Evaluation of 16S rDNA Heart Tissue PCR as a Complement to Blood Cultures for the Routine Etiological Diagnosis of Infective Endocarditis.

Identification of the causative pathogen is required to optimize the effective therapy in infective endocarditis (IE). The aim of this study was to assess a 16S rDNA PCR to identify bacteria from heart valve tissues and to evaluate its usefulness as a complement to blood and removed valves cultures. A total of 266 patients diagnosed with IE from January 2015 to December 2019 were evaluated. Results between 16S rDNA PCR from heart valve tissues were compared with microbiological cultures. Blood cultures were positive in 83.5% of patients diagnosed with IE, while 39.6% and 71.8% of the evaluated heart valve samples were positive by culture and 16S rDNA PCR, respectively. For 32 (12%) patients, 16S rDNA tissue PCR provided valuable information supporting the results of blood cultures in the case of bacteria characteristic from the skin microbiota. Additionally, a microorganism was identified by using 16S rDNA PCR in 36% of blood culture-negative cases. The present study reveals that molecular diagnosis using 16S rDNA tissue PCR provides complementary information for the diagnosis of IE, and it should be recommended in surgical endocarditis, especially when blood cultures are negative.

In vitro activity of ceftaroline and ceftobiprole against clinical isolates of Gram-positive bacteria from infective endocarditis: are these drugs potential options for the initial management of this disease?

The in vitro activity of ceftaroline and ceftobiprole was assessed against 77 Gram-positive bacterial isolates recovered from patients diagnosed with infective endocarditis (IE). Our data confirm that these drugs are highly in vitro active against the most common agents of IE including methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative staphylococci, and Streptococcus spp., with no significant differences between them. Also, ceftaroline and ceftobiprole have demonstrated a good activity against Enterococcus faecalis (MIC90 0.75 µg/mL and 0.5 µg/mL, respectively). The spectrum of these drugs together with the in vitro and in vivo data on them related with IE published in the scientific literature places them as potential options for the initial management of this disease.

Vigilancia epidemiológica para microorganismos multirresistentes en una UCI polivalente / Epidemiological surveillance for multidrug-resistant microorganisms in a general ICU

Introducción. Los microorganismos multirresistentes (MMR) suponen una amenaza para los pacientes ingresados en las Unidades de Cuidados Intensivos (UCIs). El objetivo de este estudio es analizar los resultados de los cultivos de vigilancia epidemiológica de dichos microorganismos en una de estas unidades. Material y métodos. UCI polivalente. Análisis retrospectivo, estadística descriptiva. Análisis de cultivos de vigilancia epidemiológica para MMR. Microorganismos estudiados: Staphylococcus aureus resistente a meticilina (SARM), Klebsiella pneumoniae productora de BLEE y/o carbapenemasa (KPBLEE-C) y Acinetobacter baumannii multirresistente (ABMR). Resultados. 1.259 pacientes ingresados. Se analizaron 2.234 muestras (exudado rectal 690, faríngeo 634, nasal 624, cutáneo 286) procedentes de 384 pacientes. La mayor rentabilidad alcanzada con las diferentes muestras para los distintos microorganismos fue: SARM, exudado nasal 79%, nasal + faríngeo 90%. ABMR: faríngeo 80%, faríngeo + rectal 95%. KPBLEE-C: rectal 95%, faríngeo + rectal 98%. De los 384 pacientes 94 (24,4%) estaban colonizados/infectados al ingreso con alguno de estos microorganismos. Durante su estancia, 134 pacientes (10,6% del total de pacientes ingresados) se colonizaron/infectaron por un total de 169 microorganismos. La colonización/infección más precoz fue para SARM (9,2 ± 6,4 días) y la más tardía para enterobacterias productoras de BLEE (18,7±16,4 días). Conclusiones. El 24,4% de los pacientes estaban colonizados/infectados por MMR al ingreso. Las muestras más rentables fueron exudado nasal para SARM, faríngeo para ABMR y rectal para KPBLEE-C. La asociación de dos muestras mejora la detección, excepto en KPBLEE-C. Los exudados cutáneos son poco rentables. El MMR más frecuente al ingreso son las enterobacterias productoras de BLEE y el adquirido intra UCI el ABMR (AU)

