Prospective multicentre study of rectal carriage of multidrug-resistant Enterobacteriaceae among health-care workers in Spain.

OBJECTIVES: To investigate the rectal carriage of multidrug-resistant Enterobacteriaceae (colistin-resistant, extended-spectrum ß-lactamase (ESBL) -producers and/or carbapenemase-producers) among health-care workers (HCWs) from six Spanish hospitals. METHODS: Rectal swabs from 258 HCWs, employed in intensive care units, haematology wards and clinical microbiology laboratories from six hospitals in northern Spain were studied. They were cultured in selective media for Gram-negative resistant bacteria. Detection of antimicrobial resistance genes and multilocus sequence typing were performed by PCR and further sequencing. A questionnaire including data related to risk factors of colonization/infection by resistant bacteria (age, gender, chronic diseases, immunosuppressive therapies, invasive procedures or antimicrobial treatments) was given to each participant. RESULTS: No carbapenemase-producing Enterobacteriaceae were recovered. However, 8/258 HCWs (3.1%) were positive for ESBL-producing isolates. This rate was not higher than the colonization rate previously reported in Spain for healthy people in the community. Five isolates showed high-level resistance to colistin (MICs ranging from 8 to 128 mg/L) but all of them were negative for the mcr genes tested. No statistically significant risk factors for gut colonization by ESBL-producing or colistin-resistant Enterobacteriaceae were identified among the HCWs participating in the study. CONCLUSIONS: Our data suggest that working in hospitals does not represent a risk for rectal carriage of multidrug-resistant Enterobacteriaceae.

Utilidad de una técnica antigénica rápida en el diagnóstico de faringoamigdalitis por Streptococcus pyogenes / Use of the rapid antigen technique in the diagnosis of Streptococcus pyogenes pharyngotonsillitis

Introducción: El Streptococcus pyogenes es la causa bacteriana más importante de faringoamigdalitis aguda. Se analizó la validez de una prueba antigénica rápida para su diagnóstico, en consultas de atención primaria; asimismo se identificó el perfil clínico con mejor rendimiento diagnóstico, se cuantificó el uso innecesario de antibióticos cuando se utilizaba la prueba o solamente diagnóstico clínico y se determinó la sensibilidad microbiana a penicilina, eritromicina y clindamicina. Pacientes y métodos: Estudio descriptivo transversal a niños/as entre 2-14 años con amigdalitis y/o faringitis aguda atendidos en 5 consultas, desde enero de 2008 hasta mayo de 2010. Tras el diagnóstico clínico se realizó frotis faringoamigdalar con 2 hisopos: con el primero se realizó una prueba antigénica rápida y con el segundo cultivo y sensibilidad antibiótica, siendo su análisis ciego al resultado de la prueba. Se ha previsto una muestra de 546 personas y muestreo consecutivo. Resultados: Se incluyó a 192 pacientes. La prevalencia de Streptococcus pyogenes fue del 38,7%(IC del 95%: 31,4-45,7). La odinofagia y el exantema escarlatiniforme fueron más probables con cultivo positivo. En el 100% hubo sensibilidad a la penicilina, en el 97,3% a eritromicina y en el 86,3% a clindamicina. La especificidad de la prueba fue del 91,5% y el valor predictivo negativo del 91,5%. El 49,2% de quienes recibirían antibióticos por sospecha clínica serían tratados innecesariamente, disminuyendo al menos un 29,5% con la prueba. Conclusiones: La prueba permitió un uso más adecuado de antibióticos. Parece recomendable su uso en pediatría de atención primaria, sin necesidad de confirmación con cultivo cuando resulte negativa, en los centros con difícil acceso al laboratorio(AU)

Introduction: Streptococcus pyogenes is the most frequent bacterial cause of acute tonsillopharyngitis. The validity of the rapid antigen test was analysed for its diagnosis in a Paediatric Primary Care setting. The clinical profile with better diagnostic yield was also identified. The unnecessary use of antibiotics was quantified when the rapid antigen test or only the clinical diagnosis was used. The sensitivity of the assay to penicillin, erythromycin and clindamycin was also determined. Patients and methods: Cross-sectional study was conducted on children between 2 to 14 years with acute tonsillitis and/or pharyngitis seen in five Primary Care Centres, from January 2008to May 2010. After a clinical diagnosis, two swabs were taken for pharyngotonsillar smears: the first was used for a rapid antigen test, and the second one for a culture and a study of antibiotic sensitivity, with its analysis being blind to the rapid test result. A total sample of546 consecutive was envisaged and with consecutive sampling. Results: A total 192 patients were included. The prevalence of Streptococcus pyogenes was38.7% (95% CI: 31.4-45.7). Odynophagia and scarlatiniform rash were most likely with positive cultures, the Streptococcus pyogenes was sensitive to penicillin in 100%, to erythromycin in97.3% and to clindamycin in 86.3%. The specificity of the rapid antigen test was 91.5% and with a Negative Predictive Value of 91.5%. About half (49.2%) of those who would have receive antibiotics for clinical suspicion would have been treated unnecessarily, with this decreasing to at least in 29.5% when using the rapid antigen test. Conclusions: The rapid antigen test can lead to a better use of antibiotics. Its use in Paediatric Primary Health Care could be useful when, as when the result is negative, there would be no need to confirm by a culture, in those Health Centres with difficult access to laboratory(AU)

[Use of the rapid antigen technique in the diagnosis of Streptococcus pyogenes pharyngotonsillitis]. / Utilidad de una técnica antigénica rápida en el diagnóstico de faringoamigdalitis por Streptococcus pyogenes.

INTRODUCTION: Streptococcus pyogenes is the most frequent bacterial cause of acute tonsillopharyngitis. The validity of the rapid antigen test was analysed for its diagnosis in a Paediatric Primary Care setting. The clinical profile with better diagnostic yield was also identified. The unnecessary use of antibiotics was quantified when the rapid antigen test or only the clinical diagnosis was used. The sensitivity of the assay to penicillin, erythromycin and clindamycin was also determined. PATIENTS AND METHODS: Cross-sectional study was conducted on children between 2 to 14 years with acute tonsillitis and/or pharyngitis seen in five Primary Care Centres, from January 2008 to May 2010. After a clinical diagnosis, two swabs were taken for pharyngotonsillar smears: the first was used for a rapid antigen test, and the second one for a culture and a study of antibiotic sensitivity, with its analysis being blind to the rapid test result. A total sample of 546 consecutive was envisaged and with consecutive sampling. RESULTS: A total 192 patients were included. The prevalence of Streptococcus pyogenes was 38.7% (95% CI: 31.4-45.7). Odynophagia and scarlatiniform rash were most likely with positive cultures, the Streptococcus pyogenes was sensitive to penicillin in 100%, to erythromycin in 97.3% and to clindamycin in 86.3%. The specificity of the rapid antigen test was 91.5% and with a Negative Predictive Value of 91.5%. About half (49.2%) of those who would have receive antibiotics for clinical suspicion would have been treated unnecessarily, with this decreasing to at least in 29.5% when using the rapid antigen test. CONCLUSIONS: The rapid antigen test can lead to a better use of antibiotics. Its use in Paediatric Primary Health Care could be useful when, as when the result is negative, there would be no need to confirm by a culture, in those Health Centres with difficult access to laboratory.