Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008-2018): Epidemiology, Clinical Characteristics and Outcomes.

BACKGROUND: The epidemiology of community-acquired pneumonia (CAP) has changed, influenced by sociosanitary conditions and vaccination status. We aimed to analyze the recent epidemiology of bacterial CAP in hospitalized children in a setting with high pneumococcal vaccination coverage and to describe the clinical characteristics of pediatric Staphylococcus aureus CAP. METHODS: Children <17 years old hospitalized from 2008 to 2018 with bacterial CAP in 5 tertiary hospitals in Spain were included. Cases with pneumococcal CAP were randomly selected as comparative group following a case-control ratio of 2:1 with S. aureus CAP. RESULTS: A total of 313 bacterial CAP were diagnosed: Streptococcus pneumoniae CAP (n = 236, 75.4%), Streptococcus pyogenes CAP (n = 43, 13.7%) and S. aureus CAP (n = 34, 10.9%). Throughout the study period, the prevalence of S. pyogenes increased (annual percentage change: +16.1% [95% CI: 1.7-32.4], P = 0.031), S. pneumoniae decreased (annual percentage change: -4.4% [95 CI: -8.8 to 0.2], P = 0.057) and S. aureus remained stable. Nine isolates of S. aureus (26.5%) were methicillin-resistant. Seventeen cases (50%) with S. aureus CAP had some pulmonary complication and 21 (61.7%) required intensive care. S. pneumoniae CAP showed a trend toward higher prevalence of pulmonary complications compared with S. aureus CAP (69.1% vs. 50.0%, P = 0.060), including higher frequency of pulmonary necrosis (32.4% vs. 5.9%, P = 0.003). CONCLUSIONS: The incidence of S. aureus CAP in children remained stable, whereas the prevalence of pneumococcal CAP decreased and S. pyogenes CAP increased. Patients with S. aureus presented a high frequency of severe outcomes, but a lower risk of pulmonary complications than patients with S. pneumoniae.

Oral care in a neonatal intensive care unit.

OBJECTIVE: Compare the oral colonization profile of premature infants admitted at NICU before and after doing oral care routine with sterile water versus no intervention. METHODS: It was a randomized clinical trial composed of 37 premature infants admitted at the Neonatal Intensive Care Unit (NICU) with a birth weight (BW) <1500 g. They were distributed in two groups: the study group (SG) with 15 patients who received an oral hygiene with sterile water; and a control group (CG) (no intervention) formed by 22 patients. Primary outcome was oral colonization profile before and after doing oral care. RESULT: In the study group, the number of patients colonized by the Gram-positive bacteria at the beginning of the study was 53% versus 40% at the end (p=0.10). For Gram negative, 40% at the study's beginning versus 60% at the end (p=0.18). In the control group, the number of colonized patients for the Gram-positive bacteria at the onset of the study was 54.5% versus 32% patients at the end (p=0.24). For Gram negative, 32% patients at the start of the study versus 77% at the end (p = 0.003). CONCLUSION: There is a significant increase of the Gram-negative flora in those patients without oral care.

Infecciones neonatales por Staphylococcus aureus de inicio en la comunidad / Community-onset Staphylococcus aureus infection in neonates

Introducción Staphylococcus aureus es una causa importante de infecciones neonatales de inicio en la comunidad. En los últimos años se ha notificado en Estados Unidos la emergencia de infecciones por cepas resistentes a la meticilina en este grupo de edad, aunque existen pocos estudios en España. El objetivo de este estudio es describir las características epidemiológicas, clínicas y microbiológicas de las infecciones por S. aureus de inicio en la comunidad en neonatos. Métodos Estudio prospectivo de las infecciones neonatales por S. aureus de inicio en la comunidad realizado durante 3 años (2007-2009) en el Servicio de Urgencias Pediátricas del Hospital 12 de Octubre de Madrid (España).Resultado sSe registraron 30 casos de los que solo un aislado (3,3%) fue resistente a la meticilina y 2 (6,7%) fueron LPV(+).Conclusiones A pesar de la emergencia de SARM y/o productor de LPV fuera del ambiente hospitalario en población pediátrica en España, dichas infecciones son todavía poco frecuentes en neonatos (AU)

Introduction Staphylococcus aureus is a major cause of neonatal community-onset infections. The emergence of methicillin-resistant S. aureus infections in this age group has been reported in USA in the last few years; however there are no studies in Spain. The aim of this study is to describe the epidemiological, clinical and microbiological characteristics of S. aureus community-onset infections in neonates. Methods We prospectively reviewed the S. aureus infections in neonates over a three year period (2007-2009) in the Pediatric Emergency Department of Hospital 12 de Octubre in Madrid (Spain).ResultsWe recorded 30 cases of neonatal S. aureus community-onset infections. Only one isolated (3.3%) was resistant to methicillin, and two (6.7%) were PVL(+).Conclusions Despite the emergence of MRSA outside the hospital in pediatric population in Spain, CA-MRSA and SA PVL(+) infections are not frequent in neonates (AU)

Determination of Dornic acidity as a method to select donor milk in a milk bank.

