Clinical and Microbiological Impact of Implementing a Decision Support Algorithm through Microbiologic Rapid Diagnosis in Critically Ill Patients: An Epidemiological Retrospective Pre-/Post-Intervention Study.

BACKGROUND: Data on the benefits of rapid microbiological testing on antimicrobial consumption (AC) and antimicrobial resistance patterns (ARPs) are scarce. We evaluated the impact of a protocol based on rapid techniques on AC and ARP in intensive care (ICU) patients. METHODS: A retrospective pre- (2018) and post-intervention (2019-2021) study was conducted in ICU patients. A rapid diagnostic algorithm was applied starting in 2019 in patients with a lower respiratory tract infection. The incidence of nosocomial infections, ARPs, and AC as DDDs (defined daily doses) were monitored. RESULTS: A total of 3635 patients were included: 987 in the pre-intervention group and 2648 in the post-intervention group. The median age was 60 years, the sample was 64% male, and the average APACHE II and SOFA scores were 19 points and 3 points. The overall ICU mortality was 17.2% without any differences between the groups. An increase in the number of infections was observed in the post-intervention group (44.5% vs. 17.9%, p < 0.01), especially due to an increase in the incidence of ventilator-associated pneumonia (44.6% vs. 25%, p < 0.001). AC decreased from 128.7 DDD in 2018 to 66.0 DDD in 2021 (rate ratio = 0.51). An increase in Pseudomonas aeruginosa susceptibility of 23% for Piperacillin/tazobactam and 31% for Meropenem was observed. CONCLUSION: The implementation of an algorithm based on rapid microbiological diagnostic techniques allowed for a significant reduction in AC and ARPs without affecting the prognosis of critically ill patients.

¿Es la fosfomicina una buena alternativa terapéutica para la gonorrea en nuestro medio? / Is fosfomycin a good alternative drug for gonorrhoea treatment in our setting?

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Mycobacterium lentiflavum como causa principal de linfadenitis en población pediátrica / Mycobacterium lentiflavum as the main cause of lymphadenitis in pediatric population

INTRODUCCIÓN: La linfadenitis cervical es la infección más frecuente por micobacterias no tuberculosas (MNT) en niños inmunocompetentes, principalmente menores de 5 años. Durante años se ha considerado a Mycobacterium lentiflavum (M. lentiflavum) una inusual MNT causante de esta patología. MÉTODOS: Se realizó un estudio retrospectivo, observacional desde 2009 a 2016, que incluyó a pacientes pediátricos del Hospital Infantil Universitario Niño Jesús de Madrid, diagnosticados clínicamente y microbiológicamente de linfadenitis cervical por MNT. RESULTADOS: En el periodo estudiado se registraron 28 casos de linfadenitis cervical. En 23 (82,14%) pacientes se aisló M. lentiflavum y en 5 (17,85%), Mycobacterium avium. De los 23 pacientes con infección por M. lentiflavum, la localización más frecuente fue la submandibular (43,47%), 15 (65,21%) fueron niños, la media de edad global fue de 30,8 meses y todos los casos evolucionaron satisfactoriamente. CONCLUSIÓN: M. lentiflavum debe ser considerado como un importante patógeno emergente causante de linfadenitis cervical en población pediátrica

INTRODUCTION: Cervical lymphadenitis is the most common nontuberculous mycobacteria (NTM) infection in immunocompetent children, mainly in those under 5years. For many years Mycobacterium lentiflavum (M. lentiflavum) has been considered a rare NTM causing lymphadenitis. METHODS: A restrospective study was performed in pediatric patients with microbiologically confirmed NTM cervical lympahdenitis at the Niño Jesús Hospital in Madrid during 2009-2016. RESULTS: During the period studied, 28 cases of cervical lymphadenitis were recorded. In 23 (82.14%) and in 5 (17,85%) cases, M. lentiflavum and Mycobacterium avium were isolated, respectively. In those patients infected with M. lentiflavum, the most frequent location was sub-maxilar (43.47%); 15 (65.21%) were boys, global median age was 30,8 months and all cases showed a satisfactory evolution. CONCLUSION: We propose that M. lentiflavum should be considered an important emergent pathogen cause of cervical lymphadenitis in the pediatric population

Mycobacterium lentiflavum as the main cause of lymphadenitis in pediatric population. / Mycobacterium lentiflavum como causa principal de linfadenitis en población pediátrica.

INTRODUCTION: Cervical lymphadenitis is the most common nontuberculous mycobacteria (NTM) infection in immunocompetent children, mainly in those under 5years. For many years Mycobacterium lentiflavum (M. lentiflavum) has been considered a rare NTM causing lymphadenitis. METHODS: A restrospective study was performed in pediatric patients with microbiologically confirmed NTM cervical lympahdenitis at the Niño Jesús Hospital in Madrid during 2009-2016. RESULTS: During the period studied, 28 cases of cervical lymphadenitis were recorded. In 23 (82.14%) and in 5 (17,85%) cases, M. lentiflavum and Mycobacterium avium were isolated, respectively. In those patients infected with M. lentiflavum, the most frequent location was sub-maxilar (43.47%); 15 (65.21%) were boys, global median age was 30,8 months and all cases showed a satisfactory evolution. CONCLUSION: We propose that M. lentiflavum should be considered an important emergent pathogen cause of cervical lymphadenitis in the pediatric population.