Demora diagnóstica como principal factor contribuyente a un importante brote de tuberculosis en una universidad / Diagnostic delay as main contributing factor to a large outbreak of tuberculosis in a university

OBJETIVO: Describir las características epidemiológicas de un importante brote de tuberculosis en el ámbito universitario y los principales factores de riesgo asociados. MÉTODO: Se realizó un análisis descriptivo de los datos recogidos de las personas enfermas y de los contactos. Para el estudio de contactos se siguieron las pautas establecidas en el Programa de Tuberculosis de la Comunidad Autónoma del País Vasco. Seis de las cepas del brote fueron enviadas al Centro Nacional de Microbiología para su tipado molecular. RESULTADOS: El número total de casos del brote fue de 11. La tasa de infección tuberculosa en el aula del caso índice, incluidas las personas enfermas, fue del 88,1% (59 infectados y solo 8 no infectados). La demora diagnóstica del caso índice fue de 260 días, y en los otros 8 casos sintomáticos osciló entre 10 y 70 días. El patrón obtenido por las 2 técnicas de genotipado fue idéntico en las 6 cepas estudiadas. CONCLUSIONES: La gran demora diagnóstica del caso índice auténtico, que se diagnosticó en el estudio de contactos, y las malas condiciones de ventilación del aula determinaron el alto número de casos secundarios asociados a este brote

OBJECTIVE: To describe the epidemiological characteristics of a large tuberculosis outbreak in the university environment and the main risk factors associated with it. METHOD: A descriptive analysis of the data collected from sick individuals and their contacts was made. For the contact tracing, the guidelines established in the Tuberculosis Programme of the Autonomous Community of the Basque Country were followed. Six of the outbreak strains were sent to the National Centre of Microbiology for molecular typing. RESULTS: The total number of cases of the outbreak was 11. The rate of tuberculosis infection in the classroom of the index case, including the sick individuals, was 88.1% (59 infected and only 8 uninfected). The diagnostic delay of the index case was 260 days, and in the other 8 symptomatic cases it ranged between 10 and 70 days. The pattern obtained by the 2 genotyping techniques was identical in the 6 strains studied. CONCLUSIONS: The long diagnostic delay of the authentic index case, which was diagnosed in the contact tracing, and the poor ventilation conditions of the classroom, determined the high number of secondary cases associated with this outbreak

Diagnostic delay as main contributing factor to a large outbreak of tuberculosis in a university. / Demora diagnóstica como principal factor contribuyente a un importante brote de tuberculosis en una universidad.

OBJECTIVE: To describe the epidemiological characteristics of a large tuberculosis outbreak in the university environment and the main risk factors associated with it. METHOD: A descriptive analysis of the data collected from sick individuals and their contacts was made. For the contact tracing, the guidelines established in the Tuberculosis Programme of the Autonomous Community of the Basque Country were followed. Six of the outbreak strains were sent to the National Centre of Microbiology for molecular typing. RESULTS: The total number of cases of the outbreak was 11. The rate of tuberculosis infection in the classroom of the index case, including the sick individuals, was 88.1% (59 infected and only 8 uninfected). The diagnostic delay of the index case was 260 days, and in the other 8 symptomatic cases it ranged between 10 and 70 days. The pattern obtained by the 2genotyping techniques was identical in the 6 strains studied. CONCLUSIONS: The long diagnostic delay of the authentic index case, which was diagnosed in the contact tracing, and the poor ventilation conditions of the classroom, determined the high number of secondary cases associated with this outbreak.

Tratamiento inhalado con colistina a largo plazo en pacientes ancianos con infección crónica por Pseudomonas aeruginosa y bronquiectasias / Inhaled colistin in elderly patients with non-cystic fibrosis bronchiectasis and chronic Pseudomonas aeruginosa bronchial infection

Introducción: Las bronquiectasias son una causa frecuente de ingreso en ancianos. Aunque algunas guías recomiendan el uso de antibiótico inhalado a largo plazo en bronquiectasias sin fibrosis quística falta evidencia que avale el uso de estos tratamientos en esta población. El objetivo de nuestro trabajo es evaluar la efectividad y tolerancia del tratamiento inhalado con colistina a largo plazo en pacientes ancianos con bronquiectasias sin fibrosis quística e infección crónica por P aeruginosa para reducir las exacerbaciones graves que precisan ingreso. Material y métodos: Estudio cuasi experimental, prospectivo, controlado, abierto. Incluimos pacientes con bronquiectasias diagnosticadas por TAC y persistencia de Pseudomonas aeruginosa en esputo después de tratamiento apropiado. Todos los pacientes recibieron educación y fisioterapia respiratoria. El grupo de intervención recibió además colistina inhalada 1 millón UI dos veces al día. Se recogieron datos demográficos, características clínicas y funcionales, ingresos y visitas a urgencias en el año previo. Los pacientes fueron seguidos durante un año recogiendo cada 2 meses cultivo de esputo, datos clínicos funcionales, y uso de recursos sanitarios. Resultados: Se incluyeron 39 pacientes, 20 en el grupo con colistina y 19 en el grupo de tratamiento convencional. No hubo diferencias significativas entre los 2 grupos en las características basales. La edad media fue de 77,7 +/- 5, y el FEV1 41 %. Cinco pacientes (25 %) interrumpieron el tratamiento por efectos secundarios.Pseudomonas aeruginosa desapareció del esputo en 9 pacientes del grupo de tratamiento (45 %) y solo en uno del grupo control, con significación estadística, sin embargo, al final del año de estudio no hubo diferencias en el número de ingresos (grupo control 1,6 +/- 1,7 and 2,7 +/- 3 grupo con colistina) ni en días ingresados (19 +/- 31 and 23 +/- 20). Tampoco se detectaron diferencias entre los dos grupos en resultados funcionales o síntomas clínicos. No hubo cambios en la flora ni en la sensibilidad antibiótica. Conclusiones: El tratamiento inhalado con colistina a largo plazo en pacientes ancianos colonizados por Pseudomonashizo que disminuyera la presencia de Pseudomonas aeruginosa en esputo, pero esto no se tradujo en una disminución en el uso de recursos sanitarios, ni en mejoría clínica o funcional. Los efectos secundarios fueron frecuentes. Son necesarios más estudios para identificar subgrupos de pacientes que se beneficien de estos tratamientos a largo plazo (AU)

