Predictors for Prolonged Hospital Stay Solely to Complete Intravenous Antifungal Treatment in Patients with Candidemia: Results from the ECMM Candida III Multinational European Observational Cohort Study.

BACKGROUND: To date, azoles represent the only viable option for oral treatment of invasive Candida infections, while rates of azole resistance among non-albicans Candida spp. continue to increase. The objective of this sub-analysis of the European multicenter observational cohort study Candida III was to describe demographical and clinical characteristics of the cohort requiring prolonged hospitalization solely to complete intravenous (iv) antifungal treatment (AF Tx). METHODS: Each participating hospital (number of eligible hospitals per country determined by population size) included the first ~ 10 blood culture proven adult candidemia cases occurring consecutively after July 1st, 2018, and treating physicians answered the question on whether hospital stay was prolonged only for completion of intravenous antifungal therapy. Descriptive analyses as well as binary logistic regression was used to assess for predictors of prolonged hospitalization solely to complete iv AF Tx. FINDINGS: Hospital stay was prolonged solely for the completion of iv AF Tx in 16% (100/621) of candidemia cases by a median of 16 days (IQR 8 - 28). In the multivariable model, initial echinocandin treatment was a positive predictor for prolonged hospitalization to complete iv AF Tx (aOR 2.87, 95% CI 1.55 - 5.32, p < 0.001), while (i) neutropenia, (ii) intensive care unit admission, (iii) catheter related candidemia, (iv) total parenteral nutrition, and (v) C. parapsilosis as causative pathogen were found to be negative predictors (aOR 0.22 - 0.45; p < 0.03). INTERPRETATION: Hospital stays were prolonged due to need of iv AF Tx in 16% of patients with candidemia. Those patients were more likely to receive echinocandins as initial treatment and were less severely ill and less likely infected with C. parapsilosis.

A prospective survey of Aspergillus spp. in respiratory tract samples: Species identification and susceptibility patterns.

We analyzed the species distribution and susceptibility patterns of 433 strains of Aspergillus spp. isolated from respiratory samples of 419 in-patients included in multicenter prospective study (FUNGAE-IFI) between July 2014 and October 2015. Identification was carried out by conventional methods at each participating center and by molecular sequencing of a portion of the ß-tubulin gene at one of the centers. In vitro susceptibility was evaluated by broth microdilution methods and using the E-test (for cryptic species). Species identified included 249 A. fumigatus sensu stricto, 60 A. terreus sensu stricto, 47 A. flavus sensu stricto, 44 A. tubingensis, 18 A. niger sensu stricto , five A. nidulans sensu stricto, three A. tamarii, two A. calidoustus, two A. carneus, one A. acuelatus, one A. carbonarius, and one A. sydowii. Cryptic species were found in 12.5% of isolates (n = 54). The frequency of non-wild-type isolates for amphotericin B was 3.4% (n = 15) of the isolates tested and for azoles 3% (n = 10). None of the Aspergillus spp. were non-wild type to echinocandins. Of the 54 cryptic species only two strains were non-wild-type strains by microdilution method (3.7%) (two A. tubingensis, one to amphotericin B and another one to voriconazole) and by E-test method five strains of A. tubingensis showed high minimal inhibitory concentration (MIC) to amphotericin B (11.4%) and five to azoles (12.1%), one A. calidoustus strain showed high MICs for three azoles (50%), A. carneus to itraconazole (100%) and A. sydowii to amphotericin B and itraconazole (100%). These results provide relevant information on susceptibility patterns, frequency, and epidemiology of species involved in respiratory tract samples and of the incidence of recently described cryptic species.

Acetazolamide Therapy for Metabolic Alkalosis in Pediatric Intensive Care Patients.

