RESUMEN
The aim of this study was to assess the value of surveillance cultures in identifying extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL) carriers upon admission to hospital, and to identify risk factors for carriage. This prospective cross-sectional study included all hospital admissions over one week. Of 525 patients screened, 56 were positive for ESBLs. Half were only identified through screening. Four independent risk factors were identified: nursing home residency, hospitalization in the previous year, prior antibiotic treatment and prior ESBL carriage. Over 50% of the screened patients had at least one risk factor. By screening this targeted population, 87.5% of positive patients would have been identified.
Asunto(s)
Portador Sano/epidemiología , Infecciones por Enterobacteriaceae/epidemiología , Enterobacteriaceae/enzimología , beta-Lactamasas/metabolismo , Anciano , Portador Sano/microbiología , Estudios Transversales , Pruebas Diagnósticas de Rutina , Enterobacteriaceae/aislamiento & purificación , Infecciones por Enterobacteriaceae/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Factores de RiesgoRESUMEN
The emergence of fluconazole-resistant Candida (FRC) is worrisome, but little is known about susceptibility patterns in different nosocomial settings. We prospectively analysed Candida bloodstream isolates in 18 medical centres in Israel (six tertiary-care and 12 community hospitals). The study included 444 episodes of candidaemia (450 patient-specific isolates, 8.5% fluconazole-resistant). Institutional FRC bloodstream infection rates correlated with annual inpatient days, and were strongly associated with the presence and activity of haematology/oncology services. Infection with Candida krusei and fluconazole-resistant Candida glabrata occurred exclusively in hospitals with >600 beds. These findings suggest that empirical antifungal strategies should be tailored to the nosocomial setting.
Asunto(s)
Antifúngicos/farmacología , Candida/efectos de los fármacos , Candidemia/epidemiología , Infección Hospitalaria/epidemiología , Farmacorresistencia Fúngica , Fluconazol/farmacología , Adulto , Anciano , Candida/aislamiento & purificación , Candida glabrata , Femenino , Hospitales , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios ProspectivosRESUMEN
From 2006 to 2009, 315 clinical methicillin-resistant Staphylococcus aureus (MRSA) isolates were collected from 5 hospitals across Israel. Most isolates (64%) were related to the global clones spa types t001-SCCmec-I (SCCmec-I stands for staphylococcal cassette chromosome mec type I) (n = 99; 31%), t002-SCCmec-II (n = 82; 26%), and t008-SCCmec-IV (n = 21; 7%), five of which were identified as MRSA strain USA-300. Seventeen strains unique to Israel were identified. SCCmec types IV and V were common among hospital-acquired isolates.
Asunto(s)
Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Tipificación Molecular , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Análisis por Conglomerados , ADN Bacteriano/genética , Genotipo , Humanos , Israel/epidemiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Epidemiología MolecularRESUMEN
The purpose of this investigation was to assess the effect of empirical antibiotic treatment on 30-day mortality among debilitated inpatients with dementia and Gram-negative bacteremia. A retrospective cohort study in the years 2005-2007 was undertaken. Data were collected through patient chart review. The association between individual variables and 30-day mortality was assessed through univariate analysis. Variables significantly associated with mortality (p < 0.05) were entered into a logistic regression analysis. Adjusted odds ratios (ORs) for mortality with 95% confidence intervals (CIs) are shown. Subgroup analysis of patients with and without decubitus ulcers was performed. In our cohort of 378 patients with dementia and Gram-negative bacteremia, the 30-day mortality was 39% overall and 61% in the subgroup of patients with decubitus ulcers. Inappropriate empirical therapy was associated with higher mortality, although this effect was not statistically significant (OR 1.41, 95% CI 0.86-2.29). Inappropriate empirical therapy did not affect mortality in the subgroup of patients with decubitus ulcers (OR 0.37, 95% CI 0.11-1.28). Other factors found to independently affect mortality included age, co-morbidities, source of infection, sepsis severity, and hospital-acquired infection. Appropriate empirical antibiotic therapy for patients with dementia and severe bacterial infection did not have a clear advantage, especially in the sickest group of patients with decubitus ulcers.
Asunto(s)
Antibacterianos/administración & dosificación , Bacteriemia/tratamiento farmacológico , Bacteriemia/mortalidad , Demencia/complicaciones , Quimioterapia/métodos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/mortalidad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Molecular characterization of methicillin-resistant Staphylococcus aureus isolates from three hospitals in Israel was the aim of the study presented here. We identified 11 distinct genetic clones by pulsed-field gel electrophoresis. Molecular typing identified four different SCCmec types-I, II, IV, and V-and nine spa types. Spa type t002 was the most common.