BACKGROUND: Dornic acidity may be an indirect measurement of milk's bacteria content and its quality. There are no uniform criteria among different human milk banks on milk acceptance criteria. The main aim of this study is to report the correlation between Dornic acidity and bacterial growth in donor milk in order to validate the Dornic acidity value as an adequate method to select milk prior to its pasteurization. MATERIALS AND METHODS: From 105 pools, 4-mL samples of human milk were collected. Dornic acidity measurement and culture in blood and McConkey's agar cultures were performed. Based on Dornic acidity degrees, we classified milk into three quality categories: top quality (acidity <4°D), intermediate (acidity between 4°D and 7°D), and milk unsuitable to be consumed (acidity ≥ 8°D). Spearman's correlation coefficient was used to perform statistical analysis. RESULTS: Seventy percent of the samples had Dornic acidity under 4°D, and 88% had a value under 8°D. A weak positive correlation was observed between the bacterial growth in milk and Dornic acidity. The overall discrimination performance of Dornic acidity was higher for predicting growth of Gram-negative organisms. In milk with Dornic acidity of ≥ 4°D, such a measurement has a sensitivity of 100% for detecting all the samples with bacterial growth with Gram-negative bacteria of over 10(5) colony-forming units/mL. CONCLUSIONS: The correlation between Dornic acidity and bacterial growth in donor milk is weak but positive. The measurement of Dornic acidity could be considered as a simple and economical method to select milk to pasteurize in a human milk bank based in quality and safety criteria.

Algorithm proposal based on the C. Diff Quik Chek Complete ICT device for detecting Clostridium difficile infection

Objective: To assess a new immunochromatography (ICT) test that detects glutamate dehydrogenase (GDH) antigen and Clostridium difficile toxin A/B simultaneously, and to propose an algorithm for the diagnosis of C. difficile infection (CDI) based on this test. Methods We analysed 970 stool samples. Discrepant results between GDH and toxin A/B were resolved using toxigenic culture as the reference. Results This test enabled us to obtain a conclusive result in <30min in 93.8% of the samples. Among the discrepant results (GDH (+)/Toxin A/B (-)), 41.7% (25/60) were found to be toxigenic C. difficile by toxigenic culture. Conclusion This test has a high sensitivity and specificity for the diagnosis of CDI (AU)

Objetivo: Evaluar una nueva prueba inmunocromatográfica que detecta el antígeno glutamato deshidrogenasa (GDH) y la toxina A/B de Clostridium difficile simultáneamente y proponer un algoritmo para el diagnóstico de infección por C. difficile (ICD) basado en esta prueba. Métodos: Se analizaron 970 muestras. Las discrepancias entre GDH y toxina A/B se resolvieron utilizando el cultivo toxigénico como método de referencia. Resultados: Esta prueba permitió obtener el resultado del 93,8% de las muestras en < 30 minutos. El 41,7%(25/60) de las muestras discrepantes (GDH (+)/Toxina A/B (-)) fueron C. difficile toxigénicos, mediante cultivo toxigénico. Conclusión: Esta prueba es sensible y específica para el diagnóstico de ICD (AU)

[Community-onset Staphylococcus aureus infection in neonates]. / Infecciones neonatales por Staphylococcus aureus de inicio en la comunidad.

INTRODUCTION: Staphylococcus aureus is a major cause of neonatal community-onset infections. The emergence of methicillin-resistant S. aureus infections in this age group has been reported in USA in the last few years; however there are no studies in Spain. The aim of this study is to describe the epidemiological, clinical and microbiological characteristics of S. aureus community-onset infections in neonates. METHODS: We prospectively reviewed the S. aureus infections in neonates over a three year period (2007-2009) in the Pediatric Emergency Department of Hospital 12 de Octubre in Madrid (Spain). RESULTS: We recorded 30 cases of neonatal S. aureus community-onset infections. Only one isolated (3.3%) was resistant to methicillin, and two (6.7%) were PVL(+). CONCLUSIONS: Despite the emergence of MRSA outside the hospital in pediatric population in Spain, CA-MRSA and SA PVL(+) infections are not frequent in neonates.