OBJECTIVE: Patients in PICUs frequently present hypochloremic metabolic alkalosis secondary to loop diuretic treatment, especially those undergoing cardiac surgery. This study evaluates the effectiveness of acetazolamide therapy for metabolic alkalosis in PICU patients. DESIGN: Retrospective, observational study. SETTING: A tertiary care children's hospital PICU. PATIENTS: Children receiving at least a 2-day course of enteral acetazolamide. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic variables, diuretic treatment and doses of acetazolamide, urine output, serum electrolytes, urea and creatinine, acid-base excess, pH, and use of mechanical ventilation during treatment were collected. Patients were studied according to their pathology (postoperative cardiac surgery, decompensated heart failure, or respiratory disease). A total of 78 episodes in 58 patients were identified: 48 were carried out in cardiac postoperative patients, 22 in decompensated heart failure, and eight in respiratory patients. All patients received loop diuretics. A decrease in pH and PCO2 in the first 72 hours, a decrease in serum HCO3 (mean, 4.65 ± 4.83; p < 0.001), and an increase in anion gap values were observed. Urine output increased in cardiac postoperative patients (4.5 ± 2.2 vs 5.1 ± 2.0; p = 0.020), whereas diuretic treatment was reduced in cardiac patients. There was no significant difference in serum electrolytes, blood urea, creatinine, nor chloride after the administration of acetazolamide from baseline. Acetazolamide treatment was well tolerated in all patients. CONCLUSIONS: Acetazolamide decreases serum HCO3 and PCO2 in PICU cardiac patients with metabolic alkalosis secondary to diuretic therapy. Cardiac postoperative patients present a significant increase in urine output after acetazolamide treatment.

A novel paramyxean parasite, Marteilia octospora n. sp. (Cercozoa) infecting the Grooved Razor Shell clam Solen marginatus from Galicia (NW Spain).

Protozoan parasites of the genus Marteilia have been detected in marine bivalves and other invertebrates around the world, associated in some cases with mass mortalities. The present paper reports the characterization of the Marteilia sp. protozoan infecting the digestive gland of the Grooved Razor Shell clam (Solen marginatus) from Galicia (NW Spain), proposing a novel species in the genus: Marteilia octospora n. sp. Morphological and molecular techniques were used for the description of this parasite. Tissue imprints were essential in the study to confirm the presence of 8 spores per sporangium, a number never reported in other species from this genus. An ultrastructural study revealed that the size and number of dense granules, free in the mature sporangia, were quite different from granules in other Marteilia spp. Another morphological difference is the absence of a layer of concentric membranes found surrounding the mature spore in other species. In addition, concentric membranous structures observed in the different stages of the parasite have never been mentioned in other species of genus Marteilia. Moreover, molecular analysis of the rDNA intergenic spacer (IGS) and the internal transcribed spacer (ITS-1) showed differences with the sequences available for other Marteilia spp.

Postoperative neutrophil gelatinase-associated lipocalin predicts acute kidney injury after pediatric cardiac surgery*.

OBJECTIVE: We investigated the temporal pattern and predictive value of neutrophil gelatinase-associated lipocalin for early identification of acute kidney injury in children undergoing cardiac surgery. DESIGN: Prospective observational cohort study. SETTING: One PICU in a tertiary medical center in Madrid, Spain. PATIENTS: One hundred six children older than 15 days and younger than 16 years undergoing surgery for congenital cardiac lesions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Urine samples were obtained before and at intervals after surgery. Acute kidney injury was defined according to pediatric Risk, Injury, Failure, Loss, and End-stage kidney disease criteria. The temporal pattern of both urine neutrophil gelatinase-associated lipocalin absolute concentration elevation and normalized to urine creatinine concentration was correlated with the development of acute kidney injury and other clinical outcomes. We evaluated the predictive ability of both urine neutrophil gelatinase-associated lipocalin and urine neutrophil gelatinase-associated lipocalin/creatinine by area under the curve, when added to a clinical predictive model. Data from 106 pediatric patients were analyzed. Acute kidney injury occurred in 42 patients (39.6%). Urine neutrophil gelatinase-associated lipocalin significantly increased in patients with acute kidney injury at 1, 3, and 15 hours postoperatively. Urine neutrophil gelatinase-associated lipocalin and urine neutrophil gelatinase-associated lipocalin/creatinine correlated with surgical variables and clinical outcomes. Acute kidney injury prediction improved when urine neutrophil gelatinase-associated lipocalin was added to a clinical model (area under the curve increased at 1 hr from 0.85 to 0.91 and at 3 hr to 0.92). Neither the urine neutrophil gelatinase-associated lipocalin nor the urine neutrophil gelatinase-associated lipocalin/creatinine values were significantly different between patients with prerenal and sustained acute kidney injury. CONCLUSIONS: Urine neutrophil gelatinase-associated lipocalin is a predictive biomarker for acute kidney injury after pediatric cardiac surgery, and it may permit earlier intervention that improves outcome of acute kidney injury. Urine neutrophil gelatinase-associated lipocalin normalized to urine creatinine improves the prediction of acute kidney injury severity but offers no advantage in acute kidney injury diagnosis.

