Prevalence and Phenotypic Susceptibility to Doravirine of the HIV-1 Reverse Transcriptase V106I Polymorphism in B and Non-B Subtypes.

BACKGROUND: Limited data are available regarding the susceptibility of the reverse transcriptase V106 polymorphism to doravirine. METHODS: Doravirine susceptibility was measured in site-directed mutants (SDMs) containing V106I, V106A, V106M, and Y188L mutations in subtype B (NL4-3, HXB2) and CRF02_AG background and in recombinant viruses with RT harboring V106I alone derived from 50 people with HIV. RESULTS: HIV-1 B subtype was detected in 1523 of 2705 cases. Prevalence of V106I was 3.2% in B and 2.5% in non-B subtypes, and was higher in subtype F (8.1%) and D (14.3%). Fold-changes (FC) in susceptibility for SDMs were below doravirine biological cutoff (3.0) for V106I, but not for V106A, V106M, and Y188L. Clinically derived viruses tested included 22 B (median FC, 1.2; interquartile range [IQR], 0.9-1.6) and 28 non-B subtypes (median FC, 1.8; IQR, 0.9-3.0). Nine (18%) viruses showed FC values equal or higher than the doravirine biological FC cutoff. CONCLUSIONS: The prevalence of the HIV-1 RT V106I polymorphism in MeditRes HIV consortium remains low, but significantly more prevalent in subtypes D and F. V106I minimally decreased the susceptibility to doravirine in SDMs and most clinical isolates. Reduced susceptibility seems to occur at increased frequency in subtype F1; however, the clinical impact remains to be investigated. CLINICAL TRIALS REGISTRATION: NCT04894357.

Epidemiological and clinical insights into the enterovirus D68 upsurge in Europe 2021/22 and the emergence of novel B3-derived lineages, ENPEN multicentre study.

Enterovirus D68 (EV-D68) infections are associated with severe respiratory disease and acute flaccid myelitis (AFM). The European Non-Polio Enterovirus Network (ENPEN) aimed to investigate the epidemiological and genetic characteristics of EV-D68 and its clinical impact during the fall-winter season of 2021/22. From 19 European countries, 58 institutes reported 10,481 (6.8%) EV-positive samples of which 1,004 (9.6%) were identified as EV-D68 (852 respiratory samples). Clinical data was reported for 969 cases. 78.9% of infections were reported in children (0-5 years); 37.9% of cases were hospitalised. Acute respiratory distress was commonly noted (93.1%) followed by fever (49.4%). Neurological problems were observed in 6.4% of cases with six reported with AFM. Phylodynamic/Nextstrain and phylogenetic analyses based on 694 sequences showed the emergence of two novel B3-derived lineages, with no regional clustering. In conclusion, we describe a large-scale EV-D68 European upsurge with severe clinical impact and the emergence of B3-derived lineages.

Comparison of gradient diffusion and molecular methods using Allplex™ NG&DR assay (Seegene®) for macrolide and fluoroquinolone screening resistance in Neisseria gonorrhoeae.

Antimicrobial resistance in Neisseria gonorrhoeae (NG) is increasing worldwide. Second-line treatments with macrolides or fluoroquinolones are an option for NG infections in some cases following the STI guideline recommendations. In our study, we compared the gradient diffusion test using EUCAST 2024 breakpoints with a new molecular method using the Allplex™ NG&DR assay (Seegene®) including A2059G/C2611 mutations (23S rRNA) associated with high/moderate-level macrolide resistance and S91F mutation (gyrA) relationship with fluoroquinolone resistance in NG isolates (n = 100). We calculated the sensitivity, specificity, and correlation of the molecular test for fluoroquinolone using the gradient diffusion as the reference method. In twenty-three strains was not detected any mutation associated with macrolides or fluoroquinolone resistance. No A2059G/C2611T mutations were detected, and the S91F mutations were detected in 77 out of the 100 isolates screened. Twenty-three NG isolates were reported to be resistant to azithromycin (ECOFF: >1 mg/L), and 78 NG isolates were resistant to ciprofloxacin (MIC: >0.06 mg/L). The molecular method showed a sensitivity of 96.1% and, a specificity of 90.9% for fluoroquinolone susceptibility, but the statistical analysis between the molecular test and gradient diffusion test was not statistically significant for fluoroquinolone resistance (p = 1). Statistical analysis was not performed for macrolides because of the absence of positive RT-PCR results. According to our data, Allplex™ assay cannot replace the gradient diffusion test for macrolide resistance. However, the assay could be used to test fluoroquinolone resistance in NG isolates as a replacement for phenotypic methods.

