Enteropatógenos y antibióticos / Enteropathogens and antibiotics

La gastroenteritis infecciosa continúa siendo un problema de salud pública. La etiología bacteriana es la responsable de la mayoría de los casos graves. En nuestro país, Campylobacter y Salmonella son los géneros bacterianos más prevalentes, mientras que Yersinia y Shigella son mucho menos frecuentes. La mayoría de los casos suelen ser autolimitados y, en general, el tratamiento antibiótico no está indicado, salvo en pacientes con factores de riesgo de infección grave y en shigelosis. Ciprofloxacino, cefalosporinas de tercera generación, azitromicina, ampicilina, cotrimoxazol y doxiciclina son los fármacos más recomendados. El patrón de sensibilidad de las diferentes bacterias determina la elección del tratamiento antibiótico más adecuado. El objetivo de esta revisión es analizar la situación, las novedades y la evolución de la resistencia y la multirresistencia en estos 4 enteropatógenos (AU)

Infectious gastroenteritis remains a public health problem. The most severe cases are of bacterial origin. In Spain, Campylobacter and Salmonella are the most prevalent bacterial genus, while Yersinia and Shigella are much less frequent. Most cases are usually self-limiting and antibiotic therapy is not generally indicated, unless patients have risk factors for severe infection and shigellosis. Ciprofloxacin, third generation cephalosporins, azithromycin, ampicillin, cotrimoxazole and doxycycline are the most recommended drugs. The susceptibility pattern of the different bacteria determines the choice of the most appropriate treatment. The aim of this review is to analyse the current situation, developments, and evolution of resistance and multidrug resistance in these 4 enteric pathogens (AU)

Enteropathogens and antibiotics. / Enteropatógenos y antibióticos.

Infectious gastroenteritis remains a public health problem. The most severe cases are of bacterial origin. In Spain, Campylobacter and Salmonella are the most prevalent bacterial genus, while Yersinia and Shigella are much less frequent. Most cases are usually self-limiting and antibiotic therapy is not generally indicated, unless patients have risk factors for severe infection and shigellosis. Ciprofloxacin, third generation cephalosporins, azithromycin, ampicillin, cotrimoxazole and doxycycline are the most recommended drugs. The susceptibility pattern of the different bacteria determines the choice of the most appropriate treatment. The aim of this review is to analyse the current situation, developments, and evolution of resistance and multidrug resistance in these 4 enteric pathogens.

Evaluación de una técnica de diagnóstico molecular Xpert EV (Cepheid(R)) en la meningitis por enterovirus / Evaluation of an Xpert EV (Cepheid(R)) molecular diagnostic technique for enteroviral meningitis

Introducción: Las técnicas de biología molecular han demostrado ser útiles en la detección del enterovirus en niños con meningitis aséptica. El objetivo de nuestro estudio fue analizar cambios en la práctica clínica tras la introducción de una técnica de RT-PCR a tiempo real, ensayo Xpert EV (Cepheid(R)), para la detección de enterovirus en muestras de líquido cefalorraquídeo de niños con sospecha de meningitis vírica. Métodos: Estudio retrospectivo de los niños mayores de 1año diagnosticados de meningitis por enterovirus en un hospital de tercer nivel desde noviembre de 2006 a febrero de 2013. Se comparó el periodo previo a la introducción del ensayo Xpert EV (Cepheid(R)) (grupo1: noviembre 2006-agosto de 2010) con el periodo posterior (grupo2: septiembre 2010-febrero 2013). Se compararon las características clínicas, los tiempos de estancia media y los costes por hospitalización. Resultados: Se incluyeron 41 pacientes con una mediana de edad de 64 meses (rango intercuartílico, 28-96). En el grupo 2 se incluyeron 26 pacientes (63,4%). No hubo diferencias epidemiológicas, de gravedad, ni de laboratorio estadísticamente significativas entre los pacientes valorados en ambos grupos. Se observó una disminución significativa en la duración de estancia media hospitalaria en el grupo 2 (48 h vs 40,5 h, p = 0,039) y una disminución significativa en el gasto por paciente hospitalizado (779,77 Euros vs. 656,05 Euros, p<0,05). Conclusiones: La incorporación de la técnica Xpert EV (Cepheid(R)) permitió disminuir la estancia y el gasto asociado a hospitalización en niños con meningitis por enterovirus (AU)

