Estudio de casos-controles de la infección por Clostridioides difficile en un área sanitaria rural / Case-control study of Clostridioides difficile in a rural health care area

Objetivo: Determinar los factores de riesgo y factores pronósticos de la infección por Clostridioides difficile (ICD). Pacientes y métodos: Estudio prospectivo de casos-controles (61 casos y 64 controles) de 2 años o más con diarrea, atendidos en un área sanitaria manchega durante 14 meses. El diagnóstico se realizó mediante inmunocromatografía (glutamato deshidrogenasa y toxina A/B), realizando amplificación isotérmica en los casos discordantes. Se recogieron variables demográficas, comorbilidades, tipo de adquisición, administración previa de antibióticos, antiácidos e inmunosupresores y evolución. Los datos se analizaron mediante la prueba de χ2 y el efecto de los factores de riesgo y pronósticos se cuantificó mediante odds ratio con intervalos de confianza del 95%. Resultados: Como factores de riesgo independientes de ICD encontramos el ingreso hospitalario las 4 semanas previas a la infección, la hipoalbuminemia y la administración previa de antibióticos. Presentar estos 3 factores supuso un riesgo casi 3 veces mayor de infectarse. En el grupo de adquisición nosocomial se encontró mayor número de ingresos hospitalarios las 4-12 semanas previas a la ICD y, aunque hubo mayor tendencia a las recurrencias y al pronóstico desfavorable entre los casos intrahospitalarios, estas diferencias no fueron significativas. Identificamos como factores de pronóstico desfavorable la fiebre y el ingreso hospitalario las 4 semanas previas a la infección. Conclusiones:Los factores de riesgo independientes de ICD fueron: ingreso hospitalario las 4 semanas previas a la infección, hipoalbuminemia y administración previa de antibióticos. La fiebre y la hospitalización las 4 semanas anteriores se identificaron además como factores pronósticos de evolución desfavorable.(AU)

Objective: To determine the risk and prognostic factors for Clostridioides difficile infection (CDI). Patients and methods: Prospective, case-control study with 61 cases and 64 controls, aged ≥2 years with diarrhoea, carried out in Castilla-La Mancha Health Care Area for 14 months. The diagnosis was made by immunochromatography technics (glutamate dehydrogenase and toxin A/B), confirming discordant cases by isothermal amplification. Demographic variables, comorbidities, type of acquisition, previous administration of antibiotics, antacids and immunosuppressants, and evolution were collected. The data were analysed using the chi-square test and the effect of risk and prognostic factors was quantified using an odds ratio with 95% confidence intervals. Results: Hospital admission 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics were identified as independent risk factors for CDI. Presenting these 3 factors constitutes nearly 3-fold increase in the risk of becoming infected. A greater number of hospital admissions in the 4-12 weeks prior to CDI were found in the group of nosocomial acquisition. Although there was a greater tendency to recurrence and an unfavourable prognosis among nosocomial cases, these differences were not significant. We found that fever and hospital admission in the 4 weeks prior to infection were unfavourable prognostic factors of CDI. Conclusions: The independent risk factors for CDI were: Hospital admission in the 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics. Fever and hospitalisation in the previous 4 weeks were also identified as prognostic factors of unfavourable evolution.(AU)

Case-control study of Clostridioides difficile in a rural health care area. / Estudio de casos-controles de la infección por Clostridioides difficile en un área sanitaria rural.

OBJECTIVE: To determine the risk and prognostic factors for Clostridioides difficile infection (CDI). PATIENTS AND METHODS: Prospective, case-control study with 61 cases and 64 controls, aged ≥2 years with diarrhoea, carried out in Castilla-La Mancha Health Care Area for 14 months. The diagnosis was made by immunochromatography technics (glutamate dehydrogenase and toxin A/B), confirming discordant cases by isothermal amplification. Demographic variables, comorbidities, type of acquisition, previous administration of antibiotics, antacids and immunosuppressants, and evolution were collected. The data were analysed using the chi-square test and the effect of risk and prognostic factors was quantified using an odds ratio with 95% confidence intervals. RESULTS: Hospital admission 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics were identified as independent risk factors for CDI. Presenting these 3 factors constitutes nearly 3-fold increase in the risk of becoming infected. A greater number of hospital admissions in the 4-12 weeks prior to CDI were found in the group of nosocomial acquisition. Although there was a greater tendency to recurrence and an unfavourable prognosis among nosocomial cases, these differences were not significant. We found that fever and hospital admission in the 4 weeks prior to infection were unfavourable prognostic factors of CDI. CONCLUSIONS: The independent risk factors for CDI were: Hospital admission in the 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics. Fever and hospitalisation in the previous 4 weeks were also identified as prognostic factors of unfavourable evolution.

