Missing Cases of Herpes Simplex Virus (HSV) Infection of the Central Nervous System When the Reller Criteria Are Applied for HSV PCR Testing: a Multicenter Study.

Previous studies suggested that herpes simplex virus (HSV) PCR testing can be safely deferred in patients with normal cerebrospinal fluid (CSF) white blood cell (WBC) counts and protein levels as long as they are older than 2 years of age and are not immunocompromised, the so-called Reller criteria. In this multicenter study, we retrospectively assessed the validity of these screening criteria in our setting. A total of 4,404 CSF specimens submitted for HSV PCR testing to the respective microbiology laboratories at the participating hospitals between 2012 and 2018 were included. Six commercially available HSV PCR assays were used across the participating centers. Ninety-one of the 4,404 CSF specimens (2.1%) tested were positive for HSV DNA (75 samples for HSV-1 and 16 for HSV-2). Nine patients failed to meet the Reller criteria, of whom seven were deemed to truly have HSV encephalitis. Overall, no significant correlation between HSV PCR cycle threshold (CT ) values and WBC counts or total protein levels was found. In addition, median HSV PCR CT s were comparable between patients who met the Reller criteria and those who did not (P = 0.531). In summary, we show that HSV DNA may be detected in CSF specimens with normal WBC and protein levels collected from immunocompetent individuals older than 2 years with HSV encephalitis. Nevertheless, the data also indicate that the number of cases detected could be lowered at least by half if CSF specimens with borderline WBC counts (4 cells/mm3) as well as children of any age are systematically tested.

A survey on practices for active surveillance of carriage of multidrug-resistant bacteria in hospitals in the Autonomous Community of Valencia, Spain.

A questionnaire-based cross-sectional study was conducted to gather information on current microbiological practices for active surveillance of carriage of multidrug-resistant (MDR) bacteria in hospitals from 14 health departments of the Autonomous Community of Valencia (ACV), Spain, which together provided medical attention to 3,271,077 inhabitants in 2017, approximately 70% of the population of the ACV. The survey consisted of 35 questions on MDR bacteria screening policies, surveillance approach chosen (universal vs. targeted), and microbiological methods and processes in use for routine detection and reporting of colonization by MDR bacteria, including the anatomical sites scheduled to be sampled for each MDR bacterial species, and the methodology employed (culture-based, molecular-based, or both). Our study revealed striking differences across centers, likely attributable to the lack of consensus on optimal protocols for sampling, body sites for screening, and microbiological testing, thus underscoring the need for consensus guidelines on these issues.

Pyelonephritis in pregnancy. How adequate is empirical treatment?

OBJECTIVE: To ascertain the adequacy of empirical antimicrobial treatment in pregnant women with acute pyelonephritis. MATERIAL AND METHODS: We have conducted a retrospective observational study of women admitted to the hospital with acute pyelonephritis between May 2004 and April 2011. Patients were included if the results of urine cultures and susceptibility testing to antibiotics were available. Epidemiological, clinical, therapeutical and outcome variables were collected from chart review. We considered inappropriate empirical antimicrobial treatment (IEAT) as the occurrence of microorganism that were not effectively treated at the time when the causative microorganism and its antibiotic susceptibility were known. RESULTS: Fifty women with appropriate microbiological data from a total of 93 cases of acute pyelonephritis were included in the study. The women's mean age was 26.4 years, and 58% were nulliparous. Pyelonephritis was developed in the 2nd and 3rd trimester in 88% of cases. Previous urinary tract infections were recorded in 34%. Escherichia coli was the most frequent microorganism (70%). The proportion of patients who received IEAT was 10%. Amoxicillin-clavulanate and cephalosporines were the most predominant antibiotics used, with a proportion of IEAT of 10.3% and 5.9%, respectively. CONCLUSIONS: Pregnant women with pyelonephritis received IEAT in a small but significant number of cases. Amoxicillin-clavulante and cephalosporines were adequate in most cases. More studies are needed to define the clinical impact of IEAT on prognosis.

Pyelonephritis in pregnancy. How adequate is empirical treatment?

