Vitamin D status and latent tuberculosis infection: conversion in nursing homes, Spain.

OBJECTIVE: To examine the potential association between vitamin D (VitD) deficiency and latent tuberculosis infection (LTBI) and its effect on TB infection conversion (TBIC) incidence.MATERIAL AND METHODS: We carried out a cross-sectional and prospective cohort study of nine pulmonary TB cases that occurred in 2015-2016 in five nursing homes and one mental disability institution in Castellon, Spain. QuantiFERON®-TB Gold and the tuberculin skin test were used to detect LTBI and TBIC, respectively. Serum 25-hydroxyvitamin D was measured using chemiluminescence immunoassay. Poisson regression and inverse probability weighting were used for statistical analyses.RESULTS: The study included 448 residents, 341 staff members with 48 relatives of TB cases (participation rate 82%): of these, respectively 122 (27.2%), 37 (10.9%) and 7 (14.6%) were LTBI-positive; and respectively 22 (7.7%), 10 (3.8%) and 1 (3.7%) were TBIC-positive. LTBI was not associated with VitD status. Severe VitD deficiency (SVDD; defined as VitD level < 10 ng/ml), found in 45.1% of residents, as well as VitD levels of <30 ng/ml (aRR 10.41 95% CI 1.48-73.26), were associated with increased TBIC risk (adjusted relative risk [aRR] 12.1, 95% CI 1.51-97.10), suggesting SVDD as a threshold effect. CONCLUSION: Severe VitD deficiency is a TBIC risk factor.

[Biliary microbiote in cholecystectomized patients: Review of empirical antibiotherapy]. / Microbiota biliar en pacientes colecistectomizados: Revisión de la antibioterapia empírica.

OBJECTIVE: Cholecystitis is an important cause of hospital admission. In moderate or severe cholecystitis, the delay in treatment can lead to serious complications. Our objective is to analyze the microorganisms isolated in bile from cholecystectomized patients and their sensitivity pattern, to evaluate the empirical treatment in those cases in which the surgical removal of the gallbladder should be delayed. METHODS: Prospective descriptive study of biliary cultures of patients undergoing cholecystectomy from May 2013 to February 2015, in the Surgery Department of the Hospital General Universitari de Castelló. RESULTS: We studied 196 patients, 83 women (42.3%) and 113 men (57.7%), with an average age of 61.5 years. The most used antibiotics as empiric treatment were piperacillin/tazobactam (77.8%) and amoxicillin/clavulanic (14.8%). In 46.4% of patients (91/196) bile cultures were positive. 165 microorganisms were isolated. The majority were Gram-negative bacilli (60.5%), mainly of the Enterobacterales order (91/54.5%), with Escherichia coli being the most frequent microorganism (24%) followed by Klebsiella spp. (12.5%). 3 E. coli with extended-spectrum beta-lactamase (ESBL) and 1 K. pneumoniae with ESBL were isolated. Microorganisms producing carbapenemase and methicillin-resistant Staphylococcus aureus were not isolated. CONCLUSIONS: The bile microbiota, with a predominance of Enterobacterales is similar to that found in european studies..

Peritonitis por Saccharomyces cerevisiae en un paciente sometido a diálisis peritoneal ambulatoria / No disponible

No disponible

Bacteriemias por Staphylococcus aureus en el Hospital General de Castellón (2001-2005) / Staphylococcus aureus bacteremia in Castellón General Hospital (2001-2005)

Objetivo. Conocer la frecuencia de las bacteriemias por Staphylococcus aureus y la sensibilidad que muestran las cepas, así como las características clínicas de los pacientes. Métodos. Se realizó un estudio retrospectivo de las bacteriemias por S. aureus en el Hospital General de Castellón entre los años 2001 a 2005 y se revisaron las historias clínicas de los pacientes del año 2005. Resultados. Durante el período de estudio se diagnosticaron 295 pacientes con bacteriemia por S. aureus. La distribución anual de los casos fue la siguiente: 35, 54, 62, 64 y 80. Por sexos el 62,7% eran hombres y el 37,3% mujeres. El 58,6 % estaban ingresados en servicios médicos y el 49 % eran pacientes mayores de 65 años. El 34 % de las cepas eran resistentes a oxacilina, 33 % a ciprofloxacino, 41% a eritromicina y 4,4% a gentamicina. Se observa un incremento estadísticamente significativo (p<0,05) en la resistencia a ciprofloxacino de 18,8 % en 2001 a 39,7 % en 2005. En una tercera parte de los pacientes se aisló S. aureus en otras muestras, siendo el catéter la más frecuente. El 73,5% de los pacientes tenían alguna enfermedad de base y el factor predisponente más frecuente fue la presencia de alguna localización vía vascular. El 73,5% de las bacteriemias fueron de origen nosocomial. Conclusiones. Las bacteriemias por S. aureus han aumentado en nuestro hospital a lo largo de los años del estudio, así como la resistencia a oxacilina (AU)

