The Impact of MRSA Colonization on Healthcare-Associated Infections in Long-Term Care Facility Residents: A Whole-Genome Sequencing-Based Study.

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been considered a risk factor for the development of infection, however, there are no studies that have compared the colonizing and infecting strains using whole-genome sequencing (WGS). The aim of this study is to determine the prevalence of and risk factors for MRSA colonization among long-term care facilities (LTCF) residents of Tenerife (Spain), and to analyze the epidemiological relationship between the colonizing and infecting strains using WGS. A point-prevalence study was carried out at 14 LTCFs in Tenerife from October 2020 to May 2021. Nasal swabs were cultured for MRSA. Colonized residents were followed up for two years. A phylogenetic comparison between colonization and infection strains was performed using WGS. A total of 764 residents were included. The prevalence of colonization by MRSA was 28.1% (n = 215), of which 12 (5.6%) subsequently developed infection. A close genetic relationship between colonization and infection isolates was found in three of the four (75%) residents studied. Our study confirms that colonized residents can develop serious MRSA infections from the same nasal colonization strain. Given the high prevalence of MRSA colonization in these centers, it is necessary to implement strategies with preventive measures to avoid the development of infection and the transmission of MRSA.

Bacterial Colonization of Microplastics at the Beaches of an Oceanic Island, Tenerife, Canary Islands.

(1) Isolated systems, such as oceanic islands, are increasingly experiencing important problems related to microplastic debris on their beaches. The formation of microbial biofilm on the surface of microplastics present in marine environments provides potential facilities for microorganisms to survive under the biofilm. Moreover, microplastics act as a vehicle for the dispersion of pathogenic organisms, constituting a new route of exposure for humans. (2) In this study, the microbial content (FIO and Vibrio spp. and Staphylococcus aureus) of microplastics (fragments and pellets) collected from seven beaches of the oceanic island of Tenerife, in the Canary Islands (Spain), was determined. (3) Results showed that Escherichia coli was present in 57.1% of the fragments and 28.5% of the pellets studied. In the case of intestinal Enterococci, 85.7% of the fragments and 57.1% of the pellets tested positive for this parameter. Finally, 100% of the fragments and 42.8% of the pellets analyzed from the different beaches contained Vibrio spp. (4) This study shows that microplastics act as reservoirs of microorganisms that can increase the presence of bacteria indicating faecal and pathogenic contamination in bathing areas.

Evaluation of Delayed Effective Discharge for Non-Medical Reasons in Patients Admitted to Acute Care Hospitals in Spain: A Scoping Review.

Delayed discharge for non-clinical reasons is defined as a period of stay that continues after a patient has been deemed medically fit to leave the hospital but is unable to do so for non-medical reasons. This circumstance overburdens the healthcare system and constitutes a major problem for healthcare systems and the patients themselves in this situation. The aim of this study was to evaluate the delay in effective discharge for non-medical reasons for patients admitted to acute care hospitals in Spain. A scoping review followed the Joanna Briggs Institute methodology guidelines to search for and synthesize studies published between 2019 and 2022. To identify potentially relevant documents, the following bibliographic databases were searched: EMBASE, CINAHL and MEDLINE. For the search, we used free terms («delayed discharges¼, «discharge delays¼, «bed-blocking¼, «timely discharge¼, «unnecessary days¼ and «inappropriate stays¼). Quantitative or qualitative studies published in scientific journals on delayed effective discharge for non-medical reasons for patients admitted to a hospital for any health issue of medical or surgical origin were selected. Information collection of the documents was performed using a structured datasheet specifically developed by the authors. The initial search strategy identified a total of 124 references, which were successively screened to a final selection of 13 studies. To conclude, delayed discharge from a hospital for non-clinical reasons is a multifactorial problem. This may be due to factors internal or external to the hospital, as well as personal factors. The main causes of the delay were similar among the studies found, as were the clinical characteristics of the patients, most of whom were elderly, frail and more dependent due to declining functional capacities. Further studies addressing the socio-familial characteristics of the patients and the perspective of the patient and families would be necessary.

Arterial Hypertension in Morbid Obesity after Bariatric Surgery: Five Years of Follow-Up, a Before-And-After Study.

