RESUMEN
We estimated the direct, indirect and total effects of the 13-valent pneumococcal conjugate vaccine (PCV13) on invasive pneumococcal disease (IPD) in children. A population-based cohort study followed children aged between 2.5 and 59 months between 2001 and 2014 in Navarra, Spain. IPD incidence was compared by PCV status and period. All cases diagnosed from July 2010 to December 2014 and eight matched controls per case were analysed to estimate the adjusted direct effect of PCV13. A total of 120,980 children were followed and 206 IPD cases were detected. Compared with unvaccinated children in the baseline period (2001-2004), overall IPD incidence in 2011-2014 (76% average PCV coverage) declined equally in vaccinated (total effect: 76%; hazard ratio (HR): 0.24; 95% confidence interval (CI): 0.14-0.40) and unvaccinated children (indirect effect: 78%; HR: 0.22; 95% CI: 0.09-0.55). IPD incidence from non-PCV13 serotypes increased among vaccinated children (HR: 2.84; 95% CI: 1.02-7.88). The direct effect of one or more doses of PCV13 against vaccine serotypes was 95% (odds ratio: 0.05; 95% CI: 0.01-0.55). PCV13 was highly effective in preventing vaccine-serotype IPD. The results suggest substantial and similar population-level vaccine benefits in vaccinated and unvaccinated children through strong total and indirect effects.
Asunto(s)
Vacunación Masiva/estadística & datos numéricos , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/administración & dosificación , Vigilancia de la Población , Serotipificación , Streptococcus pneumoniae/aislamiento & purificación , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Masculino , Infecciones Neumocócicas/epidemiología , Serogrupo , España/epidemiología , Streptococcus pneumoniae/clasificación , VacunaciónRESUMEN
The Sensititre YeastOne (SYO) method is a widely used method to determine the susceptibility of Candida spp. to antifungal agents. CLSI clinical breakpoints (CBP) have been reported for antifungals, but not using this method. In the absence of CBP, epidemiological cutoff values (ECVs) are useful to separate wild-type (WT) isolates (those without mechanisms of resistance) from non-WT isolates (those that can harbor some resistance mechanisms), which is the goal of any susceptibility test. The ECVs for five agents, obtained using the MIC distributions determined by the SYO test, were calculated and contrasted with those for three statistical methods and the MIC(50) and modal MIC, both plus 2-fold dilutions. The median ECVs (in mg/liter) (% of isolates inhibited by MICs equal to or less than the ECV; number of isolates tested) of the five methods for anidulafungin, micafungin, caspofungin, amphotericin B, and flucytosine, respectively, were as follows: 0.25 (98.5%; 656), 0.06 (95.1%; 659), 0.25 (98.7%; 747), 2 (100%; 923), and 1 (98.5%; 915) for Candida albicans; 8 (100%; 352), 4 (99.2%; 392), 2 (99.2%; 480), 1 (99.8%; 603), and 0.5 (97.9%; 635) for C. parapsilosis; 1 (99.2%; 123), 0.12 (99.2%; 121), 0.25 (99.2%; 138), 2 (100%; 171), and 0.5 (97.2%; 175) for C. tropicalis; 0.12 (96.6%; 174), 0.06 (96%; 176), 0.25 (98.4%; 188), 2 (100%; 209), and 0.25 (97.6%; 208) for C. glabrata; 0.25 (97%; 33), 0.5 (93.9%; 33), 1 (91.9%; 37), 4 (100%; 51), and 32 (100%; 53) for C. krusei; and 4 (100%; 33), 2 (100%; 33), 2 (100%; 54), 1 (100%; 90), and 0.25 (93.4%; 91) for C. orthopsilosis. The three statistical methods gave similar ECVs (within one dilution) and included ≥ 95% of isolates. These tentative ECVs would be useful for monitoring the emergence of isolates with reduced susceptibility by use of the SYO method.