Histological survey of symbionts and other conditions of pod razor clam Ensis siliqua (Linnaeus, 1758) in Galicia (NW Spain).

The aim of the present study was to carry out a survey of parasites and other conditions affecting pod razor clam populations, Ensis siliqua, in two beds from Galicia (NW Spain). In Galicia, the production of E. siliqua has increased in recent years due to the development of specific plans for its exploitation, however few and quite recent pathological studies have been carried out in this species. The results of this study showed the presence of different protozoa as the more prevalent group, especially Nematopsis sp. gregarines, unidentified branchial protozoa, renal coccidia and Trichodina sp. ciliates. Larval stages of trematodes and neoplastic disorders were also observed with lower prevalences. Furthermore, an ultrastructural analysis of two types of unidentified basophilic inclusions, both found in the digestive gland, revealed the presence of icosahedral viral particles and prokaryotic organisms, respectively. None of the parasites detected in E. siliqua from this study was notifiable to the World Organisation for Animal Health (OIE) and the majority of the symbionts and conditions observed in their tissues did not cause host damage. Nevertheless, parasites like bucephalid digenean sporocysts, viral inclusions, prokaryotic infections, disseminated neoplasm or germinoma detected in some samples could cause moderate or severe damage to the host depending on the intensity of infection.

Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study.

BACKGROUND: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes. METHODS: In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines. FINDINGS: 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04-1·11; p<0·0001] in patients with a central venous catheter and 1·09 [1·05-1·13; p<0·0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4-30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment with other antifungals. INTERPRETATION: Although overall mortality in patients with candidaemia was high, our study indicates that adherence to clinical guideline recommendations, reflected by higher EQUAL Candida scores, might increase survival. New antifungals, with similar activity as current echinocandins but with longer half-lives or oral bioavailability, are needed to reduce duration of hospital stay. FUNDING: Scynexis.

Electrolyte disturbances in acute pyelonephritis.

The aim of this study was to determine whether renal unresponsiveness to aldosterone associated with hyperkalemia is present in infants with acute pyelonephritis in the absence of significant urinary tract anomalies and to describe the clinical characteristics of patients presenting an inadequate renal response to hyperkalemia. The patient cohort comprised 113 infants with acute pyelonephritis (APN), based on the criteria of a temperature >38°C and significant bacteriuria. Serum and urine electrolytes, creatinine, osmolality, and renal tubular function tests were performed at diagnosis. The findings were compared to those present in 75 children who had fever without significant bacteriuria. Hyperkalemia (>5.5 mmol/L) was observed in infants with an APN diagnosis, who exhibited a lower transtubular potassium concentration gradient (TTKG) and a higher fractional sodium excretion. We defined inadequate renal response to hyperkalemia as the combination of hyperkalemia and TTKG below the normal range established for the age of the subject. Infants presenting an inadequate response to hyperkalemia were younger and associated more frequently with an APN diagnosis. This alteration could be explained by the renal interstitial inflammation present in acute pyelonephritis and the immaturity of the renal tubular responsiveness to aldosterone due to infancy in the absence of urinary tract infection or obstruction.

Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis.

