Risk factors for antibiotic-resistant bacteria colonisation in children with chronic complex conditions.

To assess drug-resistant bacterial colonisation rates and associated risk factors in children with complex chronic conditions admitted to a national reference unit in Spain. Cross-sectional study that included all children admitted to our unit from September 2018 to July 2019. Rectal swabs were obtained to determine multidrug-resistant Gram-negative bacilli (MR-GNB) colonisation, and nasal swab to determine S. aureus and methicillin-resistant S. aureus (MRSA) colonisation. Medical records were reviewed. 100 children were included, with a median of four complex chronic conditions. Sixteen percent had S. aureus colonisation, including two MRSA. S. aureus colonisation was associated with technology-dependent children, while being on antibiotic prophylaxis or having undergone antibiotic therapy in the previous month were protective factors. The prevalence of MR-GNB colonisation was 27%, which was associated with immunosuppressive therapy (aOR 31; 2.02-47]; p = 0.01), antibiotic prophylaxis (aOR 4.56; 1.4-14.86; p = 0.012), previously treated skin-infections (aOR 2.9; 1.07-8.14; p = 0.03), surgery in the previous year (aOR 1.4; 1.06-1.8; p = 0.014), and hospital admission in the previous year (aOR 1.79; [1.26-2.56]; p = 0.001). The rate of S. aureus nasal colonisation in this series was not high despite the presence of chronic conditions, and few cases corresponded to MRSA. Antibiotic prophylaxis, immunosuppressive therapies, history of infections, previous surgeries, and length of admission in the previous year were risk factors for MR-GNB colonisation.

Characterization of methicillin-resistant Staphylococcus aureus strains colonizing the nostrils of Spanish children.

OBJECTIVE: To characterize the Staphylococcus aureus strains colonizing healthy Spanish children. METHODS: Between March and July 2018, 1876 Spanish children younger than 14 years attending primary healthcare centers were recruited from rural and urban areas. Staphylococcus aureus colonization of the anterior nostrils was analyzed. MecA and mecC genes, antibiotic susceptibility, and genotyping according to the spa were determined in all strains, and the following toxins were examined: Panton-Valentine leucocidin (pvl), toxic shock syndrome toxin (tst), and exfoliative toxins (eta, etb, etd). Multilocus sequence typing (MLST) and staphylococcal cassette chromosome (SCCmec) typing were performed on methicillin-resistant Staphylococcus aureus (MRSA) strains, as well as pulsed-field gel electrophoresis (PFGE). RESULTS: 619 strains were isolated in 1876 children (33%), and 92% of them were sent for characterization to the Spanish National Centre of Microbiology (n = 572). Twenty (3.5%) of these strains were mecA-positive. Several spa types were detected among MRSA, being t002 the most frequently observed (30%), associating with SCCmec IVc. Among MSSA, 33% were positive for tst, while only 0.73% were positive for pvl. The 20 MRSA strains were negative for pvl, and 6 (30%) harbored the tst gene. CONCLUSIONS: methicillin-resistant Staphylococcus aureus nasal colonization in Spanish children is rare, with t002 being the most observed spa type, associated with SCCmec IVc. None of the MRSA strains produced pvl, but up to 30% of S. aureus strains were positive for tst.

Staphylococcus aureus Nasal Colonization in Spanish Children. The COSACO Nationwide Surveillance Study.

OBJECTIVE: To assess the prevalence and risk factors for S. aureus and methicillin-resistant S. aureus (MRSA) nasal colonization in Spanish children. METHODS: Cross-sectional study of patients <14 years from primary care centers all over Spain. Clinical data and nasal aspirates were collected from March to July 2018. RESULTS: A total of 1876 patients were enrolled. Prevalence of S. aureus and MRSA colonization were 33% (95% CI 30.9-35.1) and 1.44% (95% CI 0.9-2), respectively. Thirty-three percent of the children (633/1876) presented chronic conditions, mainly atopic dermatitis, asthma and/or allergy (524/633). Factors associated with S. aureus colonization were age ≥5 years (OR 1.10, 95% CI 1.07-1.12), male sex (OR 1.43, 95% CI 1.17-1.76), urban setting (OR 1.46, 95% CI 1.08-1.97) and the presence of asthma, atopic dermatitis or allergies (OR 1.25; 95% CI: 1.093-1.43). Rural residence was the only factor associated with MRSA colonization (OR 3.62, 95% CI 1.57-8.36). MRSA was more frequently resistant than methicillin-susceptible S. aureus to ciprofloxacin [41.2% vs 2.6%; p<0.0001], clindamycin [26% vs 16.9%; p=0.39], and mupirocin [14.3% vs 6.7%; p=0.18]. None of the MRSA strains was resistant to tetracycline, fosfomycin, vancomycin or daptomycin. CONCLUSIONS: The main risk factors for S. aureus colonization in Spanish children are being above five years of age, male gender, atopic dermatitis, asthma or allergy, and residence in urban areas. MRSA colonization is low, but higher than in other European countries and is associated with rural settings.

Evaluation of the SAMe-TT2R2 score to predict the quality of anticoagulation control in a cohort of patients with venous thromboembolism treated with vitamin K antagonists.

OBJECTIVE: The SAMe-TT2R2 score has been recently proposed to predict the quality of anticoagulation control in patients with atrial fibrillation treated with vitamin K antagonists (VKA). We aimed at calculating this score in a cohort of patients with Venous Thromboembolism (VTE) and determine its usefulness. METHODS: We included all consecutive patients with VTE treated with VKA for >90days. We collected all variables included in the score (female sex, age<60years, medical history [>2 comorbidities], treatment [interacting drugs: e.g. amiodarone], tobacco [doubled], race [doubled]) and analyzed the relationship between the SAMe-TT2R2 score and time in therapeutic range (TTR), determined by the Rosendaal method and by the percentage of INR determinations (after excluding the first month). RESULTS: 135 patients were treated with VKA for >90days, with a median TTR 65%. No differences in INR controls within range were found between patients with score 0-1 vs ≥2 (64.7±19.5% vs 66.0±20.5%, p=0.728). No differences were found in INR controls above (21.5±18.1% vs 21.2±21.3%, p=0.605) or below (3.9±14% vs 2.9±15.9%, p=0.517) the therapeutic range. CONCLUSION: The SAMe-TT2R2 score is not useful to predict quality of anticoagulation control in patients with VTE treated with VKA.