Decreased mortality among patients with catheter-related bloodstream infections at Catalan hospitals (2010-2019).

BACKGROUND: The incidence of catheter-related bloodstream infections (CRBSIs) has fallen over the last decade, especially in intensive care units (ICUs). AIM: To assess the existence of concomitant trends in outcomes and to analyse the current risk factors for mortality. METHODS: A multicentre retrospective cohort study was conducted at 24 Catalan hospitals participating in the Surveillance of healthcare-associated infections in Catalonia (VINCat). All hospital-acquired CRBSI episodes diagnosed from January 2010 to December 2019 were included. A common protocol including epidemiological, clinical, and microbiological data was prospectively completed. Mortality at 30 days after bacteraemia onset was analysed using the Cox regression model. FINDINGS: Over the study period, 4795 episodes of CRBSI were diagnosed. Among them, 75% were acquired in conventional wards and central venous catheters were the most frequently involved (61%). The 30-day mortality rate was 13.8%, presenting a significant downward trend over the study period: from 17.9% in 2010 to 10.6% in 2019 (hazard ratio (HR): 0.95; 95% confidence interval (CI): 0.92-0.98). The multivariate analysis identified age (HR: 1.03; 95% CI: 1.02-1.04), femoral catheter (1.78; 1.33-2.38), medical ward acquisition (2.07; 1.62-2.65), ICU acquisition (3.45; 2.7-4.41), S. aureus (1.59; 1.27-1.99) and Candida sp. (2.19; 1.64-2.94) as risk factors for mortality, whereas the mortality rate associated with episodes originating in peripheral catheters was significantly lower (0.69; 0.54-0.88). CONCLUSION: Mortality associated with CRBSI has fallen in recent years but remains high. Intervention programmes should focus especially on ICUs and medical wards, where incidence and mortality rates are highest.

Divergent abiotic spectral pathways unravel pathogen stress signals across species.

Plant pathogens pose increasing threats to global food security, causing yield losses that exceed 30% in food-deficit regions. Xylella fastidiosa (Xf) represents the major transboundary plant pest and one of the world's most damaging pathogens in terms of socioeconomic impact. Spectral screening methods are critical to detect non-visual symptoms of early infection and prevent spread. However, the subtle pathogen-induced physiological alterations that are spectrally detectable are entangled with the dynamics of abiotic stresses. Here, using airborne spectroscopy and thermal scanning of areas covering more than one million trees of different species, infections and water stress levels, we reveal the existence of divergent pathogen- and host-specific spectral pathways that can disentangle biotic-induced symptoms. We demonstrate that uncoupling this biotic-abiotic spectral dynamics diminishes the uncertainty in the Xf detection to below 6% across different hosts. Assessing these deviating pathways against another harmful vascular pathogen that produces analogous symptoms, Verticillium dahliae, the divergent routes remained pathogen- and host-specific, revealing detection accuracies exceeding 92% across pathosystems. These urgently needed hyperspectral methods advance early detection of devastating pathogens to reduce the billions in crop losses worldwide.

Impact of a training program on the surveillance of Clostridioides difficile infection.

A high degree of vigilance and appropriate diagnostic methods are required to detect Clostridioides difficile infection (CDI). We studied the effectiveness of a multimodal training program for improving CDI surveillance and prevention. Between 2011 and 2016, this program was made available to healthcare staff of acute care hospitals in Catalonia. The program included an online course, two face-to-face workshops and dissemination of recommendations on prevention and diagnosis. Adherence to the recommendations was evaluated through surveys administered to the infection control teams at the 38 participating hospitals. The incidence of CDI increased from 2.20 cases/10 000 patient-days in 2011 to 3.41 in 2016 (P < 0.001). The number of hospitals that applied an optimal diagnostic algorithm rose from 32.0% to 71.1% (P = 0.002). Hospitals that applied an optimal diagnostic algorithm reported a higher overall incidence of CDI (3.62 vs. 1.92, P < 0.001), and hospitals that were more active in searching for cases reported higher rates of hospital-acquired CDI (1.76 vs. 0.84, P < 0.001). The results suggest that the application of a multimodal training strategy was associated with a significant rise in the reporting of CDI, as well as with an increase in the application of the optimal diagnostic algorithm.