Diseminación interhospitalaria de Klebsiella pneumoniae ST512 productora de KPC-3. Detección por MALDI-TOF / Interhospital dissemination of KPC-3 producing-Klebsiella pneumoniae ST512. Detection by MALDI-TOF

Introducción/Objetivo: Describir un brote por Klebsiella pneumoniae (KPN) productora de KPC-3 y determinar la eficacia diagnóstica de MALDI-TOF en su detección. Métodos: Estudio retrospectivo de las KPN-KPC-3 aisladas en 2 hospitales de Ciudad Real. Se buscó el pico a 11,109kDa±15 en el espectro proporcionado por MALDI-TOF para KPN. Resultados: Se aislaron 156 cepas de KPN que portaban el gen blaKPC-3, con un único perfil perteneciente al ST512 (31 cepas estudiadas). Hubo un 25% de infectados. Un 84% tuvieron origen nosocomial o relacionado con la asistencia sanitaria. El 93% tenía alguna enfermedad de base (31% de exitus en el primer mes). La detección del pico mostró una sensibilidad del 90% y una especificidad del 100%. Conclusiones: Detectamos la diseminación clonal de una cepa de KPN ST512 productora de KPC-3 en 3 hospitales de Ciudad Real. Además, evidenciamos la rentabilidad de MALDI-TOF en la detección precoz de KPN-KPC.(AU)

Introduction/Objective: To describe an outbreak of KPC-3-producing Klebsiella pneumoniae (KPN) and determine the diagnostic efficacy of MALDI-TOF in its detection. Methods: Retrospective study of the KPC-3-KPN isolated in 2 hospitals in Ciudad Real. The peak at 11,109kDa±15 was sought in the KPN spectra provided by MALDI-TOF. Results: We isolated 156 KPN strains that carried the blaKPC-3 gene, with a unique profile belonging to ST512 (31 strains studied). There was 25% of infected patients, 84% were nosocomial or related to health care and 93% had some underlying disease (31% of exitus in the first month). The detection of the peak showed 90% sensitivity and 100% specificity. Conclusions: We detected the clonal spread of a KPN ST512 strain producing KPC-3 in 3 hospitals in Ciudad Real. In addition, we show the profitability of MALDI-TOF in the early detection of KPC-KPN.

Interhospital dissemination of KPC-3 producing-Klebsiella pneumoniae ST512. Detection by MALDI-TOF. / Diseminación interhospitalaria de Klebsiella pneumoniae ST512 productora de KPC-3. Detección por MALDI-TOF.

INTRODUCTION/OBJECTIVE: To describe an outbreak of KPC-3-producing Klebsiella pneumoniae (KPN) and determine the diagnostic efficacy of MALDI-TOF in its detection. METHODS: Retrospective study of the KPC-3-KPN isolated in 2 hospitals in Ciudad Real. The peak at 11,109kDa±15 was sought in the KPN spectra provided by MALDI-TOF. RESULTS: We isolated 156 KPN strains that carried the blaKPC-3 gene, with a unique profile belonging to ST512 (31 strains studied). There was 25% of infected patients, 84% were nosocomial or related to health care and 93% had some underlying disease (31% of exitus in the first month). The detection of the peak showed 90% sensitivity and 100% specificity. CONCLUSIONS: We detected the clonal spread of a KPN ST512 strain producing KPC-3 in 3 hospitals in Ciudad Real. In addition, we show the profitability of MALDI-TOF in the early detection of KPC-KPN.