Asunto(s)
Anfotericina B/farmacología , Antifúngicos/farmacología , Candida/efectos de los fármacos , Equinocandinas/farmacología , Flucitosina/farmacología , Micología/métodos , Candida/aislamiento & purificación , Candidiasis/microbiología , Humanos , Pruebas de Sensibilidad Microbiana/métodos , Modelos EstadísticosRESUMEN
A 1-year prospective multicenter study was performed to explore the significance of the presence of enterococci in cultures of peritoneal fluid from patients with secondary bacterial peritonitis in seven Spanish hospitals. The clinical records of patients with positive peritoneal fluid cultures were reviewed and distributed into cases (patients with cultures yielding enterococci) and controls (patients with cultures not yielding enterococci). Of a total of 158 records, 38 (24.1%) were cases and 120 (75.9%) were controls. The percentages or the scores (cases versus controls) for the variables included in the multivariate analysis were as follows: age of >50 years, 89.5% versus 68.3%; malignancy, 39.5% versus 18.3%; chronic obstructive pulmonary disease (COPD), 15.8% versus 4.2%; postoperative peritonitis, 55.3% versus 30.1%; nosocomial onset, 57.9% versus 34.2%; a higher Charlson comorbidity index, 3.29 +/- 3.38 versus 1.84 +/- 2.31; APACHE II score, 10.71 +/- 4.37 versus 8.76 +/- 5.49; ultimately or rapidly fatal disease, 63.2% versus 34.8%; need for surgical reintervention, 36.1% versus 15.1%; and admission to an intensive care unit, 45.9% versus 30.8%. In the multivariate analysis, enterococci were associated only with postoperative peritonitis (P = 0.009; odds ratio [OR] = 5.0; 95% confidence interval [CI] = 1.49 to 16.80), a higher Charlson comorbidity index (P = 0.002; OR = 1.30; 95% CI = 1.11 to 1.54), and COPD (P = 0.046; OR = 6.50; 95% CI = 1.04 to 40.73). The results of this study showed that enterococci were associated with comorbidity. An association with mortality could not be demonstrated.
Asunto(s)
Enterococcus/aislamiento & purificación , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Peritonitis/epidemiología , Peritonitis/microbiología , Anciano , Anciano de 80 o más Años , Líquido Ascítico/microbiología , Comorbilidad , Femenino , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , España/epidemiologíaRESUMEN
Eighteen clustered cases of meningococcal disease associated with B:2a:P1.5 strains doubled the annual incidence up to 4.3 x 10(5) in Navarra, Spain, in 2007. Eleven percent of cases were fatalities, and 74% of cases were individuals 10 to 24 years old. This is the third cluster associated with this strain in northern Spain since 2001.
Asunto(s)
Infecciones Meningocócicas/epidemiología , Infecciones Meningocócicas/microbiología , Neisseria meningitidis Serogrupo B/clasificación , Neisseria meningitidis Serogrupo B/aislamiento & purificación , Niño , Análisis por Conglomerados , Dermatoglifia del ADN , ADN Bacteriano/genética , Electroforesis en Gel de Campo Pulsado , Genotipo , Humanos , Incidencia , Infecciones Meningocócicas/mortalidad , Neisseria meningitidis Serogrupo B/genética , España/epidemiología , Adulto JovenRESUMEN
Abstract Infections caused by rarely encountered fungal pathogens have increased in recent decades. The present study describes a disseminated infection caused by Phialemonium curvatum, and reviews the literature in an effort to summarize prior experiences with this unusual pathogen. The clinical and microbiological characteristics of a new case due to Phialemonium are presented. The case is analysed with 19 other which have appeared in the literature since 1986. Ten cases were sporadic infections, while the others were associated with three small outbreaks. In all but our patient the skin's natural barrier was compromised (15/20 [75%]) and immunosuppression was a factor in the majority of cases (14/20 [70%]). Dissemination was noted in 83% (5/6) of the immunocompetent patients and in 57% (8/14) of immunocompromised patients. Endocarditis was the most frequent form of infection (8/20 [40%]). Blood cultures were positive in 92% (12/13) of those with disseminated disease. The mortality rate was 54% (7/13) among those with disseminated infections, but fatal outcomes were not observed in patients receiving treatment with itraconazole, voriconazole or posaconazole. The in vitro susceptibility of Phialemonium indicated a more consistent level of activity for voriconazole and posaconazole. Although infections usually occur when there is a breakdown in the skin the skin barrier or host defences are weakened, our case points out that infections due to Phialemonium species may occur in patients without these risk factors. The most frequent form of Phialemonium infections is endovascular, often with endocarditis and positive blood cultures, associated with high mortality rates. Treatment with the new triazoles is associated with improved survival.
