Intestinal colonization due to Escherichia coli ST131: risk factors and prevalence.

Background: Escherichia coli sequence type 131 (ST131) is a successful clonal group that has dramatically spread during the last decades and is considered an important driver for the rapid increase of quinolone resistance in E. coli. Methods: Risk factors for rectal colonization by ST131 Escherichia coli (irrespective of ESBL production) were investigated in 64 household members (18 were colonized) and 54 hospital contacts (HC; 10 colonized) of 34 and 30 index patients with community and nosocomial infection due to these organisms, respectively, using multilevel analysis with a p limit of < 0.1. Result: Colonization among household members was associated with the use of proton-pump inhibitors (PPI) by the household member (OR = 3.08; 95% CI: 0.88-10.8) and higher age of index patients (OR = 1.05; 95% CI; 1.01-1.10), and among HC, with being bed-ridden (OR = 21.1; 95% CI: 3.61-160.0) and having a urinary catheter (OR = 8.4; 95% CI: 0.87-76.9). Conclusion: Use of PPI and variables associated with higher need of person-to-person contact are associated with increased risk of rectal colonization by ST131. These results should be considered for infection control purposes.

Bacteraemia due to non-ESBL-producing Escherichia coli O25b:H4 sequence type 131: insights into risk factors, clinical features and outcomes.

The epidemiology and outcomes of bloodstream infections (BSIs) caused by Escherichia coli ST131 isolates not producing extended-spectrum ß-lactamases (ESBLs) are not well defined despite being more prevalent than ESBL-producers. In this study, risk factors and the impact on outcome of BSIs caused by non-ESBL-producing ST131 E. coli versus non-ST131 E. coli were investigated. A case-control study was performed in two tertiary centres to identify risk factors for ST131. Molecular methods were used to investigate all E. coli isolates from blood cultures for those belonging to O25b:H4-ST131 clonal group. fimH alleles were characterised in ST131 isolates. Multivariate analysis was performed by logistic regression or Cox regression as appropriate. A total of 33 ST131 E. coli cases and 56 controls were studied. ST131 isolates showed higher rates of resistance to ampicillin and ciprofloxacin; fimH alleles were H30 in 14 isolates (42.4%) and H22 in 12 isolates (36.4%). Only recent surgery (OR = 7.03, 95% CI 1.71-28.84; P = 0.007) and unknown source of bacteraemia (OR = 5.37, 95% CI 0.93-30.81; P = 0.05) were associated with ST131. ST131 isolates showed no association with 30-day mortality, therapeutic failure, presentation with severe sepsis/shock or length of stay. Bacteraemia due to non-ESBL-producing O25b:H4-ST131 E. coli showed few differences in terms of risk factors as well as similar outcome to non-ST131 E. coli. These data support the notion that ST131 strains are not less clinically virulent despite showing increased antimicrobial resistance, but also that they are not more virulent than other clonal groups causing BSI.

Ensayo clínico aleatorio para evaluar la eficacia de una intervención educativa desarrollada en atención primaria sobre asmáticos adultos / A randomised clinical trial to evaluate the effectiveness of an educational intervention developed for adult asthmatics in a primary care centre

OBJETIVO: Evaluar el efecto de una intervención educativa específica sobre el control del asma y la calidad de vida. DISEÑO: Ensayo clínico con asignación aleatoria de pacientes asmáticos, a un grupo de intervención educativa (GI) y otro de control (GC). Se midió el nivel de control del asma y de calidad de vida, al inicio y trimestralmente durante un año. El cegamiento solo fue posible en la recogida y análisis de datos. Emplazamiento: Dos centros de atención primaria urbanos. Participantes: Se incluyeron 163 asmáticos, de 18 a 55 años, asignados aleatoriamente 84 al GI y 79 al GC. Finalizaron el seguimiento 104 (GI: 55; GC: 49). Intervención: GI: Tres sesiones educativas, grupales, impartidas por médicos de familia. primera al inicio de la primavera, segunda a los 15 días, y tercera, de refuerzo, a los 6 meses. GC: asistencia habitual. Mediciones principales: Nivel de control del asma y de calidad de vida mediante el Asthma Control Test (ACT) y el Asthma Quality of life Questionnaire (AQLQ). RESULTADOS: Al tercer mes, hubo diferencia significativa en el porcentaje de pacientes con buen control (p = 0,002), 75% en el GI y 48,5% en el GC, RR = 1,6 [1,2 a 2,1], NNT = 3,8 [2,4 a 9,4] y una mejoría con respecto al inicio en los niveles de calidad de vida (p = 0,005); RR = 2,3 [1,3 a 4,1], NNT = 4,3 [2,6 a 12,4]. Sin diferencias en los trimestres restantes. CONCLUSIONES: Estos talleres son efectivos para mejorar el control y la calidad de vida a corto plazo, lo que nos puede orientar en la elección del momento más adecuado para realizarlos