BACKGROUND: Arterial hypertension (HTN) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study is to analyse the prevalence and evolution of HTN and weight loss in patients suffering from morbid obesity before and after bariatric surgery, during a follow-up period of five years. METHODS: A before-and-after study was carried out on severely obese patients undergoing Laparoscopic Roux-En-Y Gastric Bypass (LRYGB). Criteria for HTN diagnosis were current treatment with antihypertensive agents and/or systolic blood pressure (SBP) > 140 mmHg and/or diastolic (DBP) > 90 mmHg. HTN remission was defined as normalisation of blood pressure (BP) maintained after discontinuation of medical treatment, and HTN recurrence was considered when HTN diagnostic criteria reappeared after remission. Weight loss during the study period was evaluated for each patient, calculating excess weight loss percentage (% EWL) and BMI loss percentage (% BMIL) with reference to the baseline value. RESULTS: A total of 273 patients were included in the study. HTN was present in 48.2%; 29.4% of hypertensive patients showed HTN remission two years after the surgical procedure, 30.3% of them had relapsed at five years. CONCLUSION: LRYGB in obese patients is associated with a remission of HTN, and no weight loss differences were observed between the group of patients showing HTN remission at two years and the group who did not. However, differences were observed after the second follow-up year, with an increased weight loss in the remission group, which could indicate that sustained weight loss favours the control of HTN.

Metabolic syndrome after Roux-en-Y gastric bypass in patients with morbid obesity: Five years of follow-up, a before and after study.

BACKGROUND: Metabolic syndrome (MetS) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study is to analyse prevalence and evolution of MetS in patients suffering from morbid obesity, before and after bariatric surgery, during a follow-up period of 5 years. METHODS: A before-after study was carried out including 156 patients with MetS. The definition of metabolic syndrome according to the Joint Interim Statement (JIS) definition was used. Demographic, as well as anthropometric, biochemical, and clinical analyses were assessed before, as well as 2 and 5 years after performing laparoscopic Roux-en-Y gastric bypass (RYGB). RESULTS: High BMI (100%), elevated blood pressure (78%) and low levels of high density lipoprotein (70%) were the most prevalent criteria for MetS. The percentage of people with MetS decreased significantly to 48.9% at 2 years and 24.1% at 5 years. The weight was also significantly reduced at 2 years, although at 5 years a rebound effect is already observed. Percentage of total weight loss (%TWL) and excess BMI loss (%EBMIL) were. 49.7 ± 19.4% and 68.2 ± 18.9%, respectively, at 2 years and 29.3 ± 11.6% and 62.0 ± 24.9 at 5 years, both presenting significant differences (p < 0.001). CONCLUSION: RYGB in obese patients is associated with a significant improvement of MetS and its comorbidities. Insufficient weight loss is the main factor related to the prevalence of MetS.

Prevalence and characteristics of methicillin-resistant staphylococci in goats on the island of Tenerife, Spain.

The aim of this study was to determine the prevalence of methicillin-resistant Staphylococcus (MRS) in healthy goats on the Island of Tenerife, Spain, as well as to identify the phenotypic and genotypic characteristics of the strains found. A cross-sectional prevalence study was conducted. A total of 158 goats from 15 different farms were sampled between September 2017 and January 2018. The percentage of positive samples of methicillin-resistant Staphylococcus aureus (MRSA) was 15.8% (25/158) and that of methicillin-resistant coagulase-negative staphylococci (MRCoNS) was 6.9% (11/158). All MRSA isolates from goats belonged to one clonal group showing Multi-Locus Sequence type 398. All strains studied (n = 36) were resistant to non-carbapenem beta-lactam antibiotics and susceptible to teicoplanin, linezolid, vancomycin, rifampicin, quinupristin-dalfospristin and mupirocine. In MRSA isolates, the highest percentage of resistance obtained, besides beta-lactam non-carbapenem antibiotics, was to trimethoprim-sulphamethoxazole and, in the case of MRCoNS isolates, to phosphomycin and erythromycin. A total of 12 resistance patterns were obtained, presenting differences between patterns obtained for MRSA and MRCoNS, with 7 different patterns for MRSA and 5 for MRCoNS. We therefore consider it essential to expand the epidemiological study of these strains of animal origin, as well as to increase surveillance and control measures at all stages of the food chain.