Chlorophyll content estimation in an open-canopy conifer forest with Sentinel-2A and hyperspectral imagery in the context of forest decline.

With the advent of Sentinel-2, it is now possible to generate large-scale chlorophyll content maps with unprecedented spatial and temporal resolution, suitable for monitoring ecological processes such as vegetative stress and/or decline. However methodological gaps exist for adapting this technology to heterogeneous natural vegetation and for transferring it among vegetation species or plan functional types. In this study, we investigated the use of Sentinel-2A imagery for estimating needle chlorophyll (Ca+b) in a sparse pine forest undergoing significant needle loss and tree mortality. Sentinel-2A scenes were acquired under two extreme viewing geometries (June vs. December 2016) coincident with the acquisition of high-spatial resolution hyperspectral imagery, and field measurements of needle chlorophyll content and crown leaf area index. Using the high-resolution hyperspectral scenes acquired over 61 validation sites we found the CI chlorophyll index R750/R710 and Macc index (which uses spectral bands centered at 680 nm, 710 nm and 780 nm) had the strongest relationship with needle chlorophyll content from individual tree crowns (r2 = 0.61 and r2 = 0.59, respectively; p < 0.001), while TCARI and TCARI/OSAVI, originally designed for uniform agricultural canopies, did not perform as well (r2 = 0.21 and r2 = 0.01, respectively). Using lower-resolution Sentinel-2A data validated against hyperspectral estimates and ground truth needle chlorophyll content, the red-edge index CI and the Sentinel-specific chlorophyll indices CI-Gitelson, NDRE1 and NDRE2 had the highest accuracy (with r2 values >0.7 for June and >0.4 for December; p < 0.001). The retrieval of needle chlorophyll content from the entire Sentinel-2A bandset using the radiative transfer model INFORM yielded r2 = 0.71 (RMSE = 8.1 µg/cm2) for June, r2 = 0.42 (RMSE = 12.2 µg/cm2) for December, and r2 = 0.6 (RMSE = 10.5 µg/cm2) as overall performance using the June and December datasets together. This study demonstrates the retrieval of leaf Ca+b with Sentinel-2A imagery by red-edge indices and by an inversion method based on a hybrid canopy reflectance model that accounts for tree density, background and shadow components common in sparse forest canopies.

Previsual symptoms of Xylella fastidiosa infection revealed in spectral plant-trait alterations.

Plant pathogens cause significant losses to agricultural yields and increasingly threaten food security1, ecosystem integrity and societies in general2-5. Xylella fastidiosa is one of the most dangerous plant bacteria worldwide, causing several diseases with profound impacts on agriculture and the environment6. Primarily occurring in the Americas, its recent discovery in Asia and Europe demonstrates that X. fastidiosa's geographic range has broadened considerably, positioning it as a reemerging global threat that has caused socioeconomic and cultural damage7,8. X. fastidiosa can infect more than 350 plant species worldwide9, and early detection is critical for its eradication8. In this article, we show that changes in plant functional traits retrieved from airborne imaging spectroscopy and thermography can reveal X. fastidiosa infection in olive trees before symptoms are visible. We obtained accuracies of disease detection, confirmed by quantitative polymerase chain reaction, exceeding 80% when high-resolution fluorescence quantified by three-dimensional simulations and thermal stress indicators were coupled with photosynthetic traits sensitive to rapid pigment dynamics and degradation. Moreover, we found that the visually asymptomatic trees originally scored as affected by spectral plant-trait alterations, developed X. fastidiosa symptoms at almost double the rate of the asymptomatic trees classified as not affected by remote sensing. We demonstrate that spectral plant-trait alterations caused by X. fastidiosa infection are detectable previsually at the landscape scale, a critical requirement to help eradicate some of the most devastating plant diseases worldwide.

