Estudio transversal sobre la percepción de los factores favorecedores de la actividad investigadora en enfermedades infecciosas / Cross-sectional study on the perception of factors favoring research activity in infectious diseases

Introducción: La implicación de los médicos asistenciales en tareas de investigación clínica presenta grandes diferencias entre las diversas instituciones. Material y método: Estudio transversal basado en una encuesta enviada a los miembros del Grupo de Trabajo de Enfermedades Infecciosas (GTei) de la Sociedad Española de Medicina Interna (SEMI) durante el mes de mayo de 2022. Resultados: De 1.789 miembros del GTei, 169 miembros (9,45%) cumplimentaron la encuesta. La percepción de la conveniencia de participación de cada facultativo en una o varias líneas de investigación fue de 8 puntos (P25:7; P75: 9 puntos). La percepción sobre el estímulo para investigar del sistema sanitario o de la dirección del hospital fue de 2 puntos (1-4), respectivamente. El apoyo a la investigación fue valorado con de 5 (2-7) y 6 (3-7) puntos en relación con el jefe de servicio y los compañeros del departamento, respectivamente. Otros factores evaluados fueron la falta de tiempo por no poder reducir la actividad asistencial (9; 7-10 puntos), la priorización de las actividades de ocio durante el tiempo libre disponible (7; 5-8 puntos), la organización de la carga asistencial (6; 3-9 puntos), las dificultades en la coordinación con otros servicios clínicos o centrales (6; 5-7 puntos y 6; 5-8 puntos, respectivamente). Conclusiones: La investigación clínica es muy bien valorada por los internistas dedicados a la patología infecciosa. Las principales necesidades percibidas son un mayor apoyo institucional y de la dirección del hospital, una mejor organización del departamento, la coordinación interdepartamental y disponer de más tiempo para esta actividad.(AU)

Background: The involvement of attending physicians in clinical research activities differs greatly among institutions. Method: Cross-sectional study based on a survey submitted to the members of the Working Group on Infectious Diseases (GTei) of the Spanish Society of Internal Medicine (SEMI) during the month of May 2022. Results: Out of 1,789 members of the GTei, 169 members (9.45%) completed the survey. The perception of the convenience of participation of each physician in one or more lines of research was 8 points (P25:7; P75: 9 points). The perception of encouragement to do research by the health system or hospital management was 2points (1-4), respectively. Support for research was rated at 5 (2-7) and 6 (3-7) points inrelation to the head of service and colleagues in the department, respectively. Other factors evaluated were the lack of time due to not being able to reduce the care activity (9; 7-10 points), prioritization of leisure activities during available free time (7; 5-8 points), organization of the care load (6; 3-9 points), difficulties in coordinating with other clinical or central services (6; 5-7 points and 6; 5-8 points, respectively). Conclusions: Clinical research is highly valued by internists dedicated to infectious diseases. The main perceived needs are greater institutional and hospital managementsupport, better organization of the department, interdepartmental coordination and more time for this activity. (AU)

Diagnóstico de la infección tuberculosa en pacientes inmunodeprimidos y/o candidatos a terapias biológicas mediante el uso combinado de dos pruebas IGRA: T-SPOT.TB/QuantiFERON TB Gold In-Tube vs. T-SPOT.TB/QuantiFERON TB Gold Plus / Diagnosis of Tuberculous Infection in Immunosuppressed Patients and/or Candidates for Biologics Using a Combination of 2 IGRA Tests: T-SPOT.TB/QuantiFERON TB Gold In-Tube vs. T-SPOT.TB/QuantiFERON TB Gold Plus