Factores de riesgo en bacteriemias nosocomiales secundarias a ITU en un hospital terciario / Risk factors to secondary nosocomial bacteremia to UTI in a tertiary hospital

INTRODUCCIÓN: Las bacteriemias nosocomiales secundarias a infecciones del tracto urinario (BNS-ITU) ocurren en un 1-4% de los episodios y la mortalidad asociada puede aumentar hasta el 33%. Sin embargo, se conoce muy poco sobre la epidemiología de estas infecciones. La determinación de los factores de riesgo modificables para desarrollar este tipo de bacteriemias podría ayudar al control de la infección y reducir el gasto sanitario. MATERIAL Y MÉTODOS: Estudio de casos y controles de las BNS-ITU diagnosticadas en el Hospital Universitario de Canarias entre 2010-2014. Se recogieron las variables clínico-epidemiológicas y los factores de riesgo potenciales intrínsecos y extrínsecos. Se utilizó la regresión logística para estudiar las variables asociadas al desarrollo de BNS-ITU. RESULTADOS: Se estudiaron 178 episodios, 85 casos y 93 controles. La estancia media fue significativamente mayor en los casos; desde el ingreso hasta la bacteriemia (p< 0,003), como desde ésta hasta el alta (p< 0,005). La insuficiencia hepática (p< 0,091), el uso de ventilación mecánica (p < 0,001), de el catéter venoso central (p < 0,043) y la cirugía en el episodio (p< 0,001) se comportaron como factores de riesgo para la adquisición de BNS-ITU. CONCLUSIONES: Los dispositivos invasivos, como el catéter venoso central y la ventilación mecánica, que no había sido estudiada previamente; así como la cirugía en el episodio, que tampoco había sido estudiada, suponen factores de riesgo. Además, la BNS-ITU causa un aumento significativo de la estancia hospitalaria. Por ello, es necesario conocer los factores de riesgo para la aparición de estas infecciones, y así, prevenir su aparición y mejorar la seguridad de los pacientes hospitalizados

INTRODUCTION: Nosocomial bacteremia secondary to urinary tract infections (NBS-UTI) occur in 1-4% of episodes and the associated mortality can increase up to 33%. However, very little is known about the epidemiology of these infections. The determination of modifiable risk factors to develop this type of bacteremia could help to control the infection and reduce health costs. MATERIAL AND METHODS: Cases-control study of NBS-UTI diagnosed at the University Hospital of Canary Islands between 2010-2014. The clinical-epidemiological variables and the intrinsic and extrinsic potential risk factors were collected. Logistic regression was used to study the variables associated with the development of NBS-UTI. RESULTS: A total of 178 episodes were studied, 85 cases and 93 controls. The average stay was significantly greater in the cases; from admission to bacteremia (p <0.003), as well as from discharge to discharge (p <0.005). Hepatic insufficiency (p <0.091), the use of mechanical ventilation (p <0.001), the central venous catheter (p <0.043) and surgery in the episode (p <0.001) behaved as risk factors for the acquisition of NBS-ITU. CONCLUSION: Invasive devices, such as central venous catheter and mechanical ventilation, that had not previously been studied; as well as the surgery in the episode, which had not been studied either, suppose risk factors. In addition, NBS-ITU causes a significant increase in hospital stay. Therefore, it is necessary to know the risk factors for the appearance of these infections, and thus prevent their appearance and improve the safety of hospitalized patients

Increased Antimicrobial Resistance of MRSA Strains Isolated from Pigs in Spain between 2009 and 2018.

The problem of emerging resistant microorganisms such as Methicillin-Resistant Staphylococcus aureus (MRSA) associated to livestock is closely linked to improper use of antimicrobial agents. The aim of this study is to find out the prevalence and characteristics of these strains, as well as their evolution in healthy pigs on the Island of Tenerife, Spain. Between October 2009 and December 2010, 300 pigs from 15 wean-to-finishing farms were screened. Between 1 September 2017 and 31 March 2018, a new sampling was performed collecting 125 nasal swabs from pigs belonging to the same farms and under the same conditions as the previous study. MRSA antibiotic resistant patterns were studied. Results: Prevalence of MRSA isolates was 89.6%. All isolates belonged to Sequence Type 398 (ST398), a livestock related strain. All strains studied were resistant to beta-lactamic non-carbapenemic antibiotics and sensitive to teicoplanin, linezolid, vancomycin, rifampicin, quinupristin-dalfospristin, and mupirocine. Between 2009/2010-2017/2018 a significant increase in resistance to gentamicin, tobramycin, trimethoprim-sulfomethoxazole, clindamycin, Fosfomycin, and tigecycline antibiotics was observed in isolated MRSA strains compared to the previous period. We consider a major control and surveillance program of antibiotic use in veterinary care is needed in order to reduce the presence of MRSA strains in livestock and control this significant multi-resistance increase.

First isolation of Mycobacterium canariasense from municipal water supplies in Tenerife, Canary Islands, Spain.

