Epidemiological study of secondary bloodstream infections: The forgotten issue.

OBJECTIVE: Secondary bacteraemia infections (SBI) are poorly studied. We analyse the epidemiology of nosocomial SBI, potential risk factors and mortality of affected patients. METHODS: Prospective study of patients with bacteraemia from 2009 to 2014 in a tertiary hospital. For each SBI was recorded: primary source of infection, aetiological agent, demographic data, intrinsic and extrinsic risk factors and mortality during the episode. RESULTS: 429/1918 episodes of Nosocomial Bacteraemia (NB) (22%) were SBI (average Incidence Density: 0.41% days of admission). Onco-hematological services had the highest Incidence Density of SBI. Surgical Site Infection-SBI (SSI-BSI) was the most frequent SBI (27%), followed by Urinary Tract Infection-SBI (UTI-BSI) (24%). Gram-negative bacteria were the most prevalent microorganism (61.1%). The median interval between SBI episodes to discharge was 37±59days. Mortality rate was 29%. These patients had many intrinsic and extrinsic risk factors such as urinary catheterization (68%), CVC (69%), Arterial hypertension (48%) and hospitalization in the six previous months (45%). Mean age was significantly higher in patients with UTI-BSI and SSI-BSI. Average stay from admission to the development of bacteraemia was statistically lower in patients with Intra-abdominal Infection bacteraemia (IAB-BSI). Patient with SSI-BSI had oncologic processes and had undergone for more Mechanical ventilation than UTI-SSBI and Respiratory Tract Infections Bacteraemia (RTI-BSI). The use of CVC was significantly higher in RTI-BSI. CONCLUSIONS: SBI accounts for almost a quarter of all NB. Patients has multiple comorbidities, increases hospital stay and mortality. It would be necessary to establish measures to rapidly diagnose and treat the primary infection, in order to prevent the onset of SBI.

¿Existe relación entre el ciclo umbral de la reacción en cadena de la polimerasa y el riesgo de infección grave por Clostridium difficile? / Is there a relationship between the polimerase chain reaction cycle threshold and the risk of severe Clostridium difficile infection?

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Risk factors associated with carbapenemase-producing Klebsiella pneumoniae fecal carriage: A case-control study in a Spanish tertiary care hospital.

Asymptomatic colonization of the gastrointestinal tract by carbapenemase-producing Enterobacteriaceae is an important reservoir for transmission that may precede infection. This prospective, observational, case-control study was designed to identify risk factors for carbapenemase-producing Klebsiella pneumoniae (CPKP) fecal carriage. This study included 87 cases and 200 controls. Multivariate analysis identified length of stay (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01-1.03; P = .03), previous hospitalization (OR, 5.89; 95% CI, 1.73-20.68; P = .01), antibiotic use (OR, 0.20; 95% CI, 0.65-0.62; P = .01), and corticosteroid use (OR, 0.33; 95% CI, 0.15-0.74; P = .007) as independent risk factors for CPKP rectal carriage. Length of hospital stay, previous hospitalization, corticosteroid use, and antimicrobial exposure are important risk factors for CPKP rectal colonization. Adherence to infection control practices and directed surveillance programs appear to be critical components for CPKP control programs.

Antimicrobial resistance and molecular analysis of methicillin-resistant Staphylococcus aureus collected in a Spanish hospital.

Clonal distribution of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals may differ according to the geographic location and time period. Knowledge of MRSA clonal epidemiology in hospital settings involves much more than the study of healthcare-associated MRSA (HA-MRSA) clones. In recent years, investigators have documented the introduction of both community-associated MRSA (CA-MRSA) and livestock-associated MRSA (LA-MRSA) clones, the emergence of clones carrying Staphylococcal cassette chromosome mec (SCCmec) XI, and the genetic diversity among sporadic MRSA isolates. The allocation of certain antibiotypes to dominant MRSA clones in an institution allows their use as phenotypic markers for a preliminary search for new clones, early detection of clonal shift, and as a guide for better empirical therapy, infection control, and treatment within a particular institution. For these reasons, we identified 938 strains detected in a System of Universal Active Surveillance of MRSA in clinical samples during the period 2009-2010, obtaining the clonal distribution of MRSA at the Hospital Universitario de Canarias (Tenerife, Spain) and the relationship between antimicrobial susceptibility and three major clones present. The antibiotypes that best defined the ST5-MRSA-IV (Pediatric) clone showed resistance to tobramycin and susceptibility to clindamycin, erythromycin, gentamicin, rifampin, trimethoprim-sulfamethoxazole, vancomycin, quinupristin/dalfopristin, and linezolid, whereas the ST22-MRSA-IV clone (EMRSA-15) showed susceptibility to these antibiotics, and finally, the ST36-MRSA-II clone (EMRSA-16) was resistant to clindamycin, erythromycin, and tobramycin and susceptible to the remaining antimicrobials. Similar observations would allow the early detection of changes in clonal epidemiology by analysis of antimicrobial susceptibility of the isolates within a single institution.