Evaluación económica de la implantación del autoanalizador Alfred 60/AST de detección de crecimiento bacteriano con sembrador automático / Economic evaluation of the Alfred 60/AST device implantation for bacterial growth detection with automatic sewing machine

Introducción: En los laboratorios de microbiología se impone cada vez más utilizar sistemas de cribado automatizados para descartar las orinas negativas. Nuestro objetivo fue estimar el umbral presupuestario a partir del cual el autoanalizador Alfred-60/AST sería rentable para nuestro hospital. Material y métodos: Estudio de minimización de costes mediante árboles de decisión, realizado en un Hospital General. Se comparó el coste del urocultivo tradicional con el procesamiento automático mediante Alfred-60/AST. El procesamiento tradicional supone el cultivo manual de todas las orinas recibidas en agar sangre y MacConkey e identificación de todos los microorganismos aislados con el sistema Vitek-2. El autoanalizador sembraría solo las orinas positivas en un medio cromogénico que identificaría directamente los aislamientos de Escherichia coli. Resultados: Las variables con mayor impacto económico en el modelo fueron la probabilidad de obtener un cultivo positivo, la prevalencia de E. coli en los urocultivos y el coste por muestra del sembrador. El análisis de sensibilidad multivariante mostró que el modelo es sólido. El análisis de sensibilidad bivariable mostró que el modelo es sensible a la modificación de los costes, principalmente del sembrador automático. A un valor umbral de 1,40 euros por determinación, el procesamiento automático reduciría los costes anuales en 2.879 euros. Conclusión: La introducción del autoanalizador Alfred-60/AST en nuestro laboratorio a un precio de 1,40 euros por determinación reduciría la carga de trabajo en el procesamiento de orinas, ahorrando tiempo y costes

Introduction: It is becoming increasingly necessary to automatize screening of urine samples to culture at Microbiology laboratories. Our objective was to estimate the budget threshold from which the Alfred 60/AST device would be profitable for our hospital. Material and methods: Cost minimization study by decision trees, carried out in a General Hospital. The cost of traditional urine culture and urine processing using Alfred-60/AST were compared. Traditional processing involves the culture of all urine specimens received onto blood and MacConkey agar, and identification of every microorganism isolated by Vitek-2 system. The autoanalyzer would only inoculate the positive urines onto a chromogenic media, directly identifying the Escherichia coli isolates. Results: The variables with the greatest economic impact in the model were the probability of obtaining a positive culture, the prevalence of E. coli in the urine cultures and the cost per sample using Alfred-60/AST. The multivariate sensitivity analysis showed that the model was solid. The bivariate sensitivity analysis showed that the model is suceptible to cost modification, mainly of the automatic device. At a threshold value of 1.40 euros/determination, the automatic processing would decrease the annual costs in 2,879 euros. Conclusion: The introduction of the Alfred-60/AST device in our laboratory at 1.40 euros/determination would reduce urine processing workload, saving time and costs

Tendencia y estacionalidad de las resistencias de Escherichia coli comunitarios y su relación dinámica con el consumo de antimicrobianos mediante modelos ARIMA / Trend and seasonality of community-acquired Escherichia coli antimicrobial resistance and its dynamic relationship with antimicrobial use assessed by ARIMA models

INTRODUCCIÓN: Estudiamos la tendencia y estacionalidad de las resistencias en Escherichia coli comunitario y se cuantifica su asociación con el uso previo de determinados antibióticos. MÉTODOS: Estudio de series temporales de las resistencias de aislados comunitarios de E. coli y su relación con el consumo de antibióticos en un área de primaria durante 2008-2012. La tendencia y estacionalidad de las resistencias se estudiaron mediante regresión de Poisson. RESULTADOS: Se observó un aumento significativo de la resistencia promedio de E. coli a cefalosporinas, nitrofurantoína y aminoglucósidos. La estacionalidad de las resistencias fue significativa en otoño-invierno para amoxicilina-ácido clavulánico y ciprofloxacino. Observamos un retardo de 7, 10 y 12 meses entre el consumo de cotrimoxazol (p < 0,038), fosfomicina (p < 0,024) y amoxicilina-ácido clavulánico (p < 0,015), respectivamente, y la aparición de resistencias. CONCLUSIONES: Detectamos un retardo medio de 10 meses entre la utilización de amoxicilina-ácido clavulánico, cotrimoxazol y fosfomicina, y la aparición de cepas resistentes de E. coli comunitarios