BACKGROUND: Nontuberculous mycobacteria (NTM) are common bacteria in water and especially water supply distribution systems. Some species can cause infections, especially in immunocompromised patients and other risk groups. This study examined the frequency of occurrence of NTM in 135 household potable water samples collected from household water taps in Tenerife Island. METHODS: Mycobacteria species were identified by polymerase chain reaction targeting the 16S rRNA and 16S-23S rRNA regions, and by double-reverse hybridization on a dipstick using colloidal gold-bound and membrane-bound probes (Speed-Oligo(®) Mycobacteria). Some species were identified by sequencing the gene that encodes the 16S rRNA region. RESULTS: NTM were present in 47.4% of the samples. Mycobacterium fortuitum was the NTM isolated most frequently (70.3%), followed by Mycobacterium canariasense (6.3%) and Mycobacterium chelonae (6.3%). Other species were isolated at lower percentage frequencies. CONCLUSION: We isolated and identified the species M. canariasense in water supplies for public consumption. This species has previously been reported only in hospital settings. The elevated presence of NTM in the water supply indicates that it may be a reservoir for infections caused by recently described species of mycobacteria.

Descriptive analysis of antibiotic-resistant patterns of methicillin-resistant Staphylococcus aureus (MRSA) st398 isolated from healthy swine.

BACKGROUND: Livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) such as the MRSA ST398 strain has spread all over the world and the most worrying aspect of this fact appears to be its capacity to easily spread to humans. The excessive use of antibiotics has made swine a reservoir of MRSA. The aim of the present study was to determine the antibiotic resistance profile of MRSA samples isolated from healthy swine of the island of Tenerife (Spain). METHODS: A total of 256 MRSA isolates from swine samples and five MRSA isolates from pig worker samples were investigated for MRSA antibiotic resistant patterns. RESULTS: Analysis of the susceptibility status of MRSA pig isolates revealed that 39 isolates were resistant to one antibiotic, 71 isolates were resistant to two antibiotics and 96 isolates were resistant to three or more antibiotics. SCCmec typing revealed the presence of types IV and V. Isolates having SCCmec IV had an increased resistance to the antimicrobial agents tested than those having SCCmec V. We observed significant differences when comparing the most common resistance patterns and SCCmec type. CONCLUSIONS: MRSA isolated from humans showed similar resistance to those isolated from pigs, excepting erythromycin, since all the workers' isolates were sensitive to this antibiotic. The evolution of new MRSA clones has emphasized the need for infection control practices in animals and humans in close contact.

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.

Prevalence of CTX-M-Type extended-spectrum ß-lactamases in Escherichia coli strains isolated in poultry farms.

The aim of the study was to detect the prevalence of CTX-M-type extended-spectrum ß-lactamases (ESBL) in Escherichia coli strains isolated in healthy chickens at poultry farms in Tenerife, Spain. From November 2012 to February 2013, 260 live chickens were screened. Samples were cultured in chromogenic media. Suspect strains were identified by Vitek 2 system and ESBL production was confirmed by the double-disk synergy test. Pulsed-field gel electrophoresis (PFGE) was performed with XbaI (Promega, Madison, WI) to ESBL-E. coli isolates. The presence of CTX-M-type was detected by real-time polymerase chain reaction. Of 260 rectal swabs, 237 (91.1%) were ESBL-E. coli, 196 (75.38%) strains were characterized by PFGE, and CTX-M-type was detected in 116 (59.1%) of these strains. With respect to the susceptibility patterns of E. coli blaCTX-M strains, 7.8% showed resistance to more than two non-ß-lactam antibiotics. In our area, the prevalence of CTX-M-type in E. coli isolated in chicken was even higher than those found in other countries. The impact of food animals as a possible reservoir for ESBL-E. coli, especially CTX-M-type ESBL, and the dissemination of such strains into the food production chain need to be assessed.

Síndrome metabólico y mortalidad en población mayor de 65 años de la isla de Tenerife / Metabolic syndrome and mortality in population over 65 years of the island of Tenerife

