Sonication did not provide reliability to Maki technique for catheter related bloodstream infection diagnosis.

OBJECTIVE: The aim of our study was to analyze sonication and Maki techniques for diagnosis of catheter tip colonization and catheter-related bloodstream infection (CRBSI) on patients admitted to ICU. METHODS: Observational and prospective study in one Intensive Care Unit. Patients with some central venous catheter (CVC) at least for 7 days and catheter-related infection (CRI) suspicion (new episode of fever or sepsis) were included. We performed Maki technique followed by sonication of catheter tip. We compared area under the curve (AUC) of Maki, sonication, and techniques combination to diagnosis catheter tip colonization and CRBSI. RESULTS: We included 94 CVC from 87 CRI suspicion episodes. We found 14 cases of catheter tip colonization and 10 cases of CRBSI. Of the 14 catheter tip colonization cases, 7 (50.0%) were detected by Maki and sonication techniques, 6 (42.9%) were detected only by Maki technique, and 1 (7.1%) was detected only by sonication technique. Of the 10 CRBSI, 6 (60.0%) were detected by Maki and sonication techniques, 4 (40.0%) were detected only by Maki technique, and any only by sonication technique. We found higher AUC in Maki technique than in sonication technique to diagnosis of CRBSI (p=0.02) and to diagnosis of catheter tip colonization (p=0.03). No significant differences were found in AUC between Maki technique and combination techniques for diagnosis of catheter tip colonization (p=0.32) and of CRBSI (p=0.32). CONCLUSIONS: Sonication did not provide reliability to Maki technique for diagnosis of catheter tip colonization and CRBSI.

Introduction of a complementary screening system for the detection of sexually transmitted infections in patients with sterile pyuria.

OBJECTIVE: The aim of the study was to evaluate a complementary screening system for the detection of sexually transmitted infections in patients with sterile pyuria. METHODS: A prospective study was conducted using Real-time multiplex qPCR in 300 consecutive urine samples with data on sterile pyuria. STI prevalence and patient epidemiological data were analyzed. RESULTS: A total of 29 positive cases (9.67%) were found: 16 Chlamydia trachomatis, 5 Mycoplasma genitalium, 5 Trichomonas vaginalis and 3 co-infections. The group with sexually transmitted infections was mainly composed of women (65.5%), of which one third was pregnant. CONCLUSIONS: This study presents an effective screening system for the detection of sexually transmitted infections that can be integrated into the laboratories' work routine.

[Risk factors to secondary nosocomial bacteremia to UTI in a tertiary hospital]. / Factores de riesgo en bacteriemias nosocomiales secundarias a ITU en un hospital terciario.

OBJECTIVE: Nosocomial bacteremia secondary to urinary tract infections (NBS-UTI) occur in 1-4% of episodes and the associated mortality can increase up to 33%. However, very little is known about the epidemiology of these infections. The determination of modifiable risk factors to develop this type of bacteremia could help to control the infection and reduce health costs. METHODS: Cases-control study of NBS-UTI diagnosed at the University Hospital of Canary Islands between 2010-2014. The clinical-epidemiological variables and the intrinsic and extrinsic potential risk factors were collected. Logistic regression was used to study the variables associated with the development of NBS-UTI. RESULTS: A total of 178 episodes were studied, 85 cases and 93 controls. The average stay was significantly greater in the cases; from admission to bacteremia (p <0.003), as well as from discharge to discharge (p <0.005). Hepatic insufficiency (p <0.091), the use of mechanical ventilation (p <0.001), the central venous catheter (p <0.043) and surgery in the episode (p <0.001) behaved as risk factors for the acquisition of NBS-ITU. CONCLUSIONS: Invasive devices, such as central venous catheter and mechanical ventilation, that had not previously been studied; as well as the surgery in the episode, which had not been studied either, suppose risk factors. In addition, NBS-ITU causes a significant increase in hospital stay. Therefore, it is necessary to know the risk factors for the appearance of these infections, and thus prevent their appearance and improve the safety of hospitalized patients.

A hospital-based matched case-control study to identify risk factors for clinical infection with OXA-48-producing Klebsiella pneumoniae in rectal carriers.