Schistosomiasis in migrant children and adolescents in a paediatric tropical referral unit in Spain: diagnosis and long-term management challenges.

Globalisation and population movement have led to an increasing number of migrant children residing in areas non-endemic for schistosomiasis. However, diagnosing and managing schistosomiasis in children remain controversial. This study aims to investigate the prevalence of schistosomiasis in migrant children and to describe the diagnostic approach and management strategies, including long-term follow-up, to explore the potential role of serological tests in evaluating treatment response. We conducted a retrospective descriptive study spanning from January 2014-July 2021 at a referral unit for Paediatric Tropical Diseases in Madrid (Spain). The study included patients under 18 years diagnosed with schistosomiasis. Of 679 children screened for schistosomiasis, 73 (10.8%) tested positive. The median age was 16.3 years [IQR 9-17.6], 74% male. The majority originated from Sub-Saharan Africa (47%) and Asia (47%). Only 40% presented with symptoms, with gastrointestinal (18%) and cutaneous (17%) manifestations being the most common. Eosinophilia was observed in 43% (median [IQR]: 1103/mm3 [671-1536]), and ova were visualised in the urine of 2/50 (4.0%). Praziquantel treatment was administered to 92%, and 5 patients required retreatment. Follow-up data were available for 58 (80%) over a median period of 9 months [IQR 6-19.8], revealing a progressive decline in eosinophil count, IgE titres, and ELISA optical density.    Conclusion: In this series, the prevalence of schistosomiasis among migrant children was significant (10%), highlighting the importance of including serological tests in migrant health screening. The disease is largely asymptomatic, eosinophilia is often absent, and visualisation of ova in urine is exceedingly rare. Eosinophil count, IgE titres, and ELISA optical density could prove valuable as an initial approach for monitoring inflammation during follow-up assessments. What is Known: • The burden of disease related to schistosomiasis is significant, particulary in children, and it is advisable to screen this vulnerable population. What is New: • Eosinophilia may not be present in parasitic infections, so serological tests are crucial for screening migrant children. • Serological monitoring facilitates long-term management of migrant children with schistosomiasis.

Increase in gonococcal arthritis in Madrid, Spain, 2022-2023.

In recent years, there has been an increase in Neisseria gonorrhoeae infections in Europe and Spain. Disseminated gonococcal infection is an uncommon clinical presentation that includes gonococcal arthritis. Improved antibiotic treatment has reduced the incidence of gonococcal arthritis. However, the increase in gonococcal infections may have increased the frequency of this clinical entity in recent times. We report five cases of gonococcal arthritis in patients in a tertiary-care hospital in the northern area of Madrid (Spain) from October 2022 to October 2023. Major cases occurred in male patients with unprotected sex and polyarticular symptoms requiring hospital admission and treatment with ceftriaxone and cefixime. The use of molecular techniques has allowed the detection of a greater number of culture-negative cases of gonococcal arthritis, as well as the detection of mutations associated with resistance to fluoroquinolone for switching to oral treatment.

Increase in congenital syphilis in a tertiary-care centre from Madrid, Spain: Back to the classics.

Globally, an increase in sexually transmitted diseases worldwide has been reported, including acquired Treponema pallidum infection. Congenital syphilis is the mother-to-child transmission syphilis infection, experiencing an increase in cases returning to incidence rates of years ago. We report three cases of symptomatic congenital syphilis occurring in a tertiary-care hospital in Madrid (Spain). Cases were diagnosed by serology and molecular biology methods. The use of molecular techniques in specimens such as skin lesion, subplacental exudate swabs, bronchoalveolar aspirate, or cerebrospinal fluid could favour the diagnosis of this clinical entity, especially in symptomatic newborns with systemic involvement.

Multiplex PCR and Antibiotic Use in Children with Community-Acquired Pneumonia.

