Monkeypox and HIV in the Canary Islands: A Different Pattern in a Mobile Population.

BACKGROUND: The clinical and epidemiological data of the recent outbreak of monkeypox (MPX) differ from previous reports. One difference is the epidemiological profile; the disease mainly affects a subgroup of MSM (men who have sex with men) with high-risk sexual behaviors, frequently persons living with human immunodeficiency virus (PLHIV). METHODS: In this observational analysis, all patients with PCR (polymerase chain reaction)-confirmed MPX attending an Infectious Diseases and Tropical Medicine Unit in Gran Canaria (Spain) between May and July 2022 were considered. RESULTS: In total, 42 men were included; 88% were identified as MSM, with a median age of 40 years. Only 43% were born in Spain. All the patients had systemic symptoms and skin lesions. The distribution of lesions was more frequent in the genital/anal region, and the involvement of hands and feet was less common. Fever and lymphadenopathies were less frequent than in other series. Other unusual manifestations were proctitis, pharyngitis and penile-scrotal edema. Half of the patients had other associated infections (mainly STIs, sexually transmitted infections), and 60% of the monkeypox patients had PLHIV (People Living with HIV). When comparing the clinical characteristics between HIV-positive and -negative patients, we found three main differences: (i) a higher frequency of perioral lesions, (ii) a higher frequency of pharyngitis and (iii) a higher number of sexually transmitted infections in HIV-positive patients. CONCLUSIONS: The clinical findings in this outbreak of MPX had great variability in presentation. Several clinical differences were found in PLHIV-coinfected patients.

Tracing the trajectories of SARS-CoV-2 variants of concern between December 2020 and September 2021 in the Canary Islands (Spain).

Several variants of concern (VOCs) explain most of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic waves in Europe. We aimed to dissect the spread of the SARS-CoV-2 VOCs in the Canary Islands (Spain) between December 2020 and September 2021 at a micro-geographical level. We sequenced the viral genome of 8,224 respiratory samples collected in the archipelago. We observed that Alpha (B.1.1.7) and Delta (B.1.617.2 and sublineages) were ubiquitously present in the islands, while Beta (B.1.351) and Gamma (P.1/P.1.1) had a heterogeneous distribution and were responsible for fewer and more controlled outbreaks. This work represents the largest effort for viral genomic surveillance in the Canary Islands so far, helping the public health bodies in decision-making throughout the pandemic.

Neumonía secundaria por Bordetella hinzii enpaciente con infección por SARS-CoV-2 / Secondary Bordetella hinzii pneumonia in a patient with SARS-CoV-2 infection

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Comparación de tres procedimientos para la identificación rápida de microorganismos causantes de bacteriemias. Evaluación de su eficacia y aplicabilidad en el laboratorio de microbiología / Comparison of three procedures for the rapid identification of bacteraemia-causing microorganisms. Evaluation of their effectiveness and applicability to microbiology laboratories

INTRODUCCIÓN: Evaluamos tres procedimientos de identificación rápida de microorganismos a partir de hemocultivos positivos. MÉTODOS: Aplicamos dos métodos basados en la extracción directa desde el frasco de hemocultivo: Sepsityper(R) (Bruker Daltonics) (ST) y un método casero con saponina (MCS), y un tercer método basado en un subcultivo con incubación corta (SIC). Se comparan las identificaciones por espectrometría de masas Matrix-Assisted Laser Desorption Ionization-Time of Flight (EM-MALDI-TOF) aplicando los criterios de interpretación del fabricante y los puntos de corte corregidos (PCC). RESULTADOS: Aplicando los criterios del fabricante se identificaron a nivel de especie el 65,8%, el 45,8% y el 57,4% con ST, MCS y SIC, respectivamente. Aplicando los PCC, estos resultados fueron del 92,3%, del 80,6%, y del 85,2%, respectivamente. La identificación con ST fue significativamente mejor que el MCS. ST y SIC no mostraron diferencias significativas, excepto en levaduras. CONCLUSIONES: ST y SIC obtienen buenas tasas de identificación y pueden integrarse fácilmente en cualquier laboratorio