Objetivo. Valorar la idoneidad del tratamiento antibiótico empírico en la pielonefritis aguda en el embarazo. Material y método. Estudio observacional retrospectivo de las mujeres embarazadas admitidas en el hospital con pielonefritis aguda entre mayor de 2004 y abril de 2011. Las pacientes fueron incluidas si los resultados de los cultivos de orina y los estudios de resistencias a los antibióticos estaban disponibles. Las variables epidemiológicas, clínicas, terapéuticas y pronósticas fueron recogidas mediante revisión de las historias clínicas. Se consideró que existía un tratamiento antibiótico empírico inadecuado (IEAT) cuando el microorganismo causante de la infección no estaba siendo tratado de manera eficaz en el momento en que se conoció el microorganismo causante de la infección y el estudio de resistencias. Resultados. De un total de 93 casos de pielonefritis aguda se incluyeron en el estudio 50 mujeres cuyos datos microbiológicos fueron apropiados. La edad media de las mujeres fue de 26,4 años. El 58% de ellas fueron nulíparas. La pielonefritis se presentó en el segundo o tercer trimestre del embarazo en el 88% de los casos. Se documentó infecciones urinarias previas en el 34%. Escherichia coli fue el microorganismo más frecuentemente aislado (70%). El 10% de las pacientes recibieron IEAT. Amoxicilina-clavulánico y cefalosporinas fueron los antibióticos usados con mayor frecuencia, con una proporción de IEAT del 10,3 y 5,9% respectivamente. Conclusiones. Las mujeres embarazadas con pielonefritis aguda recibieron IEAT en un pequeño pero significativo número de casos. Amoxicilina-clavuláncio y cefalosporinas fueron antibióticos adecuados en la mayoría de los casos. Se necesitan más estudios para conocer el impacto clínico del IEAT sobre el pronóstico(AU)

Objective. To ascertain the adequacy of empirical antimicrobial treatment in pregnant women with acute pyelonephritis. Material and methods. We have conducted a retrospective observational study of women admitted to the hospital with acute pyelonephritis between May 2004 and April 2011. Patients were included if the results of urine cultures and susceptibility testing to antibiotics were available. Epidemiological, clinical, therapeutical and outcome variables were collected from chart review. We considered inappropriate empirical antimicrobial treatment (IEAT) as the occurrence of microorganism that were not effectively treated at the time when the causative microorganism and its antibiotic susceptibility were known. Results. Fifty women with appropriate microbiological data from a total of 93 cases of acute pyelonephritis were included in the study. The women’s mean age was 26.4 years, and 58% were nulliparous. Pyelonephritis was developed in the 2nd and 3rd trimester in 88% of cases. Previous urinary tract infections were recorded in 34%. Escherichia coli was the most frequent microorganism (70%). The proportion of patients who received IEAT was 10%. Amoxicillin-clavulanate and cepahlosporines were the most predominant antibiotics used, with a proportion of IEAT of 10.3% and 5.9%, respectively. Conclusions. Pregnant women with pyelonephritis received IEAT in a small but significant number of cases. Amoxicillin- clavulante and cephalosporines were adequate in most cases. More studies are needed to define the clinical impact of IEAT on prognosis(AU)

[Microbiology laboratory management: an (almost) pending matter]. / La gestión de los laboratorios de microbiología: una asignatura (casi) pendiente.