OBJECTIVE: To assess the effect of an educational intervention on asthma control and quality of life. DESIGN: A randomised clinical trial of patients with asthma, with an intervention group (IG) and a control (GC). Asthma control and quality of life was measured in both groups at baseline and every three months for one a year. Blinding was only possible in the collection and analysis of data. Location: Two urban Primary Care Health Centres. Participants: A total of 163 patients aged 18 to 55 years were included: 84 were assigned to the IG and 79 to the CG. The follow-up was completed by 104 patients (GI: 55 and GC 49). Intervention: GI: Three educational sessions in small interactive groups. The first session was at the beginning of spring, the second 15 days later, and the third 6 months later, to recall the knowledge. Main measurements: Asthma control level and quality of life using ACT(Asthma Control Test)and the AQLQ (Asthma Quality of life Questionnaire). RESULTS: In the third month, statistically significant differences were detected in the percentage of patients with good control [(p = 0.0002), 75% in the GI, and 48.5% in the GC, Relative Risk (RR)=1.6 [1.2 to 2.1], Number Needed to Treat (NNT)=3.8 [2.4 to 9.4], and an improvement in levels of quality of life from baseline (p = 0.005), RR=2.3 [1.3 to 4.1], NNT: 4.3 [2.6 to 12.4]. No differences were detected in the remaining sessions. CONCLUSIONS: These interventions are effective in improving the control and quality of life in short-term, which can guide us in choosing the best time to do it

[A randomised clinical trial to evaluate the effectiveness of an educational intervention developed for adult asthmatics in a primary care centre]. / Ensayo clínico aleatorio para evaluar la eficacia de una intervención educativa desarrollada en atención primaria sobre asmáticos adultos.

OBJECTIVE: To assess the effect of an educational intervention on asthma control and quality of life. DESIGN: A randomised clinical trial of patients with asthma, with an intervention group (IG) and a control (GC). Asthma control and quality of life was measured in both groups at baseline and every three months for one a year. Blinding was only possible in the collection and analysis of data. LOCATION: Two urban Primary Care Health Centres PARTICIPANTS: A total of 163 patients aged 18 to 55 years were included: 84 were assigned to the IG and 79 to the CG. The follow-up was completed by 104 patients (GI: 55 and GC 49). INTERVENTION GI: Three educational sessions in small interactive groups. The first session was at the beginning of spring, the second 15 days later, and the third 6 months later, to recall the knowledge. MAIN MEASUREMENTS: Asthma control level and quality of life using ACT(Asthma Control Test) and the AQLQ (Asthma Quality of life Questionnaire). RESULTS: In the third month, statistically significant differences were detected in the percentage of patients with good control [(P=.0002), 75% in the GI, and 48.5% in the GC, Relative Risk (RR)=1.6 [1.2 to 2.1], Number Needed to Treat (NNT)=3.8 [2.4 to 9.4], and an improvement in levels of quality of life from baseline (P=.005), RR=2.3 [1.3 to 4.1], NNT: 4.3 [2.6 to 12.4]. No differences were detected in the remaining sessions. CONCLUSIONS: These interventions are effective in improving the control and quality of life in short-term, which can guide us in choosing the best time to do it.