Interventions to decrease short-term peripheral venous catheter-related bloodstream infections: impact on incidence and mortality.

BACKGROUND: Short-term peripheral venous catheters are a significant source of healthcare-acquired bloodstream infections and a preventable cause of death. AIM: To assess the effectiveness of interventions applied to reduce the incidence and mortality associated with short-term peripheral venous catheter-related bloodstream infections (PVCR-BSIs). METHODS: The intervention included continuous PVCR-BSI surveillance, implementation of preventive measures related to catheter insertion and maintenance in accordance with evidence-based recommendations and the hospital's own data, front-line staff educational campaigns, and assessment of adherence to hospital guidelines by ward rounds. A Poisson regression model was used to estimate the trend of rate per year. FINDINGS: From January 2003 to December 2016, 227 episodes of PVCR-BSI were identified among hospitalized patients at a university hospital. The mean age of patients was 67 years (standard deviation 14 years), 69% were male and the median Charlson score was 3 (interquartile range 2-5). Staphylococcus aureus caused 115 (50.7%) episodes. Thirty-day mortality was 13.2%. After implementation of the intervention, the incidence of PVCR-BSIs decreased significantly from 30 episodes in 2003 (1.17 episodes/10,000 patient-days) to eight episodes in 2016 (0.36/10,000 patient-days). The number of episodes caused by S. aureus decreased from 18 episodes in 2003 (0.70/10,000 patient-days) to three episodes in 2016 (0.14/10,000 patient-day), and mortality decreased from seven cases in 2003 (0.27/10,000 patient-days) to zero cases in 2016 (0.00/10,000 patient-days). CONCLUSIONS: Surveillance, implementation of a multi-modal strategy and periodical assessment of healthcare workers' adherence to hospital guidelines led to a sustained reduction in PVCR-BSIs. This reduction had a major impact on S. aureus BSI rates and associated mortality.

Understanding the temporal dimension of the red-edge spectral region for forest decline detection using high-resolution hyperspectral and Sentinel-2a imagery.

The operational monitoring of forest decline requires the development of remote sensing methods that are sensitive to the spatiotemporal variations of pigment degradation and canopy defoliation. In this context, the red-edge spectral region (RESR) was proposed in the past due to its combined sensitivity to chlorophyll content and leaf area variation. In this study, the temporal dimension of the RESR was evaluated as a function of forest decline using a radiative transfer method with the PROSPECT and 3D FLIGHT models. These models were used to generate synthetic pine stands simulating decline and recovery processes over time and explore the temporal rate of change of the red-edge chlorophyll index (CI) as compared to the trajectories obtained for the structure-related Normalized Difference Vegetation Index (NDVI). The temporal trend method proposed here consisted of using synthetic spectra to calculate the theoretical boundaries of the subspace for healthy and declining pine trees in the temporal domain, defined by CItime=n/CItime=n+1 vs. NDVItime=n/NDVItime=n+1. Within these boundaries, trees undergoing decline and recovery processes showed different trajectories through this subspace. The method was then validated using three high-resolution airborne hyperspectral images acquired at 40 cm resolution and 260 spectral bands of 6.5 nm full-width half-maximum (FWHM) over a forest with widespread tree decline, along with field-based monitoring of chlorosis and defoliation (i.e., 'decline' status) in 663 trees between the years 2015 and 2016. The temporal rate of change of chlorophyll vs. structural indices, based on reflectance spectra extracted from the hyperspectral images, was different for trees undergoing decline, and aligned towards the decline baseline established using the radiative transfer models. By contrast, healthy trees over time aligned towards the theoretically obtained healthy baseline. The applicability of this temporal trend method to the red-edge bands of the MultiSpectral Imager (MSI) instrument on board Sentinel-2a for operational forest status monitoring was also explored by comparing the temporal rate of change of the Sentinel-2-derived CI over areas with declining and healthy trees. Results demonstrated that the Sentinel-2a red-edge region was sensitive to the temporal dimension of forest condition, as the relationships obtained for pixels in healthy condition deviated from those of pixels undergoing decline.

