[Pneumonia in patients with SARS-CoV-2 infection: series of 17 cases in the region of Murcia]. / Neumonía neumocócica en pacientes con infección por SARS-CoV-2: serie de 17 casos en la Región de Murcia.

OBJECTIVE: Currently the prevalence of pneumococcal coinfection in patients with COVID-19 is unknown. In this work we present its clinical characteristics, evolution and treatment. METHODS: Retrospective data collection from August to October 2020 in two hospitals in the Murcia region. RESULTS: Eighteen patients had COVID-19 diagnosed by PCR and pneumococcal infection confirmed by antigenuria, which represented a prevalence of 2%. A total of 88% had radiological alterations upon admission (two patients had an X-ray within normality) and 29% had elevated procalcitonin. Mortality in our series was 12%. CONCLUSIONS: It could be reasonable to consider the start of antimicrobial therapy in those cases in which there is a moderate or high suspicion of bacterial coinfection, being essential the early suspension of antibiotic treatment if it is not confirmed.

Risk factors for methicillin-resistant Staphylococcus aureus and extended-spectrum ß-lactamase producing Enterobacterales in patients with diabetic foot infections requiring hospital admission.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum ß-lactamase-producing Enterobacterales (ESBL-E) may complicate the treatment of diabetic foot infections (DFIs). The aim of this study was to determine the risk factors for these pathogens in DFIs. METHODS: This was a prospective observational study of 167 consecutive adult patients with DFIs. The diagnosis and severity of DFIs were based on the Infectious Disease Society of America (IDSA) classification system. Multivariate analyses were performed in order to identify risk factors for MRSA and ESBL-E infections. RESULTS: S. aureus was the most isolated pathogen (n=82, 37.9 %) followed by Escherichia coli (n= 40, 18.5%). MRSA accounted for 57.3% of all S. aureus and 70% of Klebsiella pneumoniae and 25% of E. coli were ESBL producers, respectively. Deep ulcer [OR 8,563; 95% CI (1,068-4,727)], previous use of fluoroquinolones [OR 2,78; 95% CI (1,156-6,685)] and peripheral vasculopathy [OR 2,47; 95% CI (1.068-4.727)] were the independent predictors for MRSA infections; and osteomyelitis [OR 6,351; 95% CI (1,609-25,068)] and previous use of cephalosporins [OR 5,824; 95% CI (1,517-22,361)] for ESBL-E infections. CONCLUSIONS: MRSA and ESBL-E have adquired a great clinical relevance in DFIs. The availability of their risk factors is very convenient to choose the empirical treatment in severe forms.

Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum ß-lactamase-producing Enterobacteriaceae.

PURPOSE: There are few data in the literature regarding sepsis or septic shock due to extended-spectrum ß-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septic patients with bloodstream infection (BSI) caused by ESBL-E. METHODS: Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts. RESULTS: 367 septic patients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. ß-lactam/ß-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy. CONCLUSIONS: BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome.

[Influence of initial protocolized treatment with steroids in length of stay and costs of community acquired pneumonia]. / Influencia de la protocolización del tratamiento inicial con corticoides en la estancia y costo de las neumonías adquiridas en la comunidad. Estudio prospectivo 2015.

OBJECTIVE: The aim of the study was to analyze the impact of steroid treatment in patients with community acquired pneumonia (CAP), both in length of stay and economical cost of admission at a clinical university hospital. METHODS: Prospective study of admitted patients with the diagnosis of CAP, both in Internal Medicine and Infectious diseases department. The study was conducted from January to march 2015; patients receiving steroids from diagnosis to end of antibiotic treatment were classified as group I; otherwise, they were considered in group II. Administration of steroids was done according to the criteria of the responsible. Cost was stablished according to CAP Diagnostic Related Group (DRG). RESULTS: Prevalence of patients younger than 65 year-old was higher in group I (p<0.05). In bivariate analyses, mean admission time was lower in group I (5.37 vs 8.88 days) (p<0.0005) and also economical cost (2,361 euros vs 3,907 euros) (p<0.0005). In multivariate analysis, factors independently associated to higher cost (>3,520 euros) were COPD (OR=2.602; 95% CI 1.074-6.305) and group II (patients with no steroids) (OR=6.2; p=0,007). CONCLUSIONS: No administration of steroids in patients with CAP was associated, together with COPD, with higher economical cost (evaluated by DRG/length of stay).

