Quantification and Progress Over Time of Specific Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2 in Breast Milk of Lactating Women Vaccinated With BNT162b2 Pfizer-BioNTech Coronavirus Disease 2019 Vaccine (LacCOVID).

Background: Several observational studies demonstrated the passage of postvaccine antibodies through breast milk in women vaccinated against coronavirus disease 2019 (COVID-19), mostly with messenger RNA (mRNA)-based vaccines, but lacked long-term data. Methods: A 6-month prospective cohort study was performed to determine severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-induced antibody levels in the breast milk of 33 lactating healthcare workers at different timepoints after mRNA BNT162b2 Pfizer-BioNTech COVID-19 vaccination. Moreover, we examined the correlation of SARS-CoV-2 antibody levels between serum and breast milk, adverse events related to vaccination, and rate of SARS-CoV-2 infections. Results: Mothers' median age was 38 (interquartile range [IQR], 36-39) years and 15 (IQR, 10-22) months for infants. Median (IQR) SARS-CoV-2 immunoglobulin G (IgG) spike protein subunit S1 (S1) vaccine-induced levels at different timepoints for serum-milk pairs were 519 (234-937) to 1 (0-2.9) arbitrary units (AU)/mL at 2 weeks after first dose and 18 644 (9923-29 264) to 78 (33.7-128), 12 478 (6870-20 801) to 50.4 (24.3-104), 4094 (2413-8480) to 19.9 (10.8-51.9), 1350 (831-2298) to 8.9 (7.8-31.5) AU/mL at 2, 4, 12 and 24 weeks after second dose, respectively. We observed a positive correlation of antibody levels between serum and breast milk, no serious adverse events related to vaccination, and 2 (6%) COVID-19 vaccine breakthrough infections. Conclusions: Women vaccinated with Pfizer-BioNTech transmit antibodies into breast milk with a positive correlation with serum levels. Both decreased over time in a 6-month follow-up.

Risk Factors of DAIR Failure and Validation of the KLIC Score: A Multicenter Study of Four Hundred Fifty-Five Patients.

Background: Debridement, antibiotic agents, and implant retention (DAIR) is a currently accepted approach for the treatment of early prosthetic joint infections (PJI). The success of a DAIR procedure has shown variable results throughout the published literature. Scoring systems such as the Kidney, Liver, Index surgery, Cemented prosthesis, and C-reactive protein value (KLIC) score for the selection of patients that are likely to benefit from DAIR have proved to be helpful in decision making. Our study aims to further validate the KLIC score using a large external multicentric cohort and to evaluate other risk factors for failure. Patients and Methods: A retrospective analysis of patients with an early acute PJI who were treated with DAIR and recorded in a database of eight Spanish university hospitals was performed. According to pre-operative variables of the KLIC study, patients were categorized into five groups: group A, ≤2 points; group B, 2.5-3.5 points; group C, 4-5 points; group D, 5.5-6.5 points; and group E, ≥7 points. Failure rates were compared between groups at 60 days and after 60 days of DAIR. Further variables for risk of failure were also analyzed. Results: A total of 455 patients with early acute PJI were included in the analyses. At 60 days, patients presenting with pre-operative elevated C-reactive protein serum levels, Staphylococcus aureus, and polymicrobial infections were associated with failure. Failure rates recorded were 12% for group A (n = 210), 18% for group B (n = 83), 26% for group C (n = 89), 24% for group D (n = 66), and 0% for group E (n = 7). Univariable analysis between consecutive groups of the KLIC score showed no differences for failure before 60 days of the DAIR procedure. Scheduled surgery and having the procedure performed by a specialized unit were also identified as important factors for DAIR success. Conclusions: Our results suggest the KLIC score was not useful for predicting failure in our cohort. Furthermore, our results indicate a specialized unit should conduct DAIR procedures.

Clinical and Economic Impact of Community-Onset Urinary Tract Infections Caused by ESBL-Producing Klebsiella pneumoniae Requiring Hospitalization in Spain: An Observational Cohort Study.

Objective: To analyze the clinical and economic impact of community-onset urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae requiring hospitalization. Methods: A retrospective cohort study that included all adults with a UTI caused by K. pneumoniae that were admitted to a tertiary care hospital in Barcelona, Spain, between 2011 and 2015. Demographic, clinical, and economic data were analyzed. Results: One hundred and seventy-three episodes of UTIs caused by K. pneumoniae were studied; 112 were non-ESBL-producing and 61 were ESBL-producing. Multivariate analysis identified ESBL production, acute confusional state associated with UTI, shock, and the time taken to obtain adequate treatment as risk factors for clinical failure during the first seven days. An economic analysis showed differences between ESBL-producing and non-ESBL-producing K. pneumoniae for the total cost of hospitalization per episode (mean EUR 6718 vs EUR 3688, respectively). Multivariate analysis of the higher costs of UTI episodes found statistically significant differences for ESBL production and the time taken to obtain adequate treatment. Conclusion: UTIs caused by ESBL-producing K. pneumoniae requiring hospitalization and the time taken to obtain adequate antimicrobial therapy are associated with worse clinical and economic outcomes.