Asymptomatic colonisation of the gastrointestinal tract by carbapenemase-producing Enterobacteriaceae is an important reservoir for transmission, which may precede infection. This retrospective observational case-control study was designed to identify risk factors for developing clinical infection with OXA-48-producing Klebsiella pneumoniae in rectal carriers during hospitalisation. Case patients (n = 76) had carbapenemase-producing K. pneumoniae (CPKP) infection and positive rectal culture for CPKP. Control patients (n = 174) were those with rectal colonisation with CPKP but without CPKP infection. Multivariate analysis identified the presence of a central venous catheter (OR 4·38; 95% CI 2·27-8·42; P = 0·008), the number of transfers between hospital units (OR 1·27; 95% CI (1·06-1·52); P < 0·001) and time at risk (OR 1·02 95% CI 1·01-1·03; P = 0·01) as independent risk factors for CPKP infection in rectal carriers. Awareness of these risk factors may help to identify patients at higher risk of developing CPKP infection.

Dissemination and clinical implications of multidrug-resistant Klebsiella pneumoniae isolates producing OXA-48 in a Spanish hospital.

BACKGROUND: Healthcare-associated infections caused by Klebsiella pneumoniae isolates are increasing and few effective antibiotics are currently available to treat patients. AIM: To assess the epidemiology, molecular basis, clinical features, and outcomes in the acquisition and dissemination of OXA-48-producing K. pneumoniae (OXA48KP) in a tertiary Spanish hospital between October 2013 and December 2015. METHODS: Clinical, demographic, and microbiological data of patients with OXA48KP in clinical samples were collected from medical records. Carbapenemase genes were detected by polymerase chain reaction. Genetic relationships were determined by pulsed-field gel electrophoresis and multi-locus sequence typing. FINDINGS: In all, 116 episodes of OXA48KP in clinical samples were identified. The most frequent types of infection were urinary tract (N = 43, 42%), secondary bloodstream (N = 18, 17%), and surgical site infection (N = 17, 17%). More than one-quarter (28%) of infected patients died in hospital. Among infected patients (N = 90, 78%), infections were mainly classified as hospital-acquired (N = 70, 88%). A high number of OXA48KP isolates showed multidrug resistance, with highest susceptibility to colistin (86%), gentamicin (69%) and amikacin (59%). Most (87%) isolates were included in a main cluster. Seven (N = 8, 88%) isolates showed an identical allelic profile, associated with ST15. Only the isolate from cluster P8 was associated with ST29. The results confirm high dissemination of OXA48KP in our hospital due to the main clone ST15. OXA48KP infection was associated with a high mortality and was mainly hospital-acquired. CONCLUSION: This study highlights the importance of active surveillance programmes, especially those focusing on hospital readmissions in order to control the spread of carbapenemase-producing Enterobacteriaceae.

Prevalencia de colonización y epidemiología de Staphylococcus aureus resistente a meticilina (SARM) en portadores nasales en los residentes de centros de larga estancia del área norte de Tenerife / Prevalence of colonisation and epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in nasal carriers in residents from long term care facilities in northern Tenerife, Canary Islands

Objetivo: Determinar la prevalencia de colonización por Staphylococcus aureus resistente a meticilina (SARM) en residentes de centros de larga estancia (CLE) de Tenerife. Identificación de factores asociados a dicha colonización. Análisis de la sensibilidad a mupirocina en los aislados de SARM. Material y métodos: Muestreo nasal y encuesta individual con variables clínico-epidemiológicas de los residentes en CLE. Los hisopos se sembraron en medio de cultivo selectivo y caldo de enriquecimiento. Las colonias sospechosas de SARM se identificaron fenotípica y molecularmente. Se determinó la sensibilidad a mupirocina. Resultados: Se incluyeron 624 individuos, de los cuales 161 (25,8%) estaban colonizados por SARM. Se obtuvo un 19,8% de resistencia a mupirocina y tres complejos clonales por PFGE. Conclusión: Los residentes en CLE de nuestra área constituyen un importante reservorio de SARM. Se debería considerar la necesidad de establecer un circuito estandarizado de derivación-tratamiento-readmisión de pacientes colonizados entre los centros hospitalarios y los CLE (AU)

Objective: To determine methicillin-resistant Staphylococcus aureus (MRSA) prevalence, factors associated with MRSA nasal carriage, molecular typing and susceptibility to mupirocin in residents from long term care facilities (LTCF) in Tenerife. Material and methods: Nasal swabs and clinical and epidemiological variables were collected among residents living in LTCF. Swabs were cultured in a selective MRSA agar medium and in a selective staphylococcal enrichment broth. Suspected MRSA colonies were identified phenotypically and molecularly. Susceptibility testing to mupirocin was performed. Results: Six hundred and twenty four subjects were included, 161(25.8%) were colonized by MRSA. We observed 19.8% resistance to mupirocin and three clonal complexes by PFGE. Conclusion: Residents in LTCF of our area constitute an important reservoir of MRSA. It should be considered the need to establish a standardized circuit derivation-treatment-readmission of patients colonised by MRSA between hospital centers and LTCF (AU)