Antibiotics are frequently prescribed to children with pneumonia, although viruses are responsible for most cases. We aimed to evaluate the impact of multiplex polymerase chain reaction (mPCR) on antibiotic use. We conducted a prospective study of children under 14 years of age admitted for suspected viral pneumonia, from October 2019 to June 2022 (except March-November 2020). A mPCR respiratory panel (FilmArray® 2plus, bioMérieux, Marcy-l'Étoile, France) was performed within 72 h of admission. Patients with positive reverse transcription PCR for respiratory syncytial virus, influenza, or SARS-CoV-2 were excluded. We compared the patients with historical controls (2017-2018) who had suspected viral pneumonia but did not undergo an aetiological study. We included 64 patients and 50 controls, with a median age of 26 months. The respiratory panel detected viral pathogens in 55 patients (88%), including 17 (31%) with co-infections. Rhinovirus/enterovirus (n = 26) and human metapneumovirus (n = 22) were the most common pathogens, followed by adenovirus and parainfluenza (n = 10). There were no statistically significant differences in the total antibiotic consumption (83% of cases and 86% of controls) or antibiotics given for ≥72 h (58% vs. 66%). Antibiotics were prescribed in 41% of the cases and 72% of the controls at discharge (p = 0.001). Ampicillin was the most commonly prescribed antibiotic among the patients (44% vs. 18% for controls, p = 0.004), while azithromycin was the most commonly prescribed among the controls (19% vs. 48% for patients and controls, respectively; p = 0.001). Our findings underscore the need for additional interventions alongside molecular diagnosis to reduce antibiotic usage in paediatric community-acquired pneumonia.

Utility of culture and molecular methods using AllplexTM Bacterial Vaginosis Plus Assay (SeegeneⓇ) as a tool for endometriosis, infertility and recurrent pregnancy loss diagnosis.

Endometriosis, infertility, or recurrent pregnancy loss (RPL) are entities characterised by a decrease in Lactobacillus spp. and an increase in bacterial vaginosis-associated bacteria, (BVAV) according with 16S rRNA sequencing studies. However, the use of nucleic acid amplification tests (NAAT) as a tool for diagnosis algorithms is unknown. Seventy-four patients were included, with a median age of 36.5 years old (IQR: 34-39) including infertility (n=31), endometriosis (n=25), or RPL (n=18), for culturing and NAAT using the Allplex™ Bacterial Vaginosis Plus (ABVP) assay (SeegeneⓇ) with endometrial samples. The objective was determining the utility of ABVP assay for diagnosing the entities. Forty-six microorganisms were isolated from 31 out of 74 patients (41.9 %). Twenty-five endometrial samples (33.8 %) were positive for some targets included in the ABVP-assay, with median Ct value ∼37 (IQR: 31.3-37.1) and Qt value 1.43 Log10copies/reaction (IQR:1.1-2.6). For Lactobacillus species, sensitivity and specificity were 80 % and 84 %, respectively. Gardnerella vaginalis, 63.6 % and 95.7 %. No significant increase in BVAV was detected in any of the gynaecological entities. The ABVP and culture based algorithm did not show utility as a tool for endometriosis, infertility, or RPL diagnosis.

Zoonosis screening in Spanish immunocompromised children and their pets.

Introduction: Although pets provide several social-emotional benefits for children, the risk of zoonosis must be considered among immunocompromised individuals. Methods: A prospective study was conducted in a tertiary hospital including immunocompromised patients younger than 20 years owning dogs and/or cats. Colonization and/or infection was evaluated by stool studies, bacterial swabs, blood polymerase chain reaction and serological studies in both patients and their pets, to evaluate potential zoonotic transmission occurrence. Results: We included 74 patients and their 92 pets (63 dogs, 29 cats). Up to 44.6% of the patients and 31.5% of the pets had at least 1 positive result. Up to 18.4% of pets' fecal samples were positive (bacteria, parasites or hepatitis E virus). No helminths were observed despite the high frequency of incorrect intestinal deworming practices. Among children, gastrointestinal microorganisms were found in 37.3% (primarily Clostridium difficile). Colonization by Staphylococcus pseudintermedius was common among pets (8.0%) but not among children (0.0%). No shared colonization between owners and pets was observed, except in one case (Blastocystis in both patient and pet feces). Among patients, serologies were positive for Strongyloides stercoralis (14.8%), Toxocara canis (3.2%), Bartonella henselae (19.1%) and hepatitis E (5.6%). Serology was positive for Rickettsia spp. (22.6%) and Babesia spp. (6.5%) in dogs and for Leishmania spp. (14.3%) and Toxoplasma spp. (14.3%) in cats. Conclusion: Exposure to zoonotic agents was detected in both patients and pets; however, shared colonization events were almost nonexistent. In our cohort, dogs and cats do not appear to entail high zoonosis transmission risk for immunocompromised patients.

Decoding the historical tale: COVID-19 impact on haematological malignancy patients-EPICOVIDEHA insights from 2020 to 2022.

Background: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020-2022). Findings: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding: Not applicable.

Isolation of filamentous basidiomycetes from respiratory samples in a tertiary care Spanish hospital.

