Treatment duration for central line-associated infection caused by Enterococcus spp.: a retrospective evaluation of a multicenter cohort.

Objective of this study was to assess the appropriate treatment duration for enterococcal central line-associated bloodstream infections (CLABSIs). This observational, retrospective, multicenter study conducted between 2011 and 2019 enrolled all hospitalized patients with monomicrobial enterococcal CLABSI. Those with infective endocarditis and non-survivors at least 7 days from index blood culture (BC) were excluded. Primary endpoint was 30-day mortality. We enrolled 113 patients, of whom 59% were male, median age was 64 (SD ± 15) and median Charlson's index score 5 (IQR 3-8). Enterococcus faecalis and Enterococcus faecium were found in 51% and 44% of cases, respectively. Median treatment duration was 11 days (IQR 6-17), and 32% of patients (n = 36) received ≤ 7 days. Characteristics of patients receiving more or less than 7 days of treatment were similar. Central line was removed in 82% (n = 93) of cases within a median of 3 days (1-8). At both uni- and multivariate analysis, duration of antibiotic treatment > 7 days was not associated with 30-day mortality [HR 0.41 (95% CI, 0.13-1.24), p = 0.12] even after adjustment with propensity score [HR 0.47 (95% CI 0.17-1.26), p = 0.13]. A 7-day treatment course appears to be safe in non-complicated enterococcal CLABSIs.

Employability skills and quality of life among employees with mild and moderate intellectual disability who attend occupation centres in Catalonia (Spain) / Competencias de empleabilidad y calidad de vida en usuarios con discapacidad intelectual leve y moderada de centros ocupacionales de Cataluña (España)

BACKGROUND: The study explores the relationship between quality of life (QoL) and employability skills in a non-random sample of 100 employees of occupa­tional centres (OCs) in Barcelona (Spain). The influence of gender, age and level of in­tellectual disability (ID) is also explored. METHOD: A quantitative approach was adopted to collect and examine data, gathered through two different instruments: the GENCAT SCALE (Verdugo et al., 2008) (and the Employability Skills Scale (Jariot, Laborda and González, 2020). RESULTS: A correlation between QoL and employability skills has been found. A relationship between age and employability skills was also found, in which younger individuals reported better in employability skills. Age was also found to have an effect on some QoL domains. The ID level turned out to be a significant factor in the development of employability skills, as well as in some QoL domains. The crucial role of job placement in personal development is underlined, as well as the need for more inclusive procedures in occupancy services

INTRODUCCIÓN: el estudio explora la relación entre calidad de vida y com­petencias de empleabilidad en una muestra no aleatoria de 100 empleados de centros ocupacionales en Barcelona (España). También se explora la influencia del género, la edad y el nivel de discapacidad intelectual en ambas variables. MÉTODO: se adoptó un en­foque cuantitativo para recopilar y examinar datos, reunidos a través de dos instrumen­tos diferentes: la Escala GENCAT (Verdugo et al., 2008) y la Escala de Competencias de Empleabilidad (Jariot, Laborda y González, 2020). RESULTADOS: existe una correlación entre la calidad de vida y las competencias de empleabilidad. También se encontró rela­ción entre la edad y dichas competencias, en la cual las personas más jóvenes obtuvieron puntuaciones más altas. También se descubrió que la edad influye en algunos dominios de calidad de vida. El grado de discapacidad resultó ser un factor significativo en el desarrollo de competencias de empleabilidad, así como en algunos dominios de calidad de vida. Se subraya el papel crucial de la inserción laboral en el desarrollo personal, así como la necesidad de procedimientos más inclusivos en los servicios de ocupación

Detection of a cfr-positive MRSA CC398 strain in a pig farmer in Spain / Detección de una cepa SARM del linaje CC398 y portadora del gen cfr en un granjero de cerdos en España

Objective: To characterize one linezolid- and methicillin-resistant Staphylococcus aureus (MRSA) isolate recovered from a nasal sample of a pig farmer patient. Methods: The detection of linezolid resistance mechanisms was performed by PCR and sequencing. The antimicrobial resistance and virulence profile was investigated, and the molecular typing was performed by molecular techniques. The transference of cfr gene was assessed by conjugation experiments and its genetic environment was investigated by specific PCRs. Results: The linezolid-resistant MRSA isolate was typed as t011-ST398/CC398-SCCmecV-agrI and carried the cfr gene. The isolate was multidrug-resistant but lacked the virulence genes studied. The cfr gene was co-located with the fexA gene on a Tn558 variant and was successfully transferred by conjugation. Conclusion: We report the first description of LA-MRSA-CC398 carrying the cfr gene in Spain. This finding highlights the importance of surveillance programmes to determine the presence and spread of the cfr gene in the livestock and clinical settings.(AU)