Background: Bronchiectasis is a frequent cause of admission for elderly patients and chronic respiratory diseases. Although some guidelines recommend long-term treatment with inhaled antibiotics in non-cystic fibrosis bronchiectasis with chronic Pseudomonas aeruginosa (P. aeruginosa) infection, there is limited evidence supporting these prolonged antibiotic treatments in this population. The aim of this study was to assess the effectiveness of inhaled colistin in elderly patients with bronchiectasis and chronic bronchial P. aeruginosainfection in reducing hospital readmissions. Material and methods: A prospective, controlled and open label study was conducted on patients with bronchiectasis diagnosed by computed tomography and persistence of P. aeruginosa in sputum after appropriate antimicrobial therapy. All patients received education, and physiotherapy training. The intervention group also received nebulized colistin 1 million IU twice a day for one year. Data were collected on the demographics, clinical and functional characteristics, admissions in previous year, and sputum microbiology. Patients were followed up every two months for one year, with readmissions, microbiological results, functional tests, and deaths being evaluated. Results: The study included 39 patients, of whom 20 received nebulized colistin and 19 conventional therapy. There were no differences between the two groups in baseline clinical and functional characteristics or previous hospital stay. The mean age was 77.7 +/- 5, Charlson index 2.85, and FEV1 % 41.3 +/- 15. Five patients (25 %) stopped the nebulized treatment because of adverse effects. P. aeruginosa was eradicated in 45 % of the colistin treated patients, and in only one of the control group (statistically significant), but at the end of the study year, there were no differences in the number of hospital admissions (control group 1.6 +/- 1.7 and 2.7 +/- 3 colistin group), or days of stay (19 +/- 31 and 23 +/- 20). There were no differences in lung function or clinical symptoms between the two groups No significant changes were observed in P. aeruginosa A antibiotic sensitivity or in sputum flora. Conclusions: More patients in the treatment group achieved Pseudomonas eradication, but benefits in clinical symptoms, lung function or use of healthcare resources in our elderly patients, could not be demonstrated. Adverse effects were common. Further studies are needed in order to identify factors associated with response, or subgroups of patients with bronchiectasis and chronic infection with P. aeruginosa, who benefit from (expensive) long term treatments with inhaled antibiotics (AU)

[Inhaled colistin in elderly patients with non-cystic fibrosis bronchiectasis and chronic Pseudomonas aeruginosa bronchial infection]. / Tratamiento inhalado con colistina a largo plazo en pacientes ancianos con infección crónica por Pseudomonas aeruginosa y bronquiectasias.

BACKGROUND: Bronchiectasis is a frequent cause of admission for elderly patients and chronic respiratory diseases. Although some guidelines recommend long-term treatment with inhaled antibiotics in non-cystic fibrosis bronchiectasis with chronic Pseudomonas aeruginosa (P. aeruginosa) infection, there is limited evidence supporting these prolonged antibiotic treatments in this population. The aim of this study was to assess the effectiveness of inhaled colistin in elderly patients with bronchiectasis and chronic bronchial P. aeruginosa infection in reducing hospital readmissions. MATERIAL AND METHODS: A prospective, controlled and open label study was conducted on patients with bronchiectasis diagnosed by computed tomography and persistence of P. aeruginosa in sputum after appropriate antimicrobial therapy. All patients received education, and physiotherapy training. The intervention group also received nebulized colistin 1 million IU twice a day for one year. Data were collected on the demographics, clinical and functional characteristics, admissions in previous year, and sputum microbiology. Patients were followed up every two months for one year, with readmissions, microbiological results, functional tests, and deaths being evaluated. RESULTS: The study included 39 patients, of whom 20 received nebulized colistin and 19 conventional therapy. There were no differences between the two groups in baseline clinical and functional characteristics or previous hospital stay. The mean age was 77.7+/-5, Charlson index 2.85, and FEV1% 41.3+/-15. Five patients (25%) stopped the nebulized treatment because of adverse effects. P. aeruginosa was eradicated in 45% of the colistin treated patients, and in only one of the control group (statistically significant), but at the end of the study year, there were no differences in the number of hospital admissions (control group 1.6+/-1.7 and 2.7+/-3 colistin group), or days of stay (19+/-31 and 23+/-20). There were no differences in lung function or clinical symptoms between the two groups No significant changes were observed in P. aeruginosa A antibiotic sensitivity or in sputum flora. CONCLUSIONS: More patients in the treatment group achieved Pseudomonas eradication, but benefits in clinical symptoms, lung function or use of healthcare resources in our elderly patients, could not be demonstrated. Adverse effects were common. Further studies are needed in order to identify factors associated with response, or subgroups of patients with bronchiectasis and chronic infection with P. aeruginosa, who benefit from (expensive) long term treatments with inhaled antibiotics.