Efficacy of an information system addressed to nursing staff for diminishing contaminated blood cultures: a blind clinical trial / Eficacia de un sistema de información dirigido al personal de enfermería para disminuir la contaminación de los hemocultivos: un ensayo clínico ciego

Introduction: Evaluate the efficacy of an information system addressed to nursing staff to lower the blood culture contamination rate. Methods: A blind clinical trial was conducted at Internal Medicine and Emergency Departments during 2011. After following a reeducation program in BC extraction, participants were randomly selected in a 1:1 ratio. Every participant of the experimental group was informed of each worker's individual performance; whereas the control group was only informed of the global results. Results: A total of 977 blood extractions were performed in 12 months. Blood culture contamination rate was 7.5%. This rate was higher in the Emergency Department than in Internal Medicine (10% vs. 3.8%; p=0.001). Factors associated with the higher risk of contamination were, in the univariate analysis, the extraction through a recently implanted blood route and the time of professional experience, while those associated with a lower risk were the extraction in Internal Medicine and through a butterfly needle. On multivariate analysis, extraction through a recently placed access was an independent risk factor for an increased contamination rate (OR 2.29; 95%CI 1.18-4.44, p=0.014), while individual information about the blood culture results (OR 0.11; 95%CI 0.023-0.57; p=0.008), and more than 9 years of professional experience were asso-ciated with fewer contaminations (OR 0.30; 95%CI 0.12-0.77; p=0.012). In the intervention group the contamination rate diminished by a 26 %. Conclusions: Drawing blood cultures through a recently taken peripheral venous access increased their risk of contamination. The intervention informing the nurse staff of the contamination rate is effective to decrease it

Objetivos: Evaluar la eficacia de un sistema de información dirigido al personal de enfermería, en la reducción de la tasa de contaminación de los hemocultivos. Métodos: Durante el año 2011, se realizó un ensayo clínico en los servicios de Medicina Interna y de Urgencias. Después de seguir un programa de reeducación en la extracción de los hemocultivos, los participantes, fueron aleatorizados en una proporción de 1:1. En el grupo de intervención se informó del porcentaje de hemocultivos contaminados de cada profesional y en el grupo control se aportaba la información del porcentaje global de contaminaciones. Resultados: Durante un periodo de 12 meses se realizaron 977 extracciones. La tasa de contaminación de los hemocultivos fue del 7,5%. Esta tasa fue mayor en Urgencias que en Medicina Interna (10% versus 3,8%, p=0,001). Los factores asociados con mayor riesgo de contaminación fueron, en el análisis univariable: la extracción a través de una vía sanguínea recientemente implantada y el tiempo de experiencia profesional; mientras que los que se asociaron con menor riesgo fueron la extracción en Medicina Interna (versus en Urgencias) y a través de una palomilla. En el análisis multivariable, la extracción de los hemocultivos de una vía recientemente implantada se relacionó de forma independiente con un incremento de las contaminaciones (OR 2,29, IC 95% 1,18-4,44, p=0,014),mientras que la información individual sobre los resultados de los hemocultivos (OR 0.11; IC 95% 0,023-0,57; p=0,008) y la experiencia profesional mayor de 9 años, lo hizo con menos contaminaciones (OR 0,30, IC 95% 0,12-0,77, p=0,012). En el grupo de intervención la tasa de contaminaciones se redujo en un 26%. Conclusión: La extracción de hemocultivos a través de una vena periférica recientemente implantada aumentó el riesgo de contaminación de los mismos. La intervención informativa a los enfermeros de la tasa de contaminación de los hemocultivos, es eficaz para disminuirla

Cuadros clínicos asociados a bacteriemia causada por las nuevas especies incluidas en el antiguo grupo Streptococcus bovis / Diseases associated with bloodstream infections caused by the new species included in the old Streptococcus bovis group

Objetivo: Establecer posibles asociaciones entre las nuevas especies incluidas en grupo Streptococcus bovis aisladas de hemocultivos, con los datos clínicos de los pacientes correspondientes. Métodos Cuarenta y cuatro hemocultivos debidos a S. bovis se identificaron mediante pruebas fenotípicas y se correlacionaron con los datos clínicos de los pacientes correspondientes. Resultados Identificamos 15 Streptococcus gallolyticus subsp. gallolyticus, 24 Streptococcus gallolyticus subsp. pasteurianus, y 5 Streptococcus infantarius en los 44 episodios de bacteriemia. Conclusiones La asociación entre bacteriemia por S. bovis y endocarditis y/o cáncer de colon está fuertemente asociada a la especie causal. Streptococcus gallolyticus subsp. gallolyticus se relaciona con endocarditis y/o enfermedad colónica, mientras Streptococcus gallolyticus subsp. pasteurianus está significativamente relacionado con patología hepato-biliar (AU)

