ABSTRACT
OBJECTIVES: To evaluate the impact of time to results (TTR) on the outcome of patients with carbapenemase-producing Enterobacterales bloodstream infections (CPE-BSI). METHODS: Times-series study conducted from January 2014 to December 2021, selecting patients with first CPE-BSI episodes. Periods of intervention were defined according to implementation of diagnostic bundle tests in the microbiology laboratory: pre-intervention (January 2014-December 2017) and post-intervention (January 2018-December 2021). TTR was defined as time elapsed from positivity time of the blood culture bottles to physicians' notification of CPE-BSI episodes, and was evaluated in patients who received inappropriate empirical and switched to appropriate targeted treatment (switch group). Analysis of a composite unfavourable outcome (mortality at Day 30 and/or persistent and/or recurrent bacteraemia) was performed for the total episodes and in the switch group. RESULTS: One hundred and nine episodes were analysed: 66 pre-intervention and 43 post-intervention. Compared with pre-intervention, patients in the post-intervention period were younger (68 versus 63 years, P =â0.04), had INCREMENT scoreâ>â7 (31.8% versus 53.5%, Pâ=â0.02) and unfavourable outcome (37.9% versus 20.9%, Pâ=â0.04). Proportion of TTRâ>â30 h was more frequent pre-intervention than post-intervention (61.7% versus 35.5%, Pâ=â0.02). In multivariate analysis of the 109 episodes, source other than urinary or biliary (OR 2.76, 95% CI 1.11-6.86) was associated with unfavourable outcome, while targeted appropriate treatment trended to being protective (OR 0.17, 95% CI 0.03-1.00). Considering the switch group (nâ=â78), source other than urinary or biliary (OR 14.9, 95% CI 3.25-69.05) and TTRâ>â30 h (OR 4.72, 95% CI 1.29-17.22) were associated with unfavourable outcome. CONCLUSIONS: Decreased TTR in the post-intervention period was associated with the outcome in patients with CPE-BSI episodes.
Subject(s)
Enterobacteriaceae Infections , Gammaproteobacteria , Sepsis , Humans , Anti-Bacterial Agents/therapeutic use , Retrospective Studies , beta-Lactamases , Bacterial Proteins , Sepsis/drug therapy , Enterobacteriaceae Infections/diagnosis , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/microbiologyABSTRACT
In 2013-2014, an outbreak involving 14 patients infected by an extensively drug-resistant strain of Pseudomonas aeruginosa was detected in a hospital in Madrid, Spain. Our objective was to evaluate an alternative strategy for investigating the outbreak in depth by means of molecular and genomic approaches. Pulsed-field gel electrophoresis (PFGE) was applied as a first-line approach, followed by a more refined whole genome sequencing analysis. Single nucleotide polymorphisms identified by whole genome sequencing were used to design a specific polymerase chain reaction (PCR) for screening unsuspected cases infected by the outbreak strain. Whole genome sequencing alerted us to the existence of greater genetic diversity than was initially assumed, splitting the PFGE-associated outbreak isolates into 4 groups, 2 of which represented coincidental transmission unrelated to the outbreak. A multiplex allele-specific PCR targeting outbreak-specific single nucleotide polymorphisms was applied to 290 isolates, which allowed us to identify 25 additional cases related to the outbreak during 2011-2017. Whole genome sequencing coupled with an outbreak-strain-specific PCR enabled us to markedly redefine the initial picture of the outbreak by 1) ruling out initially suspected cases, 2) defining likely independent coincidental transmission events, 3) predating the starting point of the outbreak, 4) capturing new unsuspected cases, and 5) revealing that the outbreak was still active.