Objective. The aim of this study was to know the frequency of bacteremias produced by Staphylococcus aureus and the sensibility that strains showed, as well as the clinical characteristics of the patients. Method. We retrospectively studied cases of S. aureus bacteremia detected in our hospital from 2001 to 2005 and also reviewed medical histories from patients during 2005. Results. A total of 295 cases of S. aureus bacteremia were detected in this study. Annual distributions of the cases were as follows: 35, 54, 62, 64 and 80. By gender, 62.7 % related to males and 37.3 % to females. A total of 58.6 % of the patients were admitted to medical services and 49 % were older than 65 years. Regarding resistance, 34 % of the strains showed resistance to oxacillin, 33 % to ciprofloxacin, 41 % to erythromycin and 4.4 % to gentamicin. In one-third of the patients, S. aureus was isolated in other samples, the catheter being the most common. A total of the 73.5 % of the patients had some baseline disease and the most frequent predisposing factor was the intravascular catheter. The bacteremias were nosocomial-acquired in 73.5 % of the cases. Conclusions. In our hospital, S. aureus bacteremia and oxacillin resistance has been increasing over the years of this study (AU)

[Ten-year retrospective study of rotavirus infection in the province of Castellón (Spain)]. / Estudio retrospectivo de 10 años de la infección por rotavirus en la provincia de Castellón.

OBJECTIVE: To determine the percentage of rotavirus infection in children aged less than 14 years old and the epidemiology in area 02 of the province of Castellón (Spain). MATERIAL AND METHODS: We performed a retrospective study from January 1995 to December 2004 in which 14,068 stool samples from pediatric patients with acute gastroenteritis were analyzed. The variables analyzed were sex, age, origin, diagnosis of rotavirus, and date of diagnosis. Differences were considered statistically significant if p<0.05. RESULTS: Rotavirus was detected in 11.9% of the samples (1687 cases) in the 10 years of the study, 12.14 % corresponded to boys and 11.81% to girls (p=0.5459). The mean age of the population was 2.63 years. The highest percentage of cases occurred in the group aged 1- 4 years old (14.1%; p<0.001) and in outpatients (12.76%; p<0.05). In this geographical region, there was a significant tendency (p<0.001) for rotavirus to occur in the winter months. CONCLUSION: Rotavirus is one of the main causes of morbidity in children both in the hospital and the outpatient setting. Children aged less than 4 years old are most frequently affected, especially those aged 1 year. The infection appears mainly in winter.

Estudio retrospectivo de 10 años de la infección por rotavirus en la provincia de Castellón / Ten-year retrospective study of rotavirus infection in the province of Castellón (Spain)

Objetivo. El objetivo de este trabajo es conocer el porcentaje de la infección por rotavirus en niños menores de 14 años y su epidemiología en el área 02 de la provincia de Castellón. Material y métodos. Se realizó un estudio retrospectivo desde enero de 1995 hasta diciembre de 2004 en el que se analizaron 14.068 muestras de heces de pacientes pediátricos con gastroenteritis aguda. Las variables analizadas fueron: sexo, edad, procedencia, diagnóstico de rotavirus y fecha de diagnóstico. Se consideraron valores significativos p < 0,05. Resultados. El rotavirus fue detectado en el 11,9 % (1.687 casos) en los 10 años del estudio; el 12,14 % en varones y el 11,81 % en mujeres (p = 0,5459). La edad media de la población del estudio fue de 2,63 años. El grupo que presentó el mayor porcentaje de casos fue el de 1 a 4 años con el 14,1 % (p < 0,001) y pacientes ambulatorios con el 12,76 % (p < 0,05). En nuestra área, el rotavirus predomina significativamente (p < 0,001) en los meses de invierno. Conclusión. El rotavirus es una de las causas más importantes de morbilidad en la edad pediátrica en el hospital y en el ambulatorio. Afecta más frecuentemente a los niños menores de 4 años, y principalmente a los de 1 año. La infección se presentó de forma predominante en el invierno

