[Economic evaluation of pneumococcal vaccination in adults aged over 65 years in Castilla y León (SPAIN)]. / Evaluación económica de la vacunación frente al neumococo en mayores de 65 años de Castilla y León.

INTRODUCTION: The burden of disease due to pneumonia in older adults has a major impact on health systems. The aim of this study is to carry out an economic evaluation of the vaccination strategy against Streptococcus pneumoniae using the 13-valent pneumococcal conjugate vaccine. MATERIAL AND METHODS: A simulated economic model has been developed in the form of a decision tree to evaluate the cost of the vaccination strategy in the population over 65 years of the Valladolid-East Health Area, versus non-vaccination, using a Monte Carlo probabilistic analysis. RESULTS: Streptococcus pneumoniae annually generates 557.24 cases of pneumococcal disease in the Valladolid-East Health Area, and 506.60 episodes have pneumonia symptoms. Vaccination of the cohort over 65 years of age is an efficient measure from the third year, with a cost per quality-adjusted life years (QALY) of 20,496.20 €. The number of QALYs gained in a decade is 86.07 and an amount of 216.252.89 € with this vaccination strategy would be saved. CONCLUSIONS: The evaluation of the different incremental costs (QALY,euros) in the years of follow-up, the pneumococcus vaccination program in people over 65 in Castilla y León is cost-effective.

[Burden of hospitalization for pneumonia in a Spanish tertiary hospital. Period 2009-2014]. / Carga de hospitalización por neumonía en un hospital terciario español. Período 2009-2014.

BACKGROUND: The aim of this paper is to estimate the burden of hospitalization for community-acquired pneumonia and pneumococcal pneumonia at a tertiary level hospital in the Spanish National Health System. METHODS: A retrospective study which compiles data from the Minimum Data Set using clinical codes of the International Code of Diseases, as well as the hospitalization rate index per thousand inhabitants, the hospitalization rate per thousand population, mortality and fatality rate, using as denominator the demographic data of the population of the Health Area. RESULTS: The discharge of 5758 episodes coded with CIE codes 480 to 486 related to pneumonia, indicates an hospitalization rate of 3.54 people hospitalized per 1000 inhabitants, 65.34 % of all hospital admissions occured in Internal Medicine Services and Pneumology. The average hospital stay per year is 16.63 days. The crude death rate is 69.15 per 100 000 inhabitants and the fatality rate is 19.56 % being higher in adults over 65 years. CONCLUSIONS: Despite the current therapeutic and preventive measures, the incidence and mortality of community-acquired pneumonia in adults remains high, which justifies the strengthening and awareness to address new strategies and prevention such as vaccination.

Introducción: el objetivo de este trabajo es estimar la carga de hospitalización por neumonía adquirida en la comunidad y neumonía neumocócica en un hospital de nivel terciario del Sistema Nacional de Salud Español. Métodos: estudio retrospectivo en el que se recogen los datos del Conjunto Mínimo de Datos Básicos que usa códigos clínicos del Código Internacional de Enfermedades, asi como el índice de hospitalización por mil habitantes, la tasa de hospitalización por mil habitantes, el índice de mortalidad y la tasa de letalidad, usando como denominador los datos demográficos de la población del Área de Salud. Resultados: la descarga de 5758 episodios codificados con los códigos CIE 480 a 486 relativos a neumonía, señalan un índice de hospitalización de 3.54 personas hospitalizadas por cada 1000 habitantes, 65.34% del total de ingresos hospitalarios se produce en los Servicios de Medicina Interna y de Neumología. La estancia media hospitalaria por año es de 16.63 días. La tasa bruta de mortalidad es de 69.15 cada 100 000 y la tasa de letalidad de 19.56%, siendo más elevadas en adultos mayores de 65 años. Conclusiones: a pesar de las medidas terapéuticas y preventivas actuales, la incidencia y la mortalidad por neumonía adquirida en la comunidad en adultos se mantienen elevadas, lo que justifica fortalecer y abordar nuevas estrategias de concienciación y prevención.

Antimicrobial resistance in more than 100,000 Escherichia coli isolates according to culture site and patient age, gender, and location.