Introduction. Multidrug resistant (MDR) microorganisms represent a threat for patients admitted in Intensive Care Units (ICUs). The objective of the present study is to analyse the results of epidemiological surveillance cultures for these microorganisms in one of these units. Material and methods. General ICU. Retrospective analysis, descriptive statistics. Analysis of epidemiological surveillance cultures for MDR microorganisms in 2015. Studied microorganisms: Methicillin-resistant Staphylococcus aureus (MRSA), ESBL-and/or carbapenemase-producing Klebsiella pneumoniae (CESBL-KP) and MDR Acinetobacter baumannii (MDRAB). Results. One thousand, two hundred and fifty nine patients admitted. A total of 2,234 specimens from 384 patients were analysed (690, 634, 62 and 286 were rectal, throat, nasal and skin swabs respectively). Global APACHE II was 18.3 ± 8 versus 21.7 ± 7.8 in patients colonized/infected on admission. Global mortality was 19.7% versus 22.3% in patients colonized/infected on admission. The higher sensitivities achieved with the different samples for the different microorganism detection were as follows. MRSA: 79% and 90% for nasal and nasal + throat swabs, respectively. MDRAB: 80% and 95% for throat and throat + rectal swabs, respectively. CESBL-KP: 95% and 98% for rectal and rectal + throat swabs, respectively. 94 out of the 384 patients (24.4%) were colonized/infected with MDR at admission. 134 patients (10.6% of the total patients admitted) were colonized/infected with a total of 169 MMR during the hospital stay. MRSA has the earliest colonization/ infection (9.2 ± 6.4days) and ESBL-producing Enterobacteriaceae, the latest (18.7± 16.4 days). Conclusions. 24.4% of patients were colonized/infected by MDR at admission. Nasal, throat and rectal swabs were the most effective specimens for recovering MRSA, MDRAB and CESBL-KP, respectively. The combination of two specimens improves MDR detection except for CESBL-KP. Skin swabs are worthless. The most prevalent MDR at admission were ESBL-producing Enterobacteriaceae while the most frequent hospital acquired MDR was MDRAB (AU)

Eligibility for and outcome of treatment of latent tuberculosis infection in a cohort of HIV-infected people in Spain.

BACKGROUND: Previous studies have demonstrated the efficacy of treatment for latent tuberculosis infection (TLTBI) in persons infected with the human immunodeficiency virus, but few studies have investigated the operational aspects of implementing TLTBI in the co-infected population.The study objectives were to describe eligibility for TLTBI as well as treatment prescription, initiation and completion in an HIV-infected Spanish cohort and to investigate factors associated with treatment completion. METHODS: Subjects were prospectively identified between 2000 and 2003 at ten HIV hospital-based clinics in Spain. Data were obtained from clinical records. Associations were measured using the odds ratio (OR) and its 95% confidence interval (95% CI). RESULTS: A total of 1242 subjects were recruited and 846 (68.1%) were evaluated for TLTBI. Of these, 181 (21.4%) were eligible for TLTBI either because they were tuberculin skin test (TST) positive (121) or because their TST was negative/unknown but they were known contacts of a TB case or had impaired immunity (60). Of the patients eligible for TLTBI, 122 (67.4%) initiated TLTBI: 99 (81.1%) were treated with isoniazid for 6, 9 or 12 months; and 23 (18.9%) with short-course regimens including rifampin plus isoniazid and/or pyrazinamide. In total, 70 patients (57.4%) completed treatment, 39 (32.0%) defaulted, 7 (5.7%) interrupted treatment due to adverse effects, 2 developed TB, 2 died, and 2 moved away. Treatment completion was associated with having acquired HIV infection through heterosexual sex as compared to intravenous drug use (OR:4.6; 95% CI:1.4-14.7) and with having taken rifampin and pyrazinamide for 2 months as compared to isoniazid for 9 months (OR:8.3; 95% CI:2.7-24.9). CONCLUSIONS: A minority of HIV-infected patients eligible for TLTBI actually starts and completes a course of treatment. Obstacles to successful implementation of this intervention need to be addressed.

Factores asociados con la no realizacion de la prueba de la tuberculina en una cohorte de pacientes VIH positivos / Factors related to non-prescription of tuberculin skin testing in a cohort of HIV-infected people

Introduccion Dada la asociacion entre tuberculosis (TB) e infeccion por VIH, la realizacion del Mantoux esta indicada en todo paciente infectado con VIH. Este articulo analiza la frecuencia de no realizacion de la prueba de la tuberculina y sus factores asociados en una cohorte de infectados con VIH. Pacientes y metodos Entre 2000-C2002 se identifico en 10 hospitales a todos los pacientes infectados con VIH y no seguidos previamente, de forma regular, en consultas especificas. Se recogio informacion de la historia clinica sobre realizacion del Mantoux y otras variables. Se calculo el porcentaje de no realizacion del Mantoux y los factores asociados mediante la utilizacion como medida de asociacion de la odds ratio (OR) y su intervalo de confianza (IC) del 95%. Para el analisis multivariante se ajusto un modelo de regresion logistica. Resultados Mil doscientos cuarenta y dos pacientes cumplieron criterios de inclusion y a 185 pacientes no se les realizo el Mantoux (el 17,6% de aquellos en los que estaba indicado). La probabilidad de no realizacion del Mantoux fue mayor en usuarios de drogas (OR: 2,6; IC del 95%: 1,1¨C6,5) y menor entre los desempleados (OR: 0,6; IC del 95%: 0,3¨C1,0), aquellos con mas de 200 CD4 (CD4 200¨C499: OR: 0,5; IC del 95%: 0,3¨C0,9; CD4 ¡Ý500: OR: 0,3; IC del 95%: 0,2¨C0,6) y los contactos con enfermos tuberculosos (OR: 0,2; IC del 95%: 0,1¨C0,5).ConclusionesEl porcentaje de no realizacion del Mantoux es bastante elevado. La no realizacion del Mantoux parece asociarse con las expectativas del medico, tanto sobre el resultado de la prueba como sobre la correcta cumplimentacion del tratamiento preventivo anti-TB por el paciente ( AU)