Mortality risk factors among non-ICU patients with nosocomial vascular catheter-related bloodstream infections: a prospective cohort study.

BACKGROUND: Vascular catheter-related bloodstream infections (CRBSIs) are highly preventable hospital-acquired infections and a major threat to patient safety. While there is significant information regarding CRBSI outcome among intensive care unit (ICU) patients, data regarding non-ICU patients are scarce. AIM: To determine the risk factors associated with 30-day mortality among non-ICU patients with nosocomial CRBSIs. METHODS: Prospective cohort study of non-ICU patients with nosocomial CRBSIs in a tertiary care centre between January 2004 and December 2014. The primary outcome was 30-day mortality, defined as death from any cause within 30 days of CRBSI. Follow-up was performed 30 days after CRBSI onset. Time until death was the dependent variable in Cox regression analysis. FINDINGS: In total, 546 cases of CRBSI were identified. The mean age of patients was 64.5 years [interquartile range (IQR) 55-75 years], 66% were male, and the mean Charlson score was 3.59 (IQR 2-5). Of the 546 cases, 58.4% resulted from central venous catheters and 41.6% from peripheral venous catheters. The causative agents were Gram-positive cocci (70.1% of cases), Gram-negative bacilli (31.1%) and Candida spp. (1%). Mortality within 30 days was 13.9%, with no significant changes over the study period. Independent risk factors for 30-day mortality were Charlson score ≥4 [hazard ratio (HR) 1.80, 95% confidence interval (CI) 1.19-2.73], Staphylococcus aureus infection (HR 2.67, 95% CI 1.61-4.43) and Candida spp. infection (HR 6.1, 95% CI 2.08-18.04). Age; area of admission; type, use and site of vascular catheter; and administration of appropriate empirical antibiotic treatment were not independent risk factors for 30-day mortality. CONCLUSION: Nosocomial CRBSIs outside ICUs are associated with high risk of mortality, particularly among patients with a higher Charlson score and bloodstream infections caused by Staphylococcus aureus and Candida spp.

Unmanned aerial platform-based multi-spectral imaging for field phenotyping of maize.

BACKGROUND: Recent developments in unmanned aerial platforms (UAP) have provided research opportunities in assessing land allocation and crop physiological traits, including response to abiotic and biotic stresses. UAP-based remote sensing can be used to rapidly and cost-effectively phenotype large numbers of plots and field trials in a dynamic way using time series. This is anticipated to have tremendous implications for progress in crop genetic improvement. RESULTS: We present the use of a UAP equipped with sensors for multispectral imaging in spatial field variability assessment and phenotyping for low-nitrogen (low-N) stress tolerance in maize. Multispectral aerial images were used to (1) characterize experimental fields for spatial soil-nitrogen variability and (2) derive indices for crop performance under low-N stress. Overall, results showed that the aerial platform enables to effectively characterize spatial field variation and assess crop performance under low-N stress. The Normalized Difference Vegetation Index (NDVI) data derived from spectral imaging presented a strong correlation with ground-measured NDVI, crop senescence index and grain yield. CONCLUSION: This work suggests that the aerial sensing platform designed for phenotyping studies has the potential to effectively assist in crop genetic improvement against abiotic stresses like low-N provided that sensors have enough resolution for plot level data collection. Limitations and future potential uses are also discussed.

Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH / Programs for optimizing the use of antibiotics (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document

Los antimicrobianos son fármacos distintos al resto. Su eficacia en la reducción de la morbilidad y la mortalidad es muy superior a la de otros grupos de medicamentos. Por otra parte, son los únicos fármacos con efectos ecológicos, de manera que su administración puede contribuir a la aparición y diseminación de resistencias microbianas. Finalmente, son utilizados por médicos de prácticamente todas las especialidades. La actual complejidad en el manejo de las enfermedades infecciosas y del aumento de las resistencias hace imprescindible el establecimiento de programas de optimización del uso de antimicrobianos en los hospitales (PROA).Este documento de consenso define los objetivos de los PROA (mejorar los resultados clínicos de los pacientes con infecciones, minimizar los efectos adversos asociados a la utilización de antimicrobianos, incluyendo aquí las resistencias, y garantizar la utilización de tratamientos coste-eficaces) y establece recomendaciones para su implantación en los hospitales españoles. Las líneas maestras de las recomendaciones son: la constitución de un equipo multidisciplinario de antibióticos, dependiente de la Comisión de Infecciones. Los PROA necesitan ser considerados programas institucionales de los hospitales donde se desarrollen. Deben incluir objetivos específicos y resultados cuantificables en función de indicadores, y basarse en la realización de actividades encaminadas a mejorar el uso de antimicrobianos, principalmente mediante actividades formativas y medidas no impositivas de ayuda a la prescripción (AU)

The antimicrobial agents are unique drugs for several reasons. First, their efficacy is higher than other drugs in terms of reduction of morbidity and mortality. Also, antibiotics are the only group of drugs associated with ecological effects, because their administration may contribute to the emergence and spread of microbial resistance. Finally, they are used by almost all medical specialties. Appropriate use of antimicrobials is very complex because of the important advances in the management of infectious diseases and the spread of antibiotic resistance. Thus, the implementation of programs for optimizing the use of antibiotics in hospitals (called PROA in this document) is necessary. This consensus document defines the objectives of the PROA (namely, to improve the clinical results of patients with infections, to minimise the adverse events associated to the use of antimicrobials including the emergence and spread of antibiotic resistance, and to ensure the use of the most cost-efficacious treatments), and provides recommendations for the implementation of these programs in Spanish hospitals. The key aspects of the recommendations are as follows. Multidisciplinary antibiotic teams should be formed, under the auspices of the Infection Committees. The PROA need to be considered as part of institutional programs and the strategic objectives of the hospital. The PROA should include specific objectives based on measurable indicators, and activities aimed at improving the use of antimicrobials, mainly through educational activities and interventions based more on training activities directed to prescribers than just on restrictive measures (AU)

[Programs for optimizing the use of antibiotics (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document]. / Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH.

The antimicrobial agents are unique drugs for several reasons. First, their efficacy is higher than other drugs in terms of reduction of morbidity and mortality. Also, antibiotics are the only group of drugs associated with ecological effects, because their administration may contribute to the emergence and spread of microbial resistance. Finally, they are used by almost all medical specialties. Appropriate use of antimicrobials is very complex because of the important advances in the management of infectious diseases and the spread of antibiotic resistance. Thus, the implementation of programs for optimizing the use of antibiotics in hospitals (called PROA in this document) is necessary. This consensus document defines the objectives of the PROA (namely, to improve the clinical results of patients with infections, to minimise the adverse events associated to the use of antimicrobials including the emergence and spread of antibiotic resistance, and to ensure the use of the most cost-efficacious treatments), and provides recommendations for the implementation of these programs in Spanish hospitals. The key aspects of the recommendations are as follows. Multidisciplinary antibiotic teams should be formed, under the auspices of the Infection Committees. The PROA need to be considered as part of institutional programs and the strategic objectives of the hospital. The PROA should include specific objectives based on measurable indicators, and activities aimed at improving the use of antimicrobials, mainly through educational activities and interventions based more on training activities directed to prescribers than just on restrictive measures.

Methicillin-susceptible Staphylococcus aureus clone related to the early pandemic phage type 80/81 causing an outbreak among residents of three occupational centres in Barcelona, Spain.