Escherichia coli and the antimicrobial pressure exerted on this microorganism can be modulated by factors dependent on the host. In this paper, we describe the distribution of antimicrobial resistance to amikacin, tobramycin, ampicillin, amoxicillin clavulanate, cefuroxime, cefoxitin, cefotaxime, imipenem, ciprofloxacin, fosfomycin, nitrofurantoin, and trimetoprim-sulfametoxazole in more than 100,000 E. coli isolates according to culture site and patient age, gender, and location. Bayesian inference was planned in all statistical analysis, and Markov chain Monte Carlo simulation was employed to estimate the model parameters. Our findings show the existence of a marked difference in the susceptibility to several antimicrobial agents depending on from where E. coli was isolated, with higher levels of resistance in isolates from medical devices, the respiratory system, and the skin and soft tissues; a higher resistance percentage in men than in women; and the existence of a clear difference in antimicrobial resistance with an age influence that cannot be explained merely by means of an increase of resistance after exposure to antimicrobials. Both men and women show increases in resistance with age, but while women show constant levels of resistance or slight increases during childbearing age and greater increases in the premenopausal age, men show a marked increase in resistance in the pubertal age. In conclusion, an overwhelming amount of data reveals the great adaptation capacity of E. coli and its close interaction with the host. Sex, age, and the origin of infection are determining factors with the ability to modulate antimicrobial resistances.

Onychomadesis outbreak in Valencia, Spain associated with hand, foot, and mouth disease caused by enteroviruses.

This report evaluates the June 2008 onychomadesis outbreak in Valencia, Spain. The study sample consisted of 221 onychomadesis cases and 77 nonaffected individuals who lived close to those affected. We collected data on dietary variables, hygiene products, and individual pathological histories. Feces and blood specimens were collected from 44 cases and 24 controls to evaluate exposure to infectious agents. Pathological background data revealed a high frequency (61%) of hand, foot, and mouth disease among the onychomadesis cases. Coxsackievirus A10 was the most commonly detected enterovirus in both case and control groups (49%). Other enteroviruses such as coxsackieviruses A5, A6, A16, B1, and B3; echoviruses 3, 4, and 9; and enterovirus 71 were present in low frequencies in the case and control groups (3-9%). The 2008 onychomadesis outbreak in the metropolitan area of Valencia was associated with an outbreak of hand, foot, and mouth disease primarily caused by coxsackievirus A10.

[Recommendations in the empiric anti-infective agents of intra-abdominal infection]. / Recomendaciones en el tratamiento antibiótico empírico de la infección intraabdominal.

A significant number of patients with abdominal infection develop advanced stages of infection and mortality is still above 20%. Failure is multifactorial and is associated with an increase of bacterial resitance, inappropriate empirical treatment, a higher comorbidity of patients and poor source control of infection. These guidelines discuss each of these problems and propose measures to avoid the failure based on the best current scientific evidence.

In vitro activities of echinocandins against Candida krusei determined by three methods: MIC and minimal fungicidal concentration measurements and time-kill studies.

We evaluated the in vitro activities of anidulafungin, micafungin, and caspofungin against Candida krusei by determining MIC and minimum fungicidal concentration (MFC) measurements and by the time-kill method. The geometric mean (GM)-MIC/GM-MFC values were 0.1/0.34, 0.25/0.44, and 1/2.29, respectively. The mean times to reach 99.9% growth reduction were 19.1 +/- 18.2 h (mean +/- standard deviation) for 2 mg/liter anidulafungin, 37.4 +/- 8.8 h for 2 mg/liter caspofungin, and 30.7 +/- 12.2 h for 1 mg/liter micafungin. Anidulafungin exhibited the highest time-kill rate, followed by micafungin. The three echinocandins showed fungicidal activity at concentrations reached in serum.

Comparison of posaconazole and voriconazole in vitro killing against Candida krusei.