Introducción: El diagnóstico de la infección tuberculosa latente (ITL) mediante IGRA sigue generando debate. La experiencia empleando dos pruebas IGRA de manera simultánea es escasa. El objetivo de este estudio es comparar los resultados de dos versiones de QuantiFERON-TB Gold (In-Tube/Plus) con los de T-SPOT.TB y analizar la eficacia de esta estrategia dual (T-SPOT.TB + QTF) para el diagnóstico de la ITL en población con alguna condición inmunosupresora.Métodos: Estudio prospectivo (mayo 2015-junio 2017) que incluye 2.999 pacientes inmunodeprimidos y/o candidatos a terapias biológicas, a los que se les realizó de manera simultánea dos IGRA: grupo-1 (1.535 pacientes): T-SPOT.TB + QuantiFERON-TB Gold-In-Tube (QTF-GIT); grupo-2 (1.464 pacientes): T-SPOT.TB + QuantiFERON-TB Gold Plus (QTF-Plus).Resultados: La concordancia entre QTF-GIT y T-SPOT.TB fue del 83,19% (κ = 0,532). Las proporciones de resultados positivos, negativos e indeterminados fueron, respectivamente: 14,33 vs. 17,06%; 82,41 vs. 74,46%; y 3,25 vs. 8,46%. La concordancia entre QTF-Plus y T-SPOT.TB fue del 87,56% (κ=0,609). Las proporciones de resultados positivos, negativos e indeterminados fueron, respectivamente: 15,02 vs. 15,36%; 82,92 vs. 79,37%; y 2,04 vs. 5,25%. Las discordancias entre T-SPOT.TB y QTF-Plus fueron del 12,43%, que implicaban que había 103 pacientes positivos y otros 79 pacientes negativos a expensas exclusivamente de uno de los dos IGRA.Conclusiones: Se evidenció una mayor concordancia entre QTF-Plus y T-SPOT.TB que entre QTF-GIT y T-SPOT.TB. Sin embargo, creemos que la proporción de resultados discordantes entre T-SPOT.TB y QTF-Plus es lo suficientemente relevante clínicamente como para justificar el empleo simultáneo de dos IGRA en este grupo específico de pacientes. (AU)

Introduction: The diagnosis of latent tuberculous infection (LTI) by IGRA continues to generate debate. Experience in the simultaneous use of 2 IGRA tests is scant. The aim of this study was to compare the results of 2 versions of QuantiFERON-TB Gold (In-Tube/Plus) with those of T-SPOT.TB, and to analyse the effectiveness of a dual strategy (T-SPOT.TB + QTF) for the diagnosis of LTI in an immunosuppressed population.Methods: We conducted a prospective study (May 2015-June 2017) that included 2,999 immunosuppressed patients and/or candidates for biologics, in whom 2 simultaneous IGRA tests were performed: Group 1 (1535 patients): T-SPOT.TB + QuantiFERON-TB Gold-In-Tube (QTF-GIT); Group 2 (1464 patients): T-SPOT.TB + QuantiFERON-TB Gold Plus (QTF-Plus).Results: The concordance between QTF-GIT and T-SPOT.TB was 83.19% (κ=0.532). The percentage of positive, negative, and indeterminate results were, respectively: 14.33% vs. 17.06%; 82.41% vs. 74.46%; and 3.25% vs. 8.46%. The concordance between QTF-Plus and T-SPOT.TB was 87.56% (κ=0.609). The percentage of positive, negative, and indeterminate results were, respectively: 15.02% vs. 15.36%; 82.92% vs. 79.37%; and 2.04% vs. 5.25%. Discrepancies between T-SPOT.TB and QTF-Plus were 12.43%, suggesting that 103 patients were positive and another 79 were negative due exclusively to 1 of the 2 IGRAs.Conclusions: Greater concordance was found between QTF-Plus and T-SPOT.TB than between QTF-GIT and T-SPOT.TB. However, we believe that the proportion of discrepancies between T-SPOT.TB and QTF-Plus is sufficiently important from a clinical point of view to justify the simultaneous use of 2 IGRA in this specific patient group. (AU)

[Translated article] Diagnosis of tuberculous infection in immunosuppressed patients and/or candidates for biologics using a combination of 2 IGRA tests: T-SPOT.TB/QuantiFERON TB Gold In-Tube vs. T-SPOT.TB/QuantiFERON TB Gold Plus / Diagnóstico de la infección tuberculosa en pacientes inmunodeprimidos y/o candidatos a terapias biológicas mediante el uso combinado de dos pruebas IGRA: T-SPOT.TB/QuantiFERON TB Gold In-Tube vs. T-SPOT.TB/QuantiFERON TB Gold Plus