Objective. To determine the percentage of rotavirus infection in children aged less than 14 years old and the epidemiology in area 02 of the province of Castellón (Spain). Material and methods. We performed a retrospective study from January 1995 to December 2004 in which 14,068 stool samples from pediatric patients with acute gastroenteritis were analyzed. The variables analyzed were sex, age, origin, diagnosis of rotavirus, and date of diagnosis. Differences were considered statistically significant if p < 0.05. Results. Rotavirus was detected in 11.9 % of the samples (1687 cases) in the 10 years of the study, 12.14 % corresponded to boys and 11.81 % to girls (p = 0.5459). The mean age of the population was 2.63 years. The highest percentage of cases occurred in the group aged 1- 4 years old (14.1 %; p < 0.001) and in outpatients (12.76 %; p < 0.05). In this geographical region, there was a significant tendency (p < 0.001) for rotavirus to occur in the winter months. Conclusion. Rotavirus is one of the main causes of morbidity in children both in the hospital and the outpatient setting. Children aged less than 4 years old are most frequently affected, especially those aged 1 year. The infection appears mainly in winter

[Antimicrobial susceptibility of Pseudomonas aeruginosa clinical isolates in Castellón, Spain]. / Sensibilidad de aislamientos clínicos de Pseudomonas aeruginosa en Castellón.

A retrospective study of the susceptibility to antimicrobials (amikacin, tobramycin, gentamicin, ceftazidime, cefepime, piperacillin, piperacil-lin-tazobactam, imipenem, meropenem and ciprofloxacin) of 5,811 Pseudomonas aeruginosa isolates was performed in a general hospital over a period of 12 years. The majority of isolates was from respiratory samples (31.99%), followed by urine samples (26.36%) and ear samples (10.51%). There was a predominance of hospital strains (69.66%); 50.30% of those from medical services, 31.74% from critical care services (mainly ICU) and the remaining from surgical services. No antimicrobial included in our study showed an activity over all isolated strains. In health centers the majority of antimicrobials showed good activity, with a percentage of resistance less than 10%. However, hospital strains showed that only amikacin, piperacillin-tazobactam and meropenem had a percentage of resistance near or lower than 10%. In both environments, gentamicin presented with the highest percentage of resistance. Strains from patients hospitalized in critical care services showed an elevated resistance to tobramycin, imipenem and ceftazidime, while strains from patients in medical services showed resistance to ciprofloxacin. Similar studies published in Spain confirm the importance of conducting local studies in order to understand the antimicrobial susceptibility of P. aeruginosa in each region, and especially to carry out empirically based treatments.

Sensibilidad de aislamientos clínicos de Pseudomonas aeruginosa en Castellón / Antimicrobial susceptibility of Pseudomonas aeruginosa clinical isolates in Castellón, Spain

Se realiza un estudio retrospectivo de la sensibilidad antibiótica de 5811 aislamientos clínicos de Pseudomonas aeruginosa frente a amikacina, tobramicina, gentamicina, ceftazidima, cefepima, piperacilina, piperacilina-tazobactam, imipenem, meropenen y ciprofloxacino, en un hospital general durante un periodo de 12 años. En su mayoría (31,99%) las cepas procedían de muestras de vías respiratorias, un 26,36% de orina y un 10,51% de exudado ótico. Un 69,66% de las cepas provenía del ámbito hospitalario, el 50,30% de servicios médicos, el 31,74% de servicios de críticos (fundamentalmente UCI) y el resto de servicios quirúrgicos. Ningún antimicrobiano incluido en el estudio mostró actividad frente a todas las cepas aisladas. En el ámbito ambulatorio, la mayoría de los antimicrobianos ensayados presentaba buena actividad, con porcentajes de resistencia menores del 10%; sin embargo, en las cepas procedentes del medio hospitalario se observa que sólo amikacina, piperacilina-tazobactam y meropenem tenían porcentajes de resistencia por debajo o cerca del 10%. En ambos lugares destaca el mayor porcentaje de resistencia a la gentamicina. Las cepas de muestras de pacientes hospitalizados en servicios de enfermos en situación crítica presentaron una elevada resistencia a tobramicina, imipenem y ceftazidima, mientras que las pertenecientes a pacientes de servicios médicos la mostraron a ciprofloxacino. Trabajos similares publicados en España reafirman la importancia de realizar estudios locales para conocer la sensibilidad antibiótica de P. aeruginosa en cada zona, sobre todo para poder realizar tratamientos empíricos orientados

