Bacteria from bronchoalveolar lavage fluid from children with suspected chronic lower respiratory tract infection: results from a multi-center, cross-sectional study in Spain.

This cross-sectional study assessed the prevalence of bacteria isolated from Spanish children with suspected chronic lower respiratory tract infection (LRTI) for whom bronchoalveolar lavage (BAL) was indicated. BAL fluid (BALF) was collected from 191 children (aged ≥ 6 months to < 6 years, with persistent or recurrent respiratory symptoms, non-responders to usual treatment) and cultured. Nasopharyngeal swabs (NPSs) were also obtained and cultured to assess concordance of BALF and NPS findings in the same patient. Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis were identified from BALF with a bacterial load indicative of infection (> 104 colony-forming units/mL) in 10.5, 8.9, and 6.3% of children, respectively. Clinical characteristics were similar among participants, regardless of positivity status for any of the bacteria. Approximately 26% of pneumococcal isolates were PCV13 serotypes, and 96% of H. influenzae isolates were non-typeable (NTHi). Concordance between BALF and NPS isolates was 51.0% for S. pneumoniae, 52.1% for H. influenzae, and 22.0% for M. catarrhalis. CONCLUSION: S. pneumoniae, NTHi, and M. catarrhalis were the main bacteria detected in BALF and NPS. Children with suspected chronic LRTI may benefit from a vaccine protecting against NTHi. What is Known: • Chronic lower respiratory tract infection (LRTI) in children can cause high morbidity and is a major use of healthcare resources worldwide. Despite this, their etiology or potential preventive measures are poorly assessed. • Bronchoalveolar lavage can be used to determine bacterial etiology of chronic LRTI. What is New: • We used conventional and molecular techniques to show that Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were present in the LRT of Spanish children with suspected chronic LRTI • Concordance between isolates from bronchoalveolar lavage fluid and nasopharyngeal swabs was low, suggesting that samples from the upper respiratory tract could not reliably predict the bacterial etiology of suspected chronic LRTI.

Seroprevalence of pertussis amongst healthcare professionals in Spain.

INTRODUCTION: This multi-center, hospital-based observational study determined the seroprevalence of pertussis antibodies amongst healthcare professionals from three different hospitals in Spain to ascertain the health status of professionals attending to susceptible groups who are at risk of contracting and transmitting pertussis. METHODS: Medical professionals from three hospitals in Spain were recruited for this study (NCT01706224). Serum samples from subjects were assessed for anti-pertussis antibodies by ELISA. The percentage of subjects positive for anti-pertussis antibodies were determined by age-strata, gender, vaccination status, professional level (physicians, nurses, ancillary nurses and midwives), hospital department, number of working years, numbers of hours spent with the patient as well as number of children in the household. RESULTS: Overall, 31.2% of subjects were seropositive; 3.3% of these healthcare professionals had ELISA values indicative of current or recent infection. There were no significant differences in terms of pertussis prevalence with respect to age, gender, hospital department, profession, number of working years and number of hours spent with patients. These levels of seronegativity amongst healthcare workers further strengthen the rationale for vaccination amongst this specific population against pertussis.

Current literature questions the routine use of low-dose dopamine.

Dopamine use in acute renal failure (ARF) patients has been considered standard practice for many years. Despite this widely accepted practice, there has been limited evidence to support its usage. Low-dose dopamine has been accepted because it is considered to pose minimal risk to the patient. Dopamine infused at low doses is thought to be specific to dopaminergic receptors. However its results are often unpredictable and can lead to several alpha and beta induced side effects. With advances in technology there is another option that may be superior in the prevention and treatment of acute renal failure. Fenoldopam is a drug specific to dopamine-1 receptors in the kidneys. It is currently being examined to determine its usefulness among patients with ARF. With the discovery of fenoldopam and the known serious side effects of dopamine, there is reason to use caution with the routine use of low-dose dopamine.

Niveles séricos de proteínas y requerimientos hídricos en el post-operatorio de cirugía cardiovascular / Serum proteim levels and liquid requerimente in the post-operative cardiosvascular surgery

Se diseñó un estudio de tipo prospectivo para determinar si existía alguna relación, entre los valores séricos de proteínas y los requerimientos líquidos en el post-operatorio de CCV. Incluyéndose 17 pacientes, a los cuales se les determinó, niveles séricos de proteínas en el pre-operatorio y luego de su admisión a UCI, el balance hídrico con particular interés hacia los coloides y cristaloides, así como también los índices hemodinámicos en la admisión y a las seis horas. Apreciamos un descenso de los niveles séricos de albúmina en el post-operatorio que continuaba de manera sostenida durante las primeras 24 horas. Igualmente, los pacientes con los niveles más bajos requirieron mayores volumenes líquidos especialmente coloides terminando con balances hídricos más positivos que los pacientes con niveles de albúmina más altos. Llegando a la conclusión de que los niveles séricos de proteínas podrían jugar un papel determinante en el manejo hemodinámico de estos pacientes por intermedio de los requerimientos de líquidos que son necesarios para lograr su estabilidad en las primeras horas del post-operatorio