Asunto(s)
Ascomicetos/patogenicidad , Micosis/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Ascomicetos/efectos de los fármacos , Ascomicetos/genética , Ascomicetos/aislamiento & purificación , Dorso/diagnóstico por imagen , Dorso/microbiología , Preescolar , Femenino , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Micosis/diagnóstico , Micosis/tratamiento farmacológico , Micosis/patología , Reacción en Cadena de la Polimerasa , Curva ROC , RadiografíaRESUMEN
BACKGROUND: The 7-valent pneumococcal conjugate vaccine (PCV7) has shown high efficacy in preventing invasive pneumococcal disease (IPD) caused by vaccine serotypes. We aimed to assess the overall effectiveness of PCV7 against IPD in Navarra, Spain. METHODS: All children aged <5 years who were diagnosed with IPD during the period 2001-2005 (n=85) and 5 control subjects per case patient (n=425), individually matched by birth date and birth hospital, were analyzed. Vaccination records were obtained from the regional immunization registry. Conditional logistic regression was used to estimate odds ratios. RESULTS: Eighteen case patients (21%) and 114 control subjects (27%) had received >or=1 dose of PCV7. PCV7 serotypes were responsible for 34 (51%) of the cases in unvaccinated children. The overall effectiveness for case prevention was 31% (odds ratio, 0.69; 95% confidence interval, 0.37-1.27). In a separate analysis, vaccination with PCV7 was 88% effective in preventing IPD due to vaccine serotypes (odds ratio, 0.12; 95% confidence interval, 0.02-0.91) and was associated with a higher risk of IPD due to nonvaccine serogroups (odds ratio, 6.16; 95% confidence interval, 1.63-23.3). CONCLUSIONS: These data reveal a higher risk of IPD caused by non-PCV7 serogroups among vaccinated children. Consequently, the overall effectiveness of PCV7 for IPD prevention may be greatly reduced.
Asunto(s)
Vacunas Meningococicas , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Estudios de Casos y Controles , Preescolar , Femenino , Vacuna Neumocócica Conjugada Heptavalente , Humanos , Lactante , Recién Nacido , Masculino , Vacunas Meningococicas/administración & dosificación , Infecciones Neumocócicas/microbiología , Vacunas Neumococicas/administración & dosificación , Factores de Riesgo , Serotipificación , España , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/aislamiento & purificación , Vacunas Conjugadas/administración & dosificaciónRESUMEN
BACKGROUND AND OBJECTIVE: The 7-valent pneumococcal conjugate vaccine (PCV7) has been commercialized in Spain since June 2001. We aim to evaluate the impact of this vaccine in the incidence of invasive pneumococcal disease (IPD) in Navarre. POPULATION AND METHOD: The laboratories of microbiology of Navarre declare all the isolations of Streptococcus pneumoniae in samples of normally sterile corporal fluids. We analyzed the incidence of IPD in children younger than 5 years between weeks 41 of 2000 and 40 of 2005. RESULTS: The doses of PCV7 sold up to 2005 would provide a cover of 27% in children younger than 5 years, having assumed 4 dose schedules. In the 5 seasons, 103 cases of IPD were diagnosed. From the 2 first seasons (2000-2002) to the last one (2004-2005) a reduction of 69% in the incidence rate of IPD caused by vaccine serotypes was observed (from 33 to 10 cases by 100,000 children under 5 years; p = 0.003). Between those same periods the incidence of IPD caused by non-vaccine serotypes increased a 36% (from 42 to 57 by 100,000; p = 0.405). The global incidence of IPD diminished a 12% (from 77 to 67 by 100,000; p = 0.689). The percentage of cases that had received PCV7 increased until 45% in season 2004-2005 (p < 0.001). The meningitis and bacteraemic pneumonias supposed 42% of the IPD, without significant changes during the period (p = 0.442). CONCLUSIONS: Since the PCV7 was marketed the pattern of serotypes has changed, but the expected reduction in the total IPD incidence has not been achieved.