Introduction: The diagnosis of latent tuberculous infection (LTI) by IGRA continues to generate debate. Experience in the simultaneous use of 2 IGRA tests is scant. The aim of this study was to compare the results of 2 versions of QuantiFERON-TB Gold (In-Tube/Plus) with those of T-SPOT.TB, and to analyse the effectiveness of a dual strategy (T-SPOT.TB + QTF) for the diagnosis of LTI in an immunosuppressed population.Methods: We conducted a prospective study (May 2015-June 2017) that included 2,999 immunosuppressed patients and/or candidates for biologics, in whom 2 simultaneous IGRA tests were performed: Group 1 (1535 patients): T-SPOT.TB + QuantiFERON-TB Gold-In-Tube (QTF-GIT); Group 2 (1464 patients): T-SPOT.TB + QuantiFERON-TB Gold Plus (QTF-Plus).Results: The concordance between QTF-GIT and T-SPOT.TB was 83.19% (κ=0.532). The percentage of positive, negative, and indeterminate results were, respectively: 14.33% vs. 17.06%; 82.41% vs. 74.46%; and 3.25% vs. 8.46%. The concordance between QTF-Plus and T-SPOT.TB was 87.56% (κ=0.609). The percentage of positive, negative, and indeterminate results were, respectively: 15.02% vs. 15.36%; 82.92% vs. 79.37%; and 2.04% vs. 5.25%. Discrepancies between T-SPOT.TB and QTF-Plus were 12.43%, suggesting that 103 patients were positive and another 79 were negative due exclusively to 1 of the 2 IGRAs.Conclusions: Greater concordance was found between QTF-Plus and T-SPOT.TB than between QTF-GIT and T-SPOT.TB. However, we believe that the proportion of discrepancies between T-SPOT.TB and QTF-Plus is sufficiently important from a clinical point of view to justify the simultaneous use of 2 IGRA in this specific patient group. (AU)

Introducción: El diagnóstico de la infección tuberculosa latente (ITL) mediante IGRA sigue generando debate. La experiencia empleando dos pruebas IGRA de manera simultánea es escasa. El objetivo de este estudio es comparar los resultados de dos versiones de QuantiFERON-TB Gold (In-Tube/Plus) con los de T-SPOT.TB y analizar la eficacia de esta estrategia dual (T-SPOT.TB + QTF) para el diagnóstico de la ITL en población con alguna condición inmunosupresora.Métodos: Estudio prospectivo (mayo 2015-junio 2017) que incluye 2.999 pacientes inmunodeprimidos y/o candidatos a terapias biológicas, a los que se les realizó de manera simultánea dos IGRA: grupo-1 (1.535 pacientes): T-SPOT.TB + QuantiFERON-TB Gold-In-Tube (QTF-GIT); grupo-2 (1.464 pacientes): T-SPOT.TB + QuantiFERON-TB Gold Plus (QTF-Plus).Resultados: La concordancia entre QTF-GIT y T-SPOT.TB fue del 83,19% (κ = 0,532). Las proporciones de resultados positivos, negativos e indeterminados fueron, respectivamente: 14,33 vs. 17,06%; 82,41 vs. 74,46%; y 3,25 vs. 8,46%. La concordancia entre QTF-Plus y T-SPOT.TB fue del 87,56% (κ=0,609). Las proporciones de resultados positivos, negativos e indeterminados fueron, respectivamente: 15,02 vs. 15,36%; 82,92 vs. 79,37%; y 2,04 vs. 5,25%. Las discordancias entre T-SPOT.TB y QTF-Plus fueron del 12,43%, que implicaban que había 103 pacientes positivos y otros 79 pacientes negativos a expensas exclusivamente de uno de los dos IGRA.Conclusiones: Se evidenció una mayor concordancia entre QTF-Plus y T-SPOT.TB que entre QTF-GIT y T-SPOT.TB. Sin embargo, creemos que la proporción de resultados discordantes entre T-SPOT.TB y QTF-Plus es lo suficientemente relevante clínicamente como para justificar el empleo simultáneo de dos IGRA en este grupo específico de pacientes. (AU)

Clinical and Epidemiological Correlates of Low IFN-Gamma Responses in Mitogen Tube of QuantiFERON Assay in Tuberculosis Infection Screening During the COVID-19 Pandemic: A Population-Based Marker of COVID-19 Mortality?

