The impact of pipeline changes and temperature increase in a hospital historically colonised with Legionella.

Healthcare-related Legionnaires' disease has a devastating impact on high risk patients, with a case fatality rate of 30-50%. Legionella prevention and control in hospitals is therefore crucial. To control Legionella water colonisation in a hospital setting we evaluated the effect of pipeline improvements and temperature increase, analysing 237 samples over a 2-year period (first year: 129, second year: 108). In the first year, 25.58% of samples were positive for Legionella and 16.67% for amoeba. Assessing the distance of the points analysed from the hot water tank, the most distal points presented higher proportion of Legionella colonisation and lower temperatures (nearest points: 6.4% colonised, and temperature 61.4 °C; most distal points: 50% and temperature 59.1 °C). After the first year, the hot water system was repaired and the temperature stabilised. This led to a dramatic reduction in Legionella colonisation, which was negative in all the samples analysed; however, amoeba colonisation remained stable. This study shows the importance of keeping the temperature stable throughout the circuit, at around 60 °C. Special attention should be paid to the most distal points of the circuit; a fall in temperature at these weak points would favour the colonisation and spread of Legionella, because amoeba (the main Legionella reservoir) are not affected by temperature.

Utility of the rapid antigen detection BinaxNOW Influenza A&B test for detection of novel influenza A (H1N1) virus.

Nasopharyngeal aspirates, collected during outbreaks, of the novel influenza A (H1N1) virus in Barcelona, were used to compare the accuracy of a rapid antigen-based test (Binax) with the real-time RT-PCR assay developed by the CDC. The sensitivity, specificity and positive predictive value of the rapid test are higher in patients less than 18 years old and during the acute stage of the epidemic than in adult patients.

El papel del internista más allá de su servicio / The role of the internist beyond the service

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Changes in bloodstream infections in HIV-positive patients in a university hospital in Spain (1995-1997).

OBJECTIVES: The Hospital Universitario Germans Trias i Pujol is a 600-bed center serving 700,000 inhabitants including 1800 patients with HIV infection in Catalonia (Spain). Highly active antiretroviral therapy (HAART) became available at the end of 1996. Thus, the period 1995 1997 was considered appropriate for evaluating possible epidemiological changes in bloodstream infections (BSI) in HIV-infected patients. METHODS: All significant bloodstream infections, including mycobacteremia and fungemia, observed in HIV-positive patients from January, 1995 to December, 1997 have been included in the study. RESULTS: One hundred and eighty six cases were evaluated, in whom a decrease in BSI was observed (68 in 1995, 86 in 1996, 32 in 1997). Over time, we observed an improvement in the immunologic situation of the patients (1995: CD4 <50/mm3 73.8% vs 1997: CD4 <50/mm3 45.5% (P=0.05)). The source of BSI was known in 80.7% of the episodes. BSI secondary to catheter and respiratory infections prevailed in 1995, whereas an increase in bacteremias related to intravenous drug use, with or without endocarditis, was seen in 1997. The most frequent isolates were Mycobacterium avium intracellulare (23) (MAI), M. tuberculosis (20), Staphylococcus aureus (20), coagulase-negative staphylococci (16), Salmonella spp. (16) and Streptococcus pneumoniae (15). In 1997, a decrease was observed in the isolation of Gram-negatives and Mycobacterium spp. with S. aureus and enterococci prevailing. CONCLUSIONS: The prevalence of bloodstream infections in HIV-positive patients has decreased since the introduction of HAART and the immunologic state has improved. Furthermore there is a trend to a decrease or disappearance of microorganisms, such as Pseudomonas spp., Mycobacterium tuberculosis, MAI or fungi related to severe immunosuppression. Lastly, bacteremia caused by the active use of intravenous drugs remains stable with the highest percentage in Spain.

[Analysis of internal notices to the emergency team of the medical area at a general hospital]. / Análisis de los avisos internos al equipo de guardia del área médica en un hospital general.

OBJECTIVE: To study the frequency and characteristics of the hospitalized patients medical emergencies. PATIENTS AND METHODS: We have collected daily the notice to the emergency room from patients hospitalized and we have analyzed the clinical and epidemiological characteristics. RESULTS: Three hundred forty-one notices were recorded. The daily mean was higher on holidays. There were mostly medical problems (78%). Complementary explorations were performed in the 44% of the patients, and in the 77% the treatment was changed. CONCLUSIONS: The in-patient emergencies account for an important charge of work for the emergency team and involve important diagnosis and therapeutic decisions.

Fiebre prolongada en una mujer de 78 años con leucemia mieloide crónica / Long lasting fever in a 78-year-old woman with chronic myeloid leukemia

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Análisis de los avisos internos al equipo de guardia del área médica en un hospital general / Analysis of the internal notices to the emergency team of the medical area in a general hospital

Fundamento: Valorar la frecuencia y características de las urgencias internas. Pacientes y métodos: Se recogen los avisos diarios al equipo de guardia durante un mes, analizando las características clínicas y epidemiológicas. Resultados: Se documentaron 341 avisos, con una media diaria superior en días festivos. Se trata de problemas fundamentalmente clínicos (78 por ciento), variables según el servicio. Se realizaron exploraciones complementarias al 44 por ciento de los pacientes, y se indicaron modificaciones terapéuticas en el 77 por ciento. Conclusiones: Las urgencias internas suponen un apartado importante de la labor asistencial de los equipos de guardia, y plantean importantes valoraciones diagnósticas y terapéuticas. (AU)

Prospective study of community-acquired pneumonia of bacterial etiology in adults.

The aim of this study was to prospectively analyze the bacterial etiology of community-acquired pneumonia in adults in Spain. From May 1994 to February 1996, 392 episodes of CAP diagnosed in the emergency department of a 600-bed university hospital were studied. An etiological diagnosis based on noninvasive microbiological investigations was achieved in 228 cases (58%); 173 of these diagnoses were definitive and 55 probable. Streptococcus pneumoniae, which caused 23.9% of the episodes, was the predominant pathogen observed, followed by Chlamydia pneumoniae (13.5%) and Legionella pneumophila (12.5%). Other less frequent pathogens found were Haemophilus influenzae (2.3%), Pseudomonas aeruginosa (1.5%), Mycoplasma pneumoniae (1.3%), Coxiella burnetii (1%), Moraxella catarrhalis (2 cases), Nocardia spp. (2 cases), and Staphylococcus aureus (2 cases). Streptococcus pneumoniae was significantly more frequent in patients with underlying disease and/or age > or =60 years (28% vs. 13%, P = 0.002), while Legionella pneumophila was more frequent in patients below 60 years of age and without underlying disease (20% vs. 9%, P = 0.006). Likewise, Streptococcus pneumoniae and Legionella pneumophila were the most frequent etiologies in patients requiring admission to the intensive care unit, occurring in 29% and 26.3% of the patients, respectively. In addition to Streptococcus pneumoniae, other microorganisms such as Chlamydia pneumoniae and Legionella spp. should be seriously considered in adults with community-acquired pneumonia when initiating empiric treatment or ordering rapid diagnostic tests.