Objective: We sought to identify possible diseases associated with bloodstream infections caused by new species of S. bovis group isolated in blood cultures and by studying patient records. Methods: Forty-four consecutive blood culture isolates initially designated bovis were further characterised using phenotypic methods Patient records were examined. Results: We (. .) (AU)

[Diseases associated with bloodstream infections caused by the new species included in the old Streptococcus bovis group]. / Cuadros clínicos asociados a bacteriemia causada por las nuevas especies incluidas en el antiguo grupo Streptococcus bovis.

OBJECTIVE: We sought to identify possible diseases associated with bloodstream infections caused by new species of S. bovis group isolated in blood cultures and by studying patient records METHODS: Forty-four consecutive blood culture isolates initially designated S. bovis were further characterised using phenotypic methods Patient records were examined. RESULTS: We identified 15 Streptococcus gallolyticus subsp. gallolyticus, 24 Streptococcus gallolyticus subsp. pasteurianus, and 5 Streptococcus infantarius isolates in 44 BSI episodes. CONCLUSIONS: The association between S. bovis bacteraemia and endocarditis and/or colon carcinoma is highly dependent on the causative species. Streptococcus gallolyticus subsp. gallolyticus is a surrogate for endocarditis and/or bowel disease, whereas Streptococcus gallolyticus subsp. pasteurianus is a surrogate for hepato-biliary disease.

Direct serogrouping of Streptococcus pneumoniae strains in clinical samples by use of a latex agglutination test.

Pneumotest-Latex (Statens Seruminstitut) was evaluated for direct serogrouping of Streptococcus pneumoniae strains in clinical samples from patients with invasive disease. The technique was accurate to its level of discrimination for 62 of 67 clinical samples (92.5%). Pneumotest-Latex would be a useful alternative for direct serogrouping of pneumococci in clinical samples.

Evaluación de una técnica de aglutinación por látex para la serotipificación de Streptococcus pneumoniae / Evaluation of a latex agglutination test for serotyping Streptococcus pneumoniae

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Human rotavirus G9 and G3 as major cause of diarrhea in hospitalized children, Spain.

In Spain, diarrhea remains a major cause of illness among infants and young children. To determine the prevalence of rotavirus genotypes and temporal and geographic differences in strain distribution, a structured surveillance study of hospitalized children <5 years of age with diarrhea was initiated in different regions of Spain during 2005. Rotavirus was detected alone in samples from 362 (55.2%) samples and as a coinfection with other viruses in 41 samples (6.3%). Enteropathogenic bacterial agents were detected in 4.9% of samples; astrovirus and norovirus RNA was detected in 3.2% and 12.0% samples, respectively; and adenovirus antigen was detected in 1.8% samples. Including mixed infections, the most predominant G type was G9 (50.6%), followed by G3 (33.0%) and G1 (20.2%). Infection with multiple rotavirus strains was detected in >11.4% of the samples studied during 2005.

Spread of Escherichia coli strains with high-level cefotaxime and ceftazidime resistance between the community, long-term care facilities, and hospital institutions.

A total of 151 Escherichia coli strains resistant to cefotaxime and ceftazidime were isolated during a prospective surveillance study. These strains were characterized by clinical, microbiological, and molecular analyses and were distributed into four clusters of 103, 11, 6, and 5 isolates, along with 25 unrelated strains. The principal cluster was isolated from urine, wound, blood, and other samples in three hospitals, eight nursing homes, and a community healthcare center. This cluster was associated with both nosocomial (65%) and community-acquired (35%) infections. Most strains were resistant to ciprofloxacin, gentamicin, tobramycin, cefepime, amoxicillin-clavulanic acid, and trimethoprim-sulfamethoxazole but were susceptible to imipenem. All isolates from the four clusters expressed the extended-spectrum beta-lactamase (ESBL) CTX-M-15. This enzyme was also present in 8 (30.8%) of the 26 unrelated isolates. The other ESBLs, CTX-M-14 and CTX-M-32, were detected in five and seven cases, respectively, but they were detected in individual E. coli isolates only. In three clusters, blaCTX-M-15 alleles were linked to an ISEcp1-like element, while in eight strains of cluster II an IS26 element preceded the blaCTX-M-15 allele. An additional pool of resistance genes included tetA, drfA14 or dfrA17, sul1 or sul2, aac(6')Ib, and aac(3)IIb. All except one of the 27 isolates tested for genetic virulence markers harbored the same three virulence genes: iutA and fyuA (siderophores), and traT (serum survival factor). Epidemic or occasional isolates of cefotaxime- and ceftazidime-resistant E. coli can spread between distinct health facilities including hospitals, community health centers, and long-term care centers.