Background: The clinical and epidemiological implications of abnormal immune responses in COVID-19 for latent tuberculosis infection (LTBI) screening are unclear. Methods: We reviewed QuantiFERON TB Gold Plus (QFT-Plus) results (36,709 patients) from July 2016 until October 2021 in Asturias (Spain). We also studied a cohort of ninety hospitalized patients with suspected/confirmed COVID-19 pneumonia and a group of elderly hospitalized patients with COVID-19 who underwent serial QFT-Plus and immune profiling testing. Results: The indeterminate QFT-Plus results rate went from 1.4% (July 2016 to November 2019) to 4.2% during the COVID-19 pandemic. The evolution of the number of cases with low/very low interferon-gamma (IFN-gamma) response in the mitogen tube paralleled the disease activity and number of deaths during the pandemic waves in our region (from March 2020 to October 2021). The percentages of positive QFT-plus patients did not significantly change before and during the pandemic (13.9% vs. 12.2%). Forty-nine patients from the suspected/confirmed COVID-19 pneumonia cohort (54.4%) had low/very low IFN-gamma response to mitogen, 22 of them (24.4%) had severe and critical pneumonia. None received immunosuppressants prior to testing. Abnormal radiological findings (P = 0.01) but not COVID-19 severity was associated with low mitogen response. Immune profiling showed a reduction of CD8 + T cells and a direct correlation between the number of EMRA CD8 + T-cells and IFN-gamma response to mitogen (P = 0.03). Conclusion: Low IFN-gamma responses in mitogen tube of QFT-Plus often occur in COVID-19 pneumonia, which is associated with a low number of an effector CD8 + T-cell subset and does not seem to affect LTBI screening; however, this abnormality seems to parallel the dynamics of COVID-19 at the population level and its mortality.

Diagnosis of Tuberculous Infection in Immunosuppressed Patients and/or Candidates for Biologics Using a Combination of 2 IGRA Tests: T-SPOT.TB/QuantiFERON TB Gold In-Tube vs. T-SPOT.TB/QuantiFERON TB Gold Plus. / Diagnóstico de la infección tuberculosa en pacientes inmunodeprimidos y/o candidatos a terapias biológicas mediante el uso combinado de dos pruebas IGRA: T-SPOT.TB/QuantiFERON TB Gold In-Tube vs. T-SPOT.TB/QuantiFERON TB Gold Plus.

INTRODUCTION: The diagnosis of latent tuberculous infection (LTI) by IGRA continues to generate debate. Experience in the simultaneous use of 2 IGRA tests is scant. The aim of this study was to compare the results of 2 versions of QuantiFERON-TB Gold (In-Tube/Plus) with those of T-SPOT.TB, and to analyse the effectiveness of a dual strategy (T-SPOT.TB + QTF) for the diagnosis of LTI in an immunosuppressed population. METHODS: We conducted a prospective study (May 2015-June 2017) that included 2,999 immunosuppressed patients and/or candidates for biologics, in whom 2 simultaneous IGRA tests were performed: Group 1 (1535 patients): T-SPOT.TB + QuantiFERON-TB Gold-In-Tube (QTF-GIT); Group 2 (1464 patients): T-SPOT.TB + QuantiFERON-TB Gold Plus (QTF-Plus). RESULTS: The concordance between QTF-GIT and T-SPOT.TB was 83.19% (κ=0.532). The percentage of positive, negative, and indeterminate results were, respectively: 14.33% vs. 17.06%; 82.41% vs. 74.46%; and 3.25% vs. 8.46%. The concordance between QTF-Plus and T-SPOT.TB was 87.56% (κ=0.609). The percentage of positive, negative, and indeterminate results were, respectively: 15.02% vs. 15.36%; 82.92% vs. 79.37%; and 2.04% vs. 5.25%. Discrepancies between T-SPOT.TB and QTF-Plus were 12.43%, suggesting that 103 patients were positive and another 79 were negative due exclusively to 1 of the 2 IGRAs. CONCLUSIONS: Greater concordance was found between QTF-Plus and T-SPOT.TB than between QTF-GIT and T-SPOT.TB. However, we believe that the proportion of discrepancies between T-SPOT.TB and QTF-Plus is sufficiently important from a clinical point of view to justify the simultaneous use of 2 IGRA in this specific patient group.