[Design and implementation of an outpatient parenteral antimicrobial therapy program in primary care: the experience at a second level hospital]. / Design and implementation of an outpatient parenteral antimicrobial therapy program in primary care: the experience at a second level hospital.

OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality. METHODS: Prospective study cohorts of patients admitted to the OPAT programme, from 1 January 2012 to 31 May 2015. RESULTS: During the period of study a total of 98 episodes were recorded. The average age of the cohort was 66 years. The most frequent comorbidity was immunosuppression (33.67 %), with an overall average of Charlson index of 5.21 ± 3.09. The most common source of infection was respiratory (33.67 %). Microbiological isolation was achieved in fifty-eight patients (59.18 %) being Escherichia coli the most frequently isolated (25%). The average number of days of antibiotics administration at home was 10.42 ± 6.02 (SD), being carbapenems (43.48%) the more administered. Eighty-six patients (87.75%) completed the treatment successfully. Thirty-two patients (32.65%) were readmitted within 30 days after being discharged and seven patients (7.14%) died. A statistically significant association was only found in the readmission with variables: elderly patients (p=0.03), being carriers of Porth-a-Cath (p=0.04) and treatment termination related with infection (p<0.05). CONCLUSIONS: This is the first programme of OPAT administration not dependent on Home Hospitalization Service in Spain, which could allow to optimize the hospital and primary care resources available. Nevertheless this pilot study results are poor in terms of optimization of antibiotics choice, transition to oral administration, de-escalation and duration.

[Coagulase-negative Staphylococcus bacteraemia: prognosis factors and influence of antibiotic treatment]. / Bacteriemias por Staphylococcus coagulasa negativa: análisis de factores pronóstico e influencia del tratamiento antibiótico.

INTRODUCTION: Coagulase-negative staphylococci (CNS) are the most frequent isolated microorganism in blood cultures; mortality has been associated to severity and to adequacy of empirical treatment but the relevance of the latter is not clearly recognised. The aims of the study were to analyze clinical and microbiological factors related to mortality in patients with CNS bacteraemia and the influence of empirical treatment in prognosis. PATIENTS AND METHODS: A prospective cohort study of patients with CNS bacteraemia was performed (January to June 2010) at a university-affiliated hospital; a determination of clinical significance was made and true bacteraemia was defined according to CDC criteria. We analysed epidemiological, clinical and microbiological variables related to mortality. RESULTS: A total of 269 cases were included (97 were considered true bacteraemia); 92% survived and mortality was 8% (1.6% CNS bacteraemia related mortality). Staphylococcus epidermidis was the most frequent isolated species; 93 patients were included in the related mortality study of patients with true bacteraemia. Factors associated to mortality in the bivariate analysis (p<0.05) were: Winton score I-III, presence of pacemakers, sepsis or infective endocarditis and persistent bacteraemia. Adequate empirical treatment was not associated to survival. CONCLUSIONS: Severity at onset, the development of septic complications and having a pacemaker are associated to mortality in patients with CNS bacteraemia; in our cohort, inadequate empirical treatment is not related to mortality.

[Effect of body mass index on PSA in northeast Mexican patients]. / Efecto del índice de masa corporal en los niveles séricos del antígeno prostático específico en pacientes del Noreste de México.

OBJECTIVE: To evaluate the effect of body mass index (BMI) on PSA in northeast Mexican patients included in prostate cancer (Pca) early detection screening campaigns offered by our institution. MATERIAL AND METHODS: One hundred and ninety seven patients came voluntarily to our Pca early detection screening campaigns. EXCLUSION CRITERIA: PSA >10 ng/dl, patients on 5-α Reductase inhibitors or hormonal replacement. Overweight and obesity were considered when BMI was between 25-29.9 and ≥30 kg/m(2) respectively. Simple linear and multiple regression were used in the statistical analysis. Mean and standard deviation were utilized to evaluate spread and normal distribution. P values <0.05 were considered statistically significant. RESULTS: One hundred and fifty two patients were included in this study. Forty four percent (83) and 30.3%(46) presented with overweight and obesity, respectively. Mean BMI was 28.16 kg/m(2) (SD 1.77). A statistically significant negative effect of BMI on PSA was observed in the linear regression. This effect persisted when adjusted for age in the multiple regression model. A decrease of 0.085 ng/dl for every unit of BMI (p <0.001) was observed in the simple linear regression. This value was 0.07 in the multiple regression (p=0.006) CONCLUSIONS: A higher negative effect of BMI on PSA was found in comparison to published literature. A higher proportion of patients with BMI >25 kg/m(2) than the national mean was observed. A multicentric national study is needed in order to challenge these results.