Asunto(s)
Vacunas Meningococicas , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Preescolar , Vacuna Neumocócica Conjugada Heptavalente , Humanos , Incidencia , Lactante , Infecciones Neumocócicas/epidemiología , España/epidemiologíaRESUMEN
OBJECTIVE: To describe a nosocomial outbreak of gastric mucormycosis caused by Rhizopus microsporus var. rhizopodiformis in five adult patients admitted to an intensive care unit (ICU). DESIGN: Epidemiological surveillance study. SETTING: A 12-bed polyvalent ICU of an acute care teaching hospital in Pamplona, Spain. PATIENTS: Five patients admitted to the ICU requiring artificial ventilation, diagnosis on admission severe pneumonia in four patients and one polytrauma patient, within a 14-week period, were diagnosed with gastric mucormycosis based on microbiological and/or histopathological characteristics. Upper gastrointestinal bleeding was the presenting manifestation in 80% of patients. INTERVENTIONS: Filamentous fungi isolated at the microbiology laboratory of the hospital were examined at the national Mycology Reference Laboratory in Madrid. MEASUREMENTS AND RESULTS: Rhizopus microsporus var. rhizopodiformis growth was detected in gastric aspiration samples, environmental samples, wooden tongue depressors used to prepare oral medications (and given to patients through a nasogastric catheter), and in some tongue depressors stored in unopened boxes unexposed to the ICU environment. All depressors were purchased from the same supplier. R. microsporus was not isolated from batches purchased at different times from the same supplier and from another supplier. The outbreak terminated when contaminated tongue depressors were withdrawn from use. CONCLUSIONS: Wooden tongue depressors contaminated by R. microsporus var. rhizopodiformis used to prepare oral medications caused an outbreak of fungal gastritis with an attributable mortality of 40%. Wooden material should not be used in the hospital setting.
Asunto(s)
Mucormicosis/microbiología , Rhizopus/aislamiento & purificación , Gastropatías/microbiología , APACHE , Adulto , Cuidados Críticos , Enfermedad Crítica , Brotes de Enfermedades , Femenino , Mucosa Gástrica/microbiología , Mucosa Gástrica/patología , Hemorragia Gastrointestinal/etiología , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Mucormicosis/complicaciones , Mucormicosis/epidemiología , España/epidemiología , Gastropatías/complicaciones , Gastropatías/epidemiologíaRESUMEN
Pneumococcal conjugate vaccines (PCVs) were licensed for use in children and became available for private purchase in Spain in 2001 (PCV7), 2009 (PCV10) and 2010 (PCV13). This study evaluates changes in the incidence of invasive pneumococcal disease (IPD) and the pattern of serotypes isolated in Navarre, Spain, between the period of use of PCV7 (2004-2009) and that of PCV13 (2010-2013). The percentage of children <2 years who received at least one dose of PCV in these periods ranged from 25 to 61% and 61 to 78%, respectively. Between the periods 2004-2009 and 2010-2013 IPD incidence declined by 37%, from 14.9 to 9.4 cases/100,000 inhabitants (p<0.001). In children <5 years it fell by 69% (p<0.001), in persons aged 5-64 years, by 34% (p<0.001), and in those ≥ 65, by 23% (p=0.024). The incidence of cases due to PCV13 serotypes declined by 81% (p<0.001) in children <5 years and by 52% (p<0.001) in the whole population. No significant changes were seen in the distribution of clinical presentations or in disease severity. The incidence of IPD has declined and the pattern of serotypes causing IPD has changed notably in children and moderately in adults following the replacement of PCV7 by PCV13.