Subject(s)
Cross Infection/epidemiology , Disease Outbreaks , Pseudomonas Infections/epidemiology , Pseudomonas aeruginosa/genetics , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial , Humans , Polymerase Chain Reaction/methods , Polymorphism, Single Nucleotide , Pseudomonas Infections/microbiology , Pseudomonas Infections/transmission , Whole Genome SequencingABSTRACT
BACKGROUND: The objective of this study was to evaluate the virulence of P. aeruginosa ventilator-associated pneumonia (VAP) strains (cases) in terms of biofilm production and other phenotypic and genotypic virulence factors compared to P. aeruginosa strains isolated from other infections (controls). METHODS: Biofilm production was tested to assess biomass production and metabolic activity using crystal violet binding assay and XTT assay, respectively. Pigment production (pyocyanin and pyoverdine) was evaluated using cetrimide agar. Virulence genes were detected by conventional multiplex PCR and virulence was tested in an in vivo model in Galleria mellonella larvae. RESULTS: We did not find statistically significant differences between VAP and no-VAP strains (p > 0.05) regarding biofilm production. VAP strains had no production of pyocyanin after 24 h of incubation (p = 0.023). The distribution of virulence genes between both groups were similar (p > 0.05). VAP strains were less virulent than non-VAP strains in an in vivo model of G. mellonella (p < 0.001). CONCLUSION: The virulence of VAP-Pseudomonas aeruginosa does not depend on biofilm formation, production of pyoverdine or the presence of some virulence genes compared to P. aeruginosa isolated from non-invasive locations. However, VAP strains showed attenuated virulence compared to non-VAP strains in an in vivo model of G. mellonella.
Subject(s)
Pneumonia, Ventilator-Associated/microbiology , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/genetics , Pseudomonas aeruginosa/pathogenicity , Biofilms , Genotype , Humans , Multiplex Polymerase Chain Reaction , Oligopeptides/metabolism , Phenotype , Pseudomonas aeruginosa/metabolism , Pyocyanine/metabolism , Ventilators, Mechanical/adverse effects , Virulence/genetics , Virulence Factors/geneticsABSTRACT
OBJECTIVES: Tropheryma whipplei has been detected in 3.5% of the blood culture-negative cases of endocarditis in Spain. Experience in the management of T. whipplei endocarditis is limited. Here we report the long-term outcome of the treatment of previously reported patients who were diagnosed with infective endocarditis (IE) caused by T. whipplei from the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) and discuss potential options for antimicrobial therapy for IE caused by T. whipplei. PATIENTS AND METHODS: Seventeen patients with T. whipplei endocarditis were recruited between 2008 and 2014 in 25 Spanish hospitals. Patients were classified according to the therapeutic regimen: ceftriaxone and trimethoprim/sulfamethoxazole, doxycycline + hydroxychloroquine and other treatment options. RESULTS: Follow-up data were obtained from 14 patients. The median follow-up was 46.5 months. All patients completed the antibiotic treatment prescribed, with a median duration of 13 months. Six patients were treated with ceftriaxone and trimethoprim/sulfamethoxazole (median duration 13 months), four with doxycycline + hydroxychloroquine (median duration 13.8 months) and four with other treatment options (median duration 22.3 months). The follow-up after the end of the treatments was between 5 and 84 months (median 24 months). CONCLUSIONS: All treatment lines were effective and well tolerated. Therapeutic failures were not detected during the treatment. None of the patients died or experienced a relapse during the follow-up. Only six patients received antibiotic treatment in accordance with guidelines. These data suggest that shorter antimicrobial treatments could be effective.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/microbiology , Tropheryma/drug effects , Tropheryma/physiology , Aged , Anti-Bacterial Agents/pharmacology , Drug Therapy, Combination , Endocarditis, Bacterial/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Spain , Treatment OutcomeABSTRACT
BACKGROUND: Streptococcus tigurinus was recently described as a new streptococcal species within the viridans group streptococci (VGS). The objectives of the present work were to analyse the clinical and microbiological characteristics of S. tigurinus isolated from patients with bacteraemias, to determine the prevalence of S. tigurinus among VGS endocarditis in Spain, and to compare the clinical characteristics and outcomes of endocarditis caused by S. tigurinus and other VGS. METHODS: Retrospective nationwide study, performed between 2008 and 2016 in 9 Spanish hospitals from 7 different provinces comprising 237 cases of infective endocarditis. Streptococcal isolates were identified by sequencing fragments of their 16S rRNA, sodA and groEL genes. Clinical data of patients with streptococcal endocarditis were prospectively collected according to a pre-established protocol. RESULTS: Patients with endocarditis represented 7/9 (77.8%) and 26/86 (30.2%) of the bacteraemias caused by S. tigurinus and other VGS, respectively (p < 0.001), in two of the hospital participants. Among patients with streptococcal endocarditis, 12 different Streptococcus species were recognized being S. oralis, S. tigurinus and S. mitis the three more common. No relevant statistical differences were observed in the clinical characteristics and outcomes of endocarditis caused by the different VGS species. CONCLUSIONS: In this multicenter study performed in Spain, S. tigurinus showed a higher predilection for the endocardial endothelium as compared to other VGS. However, clinical characteristics and outcomes of endocarditis caused by S. tigurinus did not significantly differ from endocarditis caused by other oral streptococci.