Linezolid plus rifampin as a salvage therapy in prosthetic joint infections treated without removing the implant.

The aim of this study is to describe our experience with linezolid plus rifampin as a salvage therapy in prosthetic joint infections (PJIs) when other antibiotic regimens failed or were not tolerated. A total of 161 patients with a documented prosthetic joint infection were diagnosed with a PJI and prospectively followed up from January 2000 to April 2007. Clinical characteristics, inflammatory markers, microbiological and radiological data, and antibiotic treatment were recorded. After a 2-year follow-up, patients were classified as cured when the prosthesis was not removed, symptoms of infection disappeared, and inflammatory parameters were within the normal range. Any other outcome was considered a failure. The mean age of the entire cohort (n = 161) was 67 years. Ninety-five episodes were on a knee prosthesis (59%), and 66 were on a hip prosthesis (41%). A total of 49 patients received linezolid plus rifampin: 45 due to failure of the previous antibiotic regimen and 4 due to an adverse event associated with the prior antibiotics. In no case was the implant removed. The mean (standard deviation) duration of treatment was 80.2 (29.7) days. The success rate after 24 months of follow-up was 69.4% (34/49 patients). Three patients developed thrombocytopenia and 3 developed anemia; however, it was not necessary to stop linezolid. Linezolid plus rifampin is an alternative salvage therapy when the implant is not removed.

Acinetobacter baumanii multirresistente: situación clínica actual y nuevas perspectivas / Multidrug resistant Acinetobacter baumanii: clinical update and new highlights

Acinetobacter baumanii multirresistente ha pasado en losúltimos años de ser considerado un microorganismo de pocarelevancia clínica a convertirse en un patógeno cada vez másfrecuente en pacientes hospitalizados, constituyendo un verdaderoparadigma de las infecciones nosocomiales multirresistentes.Afecta fundamentalmente a pacientes con enfermedadessubyacentes graves, sometidos a cirugía, distintos tipos demanipulaciones, procedimientos invasivos, uso previo de antibióticosde amplio espectro e ingresos prolongados, incluyendoestancia en Unidades de Cuidados Intensivos/Reanimación.La multirresistencia extendida a carbapenemes (MDR-C)probablemente se asocie con una mayor gravedad clínica deestas infecciones y un mayor número de complicaciones, conuna mortalidad global en nuestro estudio del 49,3% y unamortalidad atribuible (en las primeras 72 horas tras el aislamiento)del 10,39%. El hecho de que el resto de fallecimientosse produzca a partir del séptimo día, nos lleva a plantearnos sies la propia infección por A. baumanii multirresistente con resistenciaextendida a carbapenemes la causante de la mortalidad,o ésta es debida más bien a la presencia de enfermedadsubyacente o a la aparición de complicaciones. Sin embargo,en nuestra experiencia, el tratamiento antibiótico inadecuadoy el tratamiento en monoterapia se asocian con una mayormortalidad. Es necesario llevar a cabo estudios prospectivosque contribuyan a determinar cual es el tratamiento más adecuadode los pacientes graves con sospecha de infección por A.baumanii MDR-C(AU)

