RESUMO
Peripheral venous catheter-associated bloodstream infections (PVC-BSIs) lead to prolonged hospitalization, morbidity and increased costs. The impact of infection-prevention measures on the rate of PVC-BSIs in a university hospital in Spain was assessed. An active surveillance programme was initiated in 2015, which revealed a high PVC-BSI incidence ratio (0.48/1000 patient-days). A bundle aimed at nurses, medical staff and patients was implemented, and a Catheter Infection Team (CIT) was set up. The intervention achieved a decrease in PVC-BSI rate: 0.34 in 2016, 0.29 in 2017, and 0.17 in 2018. The decline was greatest for Gram-negative PVC-BSIs (67.6% in 2015, 35.3% in 2018).
Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Controle de Infecções/métodos , Sepse/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/epidemiologia , Feminino , Humanos , Incidência , Controle de Infecções/organização & administração , Masculino , Pessoa de Meia-Idade , Sepse/epidemiologia , Espanha/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To describe the clinical and epidemiological characteristics of syphilis in men who have sex with men (MSM) in an area of Mallorca, Spain. METHODS: We performed a retrospective analysis of syphilis cases in MSM seen at a hospital in Mallorca between January 2005 and June 2013. RESULTS: Fifty-five cases of syphilis were recorded in MSM during the study period (34.3% of all cases diagnosed), and 74.5% of these patients had human immunodeficiency virus (HIV) coinfection. The two diseases had been diagnosed simultaneously in 70.7% of this population. Patients with HIV coinfection had a median CD4 count of 456cells/µL (range, 29-979 cells/µL). Syphilis was diagnosed clinically in 49.1% of cases and by screening in the remaining 50.9%. The most common form of syphilis was late latent or indeterminate syphilis (41.9% of cases). In the group of men with syphilis, MSM had a higher risk of HIV infection. CONCLUSIONS: A majority of MSM with syphilis had HIV coinfection. HIV screening is therefore essential in this population and could even result in early diagnosis.
Assuntos
Bissexualidade , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Sífilis/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Linfócito CD4 , Comorbidade , Diagnóstico Precoce , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Heterossexualidade , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Espanha/epidemiologia , Sífilis/transmissão , Sexo sem Proteção , Adulto JovemRESUMO
INTRODUCTION: Vertebral osteomyelitis (VO) is a rare entity, although its incidence has increased in recent years. The objective is to describe the patients with this infection in our environment and a comparison with other published series. METHODS: A retrospective review was conducted of epidemiological, clinical, microbiological, treatment, complications and evolution data of patients with VO during 10 years (2004-2014) in two hospitals of Mallorca. RESULTS: 51 cases, median age 66 (range 22-85) years, 37 (72.5%) men with a mean onset of symptoms of 80.1 ± 125.1 days. In thirty-six (70.6%) cases the origin of infection was considered hematogenous, although previous bacteremia was documented in 23 (45%) cases, being of urinary in 10 (43.5%) cases. Clinically at the moment of diagnosis 35 (68.8%) had fever, 32 (62.7%) pain, 14 (27.5%) irradiated nerve pain and 10 (19.6%) paralysis/paresia. MRI was the most performed radiological test 46 (90.2%), being pathological in all cases. S. aureus 23 (52.3%) was the most common microbiological isolates. At the moment of the diagnosis, blood cultures were positive in 27 (65.8%) of 41 cases and 11 (50%) of 22 percutaneous puncture was positive. Paraspinal, epidural or psoas abscesses were observed in 23 (45.1%), neurological deficit in 7 (13.7%) and chronic pain in 6 (11.8%). One patient (1.9%) died in relation with infection. CONCLUSIONS: Diagnosis was delayed in most cases. Previous bacteremia being main predisposing factor and hematogenous origin the main source of infection. S. aureus was the most isolated. Percutaneous puncture together with blood cultures increase etiologic diagnosis. A high percentage of patients had complications or sequelae.
RESUMO
Mannose-binding lectin (MBL) is a serum protein that activates the complement and mediates phagocytosis. MBL levels and MBL2 genotype may impact upon host susceptibility to tuberculosis (TB) disease but evidence to date has been conflicting. MBL2 exon 1 and promoter genotyping and serum MBL concentrations were determined in 79 patients with active tuberculosis (58 pulmonary TB and 21 extrapulmonary or miliary TB) and 120 household healthy contacts (HHC) from a Mediterranean area (Majorca Island, Spain). Significantly higher serum MBL levels were found in patients with active tuberculosis than in HHC [median MBL concentrations 3430 ng mL(-1) (10-28 415) and 2600 ng mL(-1) (5-20 000) respectively, P = 0.002]. These higher MBL levels were mainly related to the most prevalent YA/YA wild-type diplotype. There was a strong correlation between MBL2 exon 1 and promoter genotype and MBL levels. The diplotype LYQA/HYPA was present in 12 out of 57 of the pulmonary TB cases but in none of the extrapulmonary TB patients. Diplotype LXPA/HYPA, producer of high levels of MBL, was significantly more frequent in HHC than in patients (16.8% vs. 6.4%, P = 0.031) suggesting a protective role against the development of TB disease that has not been previously found.