Asunto(s)
Infecciones Neumocócicas/epidemiología , Vacunas Neumococicas/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/prevención & control , Vigilancia de Guardia , España/epidemiología , Vacunas Conjugadas/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: Recent epidemiological surveillance studies have reported an increase in fungaemia caused by non-Candida albicans species, as well as a decrease in fluconazole susceptibility. OBJECTIVES: To evaluate changes in the epidemiology of fungaemia in Spain comparing data from a new surveillance epidemiological study conducted in 2009 with a previous study carried out from 1997 to 1999 (Pemán J, et al. Eur J Clin Microbiol Infect Dis. 2005). METHODS: From January 2009 to February 2010, 44 Spanish hospitals participated in a prospective multicentre fungaemia surveillance study to ascertain whether there have been changes in the epidemiology and fluconazole susceptibility. Susceptibility was determined by the colorimetric method Sensititre Yeast One. Demographic and clinical data and the first isolate of each episode were gathered. RESULTS: A total of 1,377 isolates from 1,357 fungaemia episodes were collected, 46.7% from patients older than 64years and 8.6% from children less than 1 year old. C. albicans (44.7%), Candida parapsilosis (29.1%), Candida glabrata (11.5%), Candida tropicalis (8.2%), and Candida krusei (1.9%) were the most frequent species isolated. Distribution varied with the geographical area. C. albicans incidence has increased significantly in the last 10years in Cataluña (39.1 vs. 54.7%, P=0.03) and decreased in the Valencian Community (49.1 vs. 34.6%, P=0.002) and Extremadura (58.3 vs. 20%, P=0.01). Susceptibility to fluconazole was similar for all geographical areas, although resistance in C. albicans was ten times greater for patients aged more than 64years. The overall rate of fluconazole resistance (MIC > 32 mg/L) has decreased with respect to that obtained 10years ago (3.7 vs. 2.5%) mainly in C. albicans (3 vs. 1.6%). CONCLUSIONS: In the last ten years, species distribution and fluconazole susceptibility have not significantly changed, although a lower rate of fluconazole resistance has been observed. Species distribution varies with hospital, hospitalization Unit and geographical area.
Asunto(s)
Fluconazol/farmacología , Fluconazol/uso terapéutico , Fungemia/tratamiento farmacológico , Fungemia/epidemiología , Adolescente , Anciano , Candida/efectos de los fármacos , Niño , Farmacorresistencia Fúngica , Femenino , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Prospectivos , España/epidemiología , Factores de TiempoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Infecciones por Helicobacter/complicaciones , Bacteriemia/microbiología , Hepatitis C Crónica/complicaciones , Helicobacter/patogenicidad , Hepacivirus/patogenicidad , Antivirales/uso terapéutico , Antibacterianos/uso terapéuticoRESUMEN
Activity of tigecycline against nosocomial secondary peritonitis isolates collected along 18 months in 29 Spanish hospitals was tested by Etest in a central laboratory, considering Food and Drug Administration (FDA)/British Society for Antimicrobial Chemotherapy (BSAC)/European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. A total of 600 facultative/aerobic isolates (392 Gram negative, 208 Gram positive) and 100 anaerobes were tested. None of the 220 Escherichia coli isolates was resistant to tigecycline (MIC(50)/MIC(90) = 0.25/0.5 microg/mL), with 0.5% (FDA breakpoint) and 3.6% (BSAC/EUCAST breakpoint) intermediate strains. All Extended-spectrum beta-lactamase (ESBL)-producing E. coli isolates (15 strains), all Klebsiella pneumoniae, and Klebsiella oxytoca isolates (42 strains) were susceptible to tigecycline. No isolates resistant to tigecycline were found among Streptococcus viridans, Staphylococcus aureus, and Enterococcus faecium, but 18.9% of Enterococcus faecalis strains were intermediate following BSAC/EUCAST breakpoints. All (but 1) isolates of the Bacteroides fragilis group (n = 45) were tigecycline susceptible, as well as Gram-positive anaerobes. Tigecycline offers an adequate activity profile against isolates from secondary peritonitis when tested by Etest regardless of the breakpoints used for categorization.