INTRODUCTION: Three procedures for rapid identification of microorganisms in positive blood cultures were evaluated. METHODS: We performed two methods based on direct extraction from a blood culture: Sepsityper(R) (Bruker Daltonics) (ST) and a non-commercial saponin method (MCS), and another method consisting of a short incubation subculture (SIC). Identification values obtained by spectrometry Matrix-Assisted Laser Desorption Ionization-Time of Flight (EM MALDI-TOF) were compared by applying the manufacturer's interpretation criteria and corrected cut-off points. RESULTS: According to the manufacturer, 65.8%, 45.8% and 57.4% of microorganisms were identified at the species level by using ST, MCS and SIC, respectively. When applying corrected cut-off points, the values increased to 92.3%, 80.6% and 85.2%, respectively. ST offered significantly better results than MCS, and no significant differences were found between ST and SIC, except for with respect to yeast. Conclusions: Better identification rates were obtained by using ST and SIC, which are easily applicable in any laboratory

Comparison of three procedures for the rapid identification of bacteraemia-causing microorganisms. Evaluation of their effectiveness and applicability to microbiology laboratories. / Comparación de tres procedimientos para la identificación rápida de microorganismos causantes de bacteriemias. Evaluación de su eficacia y aplicabilidad en el laboratorio de microbiología.

INTRODUCTION: Three procedures for rapid identification of microorganisms in positive blood cultures were evaluated. METHODS: We performed two methods based on direct extraction from a blood culture: Sepsityper® (Bruker Daltonics) (ST) and a non-commercial saponin method (MCS), and another method consisting of a short incubation subculture (SIC). Identification values obtained by spectrometry Matrix-Assisted Laser Desorption Ionization-Time of Flight (EM MALDI-TOF) were compared by applying the manufacturer's interpretation criteria and corrected cut-off points. RESULTS: According to the manufacturer, 65.8%, 45.8% and 57.4% of microorganisms were identified at the species level by using ST, MCS and SIC, respectively. When applying corrected cut-off points, the values increased to 92.3%, 80.6% and 85.2%, respectively. ST offered significantly better results than MCS, and no significant differences were found between ST and SIC, except for with respect to yeast. CONCLUSIONS: Better identification rates were obtained by using ST and SIC, which are easily applicable in any laboratory.

Staphylococcus aureus resistente a la meticilina y a descolonizadores habituales con reservorio en un trabajador sanitario en un hospital de tercer nivel / Staphylococcus aureus resistant to methicillin and usual decolonizers with a reservoir in a health worker in a tertiary hospital

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Prevalencia y factores asociados a la colonización de microorganismos multirresistentes en centros de larga estancia de Gran Canaria / Prevalence and risk factors of multi-drug resistant organism colonization among long-term care facilities in Gran Canaria (Spain)

Introducción. Los microorganismos multirresistentes (MMR) son causa importante de infección nosocomial, su manejo clínico-terapéutico es complicado y producen elevada morbimortalidad, con aumento de costes sanitarios asociados. En centros sanitarios de larga estancia (CSLE), la colonización/infección de sus residentes por MMR es cada vez mayor, pudiendo estos actuar como reservorios y vehículos para brotes de cepas resistentes en los hospitales de agudos. Los objetivos del estudio fueron determinar la prevalencia de portadores de MMR y detectar factores asociados al estado de portador. Material y métodos. Estudio de prevalencia de corte en 235 residentes de 2 CSLE en Las Palmas de Gran Canaria (Islas Canarias, España) entre octubre y noviembre del 2012. Se investigó la presencia de MMR en frotis nasal, faríngeo y rectal utilizando medios de cultivo selectivos. Se estudiaron los factores de riesgo asociados al estado de portador mediante análisis univariante y multivariante. Resultados. El 36,2% de residentes fueron portadores de al menos un MMR. El 26,6% fueron portadores de enterobacterias productoras de betalactamasa de espectro extendido y el 10,2% portadores de SARM. Los factores asociados significativamente con la colonización por MMR fueron: colonización-infección previa por MMR, ingreso hospitalario en los últimos 3 meses, infecciones de repetición del tracto urinario y enfermedad arterial periférica. Conclusiones. La prevalencia de MMR en estos CSLE es mayor que la encontrada en la bibliografía, especialmente la de enterobacterias BLEE. Debido a la alta prevalencia de infección/colonización por MMR y los factores de riesgo asociados al estado de portador, es posible que los CSLE actúen de reservorio de MMR y además su diseminación se facilite con el traslado de estos pacientes a hospitales en episodios agudos (AU)