BACKGROUND: There is little clinical information about community-onset bloodstream infections (COBSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC). We investigated the prevalence and risk factors for COBSI due to ESBLEC, and described their clinical features and the impact of COBSI caused by ESBLEC on 14-day mortality. METHODS: Risk factors were assessed using a multicenter case-control-control study. Influence of ESBL production on mortality was studied in all patients with COBSI due to E. coli. Isolates and ESBLs were microbiologically characterized. Statistical analysis was performed using multivariate logistic regression. Thirteen tertiary care Spanish hospitals participated in the study. RESULTS: We included 95 case patients with COBSI due to ESBLEC, which accounted for 7.3% of all COBSI due to E. coli. The ESBL in 83 of these (87%) belonged to the CTX-M family of ESBL, and most were clonally unrelated. Comparison with both control groups disclosed association with health care (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.8), urinary catheter use (OR, 3.1; 95% CI, 1.5-6.5), and previous antimicrobial use (OR, 2.7; 95% CI, 1.5-4.9) as independent risk factors for COBSI due to ESBLEC. Mortality among patients with COBSI due to ESBLEC was lower among patients who received empirical therapy with beta-lactam/beta-lactam inhibitor combinations or carbapenems (8%-12%) than among those receiving cephalosporins or fluoroquinolones (24% and 29%, respectively). Mortality among patients with COBSI due to E. coli was associated with inappropriate empirical therapy irrespective of ESBL production. CONCLUSIONS: ESBLEC is an important cause of COBSI due to E. coli. Clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.

Histological survey of symbionts and other conditions in razor clam Ensis arcuatus (Jeffreys, 1865) (Pharidae) of the coast of Galicia (NW Spain).

Symbionts and abnormal conditions of razor clam Ensis arcuatus were surveyed in three commercially important natural beds of Galician estuaries (NW Spain). Samples of 15-20 E. arcuatus were collected every 2 months from January 2003 until July 2004 and processed for histological examination. Prokaryote-like colonies, renal coccidians, gregarines, Trichodina sp. ciliates, haplosporidian-like plasmodia, turbelaria, trematode metacercariae, cestode-like larvae and basophilic inclusion bodies were observed in razor clam tissues without causing host damage. Bucephalid digenean sporocysts and germinoma were seen in some samples causing moderate or severe damage to the host depending on the intensity of infection and both could be a cause for concern if prevalence reached epizootic levels in Galician E. arcuatus populations. None of the parasites detected is OIE notifiable and, in general, the commercially exploited beds studied seem to be devoid of serious pathogens.

Molecular detection and identification of Aspergillus spp. from clinical samples using real-time PCR.

The definite and rapid diagnosis of invasive aspergillosis is necessary because of the high mortality caused. The objective of this study was to evaluate a real-time PCR assay to detect Aspergillus spp. in clinical samples, based on the Light Cycler technology. Specificity was assessed by using DNA extracted from pathogenic and non-pathogenic bacteria/fungi from Spanish Collection including: two Aspergillus flavus, four Aspergillus fumigatus, two Aspergillus nidulans, two Aspergillus niger and two Aspergillus terreus isolates. The analytical sensitivity was evaluated with different inocula (10(1)-10(5) conidia ml(-1)), and serially diluted DNA of A. fumigatus. To assess clinical applicability, samples from patients at risk were analysed. Species identification was determined by analysing the melting curves. Reactions using genomic DNA from other species of different genera than Aspergillus were negative (specificity: 100%). Analytical sensitivity was 60 fg using DNA and 5-20 conidia using conidial suspensions. The linear range was from 60 to 6 x 10(7) fg. The Tm ranged from 67.34 to 70.7 degrees C for the different Aspergillus spp. studied. Nine hundred and forty-eight consecutive blood samples from 127 patients were processed. In total, 10 (1%) of 948 samples from blood samples were PCR-positive. The real-time PCR assay provides a high sensitivity and specificity for detection of fungal DNA and rapidly identifies most of clinically relevant Aspergillus species.

Prevalence and in vitro antifungal susceptibility of cryptic species of the genus Aspergillus isolated in clinical samples.

INTRODUCTION: The genus Aspergillus contains more than 300 species, which are divided into closely related groups called sections. Molecular studies have revealed numerous cryptic species within different sections of this genus, which have different profiles of antifungal susceptibility and lack diagnostic morphological features. However, there are few studies on the prevalence and in vitro antifungal susceptibility of the cryptic species of this genus. The aim of this study was to investigate the distribution of Aspergillus spp. among clinical samples, and to study their in vitro susceptibility to different antifungal drugs. METHOD: Over a period of 2-years (2014-2015), a total of 379 strains of the genus Aspergillus were isolated. Most of the isolates were classified as respiratory colonizations; no cases of invasive aspergillosis were found. The strains were identified by MALDI-TOF mass spectrometry, and susceptibility testing was performed by the EUCAST reference procedure. RESULTS: Twenty species belonging to 8 sections were identified, being A. fumigatus the most prevalent (44.1%). The prevalence of cryptic species was 15.3%, with a clear predominance of A. tubingensis. Among the tested antifungal drugs, amphotericin B was the less active in vitro, followed by triazole drugs and echinocandins. The cryptic species had minimun inhibitory concentrations (MICs) higher than the corresponding type species. CONCLUSIONS: Accurate identification of the genus Aspergillus at the species level and in vitro antifungal susceptibility testing are necessary because, as it has been shown, some species of this genus may show resistance profiles against available antifungal drugs.