Objetivo: Caracterizar una cepa Staphylococcus aureus resistente a meticilina (SARM) y a linezolid aislada de una muestra nasal de un paciente granjero de cerdos. Métodos: Mediante PCR y secuenciación se investigaron los mecanismos de resistencia a linezolid. Se determinó el perfil de resistencia a antimicrobianos y el perfil de virulencia, y se llevó a cabo el tipado molecular mediante diferentes técnicas moleculares. Se estudió la transferibilidad del gen cfr por conjugación y su entorno genético mediante PCR específicas. Resultados: El aislado fue tipado como t011-ST398/CC398-SCCmecV-agrI y portaba el gen cfr. Presentó un feno/genotipo de multirresistencia, pero carecía de los genes de virulencia estudiados. Se detectó el gen cfr junto con fexA en una variante del Tn558 y se transfirió mediante conjugación. Conclusión: Se describe el primer aislado SARM-CC398 cfr-positivo en España. Esto destaca la importancia de implementar programas de vigilancia para determinar su presencia y dispersión en el ámbito clínico y ganadero.(AU)

Detection of a cfr-positive MRSA CC398 strain in a pig farmer in Spain.

OBJECTIVE: To characterize one linezolid- and methicillin-resistant Staphylococcus aureus (MRSA) isolate recovered from a nasal sample of a pig farmer patient. METHODS: The detection of linezolid resistance mechanisms was performed by PCR and sequencing. The antimicrobial resistance and virulence profile was investigated, and the molecular typing was performed by molecular techniques. The transference of cfr gene was assessed by conjugation experiments and its genetic environment was investigated by specific PCRs. RESULTS: The linezolid-resistant MRSA isolate was typed as t011-ST398/CC398-SCCmecV-agrI and carried the cfr gene. The isolate was multidrug-resistant but lacked the virulence genes studied. The cfr gene was co-located with the fexA gene on a Tn558 variant and was successfully transferred by conjugation. CONCLUSION: We report the first description of LA-MRSA-CC398 carrying the cfr gene in Spain. This finding highlights the importance of surveillance programmes to determine the presence and spread of the cfr gene in the livestock and clinical settings.

High quality of life, treatment tolerability, safety and efficacy in HIV patients switching from triple therapy to lopinavir/ritonavir monotherapy: A randomized clinical trial.

TRIAL DESIGN: The QoLKAMON study evaluated quality of life, efficacy and treatment safety in HIV patients receiving lopinavir/ritonavir in monotherapy (MT) versus continuing combined antiretroviral triple treatment with a boosted protease inhibitor (TT). METHODS: This was a 24-week, open-label, multicentre study in virologically-suppressed HIV-infected participants (N = 225) with a 2:1 randomization: 146 patients who switched to MT were compared with 79 patients who remained on a TT regimen. The primary endpoint was change in patient-reported outcomes in quality of life as measured by the MOS-HIV and EQ-5D questionnaires. Secondary endpoints included treatment adherence, patient satisfaction, incidence of adverse events and differences in plasma HIV-1 RNA viral load (VL) and CD4 cell counts. RESULTS: Baseline quality of life, measured with the MOS-HIV score, was very good (overall score of 83 ± 10.5 in the MT arm and 82.3 ± 11.3 in the TT arm) and suffered no change during the study in any of the arms (at week 24, 83.5 ± 12.2 in MT arm and 81.9 ± 12.7 in TT arm), without statistically significant differences when compared. In regards to adherence to therapy and patient satisfaction, some aspects (number of doses forgotten in the last week and satisfaction of treatment measured with the CESTA score, dimension 1) improved significantly with MT. There were also no differences in the incidence and severity of adverse events, even though 22.8% of those in the MT arm switched their treatment when they were included in the study. Moreover, there was also no significant difference between the immunological and virological evolution of MT and TT. In the MT arm, the VL was always undetectable in 83% of patients (vs 90.7% in the TT arm) and there were only 6.7% of virological failures with VL > 50 copies/mL (vs 2.3% in the TT arm), without resistance mutations and with resuppression of VL after switching back to TT. CONCLUSIONS: In a new clinical trial, monotherapy as a treatment simplification strategy in HIV-1 infected patients with sustained viral suppression has demonstrated quality of life, safety and efficacy profiles comparable to those of conventional triple therapy regimens.

Emotional abilities as predictors of risky driving behavior among a cohort of middle aged drivers.

