Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008-2018): Epidemiology, Clinical Characteristics and Outcomes.

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.

Oral care in a neonatal intensive care unit.

OBJECTIVE: Compare the oral colonization profile of premature infants admitted at NICU before and after doing oral care routine with sterile water versus no intervention. METHODS: It was a randomized clinical trial composed of 37 premature infants admitted at the Neonatal Intensive Care Unit (NICU) with a birth weight (BW) <1500 g. They were distributed in two groups: the study group (SG) with 15 patients who received an oral hygiene with sterile water; and a control group (CG) (no intervention) formed by 22 patients. Primary outcome was oral colonization profile before and after doing oral care. RESULT: In the study group, the number of patients colonized by the Gram-positive bacteria at the beginning of the study was 53% versus 40% at the end (p=0.10). For Gram negative, 40% at the study's beginning versus 60% at the end (p=0.18). In the control group, the number of colonized patients for the Gram-positive bacteria at the onset of the study was 54.5% versus 32% patients at the end (p=0.24). For Gram negative, 32% patients at the start of the study versus 77% at the end (p = 0.003). CONCLUSION: There is a significant increase of the Gram-negative flora in those patients without oral care.

Determination of Dornic acidity as a method to select donor milk in a milk bank.

BACKGROUND: Dornic acidity may be an indirect measurement of milk's bacteria content and its quality. There are no uniform criteria among different human milk banks on milk acceptance criteria. The main aim of this study is to report the correlation between Dornic acidity and bacterial growth in donor milk in order to validate the Dornic acidity value as an adequate method to select milk prior to its pasteurization. MATERIALS AND METHODS: From 105 pools, 4-mL samples of human milk were collected. Dornic acidity measurement and culture in blood and McConkey's agar cultures were performed. Based on Dornic acidity degrees, we classified milk into three quality categories: top quality (acidity <4°D), intermediate (acidity between 4°D and 7°D), and milk unsuitable to be consumed (acidity ≥ 8°D). Spearman's correlation coefficient was used to perform statistical analysis. RESULTS: Seventy percent of the samples had Dornic acidity under 4°D, and 88% had a value under 8°D. A weak positive correlation was observed between the bacterial growth in milk and Dornic acidity. The overall discrimination performance of Dornic acidity was higher for predicting growth of Gram-negative organisms. In milk with Dornic acidity of ≥ 4°D, such a measurement has a sensitivity of 100% for detecting all the samples with bacterial growth with Gram-negative bacteria of over 10(5) colony-forming units/mL. CONCLUSIONS: The correlation between Dornic acidity and bacterial growth in donor milk is weak but positive. The measurement of Dornic acidity could be considered as a simple and economical method to select milk to pasteurize in a human milk bank based in quality and safety criteria.

[Community-onset Staphylococcus aureus infection in neonates]. / Infecciones neonatales por Staphylococcus aureus de inicio en la comunidad.

INTRODUCTION: Staphylococcus aureus is a major cause of neonatal community-onset infections. The emergence of methicillin-resistant S. aureus infections in this age group has been reported in USA in the last few years; however there are no studies in Spain. The aim of this study is to describe the epidemiological, clinical and microbiological characteristics of S. aureus community-onset infections in neonates. METHODS: We prospectively reviewed the S. aureus infections in neonates over a three year period (2007-2009) in the Pediatric Emergency Department of Hospital 12 de Octubre in Madrid (Spain). RESULTS: We recorded 30 cases of neonatal S. aureus community-onset infections. Only one isolated (3.3%) was resistant to methicillin, and two (6.7%) were PVL(+). CONCLUSIONS: Despite the emergence of MRSA outside the hospital in pediatric population in Spain, CA-MRSA and SA PVL(+) infections are not frequent in neonates.

Algorithm proposal based on the C. Diff Quik Chek Complete ICT device for detecting Clostridium difficile infection.

OBJECTIVE: To assess a new immunochromatography (ICT) test that detects glutamate dehydrogenase (GDH) antigen and Clostridium difficile toxin A/B simultaneously, and to propose an algorithm for the diagnosis of C. difficile infection (CDI) based on this test. METHODS: We analysed 970 stool samples. Discrepant results between GDH and toxin A/B were resolved using toxigenic culture as the reference. RESULTS: This test enabled us to obtain a conclusive result in <30min in 93.8% of the samples. Among the discrepant results (GDH (+)/Toxin A/B (-)), 41.7% (25/60) were found to be toxigenic C. difficile by toxigenic culture. CONCLUSION: This test has a high sensitivity and specificity for the diagnosis of CDI.

[Patterns of tuberculosis transmission in a health area of Madrid]. / Patrones de transmisión de la tuberculosis en un área sanitaria de Madrid.

BACKGROUND: Employing molecular epidemiology techniques for the study of tuberculosis can afford the possibility of identifying tuberculosis transmission patterns. This study has been made for the purpose of estimating the incidence of tuberculosis related to recent transmission in Madrid and of identifying the risk factors making it possible to define transmission patterns. METHODS: A three-year descriptive populational study was conducted on patients diagnosed with tuberculosis based on cultures in four districts in Madrid (550,442 inhabitants). The transmission patterns were described by means of conventional epidemiological research and molecular techniques (Restriction Fragment Length Polymorphism--RFLP--analysis with IS6110 and spoligotyping). RESULTS: An RFLP analysis was conducted on 233 clinically isolated Mycobacterium tuberculosis strains, 99 (42.5%) of which were grouped into 29 clusters. The most numerous group was comprised of 134 patients infected with M. tuberculosis strains of a single RFLP pattern. These patients averaged 48.3 years of age (DE 19.4), and 17.2% were revealed to have an endogenous risk factor. Two transmission patterns were identified among the grouped cases. The first pattern included 57 patients pertaining to 23 small clusters (2-4 cases), 25 (43.9%) of which were epidemiologically linked to another case from the same cluster. The second pattern was comprised of 42 patients grouped into 6 large clusters (5 cases or more). The subjects averaged 31.4 years of age (DE 15.8), 28.6% being intravenous drug users, 31% infected with HIV, and 26.2% having a prison background. CONCLUSIONS: Identifying tuberculosis transmission patterns by using molecular biology techniques affords the possibility of detecting population groups for whom preferential measures can be taken in the prevention and control programs.