Criptococosis cutánea / Cutaneous cryptococcosis

No disponible

Clinical, epidemiological and treatment failure data among HIV-1 non-B-infected patients in the Spanish AIDS Research Network Cohort / Datos clínicos, epidemiológicos y fracaso terapéutico en los pacientes VIH-1 infectados por variantes no-B incluidos en la Cohorte de la Red española de Investigación en Sida (CoRIS)

INTRODUCTION: The prevalence of HIV-1 non-B variants is increasing in Spain, showing a higher number of transmitted drug resistance mutations (TDR) since 2002. This study presents the features of non-B-infected patients enrolled in the cohort of antiretroviral treatment (ART) naïve HIV-infected patients included in the Research Network on HIV/AIDS (CoRIS). METHODS: The study includes a selected group of HIV-1 non-B-infected subjects from 670 subjects with pol sequences collected from 2004 to 2008 in the CoRIS cohort. Epidemiological-clinical-virological data were analyzed since cohort entry until October 2011, considering the presence or absence of treatment failure (TF). RESULTS: Eighty two non-B infected subjects with known HIV-1 variants were selected from 2004 to 2008 in the CoRIS cohort, being mainly female, immigrants, infected by recombinant viruses, and by heterosexual route. They had an intermediate TDR rate (9.4%), a high rate of TF (25.6%), of losses to follow-up (35%), of coinfections (32.9%), and baseline CD4+ counts ≥350 cells/mm3 (61.8%). Non-B subjects with TF showed higher rates of heterosexual infection (85.7% vs. 69.5%, p < 0.05), tuberculosis (30.8%vs. 9.1%, p = 0.10) and hepatitis C (23.8% vs. 13.9%, p = 0.34) coinfections and lower rates of syphilis (0% vs. 21.9%, p < 0.05), and had more frequently received first-line ART including protease inhibitors (PIs) than patients without TF (70% vs. 30%, p < 0.05). Interestingly, infection with non-B variants reduced the risk of TDR to nucleoside reverse transcriptase inhibitors and increased the risk to PIs. CONCLUSION: HIV-1 non-B-infected patients in Spain had a particular epidemiological and clinical profile that should be considered during their clinical management

INTRODUCCIÓN: La prevalencia de variantes no-B del VIH-1 está aumentando en España, mostrando un incremento de las mutaciones de resistencia transmitidas (TDR) desde 2002. Este estudio muestra las características de los pacientes infectados por variantes no-B de la cohorte de infectados por VIH sin tratamiento antirretroviral de la Red de Investigación sobre VIH/SIDA (CoRIS). MÉTODOS: De 670 individuos en CoRIS con secuencias pol recogidas entre 2004 y 2008, se seleccionaron los pacientes infectados por variantes no-B. Se analizaron los datos epidemiológicos, clínicos y virológicos desde su inclusión hasta octubre de 2011, considerando la existencia de fracaso terapéutico (FT). RESULTADOS: Los 82 pacientes infectados por variantes no-B entre 2004 y 2008 fueron principalmente mujeres, inmigrantes, infectados por variantes recombinantes y transmisión heterosexual. Presentaron una tasa intermedia de TDR (9,4%) y elevada frecuencia de FT (25,6%), pérdidas de seguimiento (35%), coinfecciones (32,9%) y recuento basal de CD4+ ≥350 células/mm3 (61,8%). Los pacientes no-B con FT vs. sin FT mostraron mayor porcentaje de transmisión heterosexual (85,7% vs. 69,5%, p < 0,05), coinfecciones por tuberculosis (30,8% vs. 9,1%, p = 0,10), hepatitis C (23,8% vs. 13,9%, p = 0,34) y menores tasas de sífilis (0% vs. 21,9%, p < 0,05). Además recibieron con mayor frecuencia tratamiento de primera línea con inhibidores de la proteasa (IP) (70% vs. 30%, p < 0,05). La infección con variantes no-B redujo el riesgo de TDR a inhibidores de la transcriptasa inversa análogos de nucleósido y aumentó el riesgo a IP. CONCLUSIÓN: Los pacientes infectados por variantes no-B del VIH-1 en España presentan un perfil epidemiológico-clínico característico que deberá ser considerado durante su seguimiento