Algorithm proposal based on the C. Diff Quik Chek Complete ICT device for detecting Clostridium difficile infection.

OBJECTIVE: To assess a new immunochromatography (ICT) test that detects glutamate dehydrogenase (GDH) antigen and Clostridium difficile toxin A/B simultaneously, and to propose an algorithm for the diagnosis of C. difficile infection (CDI) based on this test. METHODS: We analysed 970 stool samples. Discrepant results between GDH and toxin A/B were resolved using toxigenic culture as the reference. RESULTS: This test enabled us to obtain a conclusive result in <30min in 93.8% of the samples. Among the discrepant results (GDH (+)/Toxin A/B (-)), 41.7% (25/60) were found to be toxigenic C. difficile by toxigenic culture. CONCLUSION: This test has a high sensitivity and specificity for the diagnosis of CDI.

Epidemiología de las infecciones por grampositivos multirresistentes / Epidemiology of multiresistant Gram-positive infections

Durante estos últimos años hemos asistido a unincremento significativo de la resistencia de losmicroorganismos grampositivos, con un impactoepidemiológico y clínico importante en la práctica diaria. Mientras que en los hospitales españoles la prevalencia de Staphylococcus aureus resistente a la meticilina (SARM) se mantiene en unos valores elevados (alrededor del 25%), en la comunidad están emergiendo nuevas cepas de SARM en pacientes sin factores de riesgo, a menudo productoras de toxinas como la leucocidina de Panton- Valentine. Por otra parte, los estafilococos coagulasanegativos (ECN) están implicados en una gran variedad de infecciones hospitalarias y su resistencia a los antimicrobianos es globalmente superior (p. ej., > 60% a la meticilina) y de más rápida adquisición, en general, que la de S. aureus. Destaca un tercer grupo de microorganismos, Enterococcus sp., por el incremento significativo de la resistencia a ampicilina en E. faecium (el 75% en 2006), y por la emergencia de resistencia a la vancomicina, principalmente en E. faecium (el 3,9% en 2006). Los estudios revisados en este artículo muestranlos cambios epidemiológicos experimentadosrecientemente y la emergencia y diseminación de cepasmultirresistentes. Esta diseminación se está produciendodentro de los hospitales, entre hospitales y centrossociosanitarios, dentro la propia comunidad, e inclusoentre países y continentes. Por otra parte, la existencia de un reservorio nosocomial de genes de resistencia, en algunos casos potencialmente transmisibles mediante transferencia horizontal, puede contribuir a agravar el problema de la resistencia y a restringir las opciones terapéuticas

In the last few years, there has been a significant increase in resistance among Gram-positive microorganisms, with a marked epidemiological and clinical impact in daily clinical practice. While the prevalence of methicillinresistant Staphylococcus aureus (MRSA) in Spanish hospitals remains high (approximately 25%), in the community new MRSA strains are emerging in patients without risk factors, often producing toxins such as Panton-Valentine leucocidin. In addition, coagulasenegative staphylococci (CNS) are involved in a wide variety of hospital infections and their resistance to antimicrobial agents is higher (e.g. > 60% to methicillin) and more rapidly acquired, in general, than that of S. aureus. The third group of microorganisms, Enterococcus sp. are notable for the significant increase in ampicillin resistance in E. faecium (75% in 2006), and for the emergence of vancomycin resistance, mainly in E. faecium (3.9% in 2006). The studies reviewed in the present article show the recent epidemiological changes that have takenplace and the emergence and dissemination ofmultiresistant strains. This dissemination is beingproduced within hospitals, among hospitals and nursinghomes, within the community, and even among countriesand continents. Moreover, the existence of a nosocomialreservoir of resistance genes, in some cases potentiallytransmissible through horizontal transfer, could contribute to exacerbating the problem of resistance and to restricting therapeutic options

Epidemiología de las infecciones por grampositivos multirresistentes / Epidemiology of multiresistant Gram-positive infections