A retrospective study of the susceptibility to antimicrobials (amikacin, tobramycin, gentamicin, ceftazidime, cefepime, piperacillin, piperacillin- tazobactam, imipenem, meropenem and ciprofloxacin) of 5,811 Pseudomonas aeruginosa isolates was performed in a general hospital over a period of 12 years. The majority of isolates was from respiratory samples (31.99%), followed by urine samples (26.36%) and ear samples (10.51%). There was a predominance of hospital strains (69.66%); 50.30% of those from medical services, 31.74% from critical care services (mainly ICU) and the remaining from surgical services. No antimicrobial included in our study showed an activity over all isolated strains. In health centers the majority of antimicrobials showed good activity, with a percentage of resistance less than 10%. However, hospital strains showed that only amikacin, piperacillin-tazobactam and meropenem had a percentage of resistance near or lower than 10%. In both environments, gentamicin presented with the highest percentage of resistance. Strains from patients hospitalized in critical care services showed an elevated resistance to tobramycin, imipenem and ceftazidime, while strains from patients in medical services showed resistance to ciprofloxacin. Similar studies published in Spain confirm the importance of conducting local studies in order to understand the antimicrobial susceptibility of P. aeruginosa in each region, and especially to carry out empirically based treatments

[Streptococcus suis meningitis]. / Meningitis por Streptococcus suis.

Human infection by Streptococcus suis (S. suis) is a zoonosis, with a known occupational risk and clinical presentation mainly as a purulent meningitis with low mortality and frequent hearing loss and ataxia sequela. Less than 150 human cases have been reported since original one thirty years ago. There is a geographical distribution most patients living in northern Europe and south Asia. S. suis disease in human has been reported in two patients in Spain the last years. We present two patients with S. suis meningitis, both were men with occupation related by pork meet, and good outcome. They come at our hospital in a lapse of one month. Both had neurosensorial hearing loss and walking ataxia. One patient had peripheral facial paralysis and diplopia because of paresia of contralateral sixth nerve, with complete resolution at three months. The rare presentation of S. suis meningitis in our country must not forget us to record the working risk at anamnesis.

Meningitis por streptococcus suis / Streptococcus suis meningitis

La infección humana por Streptococcus suis (S. suis) es una zoono sis, con un riesgo ocupacional conocido y que suele presentarse como meningitis purulenta, que tiene baja mortalidad y frecuentes secuelas de hipoacusia y ataxia. Se han publicado menos de 150 casos humanos desde el informe original de hace 30 años. Hay una reconocida distribución geográfica viviendo la mayoría de los afectados en el norte de Europa y el sudeste Asiático. En España se han comunicado dos pacientes con enfermedad por S. suis. Presentamos dos pacientes con meningitis por S.suis, que acudieron a nuestro hospital en el plazo de un mes. Ambos eran hombres con exposición laboral a cerdos. Presentaron hipoacusia neurosensorial y ataxia de la marcha. Un paciente tuvo parálisis facial periférica y diplopía por paresia del sexto par contralateral con resolución completa a los tres meses. Lo excepcional de la meningitis por S. suis en nuestro país, no debe hacernos olvidar la importancia de registrar el riesgo laboral en la anamnesis. (AU)

Evolución de las resistencias a Mycobacterium tuberculosis en la provincia de Castellón. Años 1992-1998 / Evolution of resistant Mycobacterium tuberculosis in the province of Castellón (Spain): 1992 through 1998

Objetivos: Conocer la frecuencia de las resistencias a Mycobacterium tuberculosis y los factores de riesgo asociados a éstas en la provincia de Castellón. Material y métodos: Se ha realizado un estudio prospectivo de la sensibilidad a los tuberculostáticos, por el método de las proporciones de Canetti, de todas las cepas de M. tuberculosis aisladas en nuestra provincia (532) desde enero de 1992 a diciembre de 1998 (7 años), de las que 461 correspondían a casos nuevos. Resultados: Encontramos una tasa global de resistencias del 4,7 por ciento (25/532), de las cuales el 3,9 por ciento (18/461) fueron primarias y el 11,1 por ciento (7/63) secundarias. Por fármacos, el 3 por ciento eran resistentes a isoniacida, el 1,87 por ciento a rifampicina, el 1,87 por ciento a estreptomicina y el 0,56 por ciento a etambutol. La multirresistencia hallada ha sido del 0,2 por ciento (1/461) para los casos nuevos y del 1,1 por ciento (6/532) para el total. La presencia de resistencia de M. tuberculosis se asocia al antecedente de tratamiento antituberculoso previo (OR = 3,14; p = 0,017), y a la presencia de uno o más factores de riesgo para tuberculosis (OR = 3,32; p = 0,666). Conclusiones: La tasa global de resistencias de M. tuberculosis y la multirresistencia son bajas en la provincia de Castellón; sin embargo, se asocian a un aumento de la mortalidad, de manera que el control de algunos de estos factores de riesgo de tuberculosis prevenibles podría, tal vez, disminuir la frecuencia de resistencias. (AU)