Mortalidad y morbilidad de neonatos de muy bajo peso asistidos en el País Vasco y Navarra (2001-2006): estudio de base poblacional / Mortality and morbidity in very low birth weight infants in the Basque Country and Navarra (2001-2006): population-based study

Introducción: Este estudio describe la morbilidad y mortalidad de los recién nacidos de muy bajo peso (RNMBP) asistidos en las unidades neonatales del País Vasco y Navarra entre los años 2001-2006, y evalúa los factores que afectan a la mortalidad. Pacientes y métodos: Estudio descriptivo observacional de una cohorte de 1.318 RNMBP asistidos entre el año 2001 y 2006 en cinco hospitales del País Vasco y Navarra. Se recogieron un total de 37 variables incluidas en la base de datos de EuroNeoNet, que se refieren a factores perinatales de riesgo y protectores, características demográficas, días de ingreso, intervenciones, morbilidades y mortalidad. Resultados: Un 94% de las mujeres embarazadas recibieron cuidados prenatales y un 78,7% administración de esteroides prenatales, en ambos casos hubo un aumento significativo durante el periodo estudiado. El 42% de los embarazos fueron múltiples y en un 63% el parto fue por cesárea. La displasia broncopulmonar disminuyó de manera estadísticamente significativa de un 20 a un 15%. La incidencia de hemorragia intraventricular de grado III o IV fue de 7,5% y de leucomalacia periventricular de un 3,1%. Se diagnosticó infección vertical en un 4% de niños y sepsis o meningitis tardía en 25%, enterocolitis necrotizante en 9% y persistencia del conducto arterioso en el 14% de los niños. El tratamiento con indometacina o ibuprofeno disminuyó significativamente durante el estudio. La tasa bruta de mortalidad neonatal total, tardía y precoz se ha mantenido constante en este periodo de tiempo. La mortalidad neonatal inmediata mostró una tendencia descendente y una diferencia significativa por sexo, siendo esta mayor en los varones. Conclusión: Este estudio de base poblacional aporta información valiosa sobre variables resultado en UCIN y puede ayudar en el planteamiento de intervenciones que mejoren la calidad asistencial y disminuyan la morbilidad y mortalidad en estos neonatos de alto riesgo(AU)

Introduction: This study describes very low birth weight (VLBW) infant morbidity and mortality in Basque Country and Navarra neonatal units between the years 2001-2006, and evaluates the factors that affect the mortality. Patients and methods: A descriptive observational study of a cohort of 1,318 VLBW infants in neonatal units in five Basque Country and Navarra hospitals between 2001 and 2006. A total of 37 variables included in EuroNeoNet database were collected as regards, perinatal risk and protective factors, demographic characteristics, length of stay, interventions, morbidity and mortality. Results: A total of 94% of pregnant women received prenatal care and 78.7% antenatal steroids. In both cases there was a significant increase during the period studied. A total of 42% of pregnancies were multiple and in 63% delivery was by Caesarean section. Bronchopulmonary dysplasia statistically significantly decreased from 20% to 15%. The incidence of intraventricular haemorrhage grade III or IV was 7.5% and for periventricular leukomalacia it was 3.1%. Vertical infection was diagnosed in 4% of infants and sepsis or late meningitis in 25%, necrotizing enterocolitis in 9% and patent ductus arteriosus in 14% of the infants. The prophylactic or therapeutic treatment with indometacin or ibuprofen decreased significantly during the study. The overall rate of total, late and first day neonatal mortality was almost constant during this period of time. Nevertheless, the early neonatal mortality showed a decreasing trend and with a significant difference between sexes, being higher in males. Conclusion: This population-based study provides valuable information on clinical outcomes in NICUs, and may help in planning strategies to improve health care quality, and to reduce the morbidity and mortality in these neonates at high risk(AU)

[Mortality and morbidity in very low birth weight infants in the Basque Country and Navarra (2001-2006): population-based study]. / Mortalidad y morbilidad de neonatos de muy bajo peso asistidos en el País Vasco y Navarra (2001-2006): estudio de base poblacional.