The in vitro activity of posaconazole and voriconazole was evaluated by MIC, minimum fungicidal concentration (MFC), and time-kill methods. MFCs were determined for 15 Candida krusei and time-killing curves for 5 of these isolates. MFCs were obtained transferring 100 microL from clear MIC wells onto Sabouraud dextrose agar. Time-kill studies were performed in RPMI 1640 medium (5 mL, inoculum approximately 10(5) colony-forming unit [CFU]/mL). Geometric mean (GM) MIC and GM-MFC were 0.2 and 0.72 mg/L for posaconazole and 0.4 and 2.64 mg/L for voriconazole. The killing rate was isolate and concentration dependent; reductions in CFUs start at >or=0.12 mg/L (posaconazole) and >or= 0.5 mg/L (voriconazole). The mean time to reach a 90% growth reduction was 41.5+/-14.2 h (8 mg/L posaconazole) and 48.7+/-61.3 h (32 mg/L voriconazole). By time kill, a 99% killing rate was not reached by either agent. Both methods demonstrated that posaconazole (more active and greater killing rate) and voriconazole have fungicidal activity against C. krusei.

Fungemia due to Candida guilliermondii in a pediatric and adult population during a 12-year period.

Candida guilliermondii fungemia is usually described in adults with hematologic malignancies, but in children, only 2 episodes have been published. From 1995 to 2006, 7 episodes (5 in children) were detected in our hospital. Molecular typing excluded a common infection source. C. guilliermondii fungemia may occur in children with underlying conditions other than cancer.

[Automatic detection of bacterial and fungal infections in blood]. / Detección automática de bacterias y hongos en sangre.

Sepsis is one of the main causes of mortality and morbidity in hospitals. Early detection of pathogens using nucleic acid-based techniques speeds diagnosis of bacteremia and/or fungemia, aids the rapid application of appropriate antibiotics, reduces the use of unnecessary antibiotics, and lowers mortality. Two commercially available techniques that help to identify different sepsisproducing bacteria and fungi in a shorter time period are: LightCycler SeptiFast Test Mgrade (Roche Diagnostic SL) and GenoType Blood Culture (Hain Lifescience). We present the results of an initial in-house study using the LightCycler SeptiFast Test Mgrade. The study was carried out in 50 samples from 28 patients (1-3 samples per patient) with septic syndrome admitted to the intensive care unit by comparing the new technique with conventional blood culture. The concordance between the results of blood culture and SeptiFast was good, 79%, in the first trial and 89% in the second, after correcting for technical defects. We initially observed substantial inhibition of internal controls in Gram-negative bacilli, due to the presence of heparin in the blood used, and excess DNA because of the high number of leucocytes. To minimize these inhibitions, the second study used 24 samples at half the original volume (extracted DNA at 1/4 concentration). With these modifications, inhibitions were substantially reduced. SeptiFast is more effective than blood culture in discriminating between contamination by coagulase-negative staphylococci and species of streptococci.

Disseminated histoplasmosis with hemophagocytic syndrome in a patient with AIDS: description of one case and review of the Spanish literature.

We report a case of disseminated histoplasmosis in a 33-year old Ecuadorian patient with AIDS and a CD4 lymphocyte count of 39 cells/microl. He presented with prolonged fever and cough, was diagnosed with hemophagocytic syndrome and multiple organ failure and died 18 days after admission. Histoplasma capsulatum was isolated post-mortem from bone marrow biopsy and blood culture. In a literature review we found 22 published cases of disseminated histoplasmosis in patients with AIDS in Spain since 1988. All but two were men under 50 years old. Nineteen had been born or had lived in endemic areas. The diagnosis of histoplasmosis was established by culture of bone marrow biopsy in 10 cases. Itraconazole was introduced as a second drug after amphotericin B in ten of the thirteen patients who survived.

[Native valve Aspergillus fumigatus endocarditis with blood culture positive and negative for galactomannan antigen. Case report and literature review]. / Endocarditis por Aspergillus fumigatus en válvula nativa con hemocultivo positivo y galactomanano negativo. Descripción de un caso y revisión de la literatura.

Native valve endocarditis caused by Aspergillus spp. is an uncommon disease with a high mortality rate. Generally, Aspergillus is isolated from affected valve in post-mortem or biopsy specimens. However, its isolation from blood cultures is exceedingly rare. We report a case of fungal endocarditis in a native mitral valve with the isolation of Aspergillus fumigatus both in valve vegetation and in blood culture bottles. The patient underwent valve replacement and antifungal treatment with voriconazole and caspofungin, but he died on post-operative day 45 with disseminated aspergillosis confirmed by necropsy. Paradoxically, galactomannan antigen detection in serum was negative. This is the third case of Aspergillus endocarditis with positive blood culture reported in the literature.