Aspectos epidemiológicos de la resistenciade Escherichia coli a ciprofloxacinoen un hospital general / Epidemiological aspects of ciprofloxacin-resistant Escherichia coli in a general hospital

Se estudió retrospectivamente la sensibilidad de los aislamientos de Escherichia coli a ciprofloxacino en un hospital general durante cuatro años (1995-1998). Se recogieron datos referentes a edad, sexo, muestra, procedencia, fecha y sensibilidad de los pacientes con aislamiento de E. coli, utilizándose el estadístico c2 para la comparación de proporciones. Se identificaron 7288 aislamientos pertenecientes a 5667 pacientes, de los que 1003 presentaron un aislamiento resistente a ciprofloxacino (17,7 por ciento). La variación de la resistencia no fue estadísticamente significativa. Los aislamientos resistentes fueron significativamente más frecuentes en hombres, en muestras de orina y en pacientes no ingresados, y aumentaron con los diferentes grupos de edad. Para la población con aislamientos resistentes la edad media fue de 61,29 años (DE 21,56), siendo de 39,76 años (DE 27,41) para los pacientes con aislamientos sensibles (p <0.0001). El porcentaje de resistencias fue similar para los pacientes no ingresados procedentes de centros de salud o de consultas externas hospitalarias. Por servicios hospitalarios, los porcentajes de resistencia más altos se observaron en Urología, con un porcentaje de resistencia superior entre los pacientes de consultas externas (p <0.0001). La resistencia a otras fluoroquinolonas se mantuvo sin significación para norfloxacino y aumentó a partir de 1997 para pefloxacino, a costa de aislamientos que eran sensibles a ciprofloxacino (AU)

[Evolution of drug-resistant Mycobacterium tuberculosis in the province of Castellón. 1992-1998]. / Evolución de las resistencias a Mycobacterium tuberculosis en la provincia de Castellón. Años 1992-1998.

OBJECTIVES: To determine the frequency of resistant Mycobacterium tuberculosis and the risk factors associated with resistance in the province of Castellón (Spain). MATERIAL AND METHODS: This prospective study of M. tuberculosis sensitivity applied Canetti's method of proportions to all strains isolated in Castellón (n = 532) from January 1992 through December 1998 (7 years); 461 cases were new. RESULTS: The overall frequency of resistant strains was 4.7% (25/532), of which 3.9% (18/461) were instances of primary resistance and 11.1% (7/63) were of secondary resistance. Three percent were resistant to isoniazid, 1.87% to rifampicin, 1.87% to streptomycin and 0.56% to ethambutol. Multiple drug resistance was found in 0.2% (1/461) of the new cases and 1.1% (6/532) overall. The presence of resistant M. tuberculosis was associated with a history of antituberculous treatment (OR = 3.14; p = 0.017) and the presence of one or more risk factors for tuberculosis (OR = 3.32; p = 0.066). CONCLUSIONS: The overall rates of resistant M. tuberculosis and multiple drug resistance are low in the province of Castellón; however resistance is associated with higher mortality such that controlling some preventable risk factors might reduce the frequency of resistance.

[Vaccination against Haemophilus influenzae type b in the Valencia Community: efficacy and failure of vaccinations]. / Vacunación frente a Haemophilus influenzae tipo b en la Comunidad Valenciana: Efectividad vacunal y fallos vacunales. Grupo de Estudio de Enfermedades Invasoras.

OBJECTIVE: To study Haemophilus influenzae type b (Hib) conjugate vaccine effectivity and vaccine failures in the Valencian Community of Spain where vaccine can be obtained, but is not scheduled as a routine immunization. PATIENTS AND METHODS: A prospective surveillance system where pediatricians and microbiologists of all public hospitals of the Valencian Community reported cases of invasive Hib disease in children (under 15 years of age). Vaccination status (number of doses, dates and type of vaccine) in each case was obtained. RESULTS: Of 23 cases reported from December 1, 1995 to November 30, 1996, two had received at least one dose of Hib vaccine. One was a true vaccine failure and the other an apparent vaccine failure. Estimating a vaccine coverage of 32.5% of the children less than 5 years old, the direct vaccine effectivity was 90.6% (IC 95%: 27.9-98.8%). CONCLUSIONS: Hib conjugate vaccine is effective in the Valencian Community, however, there is still invasive disease due to the low vaccine coverage and some vaccine failures.