Introduction Tuberculin skin testing (TST) for tuberculosis (TB) is recommended for all patients with HIV infection because of the known relationship between these two conditions. In this report we analyze the incidence and variables associated with non-prescription of TST in a cohort of HIV-infected people. Patients and methods Longitudinal study conducted between 2000 and 2002 at 10 HIV hospital-based clinics. All HIV-infected patients who had not been regularly followed-up previously in dedicated clinics were identified. Data about TST and other variables related to TB were obtained from the clinical records. We calculated the percentage of patients who did not undergo TST and the associated factors, using odds ratios (ORs) and the 95% CI to investigate associations. A multivariate logistic regression analysis was performed. Results A total of 1242 patients met the inclusion criteria. TST was not performed in 185 patients (17.6% of those eligible). The fact of being an intravenous drug abuser was associated with a higher probability of TST non-prescription (OR: 2.6, 95% CI 1.1¨C6.5), whereas being unemployed (OR: 0.6, 95% CI 0.3¨C1.0), having a CD4 cell count >200 (CD4 200¨C499: OR 0.5, 95% CI 0.3¨C0.9. CD4¡Ý500: OR 0.3, 95% CI 0.2¨C0.6), and contact with persons with TB (OR 0.2, 95% CI 0.1¨C0.5) were associated with a lower probability. ConclusionsIn this study, the percentage of TST non-prescription was quite high. The results suggest that TST non-prescription in this population is related to the clinicians¡¯ expectations regarding the results of the test and the patients¡¯ adherence to treatment for latent TB infection(AU)

[Factors related to non-prescription of tuberculin skin testing in a cohort of HIV-infected people]. / Factores asociados con la no realización de la prueba de la tuberculina en una cohorte de pacientes VIH positivos.

INTRODUCTION: Tuberculin skin testing (TST) for tuberculosis (TB) is recommended for all patients with HIV infection because of the known relationship between these two conditions. In this report we analyze the incidence and variables associated with non-prescription of TST in a cohort of HIV-infected people. PATIENTS AND METHODS: Longitudinal study conducted between 2000 and 2002 at 10 HIV hospital-based clinics. All HIV-infected patients who had not been regularly followed-up previously in dedicated clinics were identified. Data about TST and other variables related to TB were obtained from the clinical records. We calculated the percentage of patients who did not undergo TST and the associated factors, using odds ratios (ORs) and the 95% CI to investigate associations. A multivariate logistic regression analysis was performed. RESULTS: A total of 1242 patients met the inclusion criteria. TST was not performed in 185 patients (17.6% of those eligible). The fact of being an intravenous drug abuser was associated with a higher probability of TST non-prescription (OR: 2.6, 95% CI 1.1-6.5), whereas being unemployed (OR: 0.6, 95% CI 0.3-1.0), having a CD4 cell count >200 (CD4 200-499: OR 0.5, 95% CI 0.3-0.9. CD4> or =500: OR 0.3, 95% CI 0.2-0.6), and contact with persons with TB (OR 0.2, 95% CI 0.1-0.5) were associated with a lower probability. CONCLUSIONS: In this study, the percentage of TST non-prescription was quite high. The results suggest that TST non-prescription in this population is related to the clinicians' expectations regarding the results of the test and the patients' adherence to treatment for latent TB infection.

Meningitis por Streptococcus salivarius tras anestesia subaracnoidea / No disponible

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Haemorrhagic cellulitis caused by Salmonella enteritidis.

Soft tissue infections are rare manifestations of extra-intestinal salmonellosis and occur more frequently in immunocompromized patients [1-4]. We report haemorrhagic cellulitis in an immunosuppressed patient with sepsis caused by a non-typhoid Salmonella.

Síndrome linfocutáneo por Mycobacterium marinum en un joven aficionado a los acuarios / Lymphocutaneous syndrome due to Mycobacterium marinum in a young aquarium fond

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