Impact of an antimicrobial stewardship program on urinary tract infections caused by extended-spectrum Beta-lactamase-producing Escherichia coli / Impacto de un programa de optimización de antimicrobianos en infecciones urinarias por Escherichia coli productor de Beta-lactamasas de espectro extendido

Objective. To analyze the clinical and economic impact of an antimicrobial stewardship program (ASP) targeting urinary tract infections (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. Methods. An observational retrospective study that included adults with a diagnosis of UTI caused by ESBL-producing E. coli admitted to a tertiary care hospital in Barcelona, Spain, between January 2014 and December 2015. The impact of the ASP was analyzed in terms of clinical and economic outcomes. Results. A total of 222 patients met the inclusion criteria and an intervention was made by the ASP team in 104 cases (47%). ASP intervention was an independent variable related to clinical cure (p = 0.008). Other variables influencing clinical outcomes were the McCabe Jackson score (p = 0.005) and outpatient status (p < 0.001). The ASP interventions in this study had no economic impact. Conclusion. Antimicrobial stewardship has a positive clinical impact on UTIs caused by ESBL-producing E. coli. Further prospective studies are needed to assess the economic impact of ASPs on UTI caused by ESBL-producing E. col

Objetivo. Analizar el impacto clínico y económico de un Programa de Optimización de Antimicrobianos (PROA) en las infecciones del tracto urinario (ITU) causadas por Escherichia coli productor de β-lactamasas de espectro extendido (BLEE). Métodos. Estudio observacional retrospectivo que incluye adultos con ITU por E. coli BLEE diagnosticados en un hospital terciario en Barcelona, España, entre enero de 2014 y diciembre de 2015. El impacto del PROA se analizó en términos de evolución clínica y consumo de recursos sanitarios. Resultados. Se incluyeron un total de 222 pacientes, de los cuales se realizó algún tipo de intervención por parte del equipo de PROA en 104 casos (47%). La intervención del PROA resultó ser una variable independiente relacionada con la curación clínica (p = 0,008). Otras variables relacionadas con la evolución clínica fueron la clasificación de McCabe Jackson (p = 0,005) y el manejo ambulatorio (p < 0,001). Las intervenciones del PROA no demostraron tener un impacto económico en este estudio. Conclusión. Las intervenciones de los PROA tienen un impacto positivo en la evolución clínica de los pacientes con ITU por E. coli productor de BLEE. Se necesitan más estudios prospectivos para determinar el impacto económico de los PROA en las ITU por E. coli productor de BLEE

Infección y enfermedad tuberculosa en relación con concentraciones plasmáticas de vitamina D / Tuberculosis: Plasma levels of vitamin D and its relation with infection and disease

Fundamento y objetivo: La vitamina D (vitD) interviene en el metabolismo fosfocálcico y la enfermedad ósea, pero también en procesos inflamatorio-infecciosos como la tuberculosis. En el presente estudio se evalúan aspectos clínicos y epidemiológicos de enfermos e infectados por Mycobacterium tuberculosis en quienes se obtuvieron concentraciones plasmáticas de vitD para determinar si existe relación entre el déficit de vitD y el riesgo de desarrollar tuberculosis activa, especialmente las formas más graves. Método: Estudio observacional retrospectivo que incluyó a 86 pacientes con tuberculosis activa y 80 contactos con infección latente, visitados en una unidad especializada, en un período de 2 años. Resultados: Al comparar enfermos con infectados, el déficit de vitD (valores de vitD < 10 ng/ml; odds ratio [OR] 2,02; intervalo de confianza del 95% [IC 95%] 1,04-3,93), el sexo varón (OR 1,9; IC 95% 0,96-3,71) y la raza no caucásica (OR 0,7; IC 95% 0,34-1,42) fueron los factores independientemente asociados al diagnóstico de tuberculosis. Conclusión: A pesar del limitado número de sujetos estudiados, se ha detectado una asociación entre el déficit grave de vitD y la forma de presentación de la tuberculosis (AU)

Background and objective: Vitamin D (vitD) is involved in the phosphor-calcium metabolism and bone pathology, but also in inflammatory and infectious processes such as tuberculosis. The present study evaluates the clinical and epidemiological aspects of active tuberculosis cases and latently infected contacts in whom plasma concentrations of vitD were obtained to determine whether the deficiency of vitD is a risk factor to develop active tuberculosis, especially the more severe forms. Method: Observational, retrospective study that included 86 tuberculosis patients and 80 contacts with latent infection in a 2-year period. Results: When comparing active tuberculosis cases with latent infection contacts, deficiency of vitD (vitD levels <10 ng/mL, odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.04 to 3.93), male sex (OR: 1.9, 95% CI: 0.96 to 3.71) and non-white race (OR: 0.7, 95% CI: 0.34 to 1.42) were factors independently associated with the diagnosis of tuberculosis. Conclusion: Despite the limited number of subjects studied, there was a association between severe deficit of vitD and the presentation of tuberculosis (AU)

[Tuberculosis: plasma levels of vitamin D and its relation with infection and disease]. / Infección y enfermedad tuberculosa en relación con concentraciones plasmáticas de vitamina D.

BACKGROUND AND OBJECTIVE: Vitamin D (vitD) is involved in the phosphor-calcium metabolism and bone pathology, but also in inflammatory and infectious processes such as tuberculosis. The present study evaluates the clinical and epidemiological aspects of active tuberculosis cases and latently infected contacts in whom plasma concentrations of vitD were obtained to determine whether the deficiency of vitD is a risk factor to develop active tuberculosis, especially the more severe forms. METHOD: Observational, retrospective study that included 86 tuberculosis patients and 80 contacts with latent infection in a 2-year period. RESULTS: When comparing active tuberculosis cases with latent infection contacts, deficiency of vitD (vitD levels <10 ng/mL, odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.04 to 3.93), male sex (OR: 1.9, 95% CI: 0.96 to 3.71) and non-white race (OR: 0.7, 95% CI: 0.34 to 1.42) were factors independently associated with the diagnosis of tuberculosis. CONCLUSION: Despite the limited number of subjects studied, there was a association between severe deficit of vitD and the presentation of tuberculosis.