BACKGROUND: The clinical significance of the filamentous basidiomycetes isolated from clinical samples is not always clear. Thus, these fungi have been considered environmental contaminants traditionally. AIMS: To review those clinical cases in which filamentous basidiomycetes from respiratory samples had been isolated. METHODS: The retrospective study was carried out in a single tertiary care hospital. We recovered all culture-confirmed isolations of filamentous basidiomycetes from respiratory samples (bronchial aspirate [BAS], bronchoalveolar lavage [BAL] and sputum) analyzed between the years 2020 and 2023. Isolates were identified by ITS region sequencing. RESULTS: In six patients a filamentous basidiomycete had been isolated from a respiratory sample. The species identified were all different: Fomitopsis sp. (BAS), Trametes ljubarskyi (BAL), Stereum gausapatum (BAS), Porostereum spadiaceum (BAS), Phlebia subserialis (sputum) and Inonotus levis (BAL). All the patients were immunosuppressed or had an underlying disease with pulmonary involvement. None of them received any specific antifungal treatment (in relation with the fungus isolated) and all six improved clinically and were discharged. CONCLUSIONS: The isolation of filamentous basidiomycetes in these patients had uncertain clinical significance. However, the isolation of any filamentous basidiomycete in respiratory samples from immunosuppressed patients or patients with chronic pulmonary disease is an emerging situation that should be carefully assessed in the context of chronic allergic episodes or suspicion of invasive fungal infections.

Rapid AST: Possibility of inferring resistance mechanisms with complex phenotypes / Pruebas rápidas de sensibilidad a los antimicrobianos: ¿es posible inferir mecanismos de resistencia con fenotipos complicados?

The new automated systems designed for rapid performance of AST have significantly reduced the response time for susceptibility testing of microorganisms causing bacteremia and sepsis. The Accelerate Pheno® system (AAC) is one such system. Our objective for this study was to determine whether the AAC system is capable of providing an accurate susceptibility profile to infer resistance mechanisms in different carbapenemase-producing isolates when compared to the MicroScan WalkAway System (MWS). Disk diffusion method was also performed on all isolates as a reference method. Additionally, we compared the results obtained with the routine AST production system. We selected 19 isolates from the cryobank of the Microbiology department, all of which were carbapenemase-producing gram-negative bacilli. AAC was able to identify and infer the resistance of a total of 10 isolates, with an EA and CA of 84.2% for meropenem and 88.2% and 64.7% for ertapenem EA and CA, respectively. If we consider the disk diffusion technique, the CA was 57.9% and 76.5% for meropenem and ertapenem. However, in the presence of carbapenemases, AAC was not able to provide adequate MICs or infer the resistance mechanisms of the isolates accurately. Further studies with a larger number of isolates, including the new antibiotics ceftolozane/tazobactam and ceftazidime/avibactam, are needed for a more comprehensive comparison. (AU)

Los nuevos sistemas automatizados diseñados para la realización rápida de antibiogramas han reducido significativamente el tiempo de respuesta para las pruebas de susceptibilidad de los microorganismos causantes de bacteriemia y sepsis. El sistema Accelerate Pheno® (AAC) es uno de ellos. Nuestro objetivo para este estudio era determinar si el sistema AAC es capaz de proporcionar un perfil de sensibilidad preciso para inferir mecanismos de resistencia en diferentes aislados productores de carbapenemasas en comparación con el sistema MicroScan WalkAway (MWS). El método de disco difusión fue incluido también en todos los aislados como método de referencia. Además, comparamos los resultados obtenidos con el sistema rutinario de producción de antibiogramas rápidos. Seleccionamos 19 aislados del criobanco del departamento de Microbiología, todos ellos bacilos gramnegativos productores de carbapenemasas. AAC fue capaz de identificar e inferir la resistencia de un total de 10 aislados, con una EA y CA del 84,2% para el meropenem y del 88,2% y 64,7% para la EA y CA del ertapenem, respectivamente. Si consideramos la técnica de disco difusión, la CA fue de un 57.9% y de un 76.5% para meropenem y ertapenem. Sin embargo, en presencia de carbapenemasas, AAC no fue capaz de proporcionar CMIs adecuadas ni de inferir con precisión los mecanismos de resistencia de los aislados. Se necesitan más estudios con un mayor número de aislados incluyendo también los nuevos antibióticos ceftolozano/tazobactam y ceftazidima/avibactam para una comparación más exhaustiva. (AU)