Clinical, epidemiological and treatment failure data among HIV-1 non-B-infected patients in the Spanish AIDS Research Network Cohort.

INTRODUCTION: The prevalence of HIV-1 non-B variants is increasing in Spain, showing a higher number of transmitted drug resistance mutations (TDR) since 2002. This study presents the features of non-B-infected patients enrolled in the cohort of antiretroviral treatment (ART) naïve HIV-infected patients included in the Research Network on HIV/AIDS (CoRIS). METHODS: The study includes a selected group of HIV-1 non-B-infected subjects from 670 subjects with pol sequences collected from 2004 to 2008 in the CoRIS cohort. Epidemiological-clinical-virological data were analyzed since cohort entry until October 2011, considering the presence or absence of treatment failure (TF). RESULTS: Eighty two non-B infected subjects with known HIV-1 variants were selected from 2004 to 2008 in the CoRIS cohort, being mainly female, immigrants, infected by recombinant viruses, and by heterosexual route. They had an intermediate TDR rate (9.4%), a high rate of TF (25.6%), of losses to follow-up (35%), of coinfections (32.9%), and baseline CD4+ counts ≥350cells/mm(3) (61.8%). Non-B subjects with TF showed higher rates of heterosexual infection (85.7% vs. 69.5%, p<0.05), tuberculosis (30.8% vs. 9.1%, p=0.10) and hepatitis C (23.8% vs. 13.9%, p=0.34) coinfections and lower rates of syphilis (0% vs. 21.9%, p<0.05), and had more frequently received first-line ART including protease inhibitors (PIs) than patients without TF (70% vs. 30%, p<0.05). Interestingly, infection with non-B variants reduced the risk of TDR to nucleoside reverse transcriptase inhibitors and increased the risk to PIs. CONCLUSION: HIV-1 non-B-infected patients in Spain had a particular epidemiological and clinical profile that should be considered during their clinical management.

[Postsurgery meningitis by Staphylococcus aureus: comparison between methicillin-sensitive and resistant strains]. / Estudio comparativo de la meningitis posquirúrgica por Staphylococcus aureus sensible y resistente a meticilina.

BACKGROUND AND OBJECTIVE: In recent years, meningitis caused by methicillin-resistant S. aureus has increased. This study was undertaken to compare the clinical characteristics and prognosis of methicillin-resistant S. aureus (MRSA) postneurosurgical meningitis and methicillin-sensible S. aureus (MSSA) postneurosurgical meningitis. PATIENTS AND METHODS: Twenty-five episodes of postneurosurgical meningitis due to S. aureus (13 methicillin-resistant strains) seen during a ten-year period were retrospectively reviewed. RESULTS: Most common underlying diseases were: intracerebral hemorrhage (50% of MRSA patients and 46% of MSSA patients) and neoplasm (53% of MRSA patients and 33% of MSSA patients). Eleven patients (6 of them with MRSA infection) had received antibiotic treatment previously. Thirteen patients were carriers of intraventricular catheters (8 with MRSA infection), 5 wore a ventriculoperitoneal shunt (4 with infections by MSSA), 5 cases had a CSF leakage (4 with infections by MRSA), and one patient with infection by MSSA wore an epidural catheter. Fifteen patients were cured (7 with MRSA infection), and 8 died due to the infection (27% with MSSA infection and 38% with MRSA infection). CONCLUSIONS: The prognosis of postneurosurgical meningitis by S. aureus does not depend on the presence of resistance to methicillin. Nowadays, the intravenous administration of vancomycin is the treatment of choice in MRSA meningitis.