Subject(s)
Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/epidemiology , Streptococcal Infections/diagnosis , Streptococcal Infections/epidemiology , Viridans Streptococci/isolation & purification , Adult , Aged , Aged, 80 and over , Bacteremia/diagnosis , Bacteremia/epidemiology , Bacteremia/microbiology , Endocarditis, Bacterial/microbiology , Epidemiological Monitoring , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , Spain/epidemiology , Streptococcal Infections/complications , Streptococcal Infections/microbiology , Viridans Streptococci/classification , Viridans Streptococci/physiology , Young AdultABSTRACT
Background: Patients with cirrhosis are at high risk of Clostridium difficile infection (CDI). Rifaximin is commonly used in cirrhotic patients as prophylaxis for hepatic encephalopathy (HE). Several studies have demonstrated the efficacy of rifaximin in the treatment of CDI; however, resistance to rifaximin has also been reported. Few studies have assessed the risk of developing CDI in cirrhotic patients receiving rifaximin. Our objective was to assess the incidence and characteristics of CDI in patients with cirrhosis, especially in those who received rifaximin. Methods: We assessed the incidence and clinical characteristics of CDI in cirrhotic patients over a 6-year period in our hospital. Medical charts were retrospectively reviewed. Ribotyping and antimicrobial susceptibility testing of all strains against rifaximin were performed. Results: A total of 388 cirrhotic patients were included, of whom 127 patients had at least 1 episode of diarrhea in which a sample was sent to the laboratory. CDI was detected in 46 patients. Fourteen patients (30.4%) were receiving rifaximin as prophylaxis for HE. The main ribotypes detected were 001 (30.4%), followed by 014 (19.6%). Resistance to rifaximin was 34.1% overall, and 84.6% in patients who had received rifaximin. Multivariate analysis showed that rifamycin therapy and ribotype 001 were significant risk factors for having a rifaximin-resistant C. difficile strain. Conclusions: A high percentage of CDI cases were detected in cirrhotic patients receiving rifaximin, mostly owing to selection of rifaximin-resistant C. difficile strains. Clinicians should be aware of the risk of CDI in cirrhotic patients, even in those receiving rifaximin.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis , Clostridium Infections/epidemiology , Hepatic Encephalopathy/prevention & control , Liver Cirrhosis/complications , Rifaximin/therapeutic use , Adult , Aged , Clostridioides difficile , Clostridium Infections/complications , Diarrhea/microbiology , Drug Resistance, Bacterial , Female , Humans , Incidence , Liver Cirrhosis/microbiology , Male , Microbial Sensitivity Tests , Middle Aged , Retrospective Studies , Ribotyping , Risk FactorsABSTRACT
Despite the wide implementation of MALDI-TOF MS for the rapid and reliable identification of most microorganisms, some taxonomic groups such as the Porphyromonas genus remain largely untested. In this study we evaluated the performance of MALDI-TOF MS on this genus using a collection of 39 isolates sent for routine identification to our institution over a 16-year period. All of them were identified by DNA-sequencing analysis of the 16S rRNA gene plus the hsp60 gene when the previous one did not yield species-level assignment. MALDI-TOF MS provided correct identification at least at the genus level of 21/39 isolates (53.9%). Twelve isolates were correctly identified at the species level with a score valueâ¯≥â¯2.0 and 9 more with score valuesâ¯<â¯2.0 andâ¯≥â¯1.7. The species most represented in the database (P. gingivalis and P. somerae) lay within this category. However, the species poorly represented in this database (P. asaccharolytica and P. uenonis) were mostly identified with lower scores (1.35-1.67) or remained unidentified by MALDI-TOF MS. The addition of two P. asaccharolytica reference spectra to our in-house library allowed 72.9% of genus-level identifications with 17/37 isolates (45.9%) identified with score valuesâ¯≥â¯2.0. Our results showed a high level of correlation between MALDI-TOF MS and DNA-based identification for Porphyromonas spp. strains at the species level, even with score valuesâ¯<â¯2.0. The reliability provided by MALDI-TOF MS increased when the database was fed with spectra from the species poorly represented in the commercial database.