In the 1950s an unusually virulent and transmissible penicillin-resistant Staphylococcus aureus clone harbouring Panton-Valentine leukocidin (PVL) genes, known as phage type 80/81 and subsequently identified as multilocus sequence type (ST) 30, emerged and caused serious infections in hospitals and the community. We describe an outbreak of skin infections caused by a PVL-positive, methicillin-susceptible S. aureus (MSSA) strain of ST1472, related to phage type 80/81, in three associated occupational centres. After identification of the first patient an active case-finding strategy was initiated among the three centres. Epidemiological and clinical features were indistinguishable from outbreaks currently caused by community-acquired methicillin-resistant S. aureus. The S. aureus was cultured and identified from nasal swabs and skin lesions by conventional methods; PVL was detected using a PCR assay. Pulsed-field gel electrophoresis and DNA-array-based genotyping were applied to MSSA isolates. MSSA was identified in nasal swabs from 49 of 133 individuals (37%). A single pulsed-field gel electrophoresis pattern, belonging to ST1472 (CC30) and PVL positivity, were detected in 20 individuals, including eight of 18 skin cultures, i.e. 15% of the screened individuals were colonized by the epidemic strain. Nasal and cutaneous decontamination with 5% nasal mupirocin ointment and 2% aqueous chlorhexidine was implemented for all individuals. Patients with active skin infections were treated with a first-generation cephalosporin. General recommendations were made to prevent cross-transmission. No new cases were reported over the following 90 days.

Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH / No disponible

Los antimicrobianos son fármacos distintos al resto. Su eficacia en términos de curación y reducción de mortalidad es muy superior a la de otros grupos de medicamentos,habiéndose demostrado que la indicación de antimicrobianosinadecuados en determinadas situaciones clínicas es un factorindependiente de aumento del riesgo de mortalidad. Por otra parte, son los únicos fármacos con efectos ecológicos, de manera que su administación afecta tanto al paciente que los recibe como al resto, dado que pueden contribuir a la aparicióny diseminación de resistencias microbianas. Finalmente, sonutilizados por médicos de prácticamente todas las especialidades.La complejidad actual motivada por los avances en el conocimiento del manejo de las nfermedades infecciosas y del aumento de las resistencias hace imprescindible el establecimiento de programas de optimización del uso de antimicrobianos en los hospitales (PROA). Este documento de consenso define los objetivos de losPROA (por este orden: mejorar los resultados clínicos de los pacientes con infecciones, minimizar los efectosadversos asociados a la utilización de antimicrobianos, incluyendo aquí la aparición y diseminación deresistencias, y garantizar la utilización de tratamientos coste-eficaces) y establece recomendaciones para suimplantación en los hospitales españoles. Las líneas maestras de las recomendaciones son las siguientes: eldiseño y desarrollo de los PROA debe basarse en la constituciónde un equipo multidisciplinar de antibióticos, dependiente de la Comisión de Infecciones. Para posibilitar su éxito, estos programas necesitan ser considerados comoparte de la propia institución sanitaria y formar parte de los objetivos de los centros donde se desarrollen (AU)

No disponible

Community-acquired methicillin-resistant Staphylococcus aureus infections: an emerging threat in Spain.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has not been recognised previously as a cause of MRSA infections in Spain. Nineteen patients carrying Panton-Valentine leukocidin (PVL)-positive MRSA were identified in a Barcelona hospital, of whom 15 were immigrants, mostly from South America. Twelve developed skin and soft-tissue infections. The associated isolates carried the PVL gene and staphylococcal chromosomal cassette (SCC)mecIV. A dominant clone belonging to sequence type (ST)8 and related to the USA300 clone was identified by pulsed-field gel electrophoresis. This clone is emerging in Spain, primarily among immigrants from South America, but dissemination to the native Spanish population could increase.

