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1.
Enferm Infecc Microbiol Clin ; 41(1): 33-35, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34334860

RESUMO

Introduction: Frontline health care workers (HCW) have higher risk than the general population to become infected by SARS.CoV.2, so they were a priority group for Covid-19 vaccine administration. We compared the incidence and prevalence of HCW infected pre-and post-vaccination with the BNT162b2 mRNA COVID-19 vaccine. Material and methods: Prospective observational study carried out between 01/12/20 and 07/03/21 in La Paz University Hospital, Madrid (Spain). SARS.CoV.2 positive cases in HCW after vaccination were collected and compared to those hospitalized COVID-19 patients at the same hospital. Results: Two weeks after finishing the first round of vaccinations daily new cases of HCW infections (symptomatic and asymptomatic) decreased substantially and cumulative cases of infected HCW and hospitalized COVID-19 patients started to diverge. No new positive cases of HCW infection were registered seven days after the second dose of BNT162b2 mRNA COVID-19 vaccine. Conclusions: BNT162b2 mRNA COVID-19 vaccine is highly effective in Spanish HCW.


Introducción: Los trabajadores sanitarios (TS) de primera línea tienen mayor riesgo de infectarse de SARS-CoV-2 que la población general, por lo que han sido un grupo prioritario para la vacunación frente a COVID-19. Comparamos la incidencia y prevalencia de TS infectados antes y después de la vacunación con BNT162b2 mRNA frente a COVID-19. Material y métodos: Estudio prospectivo observacional realizado entre 01 de diciembre de 2021 en el Hospital Universitario La Paz, Madrid, España. Se registraron los casos positivos para SARS-CoV-2 en TS y se compararon con los hospitalizados por COVID-19. Resultados: Dos semanas tras la primera ronda de vacunación las nuevas infecciones en TS (sintomáticas y asintomáticos) disminuyeron sustancialmente y los casos acumulados de TS infectados y pacientes hospitalizados por COVID-19 empezaron a divergir. No hubo nuevas infecciones en TS vacunados a los siete días de la segunda dosis de la vacuna. Conclusión: La vacuna BNT162b2 mRNA frente a SARS-CoV-2 es altamente eficaz en TS españoles.

2.
Med Mycol ; 59(4): 350-354, 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32634233

RESUMO

The aim of this work was to study the epidemiology of candidemia in our hospital in order to determine whether the T2MR system might be a useful tool for early diagnosis of candidemia in selected units. We perform a retrospective review of all candidemia episodes registered in the last 12 years in selected units of our hospital in adult and pediatric patients. Candida species and antifungal susceptibility patterns were registered. A total of 686 isolates were registered, of which 625 were infections due to the five most common species of Candida. C. albicans (45.6%) and C. parapsilosis (33.1%) were the predominant species found in our institution. In adults these species were closely followed by C. glabrata (12-21%) in all units. While in pediatric medical and intensive care units (PICU), these species were followed by other uncommon yeasts. Resistance rates to triazoles were low in C. albicans and C. parapsilosis. In C. glabrata and C. tropicalis the resistance rates to fluconazole ranged from 10.86 to 6.67%. Resistance rates for echinocandins were very low and all strains were susceptible to amphotericin B. T2Candida® might be useful to guide antifungal targeted treatment and discontinuation of antifungal empirical treatment in those units where the five most common Candida species represent more than the ninety percent of the isolates. The selection of medical and surgical units should be based on local epidemiology and antifungal susceptibility patterns. Incidence should be taken into account in order to make clinical decisions based on negative results. LAY ABSTRACT: T2Candida® might be useful selectively in clinical units according to their local epidemiology, antifungal resistance patterns, and incidence of candidemia. It optimizes the clinical value of positive results supporting decisions about targeted therapies or discontinuations based on negative results.


Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidemia/diagnóstico , Candidemia/epidemiologia , Técnicas de Laboratório Clínico/métodos , Farmacorresistência Fúngica , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Antifúngicos/classificação , Candida/classificação , Candidemia/microbiologia , Criança , Técnicas de Laboratório Clínico/instrumentação , Implementação de Plano de Saúde , Unidades Hospitalares/estatística & dados numéricos , Humanos , Incidência , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Espanha/epidemiologia
3.
Anaerobe ; 55: 130-135, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30557657

RESUMO

Anaerobiospirillum succiniciproducens is a gram-negative anaerobic spiral rod which is part of the normal flora of dogs and cats and can produce bacteraemia and diarrhoea in humans. In this report we describe two cases of bacteraemia caused by A. succiniciproducens which was successfully identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). We present a comprehensive literature review of 48 cases of A. succiniciproducens bacteraemia in which we describe previous underlying conditions, clinical presentations, identification methodology and antibiotic susceptibility data.