Improved real-time PCR for rapid detection of rifampin and isoniazid resistance in Mycobacterium tuberculosis clinical isolates.

In this study we designed two pairs of probes for the detection of rifampin and isoniazid resistance in Mycobacterium tuberculosis with real-time PCR procedures. One pair of probes spans the region between codon 510 and 528 of the rpoB gene, and the other one screens for mutation at the regulatory region of the inhA gene. We have evaluated these probes in combination with two other pairs of probes previously described to detect mutations in 20 susceptible and 53 unique resistant M. tuberculosis clinical isolates. We were able to detect nine different mutations affecting five codons of the rpoB gene, two different mutations at codon 315 of the katG gene and a nucleotide substitution (C209T) in the regulatory region of the inhA gene within two hours turnaround.

Prevalence and in vitro antifungal susceptibility of cryptic species of the genus Aspergillus isolated in clinical samples / Prevalencia y sensibilidad antifúngica in vitro de especies crípticas del género Aspergillus aisladas en muestras clínicas

INTRODUCTION: The genus Aspergillus contains more than 300 species, which are divided into closely related groups called sections. Molecular studies have revealed numerous cryptic species within different sections of this genus, which have different profiles of antifungal susceptibility and lack diagnostic morphological features. However, there are few studies on the prevalence and in vitro antifungal susceptibility of the cryptic species of this genus. The aim of this study was to investigate the distribution of Aspergillus spp. among clinical samples, and to study their in vitro susceptibility to different antifungal drugs. METHOD: Over a period of 2-years (2014-2015), a total of 379 strains of the genus Aspergillus were isolated. Most of the isolates were classified as respiratory colonizations; no cases of invasive aspergillosis were found. The strains were identified by MALDI-TOF mass spectrometry, and susceptibility testing was performed by the EUCAST reference procedure. RESULTS: Twenty species belonging to 8 sections were identified, being A. fumigatus the most prevalent (44.1%). The prevalence of cryptic species was 15.3%, with a clear predominance of A. tubingensis. Among the tested antifungal drugs, amphotericin B was the less active in vitro, followed by triazole drugs and echinocandins. The cryptic species had minimun inhibitory concentrations (MICs) higher than the corresponding type species. CONCLUSIONS: Accurate identification of the genus Aspergillus at the species level and in vitro antifungal susceptibility testing are necessary because, as it has been shown, some species of this genus may show resistance profiles against available antifungal drugs

INTRODUCCIÓN: El género Aspergillus contiene más de 300 especies, que se dividen en grupos estrechamente relacionados llamados secciones. Los estudios moleculares han revelado la existencia de numerosas especies crípticas dentro de las diferentes secciones de este género, las cuales tienen diferentes perfiles de sensibilidad antifúngica y carecen de características morfológicas diferenciales de diagnóstico. Sin embargo, hay pocos estudios sobre la prevalencia y la sensibilidad antifúngica in vitro de las especies crípticas de este género. El objetivo de este estudio fue investigar la distribución de Aspergillus spp. en muestras clínicas, y estudiar su sensibilidad in vitro a diferentes fármacos antimicóticos. MÉTODOS: Durante un período de 2 años (2014-2015), se aislaron un total de 379 cepas del género Aspergillus. La mayoría de los aislamientos se clasificaron como colonizaciones respiratorias; no encontrándose casos de aspergilosis invasiva. Las cepas se identificaron mediante espectrometría de masas MALDI-TOF, y las pruebas de sensibilidad antifúngica se realizaron mediante el procedimiento de referencia EUCAST. RESULTADOS: Se identificaron 20 especies pertenecientes a 8 secciones, siendo A. fumigatus la más prevalente (44,1%). La prevalencia de especies crípticas fue del 15,3%, con un claro predominio de A. tubingensis. Entre los fármacos antimicóticos probados, la anfotericina B fue la menos activa in vitro, seguida de los fármacos triazoles y las equinocandinas. Las concentraciones mínimas inhibitorias (CMIs) de los antifúngicos fueron más elevadas frente a las especies crípticas que frente a las especies tipo correspondientes. CONCLUSIONES: La identificación precisa de Aspergillus a nivel de especie y las pruebas de sensibilidad a antifúngicos in vitro son necesarias porque, como se ha demostrado, algunas especies de este género presentan diferentes perfiles de resistencia frente a los fármacos antimicóticos disponibles

