Evolución de la sepsis neonatal precoz por Streptococcus agalactiae en el área de Barcelona (2004-2010). Análisis de los fallos del cumplimiento del protocolo de prevención / Group B streptococcal early-onset neonatal sepsis in the area of Barcelona (2004-2010). Analysis of missed opportunities for prevention

OBJETIVOS: Estudiar la evolución de la incidencia de sepsis neonatal precoz (SNP) por Streptococcus agalactiae en el área de Barcelona y analizar los fallos de cumplimiento del protocolo de prevención. MÉTODOS: Se revisaron retrospectivamente todas las SNP en 8 centros sanitarios del área de Barcelona durante 2004-2010. RESULTADOS: Se diagnosticaron 49 SNP (48 gestantes). La incidencia fue de 0,29‰ recién nacidos vivos (0,18-0,47‰), presentando oscilaciones sin diferencias significativas a lo largo de los 7 años de estudio. La mortalidad fue del 8,16%. En el 68,5% los estudios de colonización maternos fueron negativos y en el 21% no se realizaron. El 58,3% de las gestantes no presentaron ningún factor de riesgo y el 22,9% de los partos fueron prematuros. El 58% de las gestantes no recibieron profilaxis antibiótica intraparto por no estar indicada según protocolo, y el 42%, por fallo de cumplimiento (3 cepas fueron resistentes a eritromicina). La resistencia a clindamicina fue del 33,3%. Los serotipos de Streptococcus agalactiae más frecuentes fueron el III, el V y el ia. CONCLUSIONES: No se han producido cambios significativos en la incidencia de SNP por Streptococcus agalactiae en los 7 años del estudio. El aumento de la sensibilidad de los métodos de cribado, las técnicas moleculares intraparto, la realización del antibiograma de las cepas de gestantes y la mayor comunicación entre los centros sanitarios pueden contribuir a una mejor aplicación del protocolo y a una reducción de la incidencia de SNP

OBJECTIVES: To study the evolution of the incidence of early-onset neonatal sepsis (EOS) by Streptococcus agalactiae in the area of Barcelona and to analyze failure of compliance with the prevention protocol. METHODS: A retrospective review was carried out on EOS cases in 8 Health-Care Centers in the Barcelona area between 2004 and 2010. RESULTS: Forty-nine newborns from 48 mothers were diagnosed with EOS. The incidence was 0.29‰ living newborns (0.18-0.47‰), with no significant differences in the fluctuations along the 7 years. The mortality rate was 8.16%. In 68.5% cases the maternal colonization studies were negative, and in 21% these studies were not performed. No risk factors were detected in 58.3% of pregnant women, and 22.9% of births were premature. In 58% of cases intra-partum antibiotic prophylaxis was not administered because it was not indicated, and in 42% due to failure to follow the protocol (3 strains were resistant