Subject(s)
Bacterial Typing Techniques/methods , Bacteroidaceae Infections/microbiology , Diagnostic Tests, Routine/methods , Porphyromonas/isolation & purification , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods , Bacteroidaceae Infections/diagnosis , DNA, Bacterial/genetics , Humans , Porphyromonas/chemistry , Porphyromonas/classification , Porphyromonas/genetics , RNA, Ribosomal, 16S/geneticsABSTRACT
Information regarding the use of MALDI-TOF MS as an alternative to conventional laboratory methods for the rapid and reliable identification of bacterial isolates is still limited. In this study, MALDI-TOF MS was evaluated on 295 anaerobic isolates previously identified by 16S rRNA gene sequencing and with biochemical tests (Rapid ID 32A system, BioMérieux). In total, 85.8% of the isolates were identified by MALDI-TOF MS at the species level vs 49.8% using the Rapid ID 32A system (p < 0.0001). None of the isolates was discordantly identified at the genus level using MALDI-TOF MS and only 9 of them could not be identified using the method. Thus, our results show that MALDI-TOF MS is a robust and reliable tool for the identification of anaerobic isolates in the microbiology laboratory. Its implementation will reduce the turnaround time for a final identification and the number of isolates that require 16S rRNA sequencing.
Subject(s)
Bacteria, Anaerobic/isolation & purification , Bacterial Infections/diagnosis , Bacterial Typing Techniques/methods , RNA, Ribosomal, 16S/genetics , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/standards , Anaerobiosis , Bacteria, Anaerobic/genetics , Bacterial Infections/microbiology , Bacterial Typing Techniques/instrumentation , Humans , Sensitivity and Specificity , Tertiary Care CentersABSTRACT
We studied the molecular mechanisms of linezolid resistance in 9 isolates of toxigenic Clostridium difficile with high linezolid MICs. The activity of linezolid was determined against 891 clinical isolates of toxigenic C. difficile. The MIC50 and MIC90 of linezolid were 0.75 µg/ml and 1.5 µg/ml, respectively. Nine strains (1%) showed high linezolid MICs (6 µg/ml to 16 µg/ml) and also were resistant to clindamycin, erythromycin, and chloramphenicol. These strains were selected for molecular studies: sequencing of domain V of the 23 rRNA gene, detection of the cfr methyltransferase gene, and sequencing of the ribosomal protein genes rplC and rplD. Molecular relatedness between strains was assessed using PCR ribotyping and MLVA (multilocus variable-number tandem-repeat analysis) typing. The strains belonged to ribotypes 001 (2/9), 017 (6/9), and 078 (1/9). MLVA showed that strains of ribotype 001 and 017 belonged to the same clonal complex in each ribotype. We did not detect mutations in the 23S rRNA gene. The cfr gene was detected in 7 of 9 strains. Sequencing of cfr amplicons revealed a similarity of 100% to a fragment of transposon Tn6218 of C. difficile, which was annotated as a putative chloramphenicol/florfenicol resistance protein. We were unable to detect mechanisms of resistance to linezolid in the 2 strains belonging to ribotype 001. While the relevance of our results lies in the detection of the cfr gene as a possible mechanism of resistance to linezolid in C. difficile, our findings should be assessed by further investigations to characterize these possible cfr genes and their contribution to linezolid resistance.