Asunto(s)
Antibacterianos/farmacología , Infección Hospitalaria/microbiología , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Grampositivas/efectos de los fármacos , Minociclina/análogos & derivados , Peritonitis/microbiología , Bacterias Anaerobias/efectos de los fármacos , Estudios de Cohortes , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/cirugía , Farmacorresistencia Bacteriana , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/cirugía , Bacterias Grampositivas/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Pruebas de Sensibilidad Microbiana , Minociclina/farmacología , Peritonitis/tratamiento farmacológico , Peritonitis/cirugía , TigeciclinaAsunto(s)
Acetamidas/farmacología , Glicopéptidos/farmacología , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Oxazolidinonas/farmacología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Análisis por Conglomerados , Humanos , Linezolid , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Tipificación Molecular , España/epidemiologíaRESUMEN
Antecedentes. Recientemente se ha observado un incremento de las fungemias causadas por especies diferentes de Candida albicans y una disminución de la sensibilidad de los microorganismos responsables al fluconazol. Objetivos. Evaluar la epidemiología y la sensibilidad al fluconazol de los casos de fungemia en España en 2009, comparando los resultados con los obtenidos entre los años 1997-1999 (Pemán J, et al. Eur J Clin Microbiol Infect Dis. 2005). Métodos. Estudio prospectivo multicéntrico con 44 centros participantes realizado desde enero de 2009 a febrero de 2010. Los aislamientos fúngicos procedentes de hemocultivo fueron recogidos en cada centro, donde se realizó el estudio de sensibilidad antifúngica mediante microdilución colorimétrica (Sensititre Yeast One). Resultados. Desde enero de 2009 a febrero de 2010 se recogieron 1.377 aislamientos en hemocultivos, correspondientes a 1.357 episodios de fungemia. Las fungemias se observaron principalmente en mayores de 64 años (46,7%) y el 8,6% en menores de 1 año. C. albicans (44,7%), Candida parapsilosis (29,1%), Candida glabrata (11,5%), Candida tropicalis (8,2%) y Candida krusei (1,9%) fueron las especies más frecuentes, pero su distribución no fue geográficamente homogénea. En los últimos 10 años la incidencia de C. albicans ha aumentado significativamente en Cataluña (39,1 vs. 54,7%, P=0,03) y reducido en la Comunidad Valenciana (49,1 vs. 34,6%, P=0,01). C. parapsilosis ha disminuido en Cataluña (29 vs. 12,4%, P=0,002) y Extremadura (58,3 vs. 20%, P=0,01). La sensibilidad a fluconazol fue similar en toda España pero en los aislamientos de C. albicans la resistencia fue diez veces superior en mayores de 64 años. Sin embargo, la tasa de resistencia (CMI > 32 mg/L) global ha disminuido con respecto a la obtenida hace 10 años (3,7 vs. 2,5% actual), sobre todo en C. albicans (3 vs. 1,6%). Conclusiones. En los últimos 10 años la distribución de las especies causantes de fungemia en España y la sensibilidad al fluconazol no han variado significativamente, aunque se observa una menor tasa de resistencia. La distribución de las especies varía según la unidad de hospitalización, hospital y Comunidad Autónoma(AU)
Background. Recent epidemiological surveillance studies have reported an increase in fungaemia caused by non-Candida albicans species, as well as a decrease in fluconazole susceptibility. Objectives. To evaluate changes in the epidemiology of fungaemia in Spain comparing data from a new surveillance epidemiological study conducted in 2009 with a previous study carried out from 1997 to 1999 (Pemán J, et al. Eur J Clin Microbiol Infect Dis. 2005). Methods. From January 2009 to February 2010, 44 Spanish hospitals participated in a prospective multicentre fungaemia surveillance study to ascertain whether there have been changes in the epidemiology and fluconazole susceptibility. Susceptibility was determined by the colorimetric method Sensititre Yeast One. Demographic and clinical data and the first isolate of each episode were gathered. Results. A total of 1,377 isolates from 1,357 fungaemia episodes were collected, 46.7% from patients older than 64years and 8.6% from children less than 1 year old. C. albicans (44.7%), Candida parapsilosis (29.1%), Candida glabrata (11.5%), Candida tropicalis (8.2%), and