Biopsia endomiocárdica: revisión y experiencia de 176 procedimientos / Endomyocardial biopsy: revision and experience of 176 procedures

Endomyocardial biopsy (EB) is often used in the clinical evaluation of several cardiac disease. Hundred-seventy-six consecutive procedures were performed in 65 patients, 43 men and 22 women mean age was 29.86 +/- 11.53 (range 4 days to 66 years). Group A, 26 postcardiac transplantation patients in whom 137 EB were performed (39 heterotopic and 98 orthotopic), average sample 5.2 biopsy for each patient. Group B (n = 39) was studied for several cardiac diseases during cardiac diagnostic catheterism. The jugular venous approach was performed in 3 patients (1.7%), femoral in 173 patients. Major complications were found in 3 (1.7%) cases consisting in cerebrovascular accident (stroke) and coronary fistula into the right ventricle. Endomyocardial biopsy provides a low incidence of adverse reactions, mortality was 0%.

Clinical epidemiology and outcomes of peripheral venous catheter-related bloodstream infections at a university-affiliated hospital.

Despite enormous clinical experience of using peripheral vascular catheters, there is still controversy over the incidence and clinical relevance of bloodstream infections caused by these devices and the measures for preventing them. We performed a prospective study to determine the clinical epidemiology and outcomes of nosocomial bloodstream infections caused by short- and mid-line peripheral venous catheters among a group of non-intensive care unit patients. Cases of peripheral venous catheter-related bloodstream infections (PVC-BSIs) were compared to cases of central venous catheter-related bloodstream infections (CVC-BSIs). From October 2001 to March 2003, 150 cases of vascular catheter-related bloodstream infections were identified among 147 patients. Seventy-seven episodes (0.19 cases/1000 patient-days) were PVC-BSIs and 73 episodes (0.18 cases/1000 patient-days) were CVC-BSIs. Compared with CVC-BSIs, patients with PVC-BSIs more often had the catheter inserted in the emergency department (0 vs 42%), had a shorter duration from catheter insertion to bacteraemia (mean: 15.4 vs 4.9 days) and had Staphylococcus aureus (33 vs 53%) more frequently as the causative pathogen. Among patients with PVC-BSIs, catheters inserted in the emergency department had a significantly shorter duration in situ compared with those inserted on hospital wards (mean: 3.7 vs 5.7 days). Patients with PVC-BSIs caused by S. aureus had a higher rate of complicated bacteraemia (7%) and higher overall mortality (27%) than patients with PVC-BSIs caused by other pathogens (0 and 11%, respectively). Bloodstream infections remain underestimated and potentially serious complications of peripheral vascular catheterisation. Targeted interventions should be introduced to minimise this complication.

Predictive factors of meticillin resistance among patients with Staphylococcus aureus bloodstream infections at hospital admission.

Meticillin-resistant Staphylococcus aureus (MRSA) is prevalent throughout the healthcare system in Spain, particularly in long-term care facilities (LTCF) and the incidence of MRSA bloodstream infection (MRSA-BSI) at hospital admission is increasing. This study aimed to determine factors that predict meticillin resistance among patients who require hospitalization for S. aureus BSI. We performed a case-control study comparing patients with S. aureus at hospital admission from January 1991 to December 2003. Case patients with MRSA-BSI at hospital admission (N=50) were compared with control patients with meticillin-susceptible S. aureus bloodstream infection (MSSA-BSI) at hospital admission (N=98). The incidence of MRSA-BSI at hospital admission increased significantly from 0.08 cases/1000 hospital admissions in 1991 to 0.37 cases in 2003 (P<0.001). Univariate analysis comparing patients with MRSA- and MSSA-BSI found a significant association between meticillin resistance and age >60 years, female sex, prior MRSA isolation and healthcare-related BSI. No differences were found in underlying conditions such as diabetes, haemodialysis, immunosuppression, source of infection or mortality between the two groups. Multivariate analyses identified prior MRSA isolation [odds ratio (OR): 41; 95% confidence interval (CI): 4-350] and admission from long-term care facilities (OR: 37; 95% CI: 4.5-316) as independent risk factors for MRSA-BSI.