Durante estos últimos años hemos asistido a unincremento significativo de la resistencia de losmicroorganismos grampositivos, con un impactoepidemiológico y clínico importante en la práctica diaria.Mientras que en los hospitales españoles la prevalencia deStaphylococcus aureus resistente a la meticilina (SARM)se mantiene en unos valores elevados (alrededor del 25%),en la comunidad están emergiendo nuevas cepas deSARM en pacientes sin factores de riesgo, a menudoproductoras de toxinas como la leucocidina de Panton-Valentine. Por otra parte, los estafilococos coagulasanegativos(ECN) están implicados en una gran variedad deinfecciones hospitalarias y su resistencia a losantimicrobianos es globalmente superior (p. ej., > 60% a lameticilina) y de más rápida adquisición, en general, que lade S. aureus. Destaca un tercer grupo demicroorganismos, Enterococcus sp., por el incrementosignificativo de la resistencia a ampicilina en E. faecium (el75% en 2006), y por la emergencia de resistencia a lavancomicina, principalmente en E. faecium (el 3,9% en2006). Los estudios revisados en este artículo muestranlos cambios epidemiológicos experimentadosrecientemente y la emergencia y diseminación de cepasmultirresistentes. Esta diseminación se está produciendodentro de los hospitales, entre hospitales y centrossociosanitarios, dentro la propia comunidad, e inclusoentre países y continentes. Por otra parte, la existencia deun reservorio nosocomial de genes de resistencia, enalgunos casos potencialmente transmisibles mediantetransferencia horizontal, puede contribuir a agravar elproblema de la resistencia y a restringir las opciones terapéuticas(AU)

In the last few years, there has been a significant increasein resistance among Gram-positive microorganisms, witha marked epidemiological and clinical impact in dailyclinical practice. While the prevalence of methicillinresistantStaphylococcus aureus (MRSA) in Spanishhospitals remains high (approximately 25%), in thecommunity new MRSA strains are emerging in patientswithout risk factors, often producing toxins such asPanton-Valentine leucocidin. In addition, coagulasenegativestaphylococci (CNS) are involved in a widevariety of hospital infections and their resistance toantimicrobial agents is higher (e.g. > 60% to methicillin)and more rapidly acquired, in general, than that of S.aureus. The third group of microorganisms, Enterococcussp. are notable for the significant increase in ampicillinresistance in E. faecium (75% in 2006), and for theemergence of vancomycin resistance, mainly in E. faecium(3.9% in 2006). The studies reviewed in the present articleshow the recent epidemiological changes that have takenplace and the emergence and dissemination ofmultiresistant strains. This dissemination is beingproduced within hospitals, among hospitals and nursinghomes, within the community, and even among countriesand continents. Moreover, the existence of a nosocomialreservoir of resistance genes, in some cases potentiallytransmissible through horizontal transfer, could contributeto exacerbating the problem of resistance and torestricting therapeutic options(AU)

[Patterns of tuberculosis transmission in a health area of Madrid]. / Patrones de transmisión de la tuberculosis en un área sanitaria de Madrid.

BACKGROUND: Employing molecular epidemiology techniques for the study of tuberculosis can afford the possibility of identifying tuberculosis transmission patterns. This study has been made for the purpose of estimating the incidence of tuberculosis related to recent transmission in Madrid and of identifying the risk factors making it possible to define transmission patterns. METHODS: A three-year descriptive populational study was conducted on patients diagnosed with tuberculosis based on cultures in four districts in Madrid (550,442 inhabitants). The transmission patterns were described by means of conventional epidemiological research and molecular techniques (Restriction Fragment Length Polymorphism--RFLP--analysis with IS6110 and spoligotyping). RESULTS: An RFLP analysis was conducted on 233 clinically isolated Mycobacterium tuberculosis strains, 99 (42.5%) of which were grouped into 29 clusters. The most numerous group was comprised of 134 patients infected with M. tuberculosis strains of a single RFLP pattern. These patients averaged 48.3 years of age (DE 19.4), and 17.2% were revealed to have an endogenous risk factor. Two transmission patterns were identified among the grouped cases. The first pattern included 57 patients pertaining to 23 small clusters (2-4 cases), 25 (43.9%) of which were epidemiologically linked to another case from the same cluster. The second pattern was comprised of 42 patients grouped into 6 large clusters (5 cases or more). The subjects averaged 31.4 years of age (DE 15.8), 28.6% being intravenous drug users, 31% infected with HIV, and 26.2% having a prison background. CONCLUSIONS: Identifying tuberculosis transmission patterns by using molecular biology techniques affords the possibility of detecting population groups for whom preferential measures can be taken in the prevention and control programs.