Actuación del Servicio Prevención ante riesgo de embarazo / The role of an occupational health service in managing pregnancy risk

En el momento actual existe confusión entre dos conceptos, por una parte la incapacidad temporal por riesgo clínico durante el embarazo y por otro lado el riesgo durante el embarazo relacionado con la actividad laboral de la trabajadora, esta confusión también se extiende a los trámites administrativos que esta situación comporta; esto ha dado lugar a la elaboración de un Protocolo específico para estos casos. Es fundamental la valoración técnica del puesto de trabajo para determinar los riesgos a los que pueda estar expuesta la trabajadora embarazada, con el objetivo de evitar que estos riesgos puedan afectar la seguridad y salud de la trabajadora y su descendencia Es importante mantener la comunicación entre las partes implicadas: médicos clínicos, médicos de los Servicios de Prevención y la Unidad Médica de la Dirección Provincial del Instituto Nacional de la Seguridad Social (INSS) para la orientación y asesoría en muchos de estos supuestos (AU)

The Misunderstanding between sick leave due to clinical risk during pregnancy and the situation of risk at work during pregnancy, as well as the paper work arising from this latest situation, has led to the creation of a protocol. It becomes essential to do a technical assessment of the work place, in order to determine the risks that the pregnant worker could be exposed, to avoid them being a risk to her safety, her health and her progeny. It is also important to mention the communication among all parts involved: clinical doctors, occupational health doctors and the Medical Unit of the local Direction of the National Institute of Social Insurance, for guidance and assessment in many cases (AU)

[Infectious complications in 159 consecutive kidney transplant recipients]. / Complicaciones infecciosas en 159 receptores de trasplante renal consecutivos.

INTRODUCTION: The incidence of infections has decreased in kidney transplant (KT) recipients owing to advances in the surgical techniques and clinical management of this population. Nevertheless, these complications continue to occur and the causes seem to be changing, in part because of the prophylactic strategies used. METHOD: Prospective, observational study investigating infections occurring during the first 2 years post-transplantation in KT recipients who underwent surgery between July 2003 and December 2005 at Hospital Universitario Virgen del Rocío. Univariate and multivariate regression analysis was performed to determine risk factors associated with the development of infection. RESULTS: The incidence of infection was 1.11 episodes per patient over 510+/-234 days. The most common infections were urinary tract infection (UTI) (46.6%), cytomegalovirus (CMV) infection (22.7%), and surgical site infection (8%). The causes were bacterial (50.4%), viral (45.9%), and fungal (3.6%) agents. The most frequent pathogens were CMV (36%), Escherichia coli (28%), extended-spectrum beta-lactamase (ESBL)-producers (26%), and coagulase-negative staphylococci (6.3%). Seventy-nine percent of infection episodes occurred in the 4 months following KT. One recipient died 30 days after the infection episode. In the infection group, patient and graft survival at the end of follow-up was 98% and 89%, respectively. CONCLUSIONS: The most frequent syndromes were UTI, CMV infection and surgical site infection. The infections were mainly produced by bacteria, in particular gram-negative rods, and there was a high rate of ESBL E. coli.

In vitro susceptibilities of bloodstream isolates of Candida spp.: results from a multicenter active surveillance program in Andalusia.