Assuntos
Anaerobiospirillum/isolamento & purificação , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Técnicas Bacteriológicas/métodos , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anaerobiospirillum/química , Anaerobiospirillum/classificação , Diarreia/diagnóstico , Diarreia/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
World J Microbiol Biotechnol ; 35(4): 65, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30941578

RESUMO

Early detection and identification of pathogens in bloodstream infections (BSI) is important to initiate or adjust antibiotic therapy as soon as possible. The current gold standard for diagnostic of BSI infection is the blood culture, that has a turnaround time of one to few days. Molecular tests performed directly in blood samples have promised faster diagnostics, with response times of a few hours, but their implementation into the clinical routine has been hampered by critical technical and procedural problems. Assay integration into laboratory workflows with random-access loading mode and minimal hands-on time is essential to meet rapid response times. Decreasing assay costs will favor fair clinical evaluations and might increase the applicability of the assays. Control of background contamination with bacterial DNA is one of the most difficult problems and might be avoided with pathogen-specific real-time PCR designs oriented to particular patient groups, or perhaps by quantitative, next-generation sequencing approaches.


Assuntos
Bacteriemia/diagnóstico , Técnicas de Diagnóstico Molecular , Custos e Análise de Custo , DNA Bacteriano , Humanos , Técnicas de Diagnóstico Molecular/economia , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Reação em Cadeia da Polimerase em Tempo Real/métodos , Sensibilidade e Especificidade , Sepse/diagnóstico , Sepse/microbiologia , Sepse/virologia
5.
Mycoses ; 61(1): 35-39, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28922488

RESUMO

Rhodotorula species have traditionally been considered as one of common non-virulent environmental inhabitant. They have emerged as an opportunistic pathogen, particularly in immunocompromised hosts and most infections have been associated with intravenous catheters in these patients. We review the isolates in blood cultures of Rhodotorula mucilaginosa in our Hospital. We describe the demographic and clinical features of the cases and the antifungal susceptibility profiles of the isolates. Selected patients had an isolation of R. mucilaginosa in blood cultures in our tertiary care Hospital. All data were collected retrospectively from clinical records during 5 years. We report 8 isolates in blood, two of them were considered contaminants. Immunosuppression, surgery, previous antibiotic therapy were common clinical features. For all the isolates, minimum inhibitory concentration (MIC) values were high for echinocandins and azoles and low for amphotericin B and 5-flucytosine. One strain showed atypical susceptibility profile. Rhodotorula mucilaginosa may be present on the skin and blood cultures can be contaminated. Fungaemia due to R. mucilaginosa is a rare clinical entity which requires risk factors but clinically relevant because of the multiresistant profile. Rhodotorula mucilaginosa shows high MIC values for azoles and echinocandins, therefore amphotericin B and flucytosine must be administered as antifungal therapy.


Assuntos
Antifúngicos/farmacologia , Hemocultura , Fungemia/microbiologia , Hospedeiro Imunocomprometido , Rhodotorula/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Anfotericina B/farmacologia , Antifúngicos/uso terapêutico , Azóis/farmacologia , Pré-Escolar , Equinocandinas/farmacologia , Feminino , Flucitosina/farmacologia , Fungemia/tratamento farmacológico , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Rhodotorula/efeitos dos fármacos , Rhodotorula/crescimento & desenvolvimento , Espanha , Centros de Atenção Terciária
6.
J Med Virol ; 87(5): 845-50, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25690782