Estudio comparativo de la meningitis posquirúrgica por staphylococcus aureus sensible y resistente a meticilina / Postsugery meningitis by Staphylococcus aureus: comparison between methicillin-sensitive and resistant strains

FUNDAMENTO Y OBJETIVO: En los últimos años se ha descrito con frecuencia creciente casos de meningitis producidas por cepas de Staphylococcus aureus resistentes ameticilina (SARM). Se estudian las características diferenciales tanto clínicas como pronósticas de los pacientes diagnosticados de meningitis posquirúrgicas debidas a SARM y las debidas a Staphylococcus aureus sensibles a meticilina (SASM). PACIENTES Y MÉTODOS: Estudio retrospectivo, de 1992 a 2002, de 25 episodios de meningitis nosocomial posquirúrgica por Staphylococcus aureus, de los que 13 fueron por SARM. RESULTADOS: Las enfermedades subyacentes más frecuentemente diagnosticadas fueron la hemorragia cerebral (el 50% de los pacientes con SARM y el 46% de los pacientes con SASM) y las neoplasias (el 53% de los pacientes con SARM y el 33% de los pacientes con SASM). En 11 enfermos se recogía el antecedentede tratamiento antibiótico previo (6 de ellos con infección por SARM). Trece de los pacientes eran portadores de catéteres intraventriculares (8 con infecciones por SARM), 5 portaban una derivación ventrículo peritoneal (4 con infecciones por SASM), otros 5 casos presentaban una fístula de líquido cefalorraquídeo (4con infecciones por SARM) y 1 paciente con infección por SASM tenía un catéter epidural. En 15 casos se produjo la curación (7 con SARM), 1 enfermo de cada grupo recidivó y 8 fallecieron a consecuencia directa de la infección (el 27% de los pacientes con SASM yel 38% de los enfermos con SARM). CONCLUSIONES: La presencia de resistencia a la meticilina no parece empeorar el pronóstico de los pacientes con meningitis posquirúrgica por Staphylococcus aureus. Aunque la vancomicina permanece como tratamiento de elección, es posible que nuevos antibióticos de reciente aparición cambien en el futuro el tratamiento de esta entidad

BACKGROUND AND OBJECTIVE: In recent years, meningitiscaused by methicillin-resistant S. aureus has increased. This study was undertaken to compare the clinical characteristics and prognosis of methicillin-resistantS. aureus (MRSA) postneuro surgical meningitis and methicillin-sensible S. aureus (MSSA) postneuro surgical meningitis. PATIENTS AND METHODS: Twenty-five episodes of postneurosurgical meningitis due to S. aureus (13 methicillin-resistant strains) seen during a ten-year period were retrospectively reviewed. RESULTS: Most common underlying diseases were: intracerebral hemorrhage (50% of MRSA patients and46% of MSSA patients) and neoplasm (53% of MRSA patients and 33% of MSSA patients). Eleven patients(6 of them with MRSA infection) had received antibiotic treatment previously. Thirteen patients were carriersof intraventricular catheters (8 with MRSA infection),5 wore a ventriculoperitoneal shunt (4 with infections by MSSA), 5 cases had a CSF leakage (4 with infections by MRSA), and one patient with infection by MSSA wore an epidural catheter. Fiftteen patients were cured (7 with MRSA infection), and 8 died due to the infection (27% with MSSA infection and 38% with MRSA infection). CONCLUSIONS: The prognosis of postneuro surgical meningitis by S. aureus does not depend on the presence of resistance to methicillin. Nowadays, the intravenous administration of vancomycin is the treatment of choice in MRSA meningitis