INTRODUCTION: We studied the trend and seasonality of community-acquired Escherichia coli resistance and quantified its correlation with the previous use of certain antibiotics. METHODS: A time series study of resistant community-acquired E. coli isolates and their association with antibiotic use was conducted in a Primary Health Care Area from 2008 to 2012. A Poisson regression model was constructed to estimate the trend and seasonality of E. coli resistance. RESULTS: A significant increasing trend in mean E. coli resistance to cephalosporins, aminoglycosides and nitrofurantoin was observed. Seasonal resistance to ciprofloxacin and amoxicillin-clavulanic acid was significantly higher in autumn-winter. There was a delay of 7, 10 and 12 months between the use of cotrimoxazole (P < 0.038), fosfomycin (P < 0.024) and amoxicillin-clavulanic acid (P < 0.015), respectively, and the occurrence of E. coli resistance. CONCLUSIONS: An average delay of 10 months between the previous use of amoxicillin-clavulanic acid, cotrimoxazole and fosfomycin and the appearance of resistant community-acquired E. coli strains was detected

Trend and seasonality of community-acquired Escherichia coli antimicrobial resistance and its dynamic relationship with antimicrobial use assessed by ARIMA models. / Tendencia y estacionalidad de las resistencias de Escherichia coli comunitarios y su relación dinámica con el consumo de antimicrobianos mediante modelos ARIMA.

INTRODUCTION: We studied the trend and seasonality of community-acquired Escherichia coli resistance and quantified its correlation with the previous use of certain antibiotics. METHODS: A time series study of resistant community-acquired E. coli isolates and their association with antibiotic use was conducted in a Primary Health Care Area from 2008 to 2012. A Poisson regression model was constructed to estimate the trend and seasonality of E. coli resistance. RESULTS: A significant increasing trend in mean E. coli resistance to cephalosporins, aminoglycosides and nitrofurantoin was observed. Seasonal resistance to ciprofloxacin and amoxicillin-clavulanic acid was significantly higher in autumn-winter. There was a delay of 7, 10 and 12 months between the use of cotrimoxazole (P<0.038), fosfomycin (P<0.024) and amoxicillin-clavulanic acid (P<0.015), respectively, and the occurrence of E. coli resistance. CONCLUSIONS: An average delay of 10 months between the previous use of amoxicillin-clavulanic acid, cotrimoxazole and fosfomycin and the appearance of resistant community-acquired E. coli strains was detected.

Nosocomial Candiduria in the Elderly: Microbiological Diagnosis.

Candiduria is associated with high morbidity, mortality, and long hospitalization, involving high costs for the healthcare system. The use of increasingly aggressive treatments has prolonged the lives of patients susceptible to candiduria, namely the immunosuppressed, the premature, and the elderly. Our objective was to evaluate the incidence of nosocomial candiduria and the implicated species in hospitalized patients aged over 80 years old from three Spanish centers during 2012 and 2013. Urine samples received from these patients were cultured and analyzed by flow cytometry in search of leukocyturia, hematuria, proteinuria, and microbial nitrate reductase activity. The isolated yeast species were identified microscopically, by germ tube formation in serum, colony morphology after subculture onto CHROMagar Candida (Becton-Dickinson, UK), assimilation of carbon compounds ID32C (bioMérieux, France), matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOF) (Bruker Daltonics, Germany) and, in case of inconsistency, by sequencing of the ITS regions of ribosomal DNA (ITS1-5, 8S-ITS2). Susceptibility tests were also performed. The incidence of candiduria in the elderly population was 10.3%. A total of 155 strains of yeasts were isolated. The predominant species was Candida albicans, followed by Candida glabrata and then Candida tropicalis. Several infrequent species were found; among them, the first isolate of candiduria-producing Candida pulcherrima described in the literature. Our finding should raise concerns about the elderly population, which is probably the most important risk group for candiduria in the present moment, and the emergence of unusual yeast species producing candiduria, which are resistant against the commonly used antifungal agents.