RESUMO

Human Cytomegalovirus (CMV) is the most common cause of intrauterine and perinatal infections worldwide. Postnatal CMV transmission has usually no consequences, but in some cases it may produce disease in preterm infants. Literature reports a broad range of breast milk-acquired CMV infections (5.7-58.6%), which depends on the study's design and the treatment of the milk. To evaluate CMV transmission via breast milk, a prospective study using a real-time PCR assay was performed. One hundred and thirty-one mothers (accounting for 160 children) accepted the participation in the study. Urine samples from the infants and breast milk samples from their mothers were collected at 3, 15, 30, 60, and 90 days after delivery. CMV-DNA in breast milk was analysed by quantitative real-time PCR assay Affigene® CMV Trender (Cepheid, Bromma, Sweden). The breast milk samples from 92 mothers (92 of 131, 70.2%) were positive for CMV by PCR. CMV infection was detected in thirteen children by PCR, and four of them (30.7%) had clinical symptoms. There were not significant differences in morbidity between symptomatic and non- symptomatic patients; nonetheless, the average length of hospitalization in symptomatic children was higher than that of non-symptomatic children (P < 0.05). The rtPCR technique is useful for detection of mothers with high viral loads of CMV-DNA in milk, and might be of help to decide whether to freeze the breast milk in preterm children less than 28 weeks.


Assuntos
Infecções por Citomegalovirus/transmissão , Citomegalovirus/isolamento & purificação , Recém-Nascido de Baixo Peso , Transmissão Vertical de Doenças Infecciosas , Leite Humano/virologia , Reação em Cadeia da Polimerase em Tempo Real , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , DNA Viral/isolamento & purificação , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Mães , Estudos Prospectivos , Suécia/epidemiologia , Urina/virologia
7.
Can J Microbiol ; 61(9): 647-52, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26063294

RESUMO

Extraintestinal pathogenic Escherichia coli (ExPEC) are among the most frequently isolated bacterial pathogens in hospitals. They are considered opportunistic pathogens and are found mostly in urinary and bloodstream infections. They are genetically diverse, and many studies have sought associations between genotypes or virulence genes and infection site, severity, or outcome, with varied, often contradictory, results. To understand these difficulties, we have analyzed the diversity patterns in the core genomes and virulomes of more than 500 ExPEC isolates from 5 different collections. The core genome was analyzed using a multilocus sequence type-based single-nucleotide polymorphism (SNP) pyrosequencing approach, while the virulence gene content (the virulome) was studied by polymerase chain reaction detection of 25 representative genes. SNP typing showed a similar population structure in the different collections: half of the isolates belong to a few sequence types (5 to 8), while the other half is composed of a large diversity of sequence types that are found once or twice. Sampling analysis by rarefaction plots of SNP profiles showed saturation curves indicative of a limited diversity. Contrary to this, the virulome shows an extremely high diversity, with almost as many gene profiles as isolates, and linear, nonsaturating, rarefaction plots, even within sequence types. These data show that genetic exchange rates are very heterogeneous along the chromosome, being much higher in the virulome fraction of the genome than in the core genome.


Assuntos
Infecções por Escherichia coli/microbiologia , Escherichia coli/genética , Escherichia coli/patogenicidade , Genoma Bacteriano , Escherichia coli/classificação , Escherichia coli/isolamento & purificação , Proteínas de Escherichia coli/genética , Proteínas de Escherichia coli/metabolismo , Variação Genética , Genótipo , Humanos , Tipagem de Sequências Multilocus , Polimorfismo de Nucleotídeo Único , Virulência
8.
J Clin Microbiol ; 51(3): 998-1001, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23269737

RESUMO

The mechanisms of linezolid resistance among 86 staphylococcal isolates from two intensive care units were investigated. The most frequent was the G2576T mutation in the 23S rRNA (82%). The cfr gene was found in 17% of the isolates, seven S. aureus and eight S. epidermidis isolates. Four of the S. epidermidis isolates had the G2576T mutation and the cfr gene. In four S. haemolyticus isolates, the mechanism could not be identified.


Assuntos
Acetamidas/farmacologia , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Oxazolidinonas/farmacologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus haemolyticus/efeitos dos fármacos , Proteínas de Bactérias/genética , Humanos , Unidades de Terapia Intensiva , Linezolida , Mutação Puntual , RNA Ribossômico 23S/genética , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Staphylococcus epidermidis/genética , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus haemolyticus/genética , Staphylococcus haemolyticus/isolamento & purificação , Centros de Atenção Terciária
9.
J Antimicrob Chemother ; 68(1): 89-96, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23045224