Assuntos
Éxons/genética , Predisposição Genética para Doença/genética , Lectina de Ligação a Manose/genética , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas/genética , Tuberculose/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Frequência do Gene , Genótipo , Haplótipos , Humanos , Masculino , Lectina de Ligação a Manose/sangue , Ilhas do Mediterrâneo , Pessoa de Meia-Idade , Espanha , Tuberculose/sangue , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/genética , Adulto JovemAssuntos
Listeria monocytogenes/isolamento & purificação , Listeriose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Listeriose/tratamento farmacológico , Listeriose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Recent developments of new drugs' combinations are changing the treatment paradigm in hepatitis C virus infection. Due to the side effect profile of pegylated interferons, interferon-sparing regimens have become the main target in chronic hepatitis C treatment research. Recent proofs of concept studies have suggested that cure of chronic hepatitis C can be achieved without interferon. The purpose of this paper is to provide an overview of the clinical results recently reported for the treatment of hepatitis C virus infection with interferon-free regimens, focusing on the most promising new compounds and combinations.
Assuntos
Antivirais/administração & dosagem , Antivirais/classificação , Hepatite C/tratamento farmacológico , Interferons/uso terapêutico , Inibidores de Proteases/uso terapêutico , Humanos , Interferons/efeitos adversosRESUMO
OBJECTIVES: To know the symptoms and predominant serotypes of pneumococcal infection in patients with oncohematological illness after introduction of 7-valent pneumococcal conjugate vaccine. PATIENTS AND METHODS: A prospective study (january 2006-may 2011) was made of all the incident cases of infection in oncohematological patients over 17 years of age in whom Streptococcus pneumoniae was isolated. RESULTS: A total of 131 episodes of incident cases of pneumococcal infection in 122 patients (median age of 67 years) were detected. Of these, 50% were related to health/nosocomial care (P<.001), 39.7% pneumonias and 45.1% lower respiratory tract infections, without radiological condensation. In comparison to the 803 incident cases of pneumococcal infection during the same period as in patients without oncohematological disease, the oncohematological patients were more frequently males (P<.001), had pneumonia episodes with higher FINE scores (P<.001), lower risk of death non-directly associated with pneumococcal infection (P=.006) and showed reduced susceptibility to levofloxacin (P=.043). Non-vaccine serotypes predominated. CONCLUSIONS: Pneumococcal infections in oncohematological patients are more frequent in males, mainly with lung neoplasms. They are heath care related, but not related to chemotherapy or neutropenia. After the introduction of heptavalent conjugate vaccines in pediatrics, the non-vaccine serotypes predominate.
Assuntos
Doenças Hematológicas/complicações , Vacinação em Massa , Neoplasias/complicações , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/etiologia , Estudos Prospectivos , Fatores de Risco , Vacinas Conjugadas , Adulto JovemRESUMO
OBJECTIVES: The aim of the study was to investigate whether survival after progressive multifocal leukoencephalopathy (PML) diagnosis in HIV-1-infected patients was associated with central nervous system penetration-effectiveness (CPE) score and the presence or absence of protease inhibitors in the treatment regimen. METHODS: In the absence of treatments demonstrated to be effective for PML in HIV-1-infected patients and in the light of the controversy surrounding the use of CPE scores to make decisions on treatment after diagnosis, we determined whether there were differences in survival at 1 year depending on the type and characteristics of treatment. A multicentre retrospective observational study including three Spanish hospitals was carried out for the period from 1 January 1994 to 31 December 2009. Patients with a PML diagnosis were included in the study if they were symptomatic and met at least two of the following three criteria: (1) compatible radiological findings; (2) a positive polymerase chain reaction for John Cunningham virus (JCV) in the cerebrospinal fluid (CSF); (3) an absence of findings suggesting another infection in the central nervous system, after general CSF cultures for virus, bacteria and mycobacteria. RESULTS: A total of 98 patients were included in the study; 24.5% were diagnosed in the period 1994-1999, 39.8% in 2000-2004 and 35.7% in 2005-2009. The median follow-up time was 363 days (interquartile range 108-1946 days). The median CD4 count was 76 cells/uL (interquartile range 30-166 cells/uL) and 62% of patients had an HIV viral load >50 HIV-1 RNA copies/ml. Thirty-eight per cent of patients received high-penetrance treatment, and 58% received treatment that included protease inhibitors. In the analysis of survival at 1 year, a higher CPE score did not result in an improvement in survival, but the presence of protease inhibitors in the regimen was associated with a statistically significant (P = 0.03) reduction in mortality (hazard ratio 0.40; 95% confidence interval 0.18-0.91). CONCLUSIONS: We consider that the lower mortality observed in the protease inhibitor group may be clinically relevant, and, if this is the case, a treatment based on protease inhibitors may be indicated for patients diagnosed with PML.