OBJECTIVES: The aim of this study was to determine the antifungal drug susceptibilities of Candida bloodstream isolates in Andalusia, obtained through a multicenter active laboratory-based surveillance between October 2005 and September 2006. METHODS: One hundred and ninety-seven Candida isolates were collected. The MICs of amphotericin B, fluconazole, itraconazole and voriconazole were established using the Sensititre YeastOne panel. The MICs of posaconazole and caspofungin were determined by Etest. RESULTS: C. albicans was the most frequently isolated species (49.2%), followed by C. parapsilosis (17.3%), C. tropicalis (15.2%), C. glabrata (13.7%) and C. krusei (3.6%). All strains were inhibited at MICs of or = 64 mg/L) and 7 (3.6%) were considered resistant to itraconazole (MIC > or = 1 mg/L). All the isolates were susceptible to voriconazole and caspofungin. CONCLUSION: In our study C. krusei and C. glabrata were identified in over 18% of cases of candidemia. Most clinical isolates of these species are resistant or susceptible-dose-dependent to fluconazole but susceptible to voriconazole and caspofungin. These agents must be used in the empiric treatment of candidemia rather than fluconazole.

Manejo de citostáticos y salud reproductiva: revisión bibliográfica / Cytostatic Agents and effects on reproductive health: a review of literature

Introducción: La utilización de agentes citostáticos ha mostrado suficiente evidencia científica en el origen de efectos carcinogénicos, mutagénicos y teratogénicos en seres humanos. El riesgo de exposición a estos agentes no se limita esencialmente a las personas que reciben dosis terapéuticas, también existe importante riesgo de exposición sobre la salud de los trabajadores que participan en la preparación, manipulación, administración y almacenamiento de estos medicamentos. Objetivo general: Revisar la literatura científica para establecer la relación entre el manejo de citostáticos por el personal sanitario y los posibles efectos sobre la salud reproductiva. Material y Métodos: Se realizó una revisión de la literatura existente a partir del año 2005 hasta el año 2012. La búsqueda se realizó por consulta directa y acceso por internet a la literatura recogida en las bases de datos de MEDLINE. Al introducir los filtros se obtuvo un total de 5 publicaciones de evidencia científica, las cuales fueron analizadas. Resultados: En un meta-análisis de 2005 se encontraron datos de abortos espontáneos, fetos muertos, malformaciones congénitas, embarazos ectópicos y cáncer. En un estudio posterior de casos y control se encontraron datos de partos prematuros, bajo peso al nacer y dificultades para conseguir la concepción. En los estudios de cohortes se encontró evidencia de: en uno, de abortos espontáneos; en otro de malformaciones congénitas y cáncer y en otro se encontraron datos de bajo peso al nacer y anomalías congénitas, pero con menores cifras de lo esperado. Discusión/Conclusiones: Los resultados encontrados no muestran una asociación estadística significativa, y por lo tanto sería de utilidad realizar estudios más potentes. A pesar de la existencia de Guías y Protocolos desde 2004, estudios posteriores a 2005 siguen evidenciando riesgos y efectos relacionados con la exposición, por lo tanto existe un margen para mejorar la evaluación del cumplimiento de dichos protocolos. A su vez existe rango de mejora en el campo de Vigilancia de la Salud (AU)

Introduction: The use of cytostatic agents has shown enough scientific evidence in the origin of mutagenic and cancer effects, as well as teratogenicity in human beings. The risk of exposure to these agents is not only confined to patients receiving therapeutic doses, but also there is an important exposure risk on the health of workers participating in the preparation, handling, administration and storage of these agents. General Objective: To review current literature in order to establish the relationship between cytostatic handling by health workers, and the possible effects on reproductive health. Material and Methods: A literature review between 2005 to 2012 was carried out. The search was done by direct consultation and internet access to MEDLINE data. After screening, a total of 5 publications of scientific evidence were found and analyzed. Results: In a meta-analysis in 2005, data on the following effects was found: spontaneous abortions, congenital deformities, ectopic pregnancies and cancer. Thereafter, in a case-control study, data on the following effects was found: premature childbirth, low weight at birth and difficulties in achieving conception. Cohort studies showed the following evidence: spontaneous abortions in one of them, congenital deformities and cancer in the second one, and low weight at birth and congenital deformities in the third one, but with lower figures than expected. Discussion: The results of this study don't show a strong statistical association, and therefore more powerful studies would be recommended. Despite existing Guidelines from 2004, studies from 2005 still show risks and effects related to exposure; so there is a long way to go in improving adherence and evaluation of these Guidelines. Also there is place for improvement in the field of Health Surveillance (AU)