RESUMO

OBJECTIVES: We describe clinical and microbiological features of infections caused by OXA-48-producing Klebsiella pneumoniae (O48KP) in the setting of a prolonged, hospital-wide outbreak detected in January 2011. METHODS: Clinical, demographic and microbiological data of patients with growth of O48KP in clinical specimens were collected until December 2011. PCR was used to detect carbapenemase and ß-lactamase genes. The genetic relationships were determined by automated repetitive-sequence-based PCR. RESULTS: Seventy-one patients with clinically guided cultures showing growth of O48KP were identified. Nine were considered to be colonizing rather than causing infection. The most frequent source of infection was the urinary tract (22/62), followed by surgical site infections (17/62). Blood cultures were positive in 23/62 patients. Many patients had significant comorbidity and prolonged hospital stays. In-hospital mortality among patients with O48KP infections was 43.5%. The MIC(90)s of ertapenem, imipenem and meropenem were >32, 16 and 16 mg/L, respectively. No single antimicrobial was active against all the isolates. The antibiotics most active against O48KP were amikacin (97.2% susceptible), colistin (90.1%), tigecycline (73%) and fosfomycin (66.2%). Although eight clones were identified, a predominant clone caused 73.2% of the infections. Multilocus sequence typing (MLST) of the predominant clone gave sequence type (ST) 405 and bla(TEM-1), bla(SHV-76), bla(CTX-M-15) and bla(OXA-1) genes and the insertion sequence IS1999 of the Tn1999 transposon were associated with bla(OXA-48) in this clone. CONCLUSIONS: To our knowledge, this is the largest reported series of infections caused by O48KP in the setting of a single-centre outbreak and provides further input on the clinical relevance of infections caused by O48KP and the difficulties associated with its detection and control.


Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/isolamento & purificação , Centros de Atenção Terciária , beta-Lactamases/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/genética , Feminino , Humanos , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/genética , Klebsiella pneumoniae/genética , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Centros de Atenção Terciária/tendências , Fatores de Tempo , Adulto Jovem , beta-Lactamases/isolamento & purificação
10.
J Med Virol ; 85(7): 1250-7, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23592041

RESUMO

Human cytomegalovirus (HCMV) may cause severe or fatal disease among immunocompromised patients. The first line prophylaxis and systemic HCMV disease therapy is ganciclovir (GCV). The presence of GCV-resistant virus has been linked to fatal HCMV disease. The implementation of rapid and sensitive techniques for the early detection and monitoring of GCV-resistance may be helpful to support antiviral therapy management. A pyrosequencing assay for the detection and quantitation of the most frequent mutations conferring moderate- and high-grade GCV resistance was implemented. The pyrosequencing achieved an analytical sensitivity for adequate interpretation of ≥10(3) copies/ml. The assay was validated with 18 whole blood samples taken over a 6-month period from an umbilical cord blood recipient infected persistently with HCMV and allowed the detection and monitoring of the M460I and A594V GCV-resistant mutations. The percentage of resistant quasispecies ranged from 7.9% to 55.2% for the M460I mutation and from 19.8% to 43% for the A594V mutation. Clearance of the M460I mutation occurred in parallel with a decrease in the HCMV viremia, while the A594V mutation persisted. The pyrosequencing method for detection of GCV is sensitive enough to be used directly on clinical samples for the early identification of resistance mutations and allows the quantitation of resistant and wild type virus quasispecies within hours. The quantitation of minor resistant variants is an important issue to understand their relationship with viral load modification, and potentially anticipate treatment adjustment.


Assuntos
Antivirais/farmacologia , Técnicas de Laboratório Clínico/métodos , Infecções por Citomegalovirus/virologia , Citomegalovirus/efeitos dos fármacos , Farmacorresistência Viral , Ganciclovir/farmacologia , Técnicas de Diagnóstico Molecular/métodos , Pré-Escolar , DNA Viral/química , DNA Viral/genética , Feminino , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Lactente , Testes de Sensibilidade Microbiana/métodos , Dados de Sequência Molecular , Mutação , Sensibilidade e Especificidade , Análise de Sequência de DNA
11.
Enferm Infecc Microbiol Clin (Engl Ed) ; 41(10): 617-620, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37076330