Urinary tract infection in the oldest old: a work overload for the microbiology laboratory / Infecciones del tracto urinario en los más mayores: una sobrecarga para el laboratorio de Microbiología

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Estudio de coste-efectividad del diagnóstico microbiológico de tuberculosis mediante geneXpert MTB/RIF(R) / Cost-effectiveness study of the microbiological diagnosis of tuberculosis using geneXpert MTB/RIF(R)

Introducción/Objetivo: Evaluar mediante un análisis de coste-efectividad la aplicación de una técnica de biología molecular al diagnóstico de tuberculosis frente a la alternativa diagnóstica clásica. Métodos: Se realizó un análisis de coste-efectividad para evaluar la aplicación teórica de un procedimiento de biología molecular que incluye 2 alternativas de una técnica para la detección precoz de Mycobacterium tuberculosis Complex y resistencia a rifampicina (alternativa1: una determinación a pacientes seleccionados; alternativa2: 2 determinaciones a todos los pacientes). Ambas alternativas se compararon con el procedimiento habitual de diagnóstico microbiológico de tuberculosis realizado a 1972 pacientes durante 2008-2012 (microscopia y cultivo). La medida de la efectividad se hizo en QALY y la incertidumbre se trató mediante análisis de sensibilidad univariable, multivariable y probabilístico. Resultados: Para el método habitual se obtuvo un valor de 8.588€/QALY. En la alternativa1 el gasto fue de 8.487€/QALY, mientras que en la alternativa2 el cociente coste-efectivo ascendió a 2.960€/QALY. La alternativa2 fue la de mayor eficiencia diagnóstica, alcanzando una reducción del 75% del número de días que un paciente con tuberculosis permanece sin tratamiento adecuado, así como una reducción del 70% del número de días que un paciente sin tuberculosis permanece ingresado. Conclusión: La aplicación de una técnica microbiológica molecular en el diagnóstico de tuberculosis es sumamente coste-efectiva frente al método habitual. Su introducción en el procedimiento diagnóstico de rutina supondría una mejora en la calidad asistencial de los pacientes al evitar ingresos y tratamientos innecesarios, reflejándose en un ahorro económico al hospital (AU)

Introduction/Objective: To perform a cost-effectiveness analysis of a molecular biology technique for the diagnosis of tuberculosis compared to the classical diagnostic alternative. Methods: A cost-effectiveness analysis was performed to evaluate the theoretical implementation of a molecular biology method including two alternative techniques for early detection of Mycobacterium tuberculosis Complex, and resistance to rifampicin (alternative1: one determination in selected patients; alternative2: two determinations in all the patients). Both alternatives were compared with the usual procedure for microbiological diagnosis of tuberculosis (staining and microbiological culture), and was accomplished on 1,972 patients in the period in 2008-2012. The effectiveness was measured in QALYs, and the uncertainty was assessed by univariate, multivariate and probabilistic analysis of sensitivity. Results: A value of €8,588/QALYs was obtained by the usual method. Total expenditure with the alternative1 was €8,487/QALYs, whereas with alternative2, the cost-effectiveness ratio amounted to €2,960/QALYs. Greater diagnostic efficiency was observed by applying the alternative2, reaching a 75% reduction in the number of days that a patient with tuberculosis remains without an adequate treatment, and a 70% reduction in the number of days that a patient without tuberculosis remains in hospital. Conclusion: The implementation of a molecular microbiological technique in the diagnosis of tuberculosis is extremely cost-effective compared to the usual method. Its introduction into the routine diagnostic procedure could lead to an improvement in quality care for patients, given that it would avoid both unnecessary hospitalisations and treatments, and reflected in economic savings to the hospital (AU)

Cost-effectiveness study of the microbiological diagnosis of tuberculosis using geneXpert MTB/RIF®. / Estudio de coste-efectividad del diagnóstico microbiológico de tuberculosis mediante geneXpert MTB/RIF®.

