Factors Associated With Short-Term Eradication of Rectal Colonization by KPC-2 Producing Klebsiella pneumoniae in an Outbreak Setting.

Background: KPC-producing Klebsiella pneumoniae (KPCKP) is a threat for patients admitted to healthcare institutions. Objectives: To assess the efficacy of several decolonization strategies for KPCKP rectal carriage. Methods: Observational study performed in a 750-bed university center from July to October 2018 on the efficacy of a 10-day non-absorbable oral antibiotic (NAA) regimen (colistin 10 mg/ml, amikacin 8 mg/ml, and nystatin 30 mg/ml, 10 ml/6 h) vs. the same regimen followed by a probiotic (Vivomixx®) for 20 days in adult patients with KPCKP rectal colonization acquired during an outbreak. Results: Seventy-three patients colonized by KPCKP were included, of which 21 (29%) did not receive any treatment and 52 (71.2%) received NAA either alone (n = 26, 35.6%) or followed by a probiotic (n = 26, 35.6%). Eradication was observed in 56 (76.7%) patients and the only variable significantly associated with it was not receiving systemic antibiotics after diagnosis of rectal carriage [22/24 (91.6%) vs. 34/49 (69.3%), p = 0.04]. Eradication in patients receiving NAA plus probiotic was numerically but not significantly higher than that of controls [23/26 (88.4%) vs. 15/21 (71.4%), p = 0.14] and of those receiving only NAA (OR = 3.4, 95% CI = 0.78-14.7, p = 0.09). Conclusion: In an outbreak setting, rectal carriage of KPCKP persisted after a mean of 36 days in about one quarter of patients. The only factor associated with eradication was not receiving systemic antibiotic after diagnosis. A 10-day course of NAA had no impact on eradication. Probiotics after NAA may increase the decolonization rate, hence deserving further study.

[Imported malaria from Senegal: about 17 cases in year 2000]. / Paludismo importado de Senegal: a propósito de 17 casos en el año 2000.

BACKGROUND AND OBJECTIVE: Senegal is increasingly becoming a touristic target for many people. In 2000, there was a greater number of cases of malaria in patients from this country. Our objective was to analyze such increase, to describe the characteristics of these patients and to identify the reasons for it. PATIENTS AND METHOD: From 1999 to 2002 we prospectively collected the clinical and epidemiological data of all consecutive malaria cases seen in the Unit of Tropical Medicine of the Hospital Clinic (Barcelona, Spain). RESULTS: We attended 276 patients, 74 of them during 2000; of them, 17 had travelled to Senegal and Gambia. Their mean age was 36.58 (6.9) years and 12% were women. 59% patients were Spaniards, 35% were native of Senegal and 6% of Gambia. Reason of travel was tourism in 9 cases (53%) and a visit to the family in 7 cases (41%). Mean duration of the visit was 31 (20.6) days and only 17.6% patients did a right prophylaxis. Plasmodium falciparum was the commonest species (88%). The number of patients with malaria who had visited Senegal ranged from 6.6% in 1996 to 20% in 2000 to 6.3% in 2002 (p<0.05). CONCLUSIONS: There was an unexpected increase of malaria imported from Senegal in 2000 in our Unit. Changes in both the dynamics of malaria transmission and tourism offers may account for an unsuspected increase of malaria cases.

Avaliação do escoamento do cimento fosfato de zinco como agente de fixação / Evaluation of flow of zinc phosphate cement fixation as agent

O objetivo deste trabalho foi avaliar o escoamento do cimento fosfato de zinco como agente de fixação. Foram utilizados dois cimentos de fosfato de zinco, o Cimento LS (Vigodent) e o Cimento de Zinco (SS White). Todos os cimentos foram testados de acordo com base na Especificação nº 8 da ADA, para o cimento fosfato de zinco. Após a manipulação, uma seringa BD com a ponta recortada foi utilizada para dispensar um volume de 0,5 ml sobre uma placa de vidro quadrangular de superfície lisa, com as dimensões 10 cm x 10 cm. Decorrido três minutos do início da manipulação, outra placa de vidro com dimensões 5 cm x 5 cm pesando 20 gramas e um peso adicional de 100 gramas foram colocados sobre a mistura de cimento, totalizando uma carga de 120 gramas. O peso foi removido dez minutos após o início da manipulação e o disco formado pelo cimento endurecido foi medido em seus diâmetros maior e menor utilizando um paquímetro eletrônico digital Starrett. Para o teste de consistência ou de escoamento cada cimento foi avaliado cinco vezes e os dados obtidos foram aproximados para o milímetro mais próximo. Os valores obtidos foram anotados e essas medidas foram somadas e divididas por dois para a obtenção de um diâmetro médio. Os valores foram submetidos à análise estatística através do teste “t” de Student e os resultados foram os seguintes: os maiores valores do diâmetro do círculo formado pelo cimento foram obtidos no Cimento LS (Vigodent) (p<0,05). Concluiu-se que o Cimento Fosfato de Zinco LS (Vigodent) apresentou maior escoamento em comparação com o Cimento de Zinco (SS White).

The aim of this study was to evaluate the flow of zinc phosphate cement as a fixing agent. We used two zinc phosphate cement, Cement LS (Vigodent) and Zinc cement (SS White). All cements were tested according to specification based on paragraph 8 of the ADA, for the zinc phosphate cement. After manipulation, a BD syringe with the tip cut was used to dispense a volume of 0.5 ml of a square glass plate with a smooth surface, with the dimensions 10 cm x 10 cm. Three minutes elapsed from the beginning of the manipulation, another glass plate with dimensions 5 cm x 5 cm and weighing 20 grams extra weight to 100 grams were weight placed on the cement mixture, with a total load of 120 grams. The weight was removed ten minutes after the start of the manipulation and the disk formed by the hardened cement was measured in its largest and smallest diameters using a digital caliper Starrett. To test the consistency or flow each cement was assessed five times and the data were approximated to the nearest millimeter. The values were recorded and these measures were summed and divided by two to obtain an average diameter. The values were statistically analyzed by "t" test of Student and the results were as follows: the highest values of the diameter of the circle formed by the cement were obtained in LS Cement (Vigodent) (p <0.05). It was concluded that zinc phosphate cement LS (Vigodent) showed greater flow in comparison with zinc cement (White SS).