INTRODUCTION: This study describes very low birth weight (VLBW) infant morbidity and mortality in Basque Country and Navarra neonatal units between the years 2001-2006, and evaluates the factors that affect the mortality. PATIENTS AND METHODS: A descriptive observational study of a cohort of 1,318 VLBW infants in neonatal units in five Basque Country and Navarra hospitals between 2001 and 2006. A total of 37 variables included in EuroNeoNet database were collected as regards, perinatal risk and protective factors, demographic characteristics, length of stay, interventions, morbidity and mortality. RESULTS: A total of 94% of pregnant women received prenatal care and 78.7% antenatal steroids. In both cases there was a significant increase during the period studied. A total of 42% of pregnancies were multiple and in 63% delivery was by Caesarean section. Bronchopulmonary dysplasia statistically significantly decreased from 20% to 15%. The incidence of intraventricular haemorrhage grade III or IV was 7.5% and for periventricular leukomalacia it was 3.1%. Vertical infection was diagnosed in 4% of infants and sepsis or late meningitis in 25%, necrotizing enterocolitis in 9% and patent ductus arteriosus in 14% of the infants. The prophylactic or therapeutic treatment with indometacin or ibuprofen decreased significantly during the study. The overall rate of total, late and first day neonatal mortality was almost constant during this period of time. Nevertheless, the early neonatal mortality showed a decreasing trend and with a significant difference between sexes, being higher in males. CONCLUSION: This population-based study provides valuable information on clinical outcomes in NICUs, and may help in planning strategies to improve health care quality, and to reduce the morbidity and mortality in these neonates at high risk.

Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial.

Certain guidelines for the prevention of ventilator-associated pneumonia (VAP) recommend oral care with chlorhexidine, but none refer to the use of a toothbrush for oral hygiene. The role of toothbrush use has received scant attention. Thus, the objective of this study was to compare the incidence of VAP in critical care patients receiving oral care with and without manual brushing of the teeth. This was a randomized clinical trial developed in a 24-bed medical-surgical intensive care unit (ICU). Patients undergoing invasive mechanical ventilation for than 24 h were included. Patients were randomly assigned to receive oral care with or without toothbrushing. All patients received oral care with 0.12 % chlorhexidine digluconate. Tracheal aspirate samples were obtained during endotracheal intubation, then twice a week, and, finally, on extubation. There were no significant differences between the two groups of patients in the baseline characteristics. We found no statistically significant differences between the groups regarding the incidence of VAP (21 of 217 [9.7 %] with toothbrushing vs. 24 of 219 [11.0 %] without toothbrushing; odds ratio [OR] = 0.87, 95 % confidence interval [CI] = 0.469-1.615; p = 0.75). Adding manual toothbrushing to chlorhexidine oral care does not help to prevent VAP in critical care patients on mechanical ventilation.

Rifampicin-miconazole-impregnated catheters save cost in jugular venous sites with tracheostomy.

Antimicrobial-impregnated catheters are more expensive than standard catheters (S-C). A higher incidence of catheter-related bloodstream infection (CRBSI) has been found in jugular venous access with tracheostomy than without tracheostomy. The objective of this study was to determine central venous catheter (CVC)-related costs (considering only the cost of the CVC, diagnosis of CRBSI, and antimicrobial agents used to treat CRBSI) using rifampicin-miconazole-impregnated catheters (RM-C) or S-C in jugular venous access with tracheostomy. We performed a retrospective cohort study of patients admitted to the intensive care unit (ICU) with tracheostomy who received one or more jugular venous catheters. RM-C showed a lower incidence of CRBSI compared with S-C (0 vs. 20.16 CRBSI episodes/1,000 catheter-days; odds ratio=0.05; 95% confidence interval=0.001-0.32; p<0.001) and lower CVC-related costs (including the cost of the CVC, diagnosis, and treatment of CRBSI) (11.46 ± 6.25 vs. 38.11 ± 77.25; p<0.001) in jugular venous access with tracheostomy. The use of RM-C could reduce CVC-related costs in jugular venous access with tracheostomy. The results of our study may contribute to clinical decision-making and selection of those patients who could benefit from the use of antimicrobial-impregnated catheters.

Time to culture conversion in smokers with pulmonary tuberculosis.