Candida krusei (1.9%) were the most frequent species isolated. Distribution varied with the geographical area. C. albicans incidence has increased significantly in the last 10years in Cataluña (39.1 vs. 54.7%, P =0.03) and decreased in the Valencian Community (49.1 vs. 34.6%, P =0.002) and Extremadura (58.3 vs. 20%, P =0.01). Susceptibility to fluconazole was similar for all geographical areas, although resistance in C. albicans was ten times greater for patients aged more than 64years. The overall rate of fluconazole resistance (MIC > 32 mg/L) has decreased with respect to that obtained 10years ago (3.7 vs. 2.5%) mainly in C. albicans (3 vs. 1.6%). Conclusions. In the last ten years, species distribution and fluconazole susceptibility have not significantly changed, although a lower rate of fluconazole resistance has been observed. Species distribution varies with hospital, hospitalization Unit and geographical area(AU)
Asunto(s)
Humanos , Masculino , Femenino , Fungemia/epidemiología , Fluconazol , Pruebas de Sensibilidad Microbiana/métodos , Pruebas de Sensibilidad Microbiana , Sensibilidad y Especificidad , Colorimetría/métodos , Colorimetría , Candida albicans/aislamiento & purificación , Fungemia/microbiología , Fungemia/virología , Fluconazol/aislamiento & purificación , Técnicas y Procedimientos Diagnósticos , Estudios Prospectivos , 28599 , Factores de RiesgoRESUMEN
Fundamento y objetivo: Desde junio de 2001 se comercializa en España la vacuna neumocócica conjugada heptavalente (VNC7v). Nuestro objetivo ha sido evaluar su impacto en la incidencia de enfermedad neumocócica invasiva (ENI) en Navarra. Población y método: Los laboratorios de microbiología de Navarra declaran todos los aislamientos de neumococo en muestras de fluidos corporales normalmente estériles. Analizamos la incidencia de ENI en niños menores de 5 años entre las semanas 41 de 2000 y 40 de 2005. Resultados: Las dosis de VNC7v vendidas hasta 2005 permitirían alcanzar una cobertura del 27% en menores de 5 años, suponiendo 4 dosis por niño. Entre las 5 temporadas se diagnosticaron 103 casos de ENI. Comparando la incidencia de ENI en las 2 primeras temporadas (2000-2002) con la última (2004-2005), se observa un descenso del 69% en la tasa por serotipos vacunales (de 33 a 10 casos por 100.000 menores de 5 años; p = 0,003). Entre esos mismos períodos, la incidencia de ENI por serotipos no vacunales aumentó un 36% (de 42 a 57 por 100.000; p = 0,405). La incidencia global de ENI disminuyó un 12% (de 77 a 67 por 100.000; p = 0,689). El porcentaje de casos que habían recibido VNC7v aumentó hasta el 45% en la temporada 2004-2005 (p < 0,001). Las meningitis y neumonías bacteriémicas supusieron el 42% de las ENI, sin cambios significativos durante el período (p = 0,442). Conclusiones: Tras la comercialización de la VNC7v ha cambiado el patrón de serotipos, pero no se ha conseguido el descenso esperado de la incidencia global de ENI
Background and objective: The 7-valent pneumococcal conjugate vaccine (PCV7) has been commercialized in Spain since June 2001. We aim to evaluate the impact of this vaccine in the incidence of invasive pneumococcal disease (IPD) in Navarre. Population and method: The laboratories of microbiology of Navarre declare all the isolations of Streptococcus pneumoniae in samples of normally sterile corporal fluids. We analyzed the incidence of IPD in children younger than 5 years between weeks 41 of 2000 and 40 of 2005. Results: The doses of PCV7 sold up to 2005 would provide a cover of 27% in children younger than 5 years, having assumed 4 dose schedules. In the 5 seasons, 103 cases of IPD were diagnosed. From the 2 first seasons (2000-2002) to the last one (2004-2005) a reduction of 69% in the incidence rate of IPD caused by vaccine serotypes was observed (from 33 to 10 cases by 100,000 children under 5 years; p = 0.003). Between those same periods the incidence of IPD caused by non-vaccine serotypes increased a 36% (from 42 to 57 by 100,000; p = 0.405). The global incidence of IPD diminished a 12% (from 77 to 67 by 100,000; p = 0.689). The percentage of cases that had received PCV7 increased until 45% in season 2004-2005 (p < 0.001). The meningitis and bacteraemic pneumonias supposed 42% of the IPD, without significant changes during the period (p = 0.442). Conclusions: Since the PCV7 was marketed the pattern of serotypes has changed, but the expected reduction in the total IPD incidence has not been achieved