Introduction. Multidrug resistant organisms (MDRO) are an important cause of nosocomial infections, with complicated clinical-therapeutic management and elevated morbidity-mortality, and an increase in healthcare costs. In long term care facilities (LTCFs) colonization/infection by MDRO among residents is increasing, and they may act as reservoirs and vehicles for the dissemination and production of outbreaks by resistant strains in acute hospitals. This study aimed at determining the prevalence of carriers of some common MDRO, and identifying factors associated with carrier state. Material and methods. A cross-sectional prevalence study was conducted on 235 residents in two LTCFs in the province of Las Palmas de Gran Canaria (Canary Islands, Spain) between October and November of 2012. The presence of MMR was investigated in nasal, pharyngeal and rectal swabs using selective media. Risk factors associated with carrier state were calculated using univariate and multivariate analysis. Results. More than one-third (36.2%) of residents were found to be carriers of ≥ 1 distinct MDROs. More than one-quarter (26.6%) were carriers of ESBL producing Enterobacteriaceae, and 10.2% were MRSA carriers. Factors found to be associated with colonization by any MDRO were: prior colonization or infection by MDRO, hospitalization in the past 3 months, recurrent infections of the urinary tract, and peripheral arterial disease. Conclusions. The prevalence of MDRO in the LTCFs settings studied is greater than that found in the literature, and in particular ESBL producing Enterobacteriaceae. Due to the high prevalence of infection/colonization by MDRO, it is possible that residents of LTCFs could act as important reservoirs of MDRO, and facilitate their spread into the acute care setting (AU)

[Prevalence and risk factors of multi-drug resistant organism colonization among long-term care facilities in Gran Canaria (Spain)]. / Prevalencia y factores asociados a la colonización de microorganismos multirresistentes en centros de larga estancia de Gran Canaria.

INTRODUCTION: Multidrug resistant organisms (MDRO) are an important cause of nosocomial infections, with complicated clinical-therapeutic management and elevated morbidity-mortality, and an increase in healthcare costs. In long term care facilities (LTCFs) colonization/infection by MDRO among residents is increasing, and they may act as reservoirs and vehicles for the dissemination and production of outbreaks by resistant strains in acute hospitals. This study aimed at determining the prevalence of carriers of some common MDRO, and identifying factors associated with carrier state. MATERIAL AND METHODS: A cross-sectional prevalence study was conducted on 235 residents in two LTCFs in the province of Las Palmas de Gran Canaria (Canary Islands, Spain) between October and November of 2012. The presence of MMR was investigated in nasal, pharyngeal and rectal swabs using selective media. Risk factors associated with carrier state were calculated using univariate and multivariate analysis. RESULTS: More than one-third (36.2%) of residents were found to be carriers of ≥ 1 distinct MDROs. More than one-quarter (26.6%) were carriers of ESBL producing Enterobacteriaceae, and 10.2% were MRSA carriers. Factors found to be associated with colonization by any MDRO were: prior colonization or infection by MDRO, hospitalization in the past 3 months, recurrent infections of the urinary tract, and peripheral arterial disease. CONCLUSIONS: The prevalence of MDRO in the LTCFs settings studied is greater than that found in the literature, and in particular ESBL producing Enterobacteriaceae. Due to the high prevalence of infection/colonization by MDRO, it is possible that residents of LTCFs could act as important reservoirs of MDRO, and facilitate their spread into the acute care setting.