BACKGROUND AND OBJECTIVE: It has been reported that tobacco smoking slows the sterilisation of sputum culture in pulmonary tuberculosis, but the factors that could delay culture conversion in patients who smoke are not known. Our aim is to identify the factors influencing sputum culture conversion in smokers with pulmonary tuberculosis. METHODS: Ninety-nine patients with a smoking history and diagnosed with pulmonary tuberculosis were analysed retrospectively. The relationship between sputum culture status at the second month and the following variables: age, gender, pack-years index, comorbid diseases, number acid-fast bacilli (AFB) in sputum smear examination, radiological findings (cavitary, extensive or limited disease), drug susceptibility pattern and initial treatment, was analysed. The Student t-test, chi-square test and logistic regression model with forward stepwise conditional methods were used for statistical analysis. A p value of <0.05 was considered to be statistically significant. RESULTS: Twenty six patients (26.2%): 18 males (22.2%) and 8 females (44%) were sputum culture positive at the end of the second month of treatment. In univariate analysis, culture conversion time was significantly associated with female gender and extensive disease, but in a logistic regression analysis was only correlated with female gender (OR=5.63 95% CI 1.21-20.64-p=0.02). CONCLUSION: In current smokers with pulmonary tuberculosis, the 'time to culture' conversion relates only to the female gender.

Primary cutaneous mucormycosis: a diagnosis to consider.

Primary cutaneous mucormycosis is a deep fungal infection, mainly seen in diabetics and immunocompromised subjects. Rapid diagnosis and therapy are necessary to avoid fatal outcome. We describe the complete histopathological and microbiological studies of primary cutaneous mucormycosis in a 74-year-old man with several risk factors, such as chronic obstructive pulmonary disease, respiratory acidosis, hemolytic anemia, myelodysplastic syndrome and iatrogenic diabetes, due to corticosteroid therapy. He developed two cutaneous necrotic scars on his left leg. Mucormycosis was suspected and specimens from surgical débridement were histopathologically and microbiologically studied confirming the clinical diagnosis. Amphotericin B was given topically and intravenously resulting in complete healing of the ulcer. Risk factors and microbiological studies are compared with those in the current literature. It is necessary in certain cases to suspect mucormycosis infections in diabetics, immunocompromised subjects and even in healthy individuals. Rapid diagnosis and treatment are important, but they should be based on complete histopathological and microbiological studies, to establish the genus of the causal agent.

Nosocomial infection, indices of intrinsic infection risk, and in-hospital mortality in general surgery.

The objectives of this paper are to assess whether two indices of intrinsic infection risk (the SENIC and the NNIS index) predict in-hospital mortality and the attributable in-hospital mortality due to nosocomial infection in surgical patients. A prospective study on 4714 patients admitted to three hospitals has been carried out. The relative risk and its 95% confidence interval (CI) were estimated. Multiple-risk factors adjusted for odds ratios (OR) were yielded by logistic regression analysis. Overall, 119 patients (2.5%) died before hospital discharge. Both the SENIC and the NNIS indices were related to in-hospital mortality in crude data. After controlling for several variables (age, sex, ASA score, cancer, renal failure, diabetes mellitus, stay at the ICU), the SENIC index did not show any significant trend with mortality (P = 0.252), whereas the trend was significant for the NNIS index (P < 0.001). Risk of death in patients with one nosocomial infection was 7.5%, and in patients developing more than one nosocomial infection was 17.1%. After adjusting for several confounding variables, the development of an organ/space surgical site infection was significantly related to mortality (OR = 4.5, 95% CI 1.5-15.6) as was blood infection (OR = 17.3, 95% CI 3.5-87.0). The association of a surgical site infection and either a respiratory tract infection or a blood infection also increased significantly the risk of in-hospital mortality (OR = 3.3, 95% CI 1.2-8.7). In conclusion, the NNIS index is a good predictor of in-hospital mortality. Patients developing an organ/space surgical site infection and/or a blood infection have an increased risk of in-hospital mortality.

Risk factors for surgical site infections diagnosed after hospital discharge.

A prospective cohort study on 1103 consecutive patients undergoing general surgery with a follow-up of up to 30 days was undertaken to analyse the risk factors for surgical-site infection (SSI). Relative risks (RRs), crude and multiple-risk factors adjusted for by logistic regression analysis, and their 95% confidence intervals were calculated. One hundred and four patients (9.4%) developed infection, 81 in hospital and 23 at home. Predictors for in-hospital SSI differed from those for post-discharge SSI. In a crude analysis, an increased risk of post-discharge SSI occurred after clean-contaminated surgery (but not contaminated surgery). Stepwise logistic regression failed to identify any significant predictor for post-discharge SSI.