Introducción: El Síndrome Metabólico (SM) es una situación clínica muy prevalente implicada en los mecanismos de desarrollo de la diabetes mellitus, y a la vez un importante factor de riesgo de enfermedades cardiovasculares, especialmente en la población de mayor edad. Objetivo: Determinar la prevalencia de SM en la población mayor de 65 años y su relación con la mortalidad. Métodos: Se diseñó un estudio epidemiológico descriptivo en el que se incluyeron 455 personas (231 hombres y 228 mujeres) entre 65 y 94 años de la Isla de Tenerife (España). Se estudió la prevalencia de SM utilizando la definición armonizada de la Organización Mundial de la Salud (OMS) y se relacionó con la mortalidad y supervivencia de la misma. La recogida de datos se realizó en dos fases: Un primer período desde el 1 de octubre de 2007 hasta el 31 de junio de 2009 y posteriormente el 1 junio de 2011, se accedió a la base de datos interna del Servicio Canario de Salud (INTRANET) para revisar los datos de mortalidad y supervivencia de la población incluida en el estudio. Resultados: Los resultados mostraron que la prevalencia de SM en el total de la muestra fue 47,7%, superior en mujeres que en hombres. Los sujetos con SM presentaban mayor edad que los que no tenían SM. La mortalidad general de la población fue del 26,6% y la tasa de mortalidad de 11 por 100 personas/año: 1,1x103 personas/año. Conclusiones: La prevalencia de SM fue elevada. No obtuvimos diferencias significativas de mortalidad ni de supervivencia según la población tuviese o no SM (AU)

Introduction: Metabolic syndrome (MS) is a very prevalent clinical condition involved in diabetes mellitus mechanisms of development, being at once an important risk factor for cardiovascular disease, especially in the elderly population. Objetive: to determine the prevalence of the metabolic syndrome among 458 of the adults aged 65 years and over and its relation with mortality. Methods: A descriptive epidemiological study was designed, with 459 participants (231 males and 228 females) aged between 65 and 94; living in Tenerife (Spain). The prevalence of MS was studied using the harmonized definition of World Health Organization (WHO), related to its mortality and survival. Results: The results showed a prevalence of MS in the total sample of 47.7%, and this was higher in women than in men. There were also significant differences according to age. The overall mortality of the population was 26.6% and the mortality rate of 11 per 100 persons / year: 1.1 x103 person / year. Conclusion: This report on the metabolic syndrome shows a high prevalence of this disorder. We did not find significant differences in mortality or survival of the population, either with and without MS (AU)

Risk factors for development of methicillin-resistant Staphylococcus aureus-positive clinical culture in nasal carriers after decolonization treatment.

BACKGROUND: Active surveillance systems are effective in reducing health care-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Nonetheless, some patients develop MRSA infection despite control measures. We tried to identify risk factors related to the appearance of MRSA at sites other than the nasal fossa in patients who were nasal carriers of MRSA. METHODS: A retrospective case-control study was conducted in an active surveillance program for MRSA between January 2009 and December 2010 at a Spanish teaching hospital. Cases were patients with MRSA in the anterior nares and a length of stay of at least 5 days who developed MRSA-positive clinical culture after decolonization treatment had started. Controls were patients with the same characteristics as the case group, except that they did not develop MRSA-positive clinical culture as verified by negative clinical cultures. RESULTS: After intrinsic and extrinsic risk factors were analyzed, the emergence of mupirocin-resistant MRSA clones after decolonization treatment, and residence in a nursing home were marginally significant in the univariate analysis. The detection of the emergence of mupirocin-resistant MRSA clones was independently associated with the detection of MRSA in other clinical locations. CONCLUSIONS: In an active surveillance program for MRSA it is important to determine the mupirocin susceptibility of the isolates to determine appropriate treatment and to verify negativity after decolonizing treatment has been completed.

Prevalence and characteristics of methicillin-resistant Staphylococcus aureus in pigs and pig workers in Tenerife, Spain.

Methicillin-resistant Staphylococcus aureus (MRSA) strains belonging to sequence type (ST) 398 are being reported with increasing frequency in Europe and other countries. This MRSA type has been isolated from colonized and infected animals and humans. The aim of this study was to determine the prevalence of nasal MRSA carriage in pigs and pig workers. A total of 300 pigs from 15 different farms were sampled in the slaughterhouse of Tenerife. A total of 54 pig workers were screened for MRSA: 20 belonged to farms whose pigs had been sampled and 34 to the slaughterhouse. The percentage of positive samples of MRSA in pigs was 85.7%. The overall prevalence of nasal MRSA carriage in pig workers was 9.3%. All MRSA isolates from pigs and humans belonged to one clonal group showing multilocus sequence type (MLST) 398. Two types of Staphylococcal Chromosome Cassette (SCCmec) were found, IV and V. In conclusion, the prevalence of MRSA in nasal samples from pigs and pig workers in Tenerife was high. We therefore consider it essential to deepen epidemiological study of this strain of animal origin, as well as to increase surveillance and control measures at all stages of the food chain.