INTRODUCTION/OBJECTIVE: To perform a cost-effectiveness analysis of a molecular biology technique for the diagnosis of tuberculosis compared to the classical diagnostic alternative. METHODS: A cost-effectiveness analysis was performed to evaluate the theoretical implementation of a molecular biology method including two alternative techniques for early detection of Mycobacterium tuberculosis Complex, and resistance to rifampicin (alternative1: one determination in selected patients; alternative2: two determinations in all the patients). Both alternatives were compared with the usual procedure for microbiological diagnosis of tuberculosis (staining and microbiological culture), and was accomplished on 1,972 patients in the period in 2008-2012. The effectiveness was measured in QALYs, and the uncertainty was assessed by univariate, multivariate and probabilistic analysis of sensitivity. RESULTS: A value of €8,588/QALYs was obtained by the usual method. Total expenditure with the alternative1 was €8,487/QALYs, whereas with alternative2, the cost-effectiveness ratio amounted to €2,960/QALYs. Greater diagnostic efficiency was observed by applying the alternative2, reaching a 75% reduction in the number of days that a patient with tuberculosis remains without an adequate treatment, and a 70% reduction in the number of days that a patient without tuberculosis remains in hospital. CONCLUSION: The implementation of a molecular microbiological technique in the diagnosis of tuberculosis is extremely cost-effective compared to the usual method. Its introduction into the routine diagnostic procedure could lead to an improvement in quality care for patients, given that it would avoid both unnecessary hospitalisations and treatments, and reflected in economic savings to the hospital.

[Endogenous endophthalmitis: case report and brief review of a serious ocular disease]. / Endoftalmitis endógenas: revisión de una serie de casos y revaloración de una entidad ocular grave.

INTRODUCTION: Endogenous endophthalmitis (EE) is a prevalent but serious disease. Our aim was to describe cases of EE, with emphasis in the risk factors and the improvement of the prognosis. METHODS: A review of EE cases was done between 1996-2011 in a secondary care hospital in Spain. The reported variables were: comorbidities, isolated microorganisms, susceptibility to antimicrobial treatment and visual prognosis. RESULTS: 9 cases of EE were analyzed. All had some underlying disease, diabetes mellitus being the most frequent. Seven of the nine cases had a history of eye injury. Extraocular source of infection was identified in 7 cases, with predominantly gastrointestinal disease. Most microorganisms were isolated from blood cultures. The visual prognosis was unfavorable in five patients and was associated with virulent microorganisms and delayed treatment. CONCLUSIONS: EE is a rare disease that involve immunocompromised patients with ophthalmic disease. To improve prognosis, appropriate diagnosis and early treatment is require. Therefore, we recommend funduscopy examination in patients with sepsis, risk factors and prior history of ocular disease.

[Economic impact of the introduction of a technique for early detection of Mycobacterium tuberculosis Complex in clinical samples in a Spanish hospital]. / Impacto económico de la introducción de una técnica de detección precoz de Mycobacterium tuberculosis Complex en las muestras clínicas de un hospital español.

BACKGROUND: Tuberculosis (TB) remains an important public health problem worldwide. Our objective was to estimate the economic and health care impact of the introduction of an early diagnosis tecnique of TB, the Xpert MTB/RIF® assay (Xpert). METHODS: The savings was estimated on the basis of reduction in the time of TB hospitalization at avoid the false-negative (FN) and false-positive (FP) TB cases diagnosed by auramine staining that could have been detected by Xpert between 2008-2012 in our hospital. The costs analysis was made by adding the cost arising from FN (hospitalization, special tests and equipment for respiratory isolation) and FP (TB treatment, successive medical consultations, analytical and microbiological controls). RESULTS: We detected 19 FP and 22 FN during the 5-year study. Xpert would have detected 19 FP and 15 FN. It was estimated a minimum cost of 3217 euros per FP (treatment, successive medical consultations, analytical and microbiological controls), while each FN has required an extension of hospitalization from 7 days on average (62229 euros), both translated into a global cost of 62229 euros. After an initial investment of 16250 euros (50 cases with high suspicion of TB at 65 euros/test), the hospital would have saved 45979 euros overall in five years. CONCLUSIONS: The introduction of Xpert would improve the quality of health care of patients, avoiding both unnecessary hospitalizations and treatments. Also, Xpert carries a saving for our hospital.