The role of multidrug resistant Acinetobacter baumaniiand its clinical relevance have been recently appreciatedas a ubiquitous opportunistic nosocomial pathogen.Risk factors associated with A. baumanii infectioninclude severe underlying diseases, previous surgery, invasiveprocedures, treatment with broad-spectrum antibiotics,length of hospital stay, admission to intensivecare units (ICU).Carbapenem-multidrug resistant A. baumanii infectionsare probably associated to greater severity and morecomplications; in our cohort mortality was 49.3% andrelated mortality (within 72 hours) was 10.39%. However,severe underlying diseases probably play an importantrole in the clinical outcome of patients with MDR-CA. baumanii infection and controversy exists regardingthe real mortality attributable to antimicrobial resistancebecause a high proportion of deaths took place > 7 daysafter diagnosis. Nevertheless, in our experience, carbapenemresistance, inappropriate therapy and monotherapyare associated to a higher mortality. Special attentionshould be paid to design well-controlled prospective clinicaltrials to determine the optimal antimicrobial therapyin critically ill patients suspected of having MDRAcinetobacter infection(AU)

Duración mínima del tratamiento balneario con aguas bicarbonatadas sulfatadas para conseguir un efecto antioxidante en personas mayores de 65 años / Minimum duration of spa treatment with bicarbonated-sulfated waters to obtain an antioxidant effect in persons aged more than 65 years

Introducción: desde que se utilizan los tratamientos balnearios, siempre ha habido la duda sobre el tiempo mínimo necesario para que dicho tratamiento fuera eficaz y efectivo. Forma parte de la tradición balnearia realizar la llamada "la novena", que se corresponde con la duración mínima de 9 días continuados de tratamiento y estancia balnearia para conseguir los efectos beneficiosos de la cura balnearia, hechos que han sido observados durante años. Objetivo: estudiar y evaluar el tiempo mínimo de tratamiento cenoterápico con aguas bicarbonatadas sulfatadas necesario para obtener una disminución estadísticamente significativa de la eliminación de sustancias reactivas al ácido tiobarbitúrico (TBARS) en una población balnearia mayor de 65 años. Pacientes y método: estudio clínico prospectivo realizado en el balneario de aguas bicarbonatadas sulfatadas de Jaraba-Sicilia (Zaragoza) en 3 estaciones climatológicas diferentes del mismo año, con 120 voluntarios del Programa de Termalismo Social del IMSERSO, 60 varones y 60 mujeres (edad media 70,9 ñ 0,5 años); no había diferencias estadísticamente significativas entre la edad de ambos grupos, homogéneos en su conjunto y de muestras pareadas dependientes e igual tamaño. Se obtuvieron muestras de orina para determinar la concentración de TBARS mediante espectrofotometría a la llegada al balneario, a los 9 y a los 14 días de tratamiento; se les realizó una historia clínica completa y se valoraron diferentes variables médicas tras aplicar crenoterapia por vía tópica (baños de 37,5-39 0 C durante 15 min) y/o hidropínica. Las muestras urinarias se analizaron siguiendo una modificación de la técnica descrita en 1978 por Mihara et al. Resultados: la producción urinaria de peroxidación lipídica (TBARS) en orina, principalmente malondialdehído, fue, a la llegada, de 0,368 ñ 0,0095 nM/ml, a los 9 días de tratamiento de 0,352 ñ 0,0088 nM/ml y al finalizar el mismo, tras 14 días de crenoterapia, de 0,337 ñ 0,0083 nM/ml; el beneficio poscrenoterápico obtenido en su estado oxidativo (efecto crenoterápico terapéutico) fue de -0,016 ñ 0,0019 (4,35 por ciento) a los 9 días, el cual se duplicó a los 14 días, con cifras de -0,031 ñ 0,0017 (8,4 por ciento). Esta disminución de los valores de oxidación obtenidos presentó diferencias estadísticamente significativas (p < 0,001) en toda la población estudiada. Conclusión: a partir del noveno día de tratamiento con aguas bicarbonatadas sulfatadas hay evidencias de que el efecto crenoterápico antioxidante comienza a ser eficaz y estadísticamente significativo en la población estudiada, lo que coincide con la mejoría física obtenida. Este efecto crenoterápico se potencia al doble si se prolonga el tratamiento hasta 14 días (AU)

Cambios en la peroxidación lipídica humana y en la tensión arterial, en poblaciones hipertensas y normotensas, tratadas crenoterápicamente con aguas sulfuradas y peloides / Human lipid peroxidation and blood pressure changes in hypertensive and normotensive patients treated with crenotherapy with sulphured mineral water and peloids