Many professionals from distinct disciplines work in health centers and consequently these workplaces should be considered as service companies, involving human, material and financial resources aimed at providing a service required by society. Hospitals are one of the most complex types of company, in which diverse goods and services are produced and consumed. Like the hospital as a whole, the various units and departments in which the hospital is divided, including the microbiology department, are sufficiently different to be called distinct, but related, branches of the same company, given that none can perform their function without the others. Viewing a hospital service as a branch of a large company (the hospital as a whole) allows its production, the resources used in this production, and its clients to be identified more clearly. The healthcare model based on clinical management units aims to constitute a new organizational model for public health systems in which health strategies are performed that allow innovation and decentralization of the healthcare network. Clinical management provides the framework for attending to the population's healthcare needs through a person-centered approach and involves all the professionals in any of the settings in which healthcare is provided. Among the aims of this model is to guarantee continuity of care, facilitate comprehensive health promotion and deliver daily healthcare effectively. The main instruments of clinical management are structured knowledge of the population's health needs, the use of the best scientific knowledge available, and a comprehensive and participatory practical model, together with assessment tools. Three possible clinical management models are proposed for the work of specialists in microbiology and parasitology: a) a microbiology clinical management unit; b) a biological diagnosis clinical management unit, and c) a multidisciplinary clinical management unit with cross-competencies with affiliated specialties. The latter two models have strengths and weaknesses and the choice of any model must be based on mutual trust, respect for areas of knowledge and the search for synergy among the units and services forming these models. Any of the proposed models could be valid, although the selection of a particular model should consider the working environment, the size of the hospital, and the interpersonal relations within its components, which should be based on complementariness, dialogue and the search for consensus in decision-making to achieve a synergistic environment. The model that might best satisfy clinical microbiologists' expectations and promote their future development and survival in the era of automatization of most microbiological diagnostic procedures could be the multidisciplinary model.

La gestión de los laboratorios de microbiología: una asignatura (casi) pendiente / Microbiology laboratory management: an (almost) pending matter

Un centro sanitario, en el que trabajan profesionales de distintas disciplinas, debe considerarse como una empresa de servicios, ya que se trata de un conjunto de recursos humanos, materiales y financieros orientados a la prestación de un servicio demandado por la sociedad. Un hospital es uno de los tipos de empresa más complejos, en el que se producen y consumen diversos bienes y servicios. Al igual que el hospital en su conjunto, las distintas unidades o servicios en las que se puede dividir un hospital, entre los que se incluye el servicio de microbiología, son tan diferentes que puede hablarse, en cierta forma, de distintas subempresas diferenciadas entre sí, aunque relacionadas, dado que ninguna de ellas puede cumplir su función sin las otras. Pensar en un servicio hospitalario en términos de subempresa de servicios en el interior de la gran empresa, que es el hospital, permite identificar más claramente su producción, los recursos que emplea en realizarla y sus clientes. El modelo sanitario basado en las unidades de gestión clínica pretende ser un nuevo modelo organizativo del sistema sanitario público en donde se realicen las estrategias de salud que permitan la innovación y la descentralización de la red sanitaria. La gestión clínica es el marco para atender las necesidades de salud de los ciudadanos con una atención centrada en la persona, y que se desarrolla con la implicación de todos los profesionales en cualquiera de los ámbitos en el que se preste la asistencia sanitaria. Tiene entre sus fines asegurar la continuidad asistencial, facilitar la promoción integral de la salud y articular, de forma eficaz, la práctica asistencial cotidiana. Los principales instrumentos de la gestión clínica son el conocimiento estructurado de las necesidades de salud de la población atendida, la utilización del mejor conocimiento científico disponible, y un modelo de práctica integrado y participativo, así como el uso de herramientas de evaluación. Se plantean 3 posibles modelos de gestión clínica en el desempeño profesional de los especialistas en microbiología y parasitología: a) unidad de gestión clínica de microbiología; b) unidad de gestión clínica de diagnóstico biológico, y c) unidad de gestión clínica multidisciplinar con competencias transversales con especialidades afines. Estos 2 últimos modelos presentan fortalezas y debilidades, y la elección de cualquier modelo ha de basarse en la confianza mutua, respeto de las áreas de conocimiento, y búsqueda de sinergia entre las unidades y servicios que las compongan. Cualquiera de los modelos planteados puede ser válido, aunque debe adoptarse en función del entorno laboral, tamaño del hospital y las relaciones interpersonales de los componentes de ésta, que han de basarse en la complementariedad, diálogo y búsqueda de consenso en las decisiones para lograr un efecto sinérgico entre éstos. El modelo multidisciplinar con competencias transversales entre especialidades, posiblemente, pueda satisfacer mejor las expectativas de los microbiólogos clínicos, y puede potenciar su futuro desarrollo y pervivencia ante un presente inmediato de automatización de la mayoría de los procedimientos de diagnóstico microbiológico

Infección por el virus del papiloma humano (VPH) / No disponible

No disponible