Diversity of group A human rotavirus types circulating over a 4-year period in Madrid, Spain.

The incidence and distribution of human rotavirus G types among children under 5 years old with acute gastroenteritis were determined over a 4-year period (1998 to 2002) by using monoclonal antibodies and reverse transcription-PCR methods. Rotavirus was detected in 1,155 (31%) of 3,760 specimens tested. Rotavirus was studied in every month of the 48-month survey period. Rotavirus activity occurred mainly (51%) in the typically cooler months in Spain (November to February). The age distribution of rotavirus-positive cases showed that 90% of patients (1,038 of 1,155) were under 2 years old. Rotavirus types were determined for 576 of 1,155 patients (50%). G1 was the main genotype detected (53%), and the second most common was G4 (24%). The G2, G9, and G3 rotavirus types were detected in 14, 6, and 2% of the cases, respectively. Dual infections were detected in only 0.6%. The seasonal distribution of genotypes showed a significant genotypic shift: whereas G4 strains predominated (57%) during the 1998 to 2000 seasons, the G1 gradually increased to account for 75% in the 2000 to 2002 seasons. In addition, the present study reports the first detection of the G9 genotype in human fecal samples in Spain. Therefore, additional types may be required for vaccine development strategies that currently target only types G1 to G4.

Acute viral gastroenteritis: proportion and clinical relevance of multiple infections in Spanish children.

Dual infections associated with acute infectious diarrhoea and its microbiological, epidemiological and clinical findings have been evaluated in patients selected from a comprehensive survey of children under 4 years old, admitted to hospital emergency rooms from October 1996 to November 1997. A total of 820 children (433 males and 387 females) were enrolled. Stools were tested for rotavirus, adenovirus, astrovirus and bacterial enteropathogens. Patients were grouped according to age, and the seasonality of mixed infections was evaluated. Clinical trends and severity of gastrointestinal disease by Ruuska's score were also analysed. Mixed infections were identified in 39 cases (5 %), of which 23 were males and 16 were females. The majority of cases were in the 7-18-month age group (26 cases) and occurred in autumn (67 %). Virus-virus co-infections were more frequent (26/39) than virus-bacteria co-infections (13/39). More than two infectious agents were detected in only four cases. The most common viral co-infections were rotavirus-astrovirus (13/26) and rotavirus-adenovirus (10/26). The present report is the first prospective analysis of clinical-epidemiological trends of dual infections in young Spanish children with acute viral gastroenteritis. Our results emphasize the clinical importance of mixed infections as a cause of severe diarrhoea in children.

Astrovirus acute gastroenteritis among children in Madrid, Spain.

BACKGROUND: Human astroviruses cause infantile gastroenteritis worldwide, but the prevalence of disease varies greatly by setting. Since 1997 we have conducted a survey to determine the causes of diarrhea among Spanish children attending an emergency room in Madrid and to characterize the clinical features of viral-associated gastroenteritis. OBJECTIVES: To define the epidemiologic role of astrovirus-associated gastroenteritis in Spanish children, to review its clinical features and to compare these illnesses with those caused by rotavirus. To assess the sensitivity of two methods of detection [enzyme-linked immunosorbent assay (EIA) and reverse transcriptase (RT)-PCR]. METHODS: Fecal specimens from 822 children with acute diarrhea treated at an emergency room were screened by EIA assays. Random astrovirus-positive samples were characterized by RT-PCR and nucleotide sequencing for their phylogenetic grouping. RESULTS: Astrovirus was detected in 44 (5.3%) of 822 specimens tested by EIA. No pathogens were detected in fecal specimens from 238 (29%) children; however, in 137 of those with adequate remaining specimens, we found an additional 50 (6.1%) that were positive by RT-PCR. HAstV-1 was the most prevalent type followed by HAstV-2. The gastroenteritis associated with astrovirus alone was slightly less severe and had a lower score or risk of hospitalization than that associated with rotavirus (P < 0.05). CONCLUSIONS: Astrovirus was found in 11.4% of all children whom we tested for enteric viral and bacterial pathogens, making it the second most common cause of acute gastroenteritis among Spanish children. True prevalence of astrovirus could be underestimated if only EIAs were used for detection.