Evaluation of FilmArray ME panel for the rapid diagnosis of meningitis-encephalitis in emergency departments.

To assess the impact of a rapid diagnostic system based on nucleic acid amplification techniques (FilmArray ME) on the diagnosis and treatment of patients with meningitis or encephalitis admitted to our emergency department. Between November 2016, and June 2019 we studied 79 samples of cerebrospinal fluid from patients admitted to our emergency department with suspected diagnoses of meningitis or encephalitis. FilmArray ME panel was used routinely in addition to conventional laboratory methods for the identification of microorganisms in cerebrospinal fluid samples (CSF). A total of 46 (58%) patients had clinical and CSF results suggestive of meningitis or encephalitis, and 24 (30%) had a confirmed microbiological diagnosis. Patients' mean age was 41 years (range 2 months to 90 years) and 56% were male. Four patients had been partially treated with antibiotics. FilmArray ME identified 23 cases (1 fungal, 11 bacterial, and 11 viral). Gram staining showed microorganisms in 5 cases (1 fungal, 4 bacterial), and conventional microbiology cultures identified 8 cases (1 fungal and 7 bacterial). The time difference (95% confidence interval) between FilmArray ME and cerebrospinal fluid culture results was 3.2 days (95% CI 2.7-3.7; P < 0.001). FilmArray ME results induced modifications in antimicrobial treatment in 27 (59%) patients. The FilmArray ME panel provided a fast and reliable result in a large proportion of patients, even in those patients with culture-negative bacterial meningitis. Use of FilmArray ME can contribute to antimicrobial stewardship.

Epidemiology of Severe Acute Diarrhea in Patients Requiring Hospital Admission.

BACKGROUND: Information on the epidemiology and susceptibility patterns of main pathogens causing severe acute diarrhea may help to reduce inappropriate antimicrobial use in emergency departments. OBJECTIVES: We sought to investigate the micro-organisms causing severe acute diarrhea in patients requiring hospital admission by means of a commercial multiple polymerase chain reaction system. METHODS: Between November 2016 and October 2018 we studied 132 patients with acute diarrhea who required hospital admission at a 250-bed hospital in Spain. Demographic, clinical, analytical, and microbiological data were collected from the medical records. Stool samples were processed using a rapid commercial multiple polymerase chain reaction system (FilmArray Gastrointestinal Panel), stool culture, and standard microbiological procedures. RESULTS: The median age (range) of patients was 45.5 (0.1-92) years, and 50% were male; 46.2% presented with fever, 62.8% presented with vomiting, and 12.9% presented with rectal bleeding. At least 1 enteric pathogen was identified in 93 (70.4%) patients; 28 (21.2%) patients had >1 micro-organism. FilmArray Gastrointestinal Panel results were available in a median (range) of 1 (0-3) days. The micro-organisms most frequently identified were 24 cases of Campylobacter species, 20 cases of Clostridioides difficile producing toxin A or toxin B, 20 cases of Salmonella species, 12 cases of rotavirus, and 30 cases of different types of pathogenic Escherichia coli. Among the cases of C. difficile, 12 (60%) were community-acquired and 8 (40%) had an undetermined origin. CONCLUSION: The FilmArray Gastrointestinal Panel system provides fast and reliable results and could be useful to select the most appropriate antimicrobial based on local susceptibilities until the results of the cultures are available.

El servicio de urgencias hospitalario como factor de riesgo de colonización por Staphylococcus aureus resistente a meticilina de los residentes en centros de larga estancia / Hospital emergency health service care as a risk factor for methicillin-resistant Staphylococcus aureus in residents of long-term care facilities

OBJETIVOS: Los residentes de centros de larga estancia (CLE) son población de riesgo para la colonización por Staphylococcus aureus resistente a meticilina (SARM) debido a la morbilidad asociada a la edad y la alta tasa de contactos hospitalarios, especialmente en el servicio de urgencias hospitalario (SUH). El objetivo del estudio fue determinar la prevalencia y los factores asociados a la colonización por SARM en los residentes de CLE. MÉTODO: Se realizó un estudio descriptivo transversal entre abril y junio de 2014. Como criterio de inclusión se consideró ser residente de un CLE del área norte de la isla de Tenerife. Se recogieron variables clínico-epidemiológicas y muestras nasales que se sembraron en agar chromID®MRSA, que discrimina entre colonizados por SARM o no. El tipado molecular se realizó mediante electroforesis en campo pulsante. Se realizó un análisis de regresión logística sobre la variable SARM como dependiente. RESULTADOS: Se incluyeron 624 residentes. La prevalencia de SARM fue del 25,8%. Un total de 64 residentes necesitaron ser atendidos en el SUH en los tres meses previos al estudio. En el análisis multivariante se observó que ser atendido en el SUH en los tres meses previos [odss ratio (OR): 2,05 IC 95%: 1,29-3,26, p = 0,002] y la presencia de lesiones en la piel [OR: 1,65; IC 95% (1,11-2,44), p = 0,013] fueron las variables relacionadas con la colonización por SARM. El clon predominante fue ST-5 SARM-IVa (75,8%), estrechamente relacionado con la asistencia sanitaria. CONCLUSIONES: Los CLE de nuestra área constituyen un importante reservorio de SARM. Haber sido atendido en el SUH se comportó como factor predictor de colonización por SARM, por lo que es necesario de reforzar las medidas preventivas de transmisión cruzada de microorganismos multirresistentes e implantar sistemas vigilancia activa de SARM en el SUH

