | - Diego Parra
- Instituto Universitario de Oncología del Principado de Asturias, Fundación Bancaria Caja de Ahorros de Asturias, Spain; Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Spain
| | - Jorge Parra-Ruiz
- Laboratorio de Investigación Anti Microbiana LIAM, Hospital Inmaculada, Grupo HLA SLU, Granada, Spain; Servicio de Medicina Interna, Hospital Inmaculada, Grupo HLA SLU, Granada, Spain.
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Callejas-Díaz A, Fernández-Pérez C, Ramos-Martínez A, Múñez-Rubio E, Sánchez-Romero I, Vargas Núñez JA. Impact of Pseudomonas aeruginosa bacteraemia in a tertiary hospital: Mortality and prognostic factors. Med Clin (Barc) 2018; 152:83-89. [PMID: 29885868 DOI: 10.1016/j.medcli.2018.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Pseudomonas aeruginosa bacteraemia is associated with a very high mortality, conditioned by comorbidity, source, severity of the episode and lack of adequate treatment. The aim of the study is to know the mortality and prognostic factors of bacteraemia by P.aeruginosa in our hospital. PATIENTS AND METHODS We conducted a retrospective study of P.aeruginosa bacteraemia detected between 2009 and 2014. Epidemiological, clinical and microbiological characteristics were described. A risk factor analysis for mortality was performed. RESULTS We analysed 110 episodes of bacteraemia, which was more frequent in men of advanced age and with a history of hospitalisation, comorbidity and immunosuppression. Most of the bacteraemias were secondary (mainly of respiratory or urinary source) and led to a significant clinical deterioration. The presence of antibiotic resistance was very high, with 27.3% of multiresistant strains. Empirical treatment was adequate in 60.0% and 92.3% for definite treatment. Overall mortality was 37.3% and attributable mortality was 29.1%. The most important prognostic factors were Charlson index ≥3, history of haematologic malignancy, neutropenia and previous use of corticosteroids, source of bacteraemia, Pitt index ≥4, renal insufficiency, adequate definite treatment, empiric treatment with piperacillin/tazobactam in severe episodes and focus control. CONCLUSION P.aeruginosa bacteraemia is associated with a very high mortality, possibly more related to previous comorbidity and severity of the episode than to the treatment chosen. However, the main goal in management remains to optimise treatment, including focus control.
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Affiliation(s)
- Alejandro Callejas-Díaz
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España; Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España.
| | | | - Antonio Ramos-Martínez
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España; Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Elena Múñez-Rubio
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España; Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
| | - Isabel Sánchez-Romero
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
| | - Juan Antonio Vargas Núñez
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
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López A, Varela JJ, Cid MM, Couñago M, Gago N. Hydroelectrolytic and infectious complications in one year of parenteral nutrition in critical care. ACTA ACUST UNITED AC 2018; 65:373-379. [PMID: 29680333 DOI: 10.1016/j.redar.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/13/2018] [Accepted: 03/04/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Parenteral nutrition consists of the intravenous administration of macronutrients, micronutrients and electrolytes. Our objectives were to evaluate the biochemical alterations during the first ten days of initiation and to quantify the bacteremia related to the central venous catheter during the administration of parenteral nutrition. MATERIAL AND METHODS Retrospective study of incidence and prevalence. We included 51 patients who started intravenous nutritional support therapy at Critical Care. We intend to know the infectious complications of the central line associated with parenteral nutrition, to evaluate the most frequent hydroelectrolytic complications of parenteral nutrition, and to identify minimum control points in the detection of hydroelectrolytic alterations. RESULTS Statistically significant daily variations were found for glucose, magnesium, potassium and creatinine, and bordering on the statistical significance for albumin and phosphate, the alterations occurring between the second and third days fundamentally. Hypoalbuminemia and hypocalcemia were very frequent. GGT was the liver enzyme that increased more frequently. The infection rate was 14.86 per 1,000 days of central venous catheter. CONCLUSIONS We found daily variations in glucose, potassium and magnesium, as well as a decrease in creatinine. We emphasize the frequency of hypoalbuminemia, hypocalcemia and elevation of GGT. The most important variations occurred between the second and third day, highlighting the precocity of potassium alteration and the peak of glycemia. The rate of infection related to the central venous catheter in patients with parenteral nutrition was high.
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Affiliation(s)
- A López
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur). SERGAS-UVigo, Vigo, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), Sergas, Ourense, España.
| | - J J Varela
- Servicio de Farmacia, Complexo Hospitalario Universitario de Ourense (CHUO), Sergas, Ourense, España
| | - M M Cid
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur). SERGAS-UVigo, Vigo, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), Sergas, Ourense, España
| | - M Couñago
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur). SERGAS-UVigo, Vigo, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), Sergas, Ourense, España
| | - N Gago
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur). SERGAS-UVigo, Vigo, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), Sergas, Ourense, España
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