OBJETIVO: Analizar la influencia de la crenoterapia con aguas sulfuradas en la tensión arterial y su relación con la lipoperoxidación. MÉTODO: Estudio clínico prospectivo, realizado en un balneario de aguas sulfuradas, con un grupo homogéneo de 110 voluntarios del Programa de Termalismo Social del IMSERSO, 55 hombres y 55 mujeres, edad media 68,5 años. 49 normo tensos (grupo control) y 61 hipertensos: 42 con tratamiento farmacológico (HTF) y 19 sin él (HNTF). Se determinaron niveles de eliminación urinaria de sustancias reactivas al ácido ti barbitúrico (TBARS), tensión arterial (TA), a la entrada y a la salida del balneario, además de hábitos, condiciones médicas, ingesta de fármacos, radiaciones solares recibidas, vías de administración del tratamiento, edad, sexo, dieta, etc. RESULTADOS: Los niveles urinarios de TBARS antes y después del tratamiento (hombres + mujeres) tanto en el grupo control como en el de hipertensos bajaron con una diferencia estadísticamente significativa (p< 0,05), aunque la disminución de TBARS, fue más manifiesta en hipertensos y sobre todo mujeres. No existió diferencia significativa en la excreción de TBARS, ni antes, ni después del tratamiento, entre el grupo control (normotensos) y el hipertenso. La TA disminuyó (p< 0,01) con el tratamiento. La TA sistólica/TA diastólica (TAS/TAD) del Grupo control (normotensos) disminuyó en 7 y 4 mm Hg, respectivamente; la de los HTF en 10 y 6,5 mmHg y los HNTF en 11 y 12 mmHg, existiendo diferencia significativa en los tres grupos (p< 0,01). La disminución de la TA, también fue más marcada en HNTF, sobre todo en mujeres. CONCLUSIONES: La crenoterapia con aguas sulfuradas, por vía tópica, disminuyó la eliminación de TBARS sobre todo en hipertensos y en mujeres. Igualmente disminuyó la TA en todos los pacientes y voluntarios. No hubo relación entre los valores de TBARS y la TA, independientemente de la edad y sexo (AU)

Measures of complexity in neural spike-trains of the slowly adapting stretch receptor organs.

Discrete sequence analysis methods were applied to study spike-trains generated by the isolated neuron of the slowly adapting stretch receptor organ. Calculation of the algorithmic complexity and block entropies of digitized individual spike-train forms allowed us to distinguish different classes of neural behavior. While some spike-trains exhibited significant structure, others displayed diverse degrees of randomness. The sequences recorded during the stimulated portions of the intermittent and walk-through forms, differed considerably from their randomly shuffled surrogates. Informational and grammar complexity measures (in two, four and eight-letter alphabets), tell us things about the structure of spike-trains that are not obtained with conventional spike analysis. Comparison of the conditional entropies for the digitized signals showed that the method distinguishes between different stimulated conditions. Additionally, comparison of the different stimulated conditions with their corresponding surrogates showed that, both, conditional entropies and complexities were significantly different for the two groups. Although the original and the randomly shuffled sequences had the same distribution and average firing rate, their complexity values were different. The results obtained with both measures of sequence structure were quite consistent.

[Prevalence of malnutrition in minors under 5 years of age in Tabasco]. / Prevalencia de desnutrición en menores de cinco años de Tabasco.

OBJECTIVE: To evaluate malnutrition prevalence in children under five years-old in Tabasco, Mexico, during 1996, and their evolution in 1991-1996. MATERIAL AND METHODS: A cross-sectional study, including 1,256 children under five years-old in 593 communities (31 urban and 562 rural) from 17 sanitary districts. RESULTS: The weight/age indicator for malnutrition in children under five years old showed 59% of children had normal nutrition and 41% with malnutrition, distributed as follows: 26.12% slight, 12.62% moderate and 2.39% severe. In children between 1-5 years old, malnutrition prevalence was 45%. CONCLUSIONS: The number of children with malnutrition in Tabasco during the study period (1991-1996) has decreased in proportion to the increase of those with normal nutrition. Based on the health system activities, the number of health districts with critical malnutrition indicators decreased from 6 to 4.