OBJECTIVES: Residents of long-term care facilities (LTCFs) are at risk for methicillin-resistant Staphylococcus aureus (MRSA) colonization because of age-related illnesses and high rates of hospital use, in particular, of visits to the emergency department (ED). We aimed to determine the prevalence of and risk factors for MRSA colonization in LTCF residents. METHODS: A descriptive cross-sectional study was carried out in 2014 (April-June). LTCF residents in the northern part of the island of Tenerife were eligible for enrolment. We collected clinical and epidemiologic data and took nasal swabs for culture (chromID MRSA agar) to screen for MRSA colonization. Molecular typing was established by pulsed field gel electrophoresis. MRSA colonization was the dependent variable in logistic regression analysis. RESULTS: A total of 624 residents were enrolled. MRSA was detected in 25.8%. Sixty-four of the residents had received care in a hospital ED in the 3 months prior to enrolment. Multivariant regression analysis detected 2 risk factors for MRSA colonization: hospital ED care in the last 3 months (odds ratio [OR], 2.05; 95% CI, 1.29-3.26; P=.002) and the presence of skin lesions (OR, 1.65; 95% CI, 1.11-2.44); P=.013). The health-care-associated, ST5 MRSA-IVa, was the most prevalent (75.8%). CONCLUSIONS: LTCF residents in our area are a significant reservoir of MRSA colonization. Hospital ED care was a predictor of MRSA colonization. We believe that stronger measures to prevent cross-contamination of multidrug resistant microorganisms must be implemented, along with active vigilance systems to detect MRSA in hospitals (AU)

[Hospital emergency health service care as a risk factor for methicillin-resistant Staphylococcus aureus in residents of long-term care facilities]. / El servicio de urgencias hospitalario como factor de riesgo de colonización por Staphylococcus aureus resistente a meticilina de los residentes en centros de larga estancia.

OBJECTIVES: Residents of long-term care facilities (LTCFs) are at risk for methicillin-resistant Staphylococcus aureus (MRSA) colonization because of age-related illnesses and high rates of hospital use, in particular, of visits to the emergency department (ED). We aimed to determine the prevalence of and risk factors for MRSA colonization in LTCF residents. MATERIAL AND METHODS: A descriptive cross-sectional study was carried out in 2014 (April­June). LTCF residents in the northern part of the island of Tenerife were eligible for enrollment. We collected clinical and epidemiologic data and took nasal swabs for culture (chromID MRSA agar) to screen for MRSA colonization. Molecular typing was established by pulsedfield gel electrophoresis. MRSA colonization was the dependent variable in logistic regression analysis. RESULTS: A total of 624 residents were enrolled. MRSA was detected in 25.8%. Sixty-four of the residents had received care in a hospital ED in the 3 months prior to enrollment. Multivariant regression analysis detected 2 risk factors for MRSA colonization: hospital ED care in the last 3 months (odds ratio [OR], 2.05; 95% CI, 1.29­3.26; P=.002) and the presence of skin lesions (OR, 1.65; 95% CI, 1.11­2.44); P=.013). The health-care-associated, ST5 MRSA-IVa, was the most prevalent (75.8%). CONCLUSION: LTCF residents in our area are a significant reservoir of MRSA colonization. Hospital ED care was a predictor of MRSA colonization. We believe that stronger measures to prevent cross-contamination of multidrug resistant microorganisms must be implemented, along with active vigilance systems to detect MRSA in hospitals.

OBJETIVO: Los residentes de centros de larga estancia (CLE) son población de riesgo para la colonización por Staphylococcus aureus resistente a meticilina (SARM) debido a la morbilidad asociada a la edad y la alta tasa de contactos hospitalarios, especialmente en el servicio de urgencias hospitalario (SUH). El objetivo del estudio fue determinar la prevalencia y los factores asociados a la colonización por SARM en los residentes de CLE. METODO: Se realizó un estudio descriptivo transversal entre abril y junio de 2014. Como criterio de inclusión se consideró ser residente de un CLE del área norte de la isla de Tenerife. Se recogieron variables clínico-epidemiológicas y muestras nasales que se sembraron en agar chromID®MRSA, que discrimina entre colonizados por SARM o no. El tipado molecular se realizó mediante electroforesis en campo pulsante. Se realizó un análisis de regresión logística sobre la variable SARM como dependiente. RESULTADOS: Se incluyeron 624 residentes. La prevalencia de SARM fue del 25,8%. Un total de 64 residentes necesitaron ser atendidos en el SUH en los tres meses previos al estudio. En el análisis multivariante se observó que ser atendido en el SUH en los tres meses previos [odss ratio (OR): 2,05 IC 95%: 1,29-3,26, p = 0,002] y la presencia de lesiones en la piel [OR: 1,65; IC 95% (1,11-2,44), p = 0,013] fueron las variables relacionadas con la colonización por SARM. El clon predominante fue ST­5 SARM-IVa (75,8%), estrechamente relacionado con la asistencia sanitaria. CONCLUSIONES: Los CLE de nuestra área constituyen un importante reservorio de SARM. Haber sido atendido en el SUH se comportó como factor predictor de colonización por SARM, por lo que es necesario de reforzar las medidas preventivas de transmisión cruzada de microorganismos multirresistentes e implantar sistemas vigilancia activa de SARM en el SUH

Optimización en la recuperación del estreptococo del grupo B en el cribado de mujeres embarazadas / Enhanced recovery of group B Streptoccocus in pregnant women screening

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