The aim of this study is to analyze the relationship between emotional abilities and the influence of this relationship on self reported drivers' risky attitudes. The risky driving attitudes and emotional abilities of 177 future driving instructors were measured. The results demonstrate that risky attitudes correlate negatively with emotional abilities. Regression analysis showed that adaptability and interpersonal abilities explained the differences observed in the global risk attitude index. There were some differences in the specific risk factors. The variability observed in the speed and distraction and fatigue factors could also be explained by interpersonal and adaptability abilities. Nevertheless the tendency to take risks was explained by stress management and also interpersonal components. Emotional abilities have the weakest relation with alcohol and drugs factor, and in this case the variability observed was explained by the adaptability component. The results obtained highlight the importance take off including emotional abilities in prevention programs to reduce risky driving behaviors.

Evaluación de un programa de cambio de actitudes con preconductores para prevenir los accidentes de tráfico provocados por el alcohol en Cataluña / Evaluation of a program for changing attitudes in pre-drivers to prevent road accidents related to drink-driving in Catalonia

En este estudio se presentan los resultados de una intervención para prevenir el consumo de alcohol en la conducción con preconductores de todo Cataluña. El programa que se aplicó, fundamentado en el cambio de actitudes, pretende reducir considerablemente el peligro que conlleva mezclar el alcohol con la conducción. Para ello se utilizó un diseño clásico cuasi experimental pretest-posttest con grupo control y se aplicaron do scuestionarios (uno general, con varios factores de riesgo, y otro específico sobre alcohol). El estudio se llevó a cabo con tres grupos: a) experimental 1, que recibió la aplicación completa del programa, b) experimental2, que recibió la aplicación de una parte del mismo y c) control, que no recibió los beneficios del programa de reducción del consumo de alcohol. Se constató, a partir del análisis factorial (ACP) del cuestionario específico y de la prueba ANOVA de medidas repetidas, que el grupo experimental1 presentaba resultados significativamente mejores que los grupos experimental 2 y control, hallándose diferencias significativas entre los hombres y mujeres de la muestra. Los resultados permiten evidenciar que el programa de cambio de actitudes resulta eficaz y que es posible reducir el consumo de alcohol en jóvenes preconductores (AU)

This study appraises the results of an intervention to prevent drink driving in a cohort of pre-drivers in the region of Catalonia (Spain).The program applied, based on attitude change, sets out to reduce significantly the risk of being involved in drink-driving. A classic quasiexperimental pretest-posttest design with control group was used, and two questionnaires were applied: a general one measuring several risk factors, and another one specifically addressing the question of alcohol. The study was carried out with three groups: a) experimental 1, which received the entire program, b) experimental 2, which received a part of the program, and c) control, which did not receive the benefits of the program. Results from the factor analysis (PCA) and the repeated measures ANOVA suggest that young pre-drivers who received the program obtained better results in road safety and showed less risk of drink-driving than those who did not receive the program or received only part of it. Significant differences were also found between men and women. The results confirm the effectiveness of the attitude-change program and the possibility of reducing alcohol use among young predrivers (AU)

[Evaluation of a program for changing attitudes in pre-drivers to prevent road accidents related to drink-driving in Catalonia]. / Evaluación de un programa de cambio de actitudes con preconductores para prevenir los accidentes de tráfico provocados por el alcohol en Cataluña.

This study appraises the results of an intervention to prevent drink-driving in a cohort of pre-drivers in the region of Catalonia (Spain). The program applied, based on attitude change, sets out to reduce significantly the risk of being involved in drink-driving. A classic quasi-experimental pretest-posttest design with control group was used, and two questionnaires were applied: a general one measuring several risk factors, and another one specifically addressing the question of alcohol. The study was carried out with three groups: a) experimental 1, which received the entire program, b) experimental 2, which received a part of the program, and c) control, which did not receive the benefits of the program. Results from the factor analysis (PCA) and the repeated-measures ANOVA suggest that young pre-drivers who received the program obtained better results in road safety and showed less risk of drink-driving than those who did not receive the program or received only part of it. Significant differences were also found between men and women. The results confirm the effectiveness of the attitude-change program and the possibility of reducing alcohol use among young pre-drivers.

A prediction rule for estimating the risk of bacteremia in patients with community-acquired pneumonia.

