Correlation between Streptococcus bovis bacteremia and density of cows in Galicia, northwest of Spain.

BACKGROUND: There are few data on the epidemiology of infections caused by Streptococcus bovis (Sb). Some studies suggest that both residence in rural areas and contact with livestock could be potential risk factors. METHODS: We performed a retrospective study for the period 2005-2016 of all cases of bacteremia caused by Sb in Galicia (a region in the northwest of Spain). The association between the incidence rate of Sb bacteremia and the number of cattle by province and district was analyzed. RESULTS: 677 cases were included with a median age of 76 years, 69.3% males. The most frequent infections were endocarditis (234 cases, 34.5%), primary bacteremia (213 cases, 31.5%) and biliary infection (119 cases, 17.5%). In 252 patients, colon neoplasms were detected (37.2%). S. gallolyticus subsp. gallolyticus was the predominant species (52.3%). Mortality was 15.5% (105 cases). The annual incidence rate was 20.2 cases/106 inhabitants and was correlated with the density of cattle (p < 0.001), but not with rurality. When comparing the two provinces with a strong predominance of rural population, but with important differences in the number of cattle, such as Orense and Lugo, with 6% and 47.7% of Galician cattle, respectively, the rates were very different: 15.8 and 43.6 cases/106, respectively, with an RR of 2.7 (95% CI, 2.08-3.71). Some districts of the province of Lugo had rates higher than 100 cases/106 inhabitants. CONCLUSIONS: Our study shows a significant correlation between the rates of Sb bacteremia and cattle density, suggesting a possible transmission of Sb from cows to people.

The DEP-6D, a new preference-based measure to assess health states of dependency.

In medical literature there are numerous multidimensional scales to measure health states for dependence in activities of daily living. However, these scales are not preference-based and are not able to yield QALYs. On the contrary, the generic preference-based measures are not sensitive enough to measure changes in dependence states. The objective of this paper is to propose a new dependency health state classification system, called DEP-6D, and to estimate its value set in such a way that it can be used in QALY calculations. DEP-6D states are described as a combination of 6 attributes (eat, incontinence, personal care, mobility, housework and cognition problems), with 3-4 levels each. A sample of 312 Spanish citizens was surveyed in 2011 to estimate the DEP-6D preference-scoring algorithm. Each respondent valued six out of the 24 states using time trade-off questions. After excluding those respondents who made two or more inconsistencies (6% out of the sample), each state was valued between 66 and 77 times. The responses present a high internal and external consistency. A random effect model accounting for main effects was the preferred model to estimate the scoring algorithm. The DEP-6D describes, in general, more severe problems than those usually described by means of generic preference-based measures. The minimum score predicted by the DEP-6D algorithm is -0.84, which is considerably lower than the minimum value predicted by the EQ-5D and SF-6D algorithms. The DEP-6D value set is based on community preferences. Therefore it is consistent with the so-called 'societal perspective'. Moreover, DEP-6D preference weights can be used in QALY calculations and cost-utility analysis.

Community-acquired pneumonia in immunocompromised older patients: incidence, causative organisms and outcome.

The number of elderly patients in the community with immunosuppressive conditions has increased progressively over recent decades. We sought to determine the incidence, causative organisms and outcome of community-acquired pneumonia (CAP) occurring in immunocompromised older patients. We prospectively compared cases of CAP in immunocompromised and non-immunocompromised patients admitted to five public hospitals in three Spanish regions. Of 320 cases studied, 115 (36%) occurred in immunocompromised patients, including: solid or hematological malignancy (97), corticosteroids or other immunosuppressive drugs (44), solid organ or stem cell transplant (five), and other conditions (eight). The etiology was established in 44% of immunocompromised patients vs. 32% of non-immunocompromised patients (p 0.03). Streptococcus pneumoniae was the most common causative organism in both groups (29% vs. 21%; p 0.08), followed by Legionella pneumophila (3% vs. 6%; p 0.01). Gram-negative bacilli were more frequent among immunocompromised patients (5% vs. 0.5%; p <0.01), particularly Pseudomonas aeruginosa (3% vs. 0%; p 0.04). Nocardiosis was only observed in immunocompromised patients (two cases). Bacteremia occurred similarly in the two groups. No significant differences were found with respect to ICU admission (8%, in both groups) or the length of stay (12.5 vs. 10.4 days). The early (<48 h) (3.5 vs. 0.5%; p 0.04) and overall case-fatality rates (12% vs. 3%; p <0.01) were higher in immunocompromised patients. In conclusion, a substantial number of older patients hospitalized for CAP are immunocompromised. Although relatively uncommon, CAP due to gram-negative bacilli, including P. aeruginosa, is more frequent among these patients. CAP occurring in immunocompromised patients causes significant morbidity and mortality.

Clinical experience with linezolid for the treatment of neurosurgical infections.