Subject(s)
Anti-Bacterial Agents/pharmacology , Bacterial Proteins/genetics , Clostridioides difficile/drug effects , Clostridioides difficile/genetics , Drug Resistance, Multiple, Bacterial/genetics , Linezolid/pharmacology , Chloramphenicol/pharmacology , Clindamycin/pharmacology , Clostridioides difficile/isolation & purification , DNA Transposable Elements , Drug Resistance, Multiple, Bacterial/drug effects , Erythromycin/pharmacology , Humans , Microbial Sensitivity Tests , Molecular Sequence Data , RNA, Ribosomal, 23S , Ribotyping , SpainABSTRACT
Toxins A and B are the main virulence factors of Clostridium difficile and are the targets for molecular diagnostic tests. Here, we describe a new toxin A-negative, toxin B-positive, binary toxin CDT (Clostridium difficile transferase)-negative (A(-) B(+) CDT(-)) toxinotype (XXXII) characterized by a variant type of pathogenicity locus (PaLoc) without tcdA and with atypical organization of the PaLoc integration site.
Subject(s)
Bacterial Proteins/genetics , Bacterial Toxins/genetics , Clostridioides difficile/classification , Clostridioides difficile/genetics , Enterotoxins/deficiency , Genotype , ADP Ribose Transferases/deficiency , Aged , Clostridioides difficile/isolation & purification , Cluster Analysis , Gene Order , Genomic Islands , Humans , Male , RibotypingABSTRACT
We compared two multistep diagnostic algorithms based on C. Diff Quik Chek Complete and, as confirmatory tests, GenomEra C. difficile and Xpert C. difficile. The sensitivity, specificity, positive predictive value, and negative predictive value were 87.2%, 99.7%, 97.1%, and 98.3%, respectively, for the GenomEra-based algorithm and 89.7%, 99.4%, 95.5%, and 98.6%, respectively, for the Xpert-based algorithm. GenomEra represents an alternative to Xpert as a confirmatory test of a multistep algorithm for Clostridium difficile infection (CDI) diagnosis.
Subject(s)
Algorithms , Clostridioides difficile/genetics , Clostridium Infections/diagnosis , Clostridium Infections/microbiology , Molecular Typing/methods , Aged , DNA, Bacterial/analysis , DNA, Bacterial/genetics , Humans , Middle Aged , Predictive Value of TestsABSTRACT
Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for the identification of nontuberculous mycobacterial (NTM) isolates was evaluated in this study. Overall, 125 NTM isolates were analyzed by MALDI-TOF and GenoType CM/AS. Identification by 16S rRNA/hsp65 sequencing was considered the gold standard. Agreements between MALDI-TOF and GenoType CM/AS with the reference method were, respectively, 94.4% and 84.0%. In 17 cases (13.6%), results provided by GenoType and MALDI-TOF were discordant; however, the reference method agreed with MALDI-TOF in 16/17 cases (94.1%; P = 0.002).