BACKGROUND: We endeavored to construct a simple score based entirely on epidemiological and clinical variables that would stratify patients who require hospital admission because of community-acquired pneumonia into groups with a low or high risk of developing bacteremia. METHODS: Derivation and internal validation cohorts were obtained by retrospective analysis of a database that included 3116 consecutive patients with community-acquired pneumonia from 2 university hospitals. Potential predictive factors were determined by means of a multivariate logistic regression equation applied to a cohort consisting of 60% of the patients. Points were assigned to significant parameters to generate the score. It was then internally validated with the remaining 40% of patients and was externally validated using an independent multicenter cohort of 1369 patients. RESULTS: The overall rates of bacteremia were 12%-16% in the cohorts. The clinical probability estimate of developing bacteremia was based on 6 variables: liver disease, pleuritic pain, tachycardia, tachypnea, systolic hypotension, and absence of prior antibiotic treatment. For the score, 1 point was assigned to each predictive factor. In the derivation cohort, a cutoff score of 2 best identified the risk of bacteremia. In the validation cohorts, rates of bacteremia were <8% for patients with a score 1 (43%-49% of patients), whereas blood culture results were positive in 14%-63% of cases for patients with a score 2. CONCLUSIONS: This clinical score, based on readily available and objective variables, provides a useful tool to predict bacteremia. The score has been internally and externally validated and may be useful to guide diagnostic decisions for community-acquired pneumonia.

Embarazo en la adolescencia: predictores de salud y bienestar en una muestra brasileña / Teenage pregnancy: predictors of health and well being in a Brazilian sample

Introducción: El embarazo en la adolescencia es un fenómeno con importantes implicaciones sociales y personales y puede tener consecuencias en la salud de las jóvenes que viven esta experiencia. La presente investigación tuvo por objetivo evaluar los predictores de salud y bienestar de adolescentes embarazadas. Pacientes y método: El trabajo se desarrolló a partir de un enfoque cuantitativo, con una muestra de 100 adolescentes, entre el tercero y el noveno mes del embarazo, que realizaban consultas prenatales en hospitales de la red pública de Porto Alegre (Brasil). Los datos fueron recogidos a través de un cuestionario biodemográfico y del Cuestionario General de Salud (GHQ), que se aplicó individualmente, mientras las adolescentes esperaban ser atendidas en la consulta ginecológica. Resultados: El análisis de los resultados se realizó mediante un análisis descriptivo y análisis de regresión múltiple. Las pruebas indicaron que las adolescentes presentaban una percepción positiva de su salud durante el embarazo y que haber abortado y la edad gestacional fueron significativos predictores de la salud de las embarazadas y algunos de sus factores. Conclusiones: A partir del estudio, se puede concluir que la percepción de salud de las participantes está más relacionada con los aspectos biológicos del embarazo que con los sociales (AU)

Introduction: The phenomenon of teenage pregnancy has important social and personal implications and can affect the health of these young women. The aim of the present study was to evaluate predictors of health and well being in pregnant adolescents. Patients and method: We performed a quantitative study in a sample of 100 adolescents between the third and ninth month of pregnancy who attended prenatal care in public hospitals in Porto Alegre (Brazil). Data were collected using a questionnaire for bio-demographic variables and the General Health Questionnaire (GHQ). The questionnaires were applied individually in the waiting room, before gynecological consultation. Results: The results were evaluated through descriptive and multiple regression analyses. Adolescents had a positive perception of their health during pregnancy. Significant predictors associated with health and health-related factors were having had an abortion and gestational period. Conclusions: The results of this study suggest that the health of pregnant adolescents is more closely related to biological than to social aspects of pregnancy (AU)

Community-acquired pneumonia as the initial manifestation of serious underlying diseases.

PURPOSE: Community-acquired pneumonia is common among patients with coexisting illnesses and it can be the initial manifestation of these comorbid diseases. The objectives of our study were to evaluate the frequency of this association and to analyze whether certain characteristics could predict the presence of unknown comorbid conditions. SUBJECTS AND METHODS: Over a 5-year period, we prospectively studied 660 consecutive patients with community-acquired pneumonia seen at our institution. In a subgroup of these patients, diagnosis of previously unknown comorbid conditions was established during follow-up. Characteristics of these patients were compared with data from the remaining sample of patients. RESULTS: Prior underlying diseases were present in 298 (45%) patients. One or more new comorbid conditions were found in 41 (6%), of which diabetes (14 cases), malignancies (12 cases), chronic obstructive pulmonary disease (8 cases), and human immunodeficiency virus (HIV) infection (5 cases) were the most common. In the comparative study, a bacterial etiology, positive blood cultures, and hospitalization were more frequently found (P < 0.05) in patients with new comorbid conditions than atypical microorganisms or viruses, negative blood cultures, or outpatient care. CONCLUSION: In the initial diagnostic workup of patients with community-acquired pneumonia, the possibility of unknown comorbid conditions should be carefully evaluated.