Staphylococcus aureus resistente a la meticilina y a descolonizadores habituales con reservorio en un trabajador sanitario en un hospital de tercer nivel / Antibiotic ointments and methicillin-resistant Staphylococcus aureus with a reservoir in a healthcare worker in a tertiary hospital

INTRODUCCIÓN: Staphylococcus aureus resistente a la meticilina (SARM) es un patógeno nosocomial, con reservorio en portadores o infectados y que tiene como principal mecanismo de transmisión el contacto con las manos del personal. Métodos Se puso en marcha una investigación epidemiológica y se realizaron determinaciones de laboratorio para abordar el estudio de la situación provocada por la aparición de nuevos casos de SARM resistente a los descolonizadores habituales. Resultados Desde septiembre de 2010 a febrero de 2012, en nuestro centro, 16 pacientes y una trabajadora tuvieron un aislamiento de SARM resistente a los descolonizadores habituales (mupirocina y ácido fusídico). Se detectaron casos esporádicos no relacionados, y a su vez brotes epidémicos relacionados con la ubicación de la actividad del personal sanitario portador de SARM. El análisis mediante electroforesis en campo pulsado de las muestras de pacientes y de la trabajadora puso de manifiesto la clonalidad de las cepas, lo que sugiere que el reservorio pudiera ser la trabajadora afectada. La descontaminación con antibióticos sistémicos no tuvo éxito y la trabajadora fue adscrita a otro puesto de trabajo sin contacto directo con pacientes, con lo que se consiguió que no aparecieran más casos hasta el momento actual (septiembre de 2012). Conclusiones Este trabajo ilustra el riesgo de transmisión nosocomial relacionada con la atención prestada por los trabajadores sanitarios

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become an important hospital acquired pathogen, with transfer of the organism from a carrier or infected patient to uninfected patients by the hands or clothing of staff as the main mode of transmission. METHODS: Investigation of a cluster of new cases of MRSA resistant to mupirocin and fusidic acid, using epidemiological and microbiological resources. RESULTS: From September 2010 to February 2012, sixteen patients had at least one culture positive for MRSA resistant to mupirocin and fusidic acid. Some not apparently related cases and outbreaks appeared. By analysing cultures taken from patients and staff using pulsed-field. CONCLUSION: This report illustrates the risk of nosocomial transmission linked to care delivered by healthcare workers

[Antibiotic ointments and methicillin-resistant Staphylococcus aureus with a reservoir in a healthcare worker in a tertiary hospital]. / Staphylococcus aureus resistente a la meticilina y a descolonizadores habituales con reservorio en un trabajador sanitario en un hospital de tercer nivel.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become an important hospital-acquired pathogen, with transfer of the organism from a carrier or infected patient to uninfected patients by the hands or clothing of staff as the main mode of transmission. METHODS: Investigation of a cluster of new cases of MRSA resistant to mupirocin and fusidic acid, using epidemiological and microbiological resources. RESULTS: From September 2010 to February 2012, sixteen patients had at least one culture positive for MRSA resistant to mupirocin and fusidic acid. Some not apparently related cases and outbreaks appeared. By analysing cultures taken from patients and staff using pulsed-field gel electrophoresis, it was demonstrated that most likely this situation was started by an auxiliary nurse who was a carrier of the MRSA. Healthcare worker decontamination using oral antibiotic therapy was unsuccessful. Eventually, the situation was controlled by placing the carrier in a different job, with no further cases to date (September, 2012). CONCLUSION: This report illustrates the risk of nosocomial transmission linked to care delivered by healthcare workers.