OBJECTIVES: We sought to evaluate the clinical use of linezolid for the treatment of neurosurgical infections. METHODS: Retrospective observational study of a cohort of hospitalized patients who received linezolid for a culture-positive neurosurgical infection from July 2004 to February 2009 in a tertiary hospital in Spain. RESULTS: Seventeen patients were included in the study. Main comorbidities among these patients included one or more of the following: subarachnoidal or intraventricular hemorrhage (n=8), solid neurological cancer (n=7), corticosteroids(n=9) and hydrocephalus (n=6). Eight patients underwent a craniotomy and fourteen patients had an external ventricular drainage (EVD) as predisposing factors for infection. Meningitis was the most common infection (11; 64.7%), followed by ventriculitis (4; 23.5%) and brain abscesses (2;11.8%). The main causative organisms were coagulase-negative Staphylococcus spp. (13; 76.5%). Linezolid was used as the initial therapy in 8 episodes, after therapy failure in 6 and for other reasons in 3. The oral route was used in 9 (52.9%) episodes; linezolid was initiated orally in 2 cases. The mean duration of treatment was 26.5 days (range 15-58). No adverse events were reported. Sixteen (94.1%) patients were considered cured.There was one recurrence. The mean length of hospital stay was 45.6 (range 15-112) days and the mean duration of follow-up was 7.2 (range 0.4-32) months. No related deaths occurred during active episodes. CONCLUSIONS: Linezolid was mainly indicated in post-neurosurgical EVD-associated infections due to coagulase-negative Staphylococcus spp. It was used as initial therapy in most cases. A high rate of clinical cure was observed and no related adverse events were reported. More than half of the patients were benefited by the advantages of the oral route of administration.

[Endocarditis caused by Staphylococcus lugdunensis. Hospital incidence]. / Endocarditis por Staphylococcus lugdunensis. Incidencia hospitalaria.

BACKGROUND: Staphylococcus lugdenensis is a coagulase negative staphylococcus (CNS) associated with a wide spectrum of infections among which infectious endocarditis may be found and in which it is an aggressive pathogen. METHODS: Since 1993 a systematic search for S. lugdenensis in all the staphylococci isolated in blood cultures and the possibility of endocarditis en all of these was determined. A review of all the cases of endocarditis in the literature was performed. RESULTS: Three cases of endocarditis by S. lugdenensis on the native valve were detected from January 1993 to June 1997. None of the patients presented previous heart disease or risk factors. In all the cases, at least three blood cultures were positive for S. lugdenensis and vegetations were observed by echocardiogram. Despite correct antibiotic treatment, disappearance of fever, negativization of control blood cultures and in the third case, valve replacement, two patients presented heart failure and all died. On review of the literature 31 cases of endocarditis were found with valve replacement and mortality being 55%. It should be indicated that 85% of the patients who survived required surgery. CONCLUSIONS: Endocarditis by S. lugdenensis is a severe infection frequently requiring valve replacement and is associated with a high mortality. Therefore, adequate early identification of the microorganism is necessary distinguishing it from the remaining CNS.

Type II cystic adenomatoid malformation: late diagnosis in a patient with a pulmonary mass.

We hereby report the case of a 22-year-old patient with a final diagnosis of type II cystic adenomatoid malformation, who was hospitalized due to repeated pulmonary infections. The radiographic study demonstrated a worrying image of a pulmonary mass. The different studies performed, did not put forward the diagnosis, so at last the patient was proposed a thoracotomy for diagnostic and therapeutic purposes.

[Infected atrial myxoma simulating infective endocarditis]. / Mixoma auricular infectado que simula endocarditis infecciosa.

BACKGROUND: We present a case of infected atrial myxoma simulating bacterial endocarditis. MATERIAL AND METHODS: A 75 year old male, without any antecedents of interest, with fever an evolution a month, and a cardiac murmur. Blood cultures were practiced by BACTEC N.R. 730 system. The diagnosis was performed by the bidimensional and transesophageal echo, and confirmed with the resection from surgery. The method of bibliographical review used, has been the data base of comprehensive Medline, cvc since 1987 up June 1992 and the Oncodise's Concerlit archive from the year 1985 up to june 1992 the date base of the IME (Indice Médico Español) was also review up to April 1992. RESULTS: The blood cultures were positive, 7/7 Streptococcus viridans and 3/7 a Staphylococcus epidermidis resistant to meticiline, we them with the same antibiogram. Echocardiography and angiography show a lef atrial mass, surgical resection of the mass, confirmed the hystological diagnostic of the myxoma and signs of infection. CONCLUSIONS: This is the first case in our country, with shows the rarity of it. We analyze the differential diagnosis with the non infected myxoma and the bacterial endocarditis. We think that there should be an early surgical treatment, together with antibiotic therapy, due to the high incidence of embolism in theses patients.