Endoftalmitis endógenas: revisión de una serie de casos y revaloración de una entidad ocular grave / Endogenous endophthalmitis: case report and brief review of a serious ocular disease

Endogenous endophthalmitis (EE) is a prevalent but serious disease. Our aim was to describe cases of EE, with emphasis in the risk factors and the improvement of the prognosis. Methods: A review of EE cases was done between 1996-2011 in a secondary care hospital in Spain. The reported variables were: comorbidities, isolated microorganisms, susceptibility to antimicrobial treatment and visual prognosis. Results: 9 cases of EE were analyzed. All had some underlying disease, diabetes mellitus being the most frequent. Seven of the nine cases had a history of eye injury. Extraocular source of infection was identified in 7 cases, with predominantly gastrointestinal disease. Most microorganisms were isolated from blood cultures. The visual prognosis was unfavorable in five patients and was associated with virulent microorganisms and delayed treatment. Conclusions: EE is a rare disease that involve immunocompromised patients with ophthalmic disease. To improve prognosis, appropriate diagnosis and early treatment is require. Therefore, we recommend funduscopy examination in patients with sepsis, risk factors and prior history of ocular disease.

La endoftalmitis endógena (EE) es una patología poco prevalente aunque grave. Nuestro objetivo es describir los casos de EE diagnosticados en un hospital secundario español, con particular atención a los factores de riesgo y la posible mejora del pronóstico. Material y Métodos: Revisamos las historias clínicas de los pacientes diagnosticados de EE entre 1996-2011. Las variables recogidas fueron: co-morbilidades, microorganismo/s aislados y su susceptibilidad a los antimicrobianos, tratamiento administrado y pronóstico visual. Resultados: Se estudiaron nueve casos de EE. Todos presentaban alguna enfermedad de base, siendo diabetes mellitus la más frecuente. Siete de los nueve casos presentaron antecedentes de lesión ocular. La probable fuente extraocular se identificó en siete casos, predominando el foco gastrointestinal. La mayoría de microorganismos se aisló de hemocultivos. El pronóstico visual fue desfavorable en cinco pacientes, asociándose a microorganismos virulentos y al retraso terapéutico. Conclusiones: La EE es una enfermedad inusual que afecta a pacientes con inmunidad disminuida y antecedentes oftalmológicos. Para mejorar el pronóstico se requiere un diagnóstico acertado y un tratamiento precoz, todo un reto para médicos clínicos y microbiólogos. Por ello, recomendamos realizar un fondo de ojo a los pacientes con sepsis, factores de riesgo de EE y antecedentes de patología ocular.

Impacto económico de la introducción de una técnica de detección precoz de Mycobacterium tuberculosis complex en muestras clínicas de un hospital español / Economic impact of the introduction of a technique for early detection of mycobacterium tuberculosis complex in clinical samples in a Spanih hospital

Fundamentos: La tuberculosis (TB) continúa siendo un problema importante de salud pública a nivel mundial. El objetivo del estudio fue estimar el impacto económico y asistencial de la introducción de Xpert MTB/RIF® (Xpert), técnica de diagnóstico rápido de TB. Métodos: Se estimó el ahorro en base a la reducción del tiempo de ingreso por TB al evitar los falsos negativos (FN) y falsos positivos (FP) de la baciloscopia que se habrían detectado por Xpert en el periodo 2008-2012. El análisis y cálculo de gastos se hizo sumando el coste de los FN (estancias más pruebas especiales y aislamiento respiratorio) y los FP (tratamiento antituberculoso, consultas sucesivas, analíticas y controles microbiológicos). Resultados: Durante los 5 años de estudio se detectaron 19 FP y 22 FN. Xpert habría detectado los 19 FP y 15 FN. El gasto mínimo estimado para los FP fue de 3.217 euros (tratamiento, consultas sucesivas, analíticas y controles microbiológicos), mientras que cada FN supuso una prolongación de una estancia media de 7 días (59.012 euros), traducidos ambos en un coste total de 62.229 euros. Con una inversión inicial de 16.250 euros (50 casos con elevada sospecha de TB a 65 euros/prueba) el hospital habría ahorrado un global de 45.979 euros en 5 años. Conclusión: La introducción de Xpert supondría un ahorro económico para el hospital y una mejora en la calidad asistencial, evitando estancias y tratamientos innecesarios(AU)