Subject(s)
Bacteriological Techniques/methods , Mycobacterium Infections, Nontuberculous/diagnosis , Nontuberculous Mycobacteria/isolation & purification , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods , Bacterial Proteins/genetics , Chaperonin 60/genetics , Cluster Analysis , DNA, Bacterial/chemistry , DNA, Bacterial/genetics , DNA, Ribosomal/chemistry , DNA, Ribosomal/genetics , Genotyping Techniques/methods , Molecular Sequence Data , Mycobacterium Infections, Nontuberculous/microbiology , Nontuberculous Mycobacteria/chemistry , Phylogeny , RNA, Ribosomal, 16S/genetics , Sequence Analysis, DNAABSTRACT
OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) strains carrying the mecC gene have been reported from humans and animals from several European countries, but never from Spain. We describe the first isolates of mecC-positive MRSA of human origin collected in Spain and report a fatal case of bacteraemia. METHODS: Isolates were tested for phenotypic resistance using cefoxitin, tested for the mecA/mecC genes and toxin genes by PCR, and typed by staphylococcal cassette chromosome mec (SCCmec), PFGE, spa, multilocus sequence typing and agr. RESULTS: During 2008-13 five MRSA isolates showing resistance to cefoxitin and carrying the mecC gene were recovered at one hospital in Spain. In a review of 5505 S. aureus strains received at the Spanish National Reference Centre for Staphylococci from the same period, we found two additional mecC-positive isolates. The isolates were recovered from blood (two), wounds (two), joint fluid (one), urine (one) and a nasal swab (one). All MRSA were mecA negative, presented SCCmecXI, belonged to agr group III and to clonal complex 130, and were negative for the production of the toxin genes tst1, eta, etb, etd and Panton-Valentine leucocidin. Six isolates belonged to spa type t843 (ST130 and ST1945, where ST stands for sequence type) and one to spa type t6220 (ST1945). One patient with mecC-positive MRSA sepsis died in the emergency department. CONCLUSIONS: We confirm the presence of MRSA carrying the mecC gene in Spain, the ability of this livestock-associated MRSA to cause severe infections in humans and the need to perform culture-based susceptibility testing methods in order to detect these emerging strains.
Subject(s)
Bacteremia/microbiology , Bacterial Proteins/genetics , Methicillin-Resistant Staphylococcus aureus/genetics , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/microbiology , Aged , Aged, 80 and over , Animals , Anti-Bacterial Agents/pharmacology , Cefoxitin/pharmacology , Child, Preschool , DNA, Bacterial/genetics , Fatal Outcome , Female , Genotype , Humans , Male , Methicillin-Resistant Staphylococcus aureus/classification , Methicillin-Resistant Staphylococcus aureus/drug effects , Microbial Sensitivity Tests , Middle Aged , Molecular Typing , Polymerase Chain Reaction , Spain , Virulence Factors/geneticsABSTRACT
A 59-year-old Caucasian male presented with progressive dyspnea, arthralgias and fever for three days. A diastolic regurgitation murmur was detected in the aortic area. A transesophageal echocardiograph showed several vegetations and severe aortic regurgitation. Blood cultures yielded Neisseria gonorrhoeae beta-lactamase negative. The patient had not noticed any urogenital discomfort or urethral discharge. The patient successfully underwent surgery for septal abscess debridement. The patient received ceftriaxone 2 g bid for eight weeks and the clinical follow-up was uneventful. The review of the literature revealed a total of the 38 additional cases reported between 1980 and the present. The majority of the patients were young, male and with native valve involvement. There has been a clear tendency for left-sided valve involvement (especially in the aortic valve). All valve cultures were reported negative despite, in most cases, the marked tissue destruction. Polymerase chain reaction was performed in two patients and positive results were shown in both. Cultures of exudates from other locations were negative in most cases. One striking fact is the high proportion of patients who underwent surgery (72 %). Information regarding antibiotic sensitivity was available in 28 cases, with penicillin resistance reported in six patients (21 %) and intermediate sensitivity in four patients (14 %). Resistance to ciprofloxacin was reported in two cases (7 %). A rapid increase and distribution of isolates resistant to third generation cephalosporins have been recently detected. The mortality is high, particularly taking into account that most were young patients who had not presented previous heart disease.