Patrones de transmisión de la tuberculosis en un área sanitaria de Madrid / Patterns of tuberculosis transmission in a health area in Madrid, Spain

Fundamento: La aplicación de las técnicas de epidemiología molecular en el estudio de la tuberculosis puede permitir identificar los patrones de transmisión de la enfermedad. El objetivo de este estudio ha sido estimar la incidencia de tuberculosis asociada a transmisión reciente en Madrid e identificar los factores de riesgo que permitan definir patrones de transmisión. Métodos: Se realizó un estudio descriptivo poblacional de tres años de duración en pacientes diagnosticados de tuberculosis mediante cultivo en cuatro distritos de Madrid (550.442 habitantes).La descripción de los patrones de transmisión se realizó mediante la investigación epidemiológica convencional y las técnicas moleculares (análisis de fragmentos de restricción de longitud polimórfica -RFLP- con IS6110 y spoligotyping). Resultados: Se realizó RFLP en 233 aislados clínicos de Mycobacterium tuberculosis, de los que 99 (42,5 por ciento) estaban agrupados en 29 clusters. El grupo más numeroso lo formaban 134 enfermos infectados por cepas de M. tuberculosis con patrón RFLP único. Su media de edad era 48,3 años (DE 19,4) y el 17,2 por ciento presentaba un factor de riesgo de reactivación endógena. Entre los casos agrupados se identificaron dos patrones de transmisión. El primero de ellos incluía a 57 enfermos pertenecientes a 23 clusters pequeños (2-4 casos), de los que 25 (43,9 por ciento) estaban conectados epidemiológicamente con otro caso de su mismo cluster. El segundo lo formaban 42 pacientes agrupados en 6 clusters grandes (5 casos o más). La media de edad era de 31,4 años (DE 15,8), el 28,6 por ciento eran usuarios de drogas inyectadas, el 31 por ciento estaban infectados por el VIH, y el 26,2 por ciento tenían antecedentes de estancia en prisión. Conclusiones: La identificación de patrones de transmisión de la tuberculosis utilizando técnicas de biología molecular permite detectar grupos de población susceptibles de actuación preferente en los programas de prevención y control (AU)

Transmisión reciente de la tuberculosis en Madrid: utilidad de las técnicas moleculares / Recent transmission of tuberculosis in Madrid (Spain): usefulness of molecular techniques

Fundamento: En las zonas desfavorecidas de las grandes ciudades la incidencia de tuberculosis puede deberse en gran medida a la transmisión reciente de Mycobacterium tuberculosis. Pacientes y métodos: Estudio poblacional prospectivo de los pacientes diagnosticados de tuberculosis mediante cultivo en tres distritos urbanos de Madrid (población: 455.050 habitantes), en 1997 y 1998. Se cumplimentó un protocolo clinicoepidemiológico en todos los pacientes. Se incluyeron en agrupaciones los pacientes cuyos aislados tenían: a) idéntico patrón RFLP (fragmentos de restricción de longitud polimórfica) con 6 o más bandas de IS6110, o b) idéntico patrón RFLP con ó 5 bandas e idéntico patrón con la técnica de spoligotyping. Resultados: De los 207 pacientes con cultivo positivo para Mycobacterium tuberculosis se realizó RFLP a 148 (71,5 por ciento). Se identificaron 18 agrupaciones que incluían a 62 de los 148 pacientes (41,9 por ciento). Las agrupaciones contenían entre 2 y 12 casos. Los factores de riesgo asociados a la pertenencia a las distintas agrupaciones fueron la edad < 35 años (odds ratio [OR] = 4,1, intervalo de confianza [IC] del 95 por ciento: 1,9-8,9), el uso de drogas inyectadas (OR = 4,7, IC del 95 por ciento: 1,6-14,8), la infección por el VIH (OR = 2,7, IC: del 95 por ciento: 1,1-6,8) y la estancia previa en prisión (OR = 2,9, IC del 95 por ciento: 1,2-7,2). La investigación epidemiológica confirmó la transmisión reciente de la enfermedad en el 27 por ciento de los casos agrupados. Conclusiones: Una elevada proporción de los casos de tuberculosis diagnosticados en personas residentes en el sur de la ciudad de Madrid son resultado de transmisión reciente de la enfermedad. La investigación epidemiológica y molecular realizadas conjuntamente aportan información valiosa para el control de la enfermedad (AU)