Prevalence of mutations associated with macrolide and fluoroquinolone resistance in Neisseria gonorrhoeae with Allplex™ NG&DR Assay (Seegene®) in a tertiary hospital from Madrid, Spaina / Prevalencia de mutaciones asociadas a resistencia a macrólidos y fluoroquinolonas en Neisseria gonorrhoeae con el kit Allplex™ NG&DR Assay (Seegene®) en un hospital terciario de la Comunidad de Madrid, España

Background. The prevalence of drug-resistant Neisseria gonorrhoeae (NG) infections is increasing. Studies report the prevalence of NG strains presenting A2059G/C2611T (rRNA 23S) and S91F (parC) mutations conferring resistance to azith romycin and ciprofloxacin. Material and methods. We conducted a prospective cohort study evaluating first void-urine urines, rectal, and oropharyngeal swabs collected from a cohort of patients in a tertiary hospital in Madrid between October 2022 and January 2023. Samples were screened by Allplex™ 7-STI Essential As say (Seegene®). Drug resistances were performed by Allplex™ NG&DR Assay (Seegene®). Results. A total of 1,415 patients were included, of which 112 had a positive sample for NG infection. One patient had a C2611T mutation (0.9%) and neither patient showed A2059G mutation. We found 67 (59.8%) S91F-positive patients. For ty-four patients (39.3%) not had any mutations. Conclusions. We report a low-prevalence of mutations A2059G/C2611T to macrolides and a high-prevalence to S91F in NG infections. Molecular methods for the detection of NG resistance could be useful in direct non-culturable samples (AU)

Introducción. La infección por Neisseria gonorrhoeae (NG) resistente está aumentando. Se ha descrito la prevalencia de cepas de NG con mutaciones A2059G/C2611T (rRNA 23S) y S91F (parC) que confieren resistencia a azitromicina y cipro floxacino. Material y métodos. Realizamos un estudio prospecti vo evaluando orinas de primera micción, hisopos anales y fa ríngeos recogidos de una cohorte de pacientes en un hospital terciario de Madrid entre octubre de 2022 y enero de 2023. El cribado de las muestras se realizó mediante Allplex™ 7-STI Es sential Assay (Seegene®). Las resistencias a macrólidos y fluo roquinolonas se realizaron mediante Allplex™ NG&DR Assay (Seegene®). Resultados. Se incluyeron 1.415 pacientes, de los cua les 112 fueron positivos para NG. Un paciente presentaba una mutación C2611T (0,9%) y en ningún paciente se detec tó A2059G. Encontramos 67 pacientes (59,8%) positivos pa ra S91F. Cuarenta y cuatro pacientes (39,3%) no presentaban mutaciones. Conclusiones. Reportamos una baja prevalencia de mu taciones A2059G/C2611T a macrólidos y una alta prevalencia de S91F en NG. Los métodos moleculares para la detección de resistencias en NG podrían ser útiles en muestras directas no cultivables (AU)

Procesamiento de muestras osteoarticulares para diagnóstico microbiológico: resultados de una encuesta multicéntrica nacional / Processing of osteoarticular samples for microbiological diagnosis: Results of a national multi-center survey

Introducción: Nuestro objetivo fue evaluar la variabilidad en el procesamiento de muestras osteoarticulares para el diagnóstico microbiológico entre distintos centros nacionales. Métodos: Se diseñó una encuesta online con 13 preguntas y se difundió a través de la SEIMC a los servicios de microbiología de los distintos centros. Resultados: Obtuvimos 72 respuestas. En más de la mitad de los centros, de tercer nivel, se reciben al menos 5 muestras. Aproximadamente la mitad de los centros agitan con vórtex las muestras de hueso/implante, utilizándose la sonicación sobre todo en centros de tercer nivel. Se realizan cultivos para bacterias aerobias y anaerobias durante 6-10 días de incubación, pero con diferencias en los medios de cultivo líquidos. El diagnóstico molecular se realiza en menos del 50% de los centros, siendo la PCR universal (ARNr 16S) la técnica más empleada. Conclusiones: Existe heterogeneidad fundamentalmente en el empleo de sonicación, los medios líquidos de cultivo o el diagnóstico molecular, probablemente en relación directa con los recursos y capacidades de cada centro.(AU)

Introduction. Our aim was to evaluate the variability in the processing of osteoarticular samples for microbiological diagnosis between different national centers. Methods: An online survey with 13 questions was designed and it was sent through SEIMC to the Microbiology Departments of the different centers. Results: We obtained 72 answers. In more than half of the tertiary-care centers, at least 5 samples are received. Approximately half of the centers vortex bones/implant samples. Sonication is used mostly in tertiary-care centers. Cultures for aerobic and anaerobic bacteria are performed during 6-10 days of incubation but with differences in liquid culture media. Molecular diagnosis is performed in less than 50% of the centers. Universal PCR (16S rRNA) is the most widely used technique. Conclusion: We found heterogeneity especially in the use of sonication, liquid culture media or molecular diagnosis, probably in direct relation to the resources and capacities of each center.(AU)