Introduction: Polymerase chain reaction (PCR) assays have shown to be useful and quick for the diagnosis of enterovirus in aseptic meningitis. The aim of our study was to analyse the changes in clinical practice after the introduction of a real-time polymerase chain reaction (RT-PCR) technique using the Xpert EV (Cepheid(R)) assay for the qualitative detection of enterovirus RNA in cerebrospinal fluid specimens from children with suspected viral meningitis. Methods: A retrospective study was performed in children older than 1 year, diagnosed with enterovirus meningitis in a third level hospital from November 2006 to February 2013. The first period, before the availability of Xpert EV (Cepheid(R)) (Group 1, November 2006-August 2010) was compared with the later period (Group 2, September 2010-February 2013). Clinical characteristics, the mean length of stay, and the cost per inpatient cases, were compared between the 2 periods. Results: Forty-one patients (60.9% male) were included, with a median age of 64 months (interquartile range 28-96). Twenty-six patients (63.4%) were included in Group 2. There were non-statistically significant differences in the epidemiological, disease severity, and laboratory characteristics between both periods of study. A significant difference was observed in the mean length of stay, with it being shorter in Group2 (48 hours vs 40.5 hours, P = .039), and a significant lower inpatient cost per case (Euros 779.77 vs Euros 656.05, P < .05). Conclusion: Xpert EV (Cepheid(R)) assay was useful for decreasing the length of hospital stay and the costs associated with hospitalisation in children with enterovirus meningitis (AU)

[Evaluation of an Xpert EV (Cepheid®) molecular diagnostic technique for enteroviral meningitis]. / Evaluación de una técnica de diagnóstico molecular Xpert EV (Cepheid®) en la meningitis por enterovirus.

INTRODUCTION: Polymerase chain reaction (PCR) assays have shown to be useful and quick for the diagnosis of enterovirus in aseptic meningitis. The aim of our study was to analyse the changes in clinical practice after the introduction of a real-time polymerase chain reaction (RT-PCR) technique using the Xpert EV (Cepheid®) assay for the qualitative detection of enterovirus RNA in cerebrospinal fluid specimens from children with suspected viral meningitis. METHODS: A retrospective study was performed in children older than 1year, diagnosed with enterovirus meningitis in a third level hospital from November 2006 to February 2013. The first period, before the availability of Xpert EV (Cepheid®) (Group1, November 2006-August 2010) was compared with the later period (Group2, September 2010-February 2013). Clinical characteristics, the mean length of stay, and the cost per inpatient cases, were compared between the 2periods. RESULTS: Forty-one patients (60.9% male) were included, with a median age of 64 months (interquartile range 28-96). Twenty-six patients (63.4%) were included in Group2. There were non-statistically significant differences in the epidemiological, disease severity, and laboratory characteristics between both periods of study. A significant difference was observed in the mean length of stay, with it being shorter in Group2 (48hours vs 40.5hours, P=.039), and a significant lower inpatient cost per case (€779.77 vs €656.05, P<.05). CONCLUSION: Xpert EV (Cepheid®) assay was useful for decreasing the length of hospital stay and the costs associated with hospitalisation in children with enterovirus meningitis.

Survey of Carbapenemase-Producing Enterobacteriaceae in Companion Dogs in Madrid, Spain.

We found a low prevalence (0.6%) of carbapenemase-producingEnterobacteriaceae(CPE) in fecal microbiota of companion dogs. A single VIM-1-producingKlebsiella pneumoniaeisolate belonging to sequence type (ST) 2090 was detected.blaVIM-1was carried on a class 1 integron and an untypeable ∼48-kb plasmid. Emergence and spread of CPE in this group of animals may be a threat to public health in human and veterinary medicine. This finding supports the need for active surveillance studies in companion animals that live close to humans, as interspecies transmission may occur within the same household.

Shigelosis, la importancia de la higiene en la prevención / Shigellosis, the importance of hygiene in prevention

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Long-term use of selective decontamination of the digestive tract does not increase antibiotic resistance: a 5-year prospective cohort study.

PURPOSE: Despite the evidence, the use of selective decontamination of the digestive tract (SDD) remains controversial, largely because of concerns that it may promote the emergence of antibiotic-resistant strains. The purpose of this study was to evaluate the long-term incidence of carriage of antibiotic-resistant bacteria (ARB), its clinical impact on developing infections and to explore risk factors of acquiring resistance. METHODS: This study was conducted in one 18-bed medical-surgical intensive care unit (ICU). All consecutive patients admitted to the ICU who were expected to require tracheal intubation for longer than 48 h were given a 4-day course of intravenous cefotaxime, and enteral polymyxin E, tobramycin, amphotericin B in an oropharyngeal paste and digestive solution. Oropharyngeal and rectal swabs were obtained on admission and once a week. Diagnostic samples were obtained on clinical indication. RESULTS: During 5 years 1,588 patients were included in the study. The incidence density of ARB was stable: 18.91 carriers per 1,000 patient-days. The incidence of resistant Enterobacteriaceae was stable; the resistance of Pseudomonas aeruginosa to tobramycin, amikacin and ciprofloxacin was strongly reduced; there was an increase of P. aeruginosa resistant to ceftazidime and imipenem, associated with the increase in imipenem consumption; the incidence of other nonfermenter bacilli and oxacillin-resistant Staphylococcus aureus was close to zero. Ninety-seven patients developed 101 infections caused by ARB: 23 pneumonias, 20 bloodstream infections and 58 urinary tract infections. Abdominal surgery was the only risk factor associated with ARB acquisition [risk ratio 1.56 (1.10-2.19)]. CONCLUSIONS: Long-term use of SDD is not associated with an increase in acquisition of resistant flora.