Background: Tuberculosis (TB) remains an important public health problem worldwide. Our objective was to estimate the economic and health care impact of the introduction of an early diagnosis tecnique of TB, the Xpert MTB/RIF® assay (Xpert). Methods: The savings was estimated on the basis of reduction in the time of TB hospitalization at avoid the false-negative (FN) and false-positive (FP) TB cases diagnosed by auramine staining that could have been detected by Xpert between 2008-2012 in our hospital. The costs analysis was made by adding the cost arising from FN (hospitalization, special tests and equipment for respiratory isolation) and FP (TB treatment, successive medical consultations, analytical and microbiological controls). Results: We detected 19 FP and 22 FN during the 5-year study. Xpert would have detected 19 FP and 15 FN. It was estimated a minimum cost of 3217 euros per FP (treatment, successive medical consultations, analytical and microbiological controls), while each FN has required an extension of hospitalization from 7 days on average (62229 euros), both translated into a global cost of 62229 euros. After an initial investment of 16250 euros (50 cases with high suspicion of TB at 65 euros/test), the hospital would have saved 45979 euros overall in five years. Conclusions: The introduction of Xpert would improve the quality of health care of patients, avoiding both unnecessary hospitalizations and treatments. Also, Xpert carries a saving for our hospital(AU)

Sensibilidad a antimicrobianos de cepas de Staphylococcus aureus resistente a meticilina procedentes de pacientes ambulatorios / Antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus strains from outpatient individuals

Introducción: Cepas de Staphylococcus aureus resistente a meticilina de origen comunitario (SARM-C) han aparecido en todo el mundo como causa de infección en pacientes sin factores de riesgo. Estos SARM-C son diferentes de las cepas nosocomiales en su epidemiología, microbiología y manifestaciones clínicas. Describimos las características epidemiológicas y la resistencia a los antimicrobianos de todas las cepas SARM-C aisladas en el último trienio en el Laboratorio de Microbiología del Hospital General La Mancha Centro (Alcázar de San Juan, Ciudad Real). Métodos: Realizamos un análisis retrospectivo de los cultivos microbiológicos de los pacientes con S. aureus diagnosticados desde 2007 a 2009 en el Área Sanitaria La Mancha-Centro de la Comunidad de Castilla-La Mancha. Resultados: La distribución de SARM-C a lo largo de los años fue de 26 de un total de 97 aislamientos de S. aureus en 2007 (26,8%), 40/113 en 2008 (35,4%) y 57/157 en 2009 (36,3%). La proporción en infecciones de piel y tejidos blandos fue del 63,4%. El total de las cepas fue sensible a linezolid, quinupristina/ dalfopristina y glucopéptidos. La resistencia fue elevada frente a fluoroquinolonas (94,3%), eritromicina (87,0%), tobramicina (82,9%) y clindamicina (65,3%). Conclusiones: El porcentaje de aislados de SARM-C a lo largo del periodo de estudio experimentó un claro aumento. La mayor parte correspondió a muestras de infecciones de piel y partes blandas. Las resistencias a antimicrobianos más comúnmente asociadas fueron a fluoroquinolonas, eritromicina, tobramicina y clindamicina. El conocimiento de la epidemiología de SARM-C es importante para prevenir que estas cepas lleguen a ser endémicas en el mundo(AU)

Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged worldwide as a cause of infections among patients without risk factors. This CA-MRSA is different from nosocomial strains in terms of epidemiology, microbiology and clinical manifestations. We report the epidemiologic characteristics and resistance to antimicrobial agents of CA-MRSA strains isolated in the last three years in the Microbiology Lab of Hospital General La Mancha-Centro (Alcázar de San Juan, Ciudad Real). Methods: We performed a retrospective analysis of microbiological cultures in patients with S. aureus diagnosed from 2007 to 2009 in La Mancha-Centro Health-Care Area, within Castilla-La Mancha Community. Results: The distribution of CA-MRSA in the studied period was 26 out of a total of 97 S. aureus isolates in 2007 (26.8%), 40/113 in 2008 (35.4%) and 57/157 in 2009 (36.3%). The percentage from purulent skin and soft tissue infections was 63.4%. All strains were susceptible to linezolid, quinupristin/ dalfopristin, and glycopeptides. The resistance was high to fluoroquinolones (94.3%), erythromycin (87.0%), tobramycin (82.9%), and clindamycin (65.3%). Conclusions: CA-MRSA isolates percentage increased along the period of the study. The majority were obtained from skin and soft tissue specimens. The most commonly associated antimicrobial resistance was to fluoroquinolones, erythromycin, tobramycin and clindamycin. An understanding of the CAMRSA epidemiology is important to prevent these organisms from becoming endemic in the world(AU)