Evaluation of a lateral flow immunoassay to detectCTX-M extended-spectrum B-lactamases (ESBL)directly from positive blood cultures for its potentialuse in Antimicrobial Stewardship programs / Evaluación de una inmunocromatografía paradetectar beta-lactamasas de espectro extendidoCTX-M directamente de hemocultivos positivospara su potencial uso en programas deoptimización de antibioterapia

Background. Bloodstream infections (BSI) caused by extended-spectrum beta-lactamases Enterobacteriaceae (ESBL-E) are associated with high rates of treatment failure andincreased mortality, especially when appropriate antimicrobialtherapy is delayed. Our aim was to evaluate the anticipationof ESBLs detection and the potential improvement of the timeresponse of the Vitek 2 System (BioMérieux; France).Methods. We compared this lateral flow immunoassaywhen used directly on fluid from positive blood cultures to theVITEK2 AST system. We evaluated 80 isolates, 61 tested directlyon fluid from positive blood cultures and 19 tested on fluidfrom blood cultures spiked with known ESBL positive and negative organisms.Results. The concordance between the CTX-LFIA and thereference method (Vitek 2) had a Cohen´s Kappa coefficient of0.97, indicating a particularly good correlation between bothcompared methods.Conclusion. This lateral flow immunoassay can be morerapid than the Vitek 2 for earlier presumptive identification ofCTX- M ESBLs and can be useful to anticipate results and theadjustment of antimicrobial therapy. (AU)

Antecedentes. Las bacteriemias causadas por Enterobacteriaceae productoras beta-lactamasas de espectro extendido(BLEE) están asociadas con altas tasas de fallo de tratamientoy mortalidad, especialmente cuando se retrasa el tratamientoapropiado. Nuestro objetivo ha sido evaluar la anticipación dela detección de estas BLEE y la potencial mejora en el tiempode respuesta respecto al VITEK2 System (Biomerieux; Francia).Métodos. Se comparó una inmunocromatografía para sudetección con el VITEK2 AST system directamente del hemocultivo. Se evaluaton 80 aislados, 61 evaluados directamentede hemocultivos positivos y 19 de la misma manera pero inoculados con microorganismos productores y no productores deBLEE.Resultados. La concordancia entre la inmunocromatografía y el VITEK2 AST mostró un coeficiente Kappa de 0,97,indicando una buena correlación entre ambas técnicas.Conclusión. Esta inmunocromatografía puede ser másrápida que el VITEK2 para una identificación de BLEE tipo CTXM y puede ser útil para anticipar resultados y ajustar la terapiaantimicrobiana. (AU)

Seguimiento telemático de COVID-19: experiencia de un hospital terciario / Telemedicine follow-ups for COVID-19: Experience in a tertiary hospital

Introducción: El seguimiento telefónico es una posible alternativa para la atención médica de niños con COVID-19. Nuestro objetivo es describir la experiencia del seguimiento telemático realizado en un hospital terciario.Pacientes y métodos: Estudio descriptivo retrospectivo de los niños con diagnóstico confirmado o probable de COVID-19 atendidos en la consulta de seguimiento del Hospital La Paz entre marzo y junio del 2020. Se realizaron llamadas cada 48 h hasta desaparecer los síntomas y posteriormente semanales hasta estar 14 días asintomáticos.Resultados: Se incluyó a 72 niños con una mediana de edad de 83,5 meses (RIC=16,3-157,5); 46 eran varones (63,9%) y 14 tenían comorbilidades (19,4%); 32 pacientes (44,4%) habían requerido ingreso hospitalario. Se confirmó diagnóstico de COVID-19 en 33 niños por PCR y en 7 por serología. De los confirmados por PCR, seroconvirtió el 67,7%. Se demostraron otras etiologías en 7 pacientes (5 Mycoplasma pneumoniae, uno parvovirus y uno citomegalovirus).La mediana de duración de síntomas fue 25,5 días (RIC=13,8-37), con mediana de tiempo de seguimiento de 28 días (RIC=21-39). Se realizó una mediana de 6 llamadas (RIC=4-8) por niño; 19 pacientes (26,4%) refirieron empeoramiento en el seguimiento, precisando 14 (19,4%) ser revaluados en Urgencias. Un niño necesitó reingresar, siendo la evolución favorable.Conclusiones: Ante sospecha de COVID-19, es recomendable el seguimiento médico por la prolongada duración de síntomas y el riesgo de empeoramiento. Las consultas telefónicas son útiles y seguras para el seguimiento de casos leves y pacientes hospitalizados tras el alta, permitiendo reducir controles presenciales y el consumo de otros recursos. (AU)