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Sistema Nervoso Central/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Inibidores de Proteases/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/fisiopatologia , Adulto , Contagem de Linfócito CD4 , Sistema Nervoso Central/fisiopatologia , Feminino , Infecções por HIV/mortalidade , Infecções por HIV/fisiopatologia , Humanos , Leucoencefalopatia Multifocal Progressiva/mortalidade , Leucoencefalopatia Multifocal Progressiva/fisiopatologia , Masculino , Prognóstico , Inibidores de Proteases/efeitos adversos , RNA Viral , Estudos Retrospectivos , Espanha/epidemiologia , Taxa de Sobrevida , Resultado do Tratamento , Carga ViralRESUMO
With the objective of analyzing the usefulness of a new technique of fast detection of pneumococcal antigen in urine (Binax NOW Streptococcus pneumoniae urinary antigen test) 163 community pneumonia episodes were reviewed. The test was positive in 30 cases, and gave rise to therapeutic implications in 12 patients. The global sensitivity was 57%, being superior in patients with HIV infection (70%), and the specificity was 91.6%. In 16 episodes it was the only diagnostic test of pneumococcal infection. The determination of pneumococcal antigen through this technique is a useful tool for the diagnosis of community pneumonia, mainly due its high specificity.
Assuntos
Antígenos de Bactérias/análise , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/microbiologia , Streptococcus pneumoniae/imunologia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de TempoRESUMO
BACKGROUND: To analyze the situation of resistance to antituberculous drugs among strains of Mycobacterium tuberculosis recovered in our environment during a five-year period and its relationship with HIV co-infection. PATIENTS AND METHODS: Review of the Mycobacterium tuberculosis strains recovered from patients aged older than 14 years in Hospital Joan March from 1992 to 1996 of which a susceptibility testing study by means of the multiple proportions method was available. The initial or secondary resistance was considered according to the previous antituberculosis treatment antecedent. RESULTS: The susceptibility testing was available from 179 cases (136 males and 43 females) out of a total of 214. The overall resistance rate to any of the tested drugs was 10.1% (18 cases) with a 4% (6 cases) of initial and 38.7% (12 cases) secondary resistances. Co-infection with HIV showed not to be a risk factor for the development of resistance. No significant increase was observed analyzing the temporal trend through the five years studied. CONCLUSIONS: At present, the situation of resistance to Mycobacterium tuberculosis seems not to be alarming in our environment. Co-infection with HIV has not been shown to be associated with an increase in resistance rates.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: To know the antibodies seroprevalence against hepatitis C virus (HCV), as well as other factors associated to these antibodies presence in a group of intravenous drug users (IVDU) in Baleares. To know what screening test would be the most adequate to detect antibodies against HCV in this group. METHODS: The presence of HCV antibodies in serum was determined in 110 IVDU patients, admitted to hospital during 1990 in a unit of opium detoxifying, by techniques enzyme immunotesting (ELISA) and immunoblotting (RIBA); the drug abuse history as well as serologies against human immunodeficiency virus (HIV), hepatitis B (HBV) and syphilis. RESULTS: The seroprevalence found by techniques ELISA is 71% and 95% respectively for the tests of first and second generation; using the method RIBA the seroprevalence is 86%. The HIV seroprevalence was 36% and a 53% were anti-HBs positive. No significative differences were found between the positive and negative anti HCV in relation with drug use variables: as first year of consumption and time of addiction, nor with the presence of HIV and HBV markers. CONCLUSIONS: The HCV seroprevalence among IVDU of the sample studied is similar to those described for this risk group by other authors in other zones. Such infection is not statistically associated with other variables of the drug abuse history nor with the infection by HBV and HIV. Despite the discordances of the HCV seroprevalence with the three test used in the study, the technique ELISA of second generation could be the ideal method of screening of antibodies against the HCV in this risk group.