Asunto(s)
Masculino , Femenino , Lactante , Preescolar , Humanos , Infecciones Neumocócicas/epidemiología , Meningitis Neumocócica/epidemiología , Vacunas Neumococicas/farmacocinética , Streptococcus pneumoniae/patogenicidad , Monitoreo Epidemiológico , Control de Enfermedades Transmisibles/tendenciasRESUMEN
Fundamento y objetivo: La hipertrofia ventricular izquierda (HVI) es la enfermedad cardíaca más frecuente en hipertensos. El objetivo es conocer la prevalencia de HVI en población hipertensa de larga evolución tratada en el ámbito de atención primaria (AP), así como su perfil epidemiológico. Pacientes y método: Estudio descriptivo, transversal y multicéntrico, de 915 hipertensos que acudieron consecutivamente a consultas de AP y llevaban más de 5 años en tratamiento farmacológico. Se midió la presión arterial y se realizó anamnesis y registro de datos electrocardiográficos y bioquímicos. Se evaluó la HVI según criterios de Cornell y/o Sokolow-Lyon. Resultados: La población estudiada (el 63% mujeres) tiene una media de edad de 68,7 años; el 31,6% son diabéticos y el 37,5% tiene la presión arterial controlada. El 30,5% presenta criterios electrocardiográficos de HVI, con mayor prevalencia en mujeres; asimismo, las mujeres con HVI tienen una edad más avanzada. El 30% tiene antecedentes de enfermedad cardiovascular y la prevalencia de insuficiencia cardíaca es mayor en pacientes con HVI. El 54% está en politerapia antihipertensiva y no hay diferencias significativas en el tratamiento de los pacientes con y sin HVI. El 77% de los pacientes con HVI cumplen únicamente el criterio de Cornell; el 12%, sólo el de Sokolow-Lyon y el 11%, ambos criterios. Los pacientes que sólo tienen positividad para el criterio de Cornell se caracterizan por predominio del sexo femenino y mayor prevalencia de obesidad. Conclusiones: La prevalencia de HVI, valorada mediante criterios electrocardiográficos, es elevada en hipertensos de larga evolución, especialmente en mujeres. Es preciso insistir en la realización periódica de electrocardiogramas en hipertensos e incrementar el esfuerzo terapéutico
Background and objective: Left ventricular hypertrophy (LVH) is the most frequent manifestation of cardiac damage in hypertension. The objective of this study was to evaluate the prevalence of LVH in hypertensive patients of long evolution at Primary Care (PC) and to describe their epidemiological profile. Patients and method: 915 hypertensive patients treated for more than 5 years with antihypertensive drugs, who were atended in a consecutive way by de PC physicians, were evaluated in a multicentral and descriptive study. Clinical evaluation data together with electrocardiographic (EKG) and laboratory results were recorded. LVH was assessed by the Cornell and/or Sokolow-Lyon criteria. Results: Study population was characterized by a mean age of 68.7 years, 63% women, 31.6% diabetics, and 37.5% presented controlled blood pressure levels. 30.5% of them presented LVH criteria on EKG, being more prevalent among women, and on the other hand, women with LVH were of a greater age. 30% of patients presented history of cardiovascular disease and heart failure was more frequent among those with LVH. 54% were polymedicated with blood pressure lowering drugs, however there were no differences between groups of patients with and without LVH regarding their treatment. The Cornell criterion and the Sokolow-Lyon criterion alone were presented in a 77% and 12% of patients, respectively, and 11% of them were positive for both criteria. Patients with positivity for only the Cornell criterion were characterized by a greater prevalence of women and obesity. Conclusions: The prevalence of LVH assessed by EKG criteria is high among hypertensive population of long evolution. A greater effort is needed to guarantee a periodic EKG performance in hypertensive patients together with a therapeutic strategy improvement
Asunto(s)
Humanos , Hipertrofia Ventricular Izquierda/epidemiología , Hipertensión/complicaciones , Atención Primaria de Salud/estadística & datos numéricos , Antihipertensivos/uso terapéutico , Factores de Riesgo , Obesidad/complicaciones , Estudios TransversalesRESUMEN
No disponible