Introduction: Telemedicine is an attractive option for the follow-up of paediatric patients with SARS-CoV-2 infection. The aim of this article is to describe the experience with telephone consultations in a tertiary hospital.Patients and methods: Retrospective descriptive study of children with confirmed or probable diagnosis of COVID-19 attended by telephone consultations in Hospital La Paz (Madrid) between March and June 2020. Patients were referred from the Emergency Department after being discharged from the hospital. Telephone consultations were made every 48hours until symptoms resolved, then weekly until completing 14 days without symptoms.Results: A total of 72 children were included, with median age of 83.5 months (IQR=16.3-157.5). Of those 46 (63.9%) were male, and 14 (19.4%) had comorbidities. There were 32 (44.4%) hospital admissions. COVID-19 diagnosis was confirmed in 33 children by RT-PCR, and in 7 by serology tests. The seroconversion rate was 67.7% in those patients with a positive RT-PCR. Other infections were found in 7 patients (5 Mycoplasma pneumoniae, 1 parvovirus, and 1 cytomegalovirus).Median symptom duration was 25.5 days (IQR=13.8-37), while median follow-up duration was 28 days (IQR=21-39). The median number of telephone consultations per patient was 6 (IQR=4-8). Clinical worsening was reported in 19 (26.4%) during follow-up, and 14 (19.4%) were re-evaluated in the Emergency Department. One patient required hospital admission, but he had a favourable outcome.Conclusions: Children with suspected SARS-CoV-2 infection should be followed-up due to prolonged duration of symptoms, and the risk of clinical deterioration. Telephone consultations are a useful and safe alternative for the follow-up of patients with mild symptoms, and for children discharged from the hospital. (AU)

Seguimiento telemático de COVID-19: experiencia de un hospital terciario / Telemedicine follow-ups for COVID-19: Experience in a tertiary hospital

INTRODUCCIÓN: El seguimiento telefónico es una posible alternativa para la atención médica de niños con COVID-19. Nuestro objetivo es describir la experiencia del seguimiento telemático realizado en un hospital terciario. PACIENTES Y MÉTODOS: Estudio descriptivo retrospectivo de los niños con diagnóstico confirmado o probable de COVID-19 atendidos en la consulta de seguimiento del Hospital La Paz entre marzo y junio del 2020. Se realizaron llamadas cada 48 h hasta desaparecer los síntomas y posteriormente semanales hasta estar 14 días asintomáticos. RESULTADOS: Se incluyó a 72 niños con una mediana de edad de 83,5 meses (RIC = 16,3-157,5); 46 eran varones (63,9%) y 14 tenían comorbilidades (19,4%); 32 pacientes (44,4%) habían requerido ingreso hospitalario. Se confirmó diagnóstico de COVID-19 en 33 niños por PCR y en 7 por serología. De los confirmados por PCR, seroconvirtió el 67,7%. Se demostraron otras etiologías en 7 pacientes (5 Mycoplasma pneumoniae, uno parvovirus y uno citomegalovirus). La mediana de duración de síntomas fue 25,5 días (RIC = 13,8-37), con mediana de tiempo de seguimiento de 28 días (RIC = 21-39). Se realizó una mediana de 6 llamadas (RIC = 4-8) por niño; 19 pacientes (26,4%) refirieron empeoramiento en el seguimiento, precisando 14 (19,4%) ser revaluados en Urgencias. Un niño necesitó reingresar, siendo la evolución favorable. CONCLUSIONES: Ante sospecha de COVID-19, es recomendable el seguimiento médico por la prolongada duración de síntomas y el riesgo de empeoramiento. Las consultas telefónicas son útiles y seguras para el seguimiento de casos leves y pacientes hospitalizados tras el alta, permitiendo reducir controles presenciales y el consumo de otros recursos