RESUMO

INTRODUCTION: Respiratory infection is the most common human adenovirus (HAdV) disease accounting for 7-8% of viral respiratory diseases in children less than 5 years. Differentiation of bacterial infections and viral infections is a common clinical problem. MATERIAL AND METHODS: One hundred oropharyngeal swabs obtained from October 2019 to November 2020 from patients attending the paediatric emergency room with suspicion of upper respiratory tract infection and negative results in influenza and RSV tests were included. Oropharyngeal swabs specimens were rapidly processed with STANDARD™ F Adeno Respi Ag FIA and the results were confirmed by RealStar® Adenovirus PCR Kit 1.0 (Altona diagnostics). RESULTS: STANDARD™ F Adeno Respi Ag FIA had sensitivity and specificity values of 71.93% and 100% respectively. The performance of the test was higher in samples from children younger than 24 months and taken less than 72h since the beginning of symptoms. In this subgroup the test had 88.8% sensitivity and 100% specificity. CONCLUSION: STANDARD™ F Adeno Respi Ag FIA may improve the management of respiratory diseases in children younger than 24 months and less than 72h since the beginning of symptoms in paediatric emergency rooms.


Assuntos
Infecções por Adenoviridae , Adenovírus Humanos , Infecções Respiratórias , Humanos , Criança , Adenoviridae , Infecções por Adenoviridae/diagnóstico , Infecções Respiratórias/diagnóstico , Reação em Cadeia da Polimerase , Adenovírus Humanos/genética
12.
Int J Infect Dis ; 136: 37-42, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37669725

RESUMO

BACKGROUND: Little is known about the incidence of influenza among admissions to the cardiac intensive care unit (C-ICU), accuracy of clinical suspicion, and influenza vaccination uptake. We evaluated the incidence of influenza at C-ICU admission during the influenza season, potential underdiagnosis, and vaccination uptake. METHODS: Prospective study at five C-ICUs during the 2017-2020 influenza seasons. A nasopharyngeal swab was collected at admission from patients who consented (n = 788). Testing was with Xpert®XpressFlu/RSV. RESULTS: Influenza was detected in 43 patients (5.5%) (40 FluA; 3 FluB) and clinically suspected in 27 (62.8%). Compared to patients without influenza, patients with influenza more frequently had heart failure (37.2% vs 22.8%, P = 0.031), previous contact with relatives with influenza-like illnesses (23.3% vs 12.5%, P = 0.042), antimicrobial use (67.4% vs 23.2%, P <0.01), and need for mechanical ventilation (25.6% vs 14.5%, P = 0.048). Patients received oseltamivir promptly. We found no differences in mortality (11.6% vs 5.2%, P = 0.076). Patients with influenza more frequently had myocarditis (9.3% vs 0.9%, P <0.01) and pericarditis (7.0% vs 0.8%, P = 0.01). Overall, 43.0% of patients (339/788) were vaccinated (51.9% of those with a clear indication [303/584]). CONCLUSION: Influenza seems to be a frequently underdiagnosed underlying condition in admissions to the C-ICU. Influenza should be screened for at C-ICU admission during influenza epidemics.


Assuntos
Influenza Humana , Humanos , Influenza Humana/diagnóstico , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Estudos Prospectivos , Estações do Ano , Espanha/epidemiologia , Unidades de Terapia Intensiva
13.
Artigo em Inglês | MEDLINE | ID: mdl-36621246

RESUMO

INTRODUCTION: Frontline health care workers (HCW) have higher risk than the general population to become infected by SARS.CoV.2, so they were a priority group for Covid-19 vaccine administration. We compared the incidence and prevalence of HCW infected pre-and post-vaccination with the BNT162b2 mRNA COVID-19 vaccine. MATERIAL AND METHODS: Prospective observational study carried out between 01/12/20 and 07/03/21 in La Paz University Hospital, Madrid (Spain). SARS.CoV.2 positive cases in HCW after vaccination were collected and compared to those hospitalized COVID-19 patients at the same hospital. RESULTS: Two weeks after finishing the first round of vaccinations daily new cases of HCW infections (symptomatic and asymptomatic) decreased substantially and cumulative cases of infected HCW and hospitalized COVID-19 patients started to diverge. No new positive cases of HCW infection were registered seven days after the second dose of BNT162b2 mRNA COVID-19 vaccine. CONCLUSIONS: BNT162b2 mRNA COVID-19 vaccine is highly effective in Spanish HCW.