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/surgery , Gonorrhea/complications , Neisseria gonorrhoeae/isolation & purification , Colony Count, Microbial , Drug Resistance, Bacterial , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/mortality , Gonorrhea/drug therapy , Gonorrhea/mortality , Gonorrhea/surgery , Humans , Male , Middle Aged , Neisseria gonorrhoeae/drug effects , Neisseria gonorrhoeae/physiology , Polymerase Chain Reaction , Treatment OutcomeABSTRACT
INTRODUCTION: Clostridium difficile ribotype 027 (Cd027) has caused outbreaks in the United States, Canada, and Europe since 2001. In Spain, the importance of Cd027 is still unknown. In 2007, we began active surveillance of Cd027 to determine its incidence in our hospital. METHODS: From January 2007 to April 2012, isolates of C. difficile by multiplex PCR were studied to detect toxin genes. Binary toxin-positive isolates were characterized using PCR-ribotyping. Cd027 were further characterized by toxino-typing, sequencing of tcdC gene, and MLVA (multilocus-variable-number-tandem-repeat-analysis). RESULTS: Only 8 strains were Cd027 from 3666 isolates of C. difficile analyzed during the study period. These strains were isolated from 4 patients: a Spanish patient previously hospitalized in the UK, a pregnant laboratory technician, a British tourist, and a Spanish patient without epidemiological antecedents for acquiring Cd027. MLVA typing of Cd027 isolates revealed 4 different patterns. The first patient had 2 episodes of diarrhea caused by different Cd027. The strains from the first episode of patient 1 and the strain from patient 2 were grouped in the same clonal cluster (these cases were previously published as laboratory transmission), while strains from patients 3 and 4 were genetically unrelated to each other, and to the strains from patients 1 and 2. CONCLUSION: We report the first finding of an autochthonous case of non-severe Cd027 infection. Our results indicate that Cd027 diarrhea is uncommon in our area, and it appears mainly as imported cases. MLVA typing enables us to distinguish different genotypes among our Cd027 isolates.
Subject(s)
Clostridioides difficile/classification , Clostridioides difficile/genetics , Clostridium Infections/microbiology , Pregnancy Complications, Infectious/microbiology , Ribotyping , Adult , Aged, 80 and over , Clostridioides difficile/isolation & purification , Female , Humans , Male , Middle Aged , Polymerase Chain Reaction , Pregnancy , SpainABSTRACT
OBJECTIVES: To test two interventions aiming at improving the compliance of primary health care physicians with an agreed-on protocol of referrals to a urology department. METHODS: Joint formative meetings (every six months) were celebrated throughout a 24-month period. Also a counseling telephone line was implemented. 18.088 referrals were analyzed. The effect of both expositions was tested comparing basal data (T0) with the performance at 6, 12, 18 and 24 months later (T1, T2, T3 and T4, respectively). An additional comparison was conducted to approach the results 1 year after the study ended (T5). RESULTS: 61.7% of the referrals at baseline complied with the protocol. A significant improvement was detected at T1 (compliance 73.4%, RR with respect to T0 1.19, 95% CI 1.14- 1.23). At T2, 73.7% of referrals were adequate (RR with respect to T0 1.19, 95% CI 1.15-1.24). The percent of adequate referrals at T3 remained stable (73.4%, RR with respect to T0 1.18, 95% CI 1.15-1.23). Nevertheless, adequacy of referrals by the end of the second year (T4) significantly decreased (67.3%, RR with respect to T0, 1.09, 95% CI 1.05-1.12). Adequacy at T5 was almost identical to the basal (64.4%, RR with respect to T0, 1.04 95% CI 1.04-1.07). CONCLUSIONS: Learning activities can be effective in improving the quality of referrals from primary care to one urology department. Stopping the activities entails an immediate return to the basal standards.
Subject(s)
Primary Health Care/organization & administration , Urology Department, Hospital/organization & administration , Counseling , Humans , Patient Compliance , Quality Improvement , Referral and Consultation , SpainABSTRACT
[This corrects the article DOI: 10.3389/fcimb.2021.521014.].