INTRODUCTION: Telemedicine is an attractive option for the follow-up of paediatric patients with SARS-CoV-2 infection. The aim of this article is to describe the experience with telephone consultations in a tertiary hospital. PATIENTS AND METHODS: Retrospective descriptive study of children with confirmed or probable diagnosis of COVID-19 attended by telephone consultations in Hospital La Paz (Madrid) between March and June 2020. Patients were referred from the Emergency Department after being discharged from the hospital. Telephone consultations were made every 48 hours until symptoms resolved, then weekly until completing 14 days without symptoms. RESULTS: A total of 72 children were included, with median age of 83.5 months (IQR = 16.3-157.5). Of those 46 (63.9%) were male, and 14 (19.4%) had comorbidities. There were 32 (44.4%) hospital admissions. COVID-19 diagnosis was confirmed in 33 children by RT-PCR, and in 7 by serology tests. The seroconversion rate was 67.7% in those patients with a positive RT-PCR. Other infections were found in 7 patients (5 Mycoplasma pneumoniae, 1 parvovirus, and 1 cytomegalovirus). Median symptom duration was 25.5 days (IQR=13.8-37), while median follow-up duration was 28 days (IQR = 21-39). The median number of telephone consultations per patient was 6 (IQR = 4-8). Clinical worsening was reported in 19 (26.4%) during follow-up, and 14 (19.4%) were re-evaluated in the Emergency Department. One patient required hospital admission, but he had a favourable outcome. CONCLUSIONS: Children with suspected SARS-CoV-2 infection should be followed-up due to prolonged duration of symptoms, and the risk of clinical deterioration. Telephone consultations are a useful and safe alternative for the follow-up of patients with mild symptoms, and for children discharged from the hospital

Alergia a antibióticos: perspectiva desde un hospital de tercer nivel / Allergy to antibiotics: Perspective from a tertiary care hospital

No disponible

Isolation of Candida in the blood cultures of patients admitted to the Emergency Room in a tertiary care hospital / Aislamiento de Candida en hemocultivos de pacientes ingresados en el Servicio de Urgencias de un hospital de tercer nivel

Background: In Spain, data of candidemia are limited to surveys conducted in specific areas or tertiary care centers. Also, in recent years, attention has shifted toward episodes of candidemia in non-ICU wards. Aims: We reviewed the cases of Candida isolates recovered from the blood of patients admitted to the Emergency Room (ER) in our tertiary care hospital. Methods: The patients selected for this study had an isolation of Candida in the blood culture. All data were collected retrospectively from the clinical records of a 11-year period. Results: Candida albicans and other species of the genus were present in 10 and 18 patients, respectively. The patients did not present different clinical features in comparison with other reports of hospitalized patients. All patients had several risk factors for candidemia. Only two patients had received previous antifungal therapy before admission. All the isolates of C. albicans, Candida glabrata and the only isolate of Candida tropicalis were susceptible to all the antifungal agents tested. Only one isolate of Candida parapsilosis was susceptible dose-dependent to fluconazole, and the only isolate of Candida metapsilosis was resistant to fluconazole. Conclusions: It is essential to evaluate the risk factors, underlying conditions and clinical features in non-hospitalized patients in order to determine whether an empirical treatment for candidemia is appropriate

Antecedentes: En España, los datos sobre candidemia están limitados a áreas específicas u hospitales de tercer nivel. En los últimos años el foco de atención sobre esta infección se ha desplazado a áreas de pacientes que no son críticos. Objetivos: Se revisaron los aislamientos de Candida obtenidos de hemocultivos de pacientes que ingresaron en el Servicio de Urgencias de nuestro hospital de tercer nivel. Métodos: Los pacientes se seleccionaron por presentar un aislamiento de Candida en hemocultivo. Todos los datos fueron recogidos retrospectivamente de las historias clínicas de los pacientes atendidos en un período de 11 años. Resultados: Candida albicans y otras especies del género se aislaron en 10 y 18 pacientes, respectivamente. Las características clínicas de los pacientes no mostraban diferencias en comparación con los datos publicados en la bibliografía sobre pacientes hospitalizados. Todos los pacientes presentaban factores de riesgo para desarrollar candidemia. Únicamente dos pacientes habían recibido tratamiento antimicótico antes del ingreso. Todas los aislamientos de C. albicans,Candida glabrata y el único de Candida tropicalis fueron sensibles a todos los antimicóticos probados. Solo un aislamiento de Candida parapsilosis fue sensible al fluconazol en función de la dosis y el único aislamiento de Candida metapsilosis fue resistente al fluconazol. Conclusiones: Es fundamental evaluar los factores de riesgo, las enfermedades de base y otras características clínicas de los pacientes no hospitalizados con el fin de establecer la instauración de un tratamiento empírico para la candidemia