Assuntos
Vacina BNT162 , COVID-19 , Humanos , Vacinas contra COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Pessoal de Saúde , Hospitais Universitários , RNA Mensageiro
15.
Pediatr Infect Dis J ; 41(5): e235-e242, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35333816

RESUMO

BACKGROUND: The epidemiology of community-acquired pneumonia (CAP) has changed, influenced by sociosanitary conditions and vaccination status. We aimed to analyze the recent epidemiology of bacterial CAP in hospitalized children in a setting with high pneumococcal vaccination coverage and to describe the clinical characteristics of pediatric Staphylococcus aureus CAP. METHODS: Children <17 years old hospitalized from 2008 to 2018 with bacterial CAP in 5 tertiary hospitals in Spain were included. Cases with pneumococcal CAP were randomly selected as comparative group following a case-control ratio of 2:1 with S. aureus CAP. RESULTS: A total of 313 bacterial CAP were diagnosed: Streptococcus pneumoniae CAP (n = 236, 75.4%), Streptococcus pyogenes CAP (n = 43, 13.7%) and S. aureus CAP (n = 34, 10.9%). Throughout the study period, the prevalence of S. pyogenes increased (annual percentage change: +16.1% [95% CI: 1.7-32.4], P = 0.031), S. pneumoniae decreased (annual percentage change: -4.4% [95 CI: -8.8 to 0.2], P = 0.057) and S. aureus remained stable. Nine isolates of S. aureus (26.5%) were methicillin-resistant. Seventeen cases (50%) with S. aureus CAP had some pulmonary complication and 21 (61.7%) required intensive care. S. pneumoniae CAP showed a trend toward higher prevalence of pulmonary complications compared with S. aureus CAP (69.1% vs. 50.0%, P = 0.060), including higher frequency of pulmonary necrosis (32.4% vs. 5.9%, P = 0.003). CONCLUSIONS: The incidence of S. aureus CAP in children remained stable, whereas the prevalence of pneumococcal CAP decreased and S. pyogenes CAP increased. Patients with S. aureus presented a high frequency of severe outcomes, but a lower risk of pulmonary complications than patients with S. pneumoniae.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia Pneumocócica , Infecções Estafilocócicas , Adolescente , Criança , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Humanos , Vacinas Pneumocócicas , Pneumonia Pneumocócica/epidemiologia , Pneumonia Pneumocócica/microbiologia , Pneumonia Pneumocócica/prevenção & controle , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus , Streptococcus pneumoniae , Cobertura Vacinal
20.
Enferm Infecc Microbiol Clin ; 29(1): 19-25, 2011 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-21251730

RESUMO

OBJECTIVES: To describe: 1) the main features of antimicrobial stewardship activities (ASA) in Spanish hospitals and 2) the perceptions of the Spanish Infectious Diseases (ID) community on ASA. METHODS: An online survey was designed and distributed through the e-mailing lists of several working groups of the Spanish Clinical Microbiology and Infectious Diseases Society. RESULTS: Between September 15 and November 23, 2009, surveys representing 78 hospitals were received. Most of the respondents were either ID physicians (30%) or microbiologists (29%), and 31/78 hospitals (40%) had ongoing ASA. These hospitals were concentrated in 4 of the 17 regions, particularly in Catalonia. Professionals belonging to 26/31 centres with ASA completed the survey. The most frequent principles of antibiotic (ABX) stewardship implemented in these programs were: 1) ABX streamlining (22/26) and 2) intravenous to oral switch (22/26) followed by 3) strategic monitoring of ABX (21/26). In 22/26 (86%) of the centres with ASA any physician could initially prescribe any of the antimicrobials included in the formulary. The most frequent activity carried out was ABX restriction, 69% (18/26) followed by conferences 61% (16/26) and therapeutic audit and feed-back 54% (14/26). When asked which antimicrobials that should be closely monitored, carbapenems were considered by all respondents in centres with ongoing ASA. CONCLUSIONS: 1) A minority (40%) of the surveyed hospitals in Spain has an ongoing ASA and large geographical variations were observed. 2) ASA were most commonly structured in the form of an integrated part-time multidisciplinary team of ID physicians and Pharmacists, and 3) Carbapenems were considered the ABX most required to be monitored.


Assuntos
Antibacterianos/uso terapêutico , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Coleta de Dados , Uso de Medicamentos/normas , Uso de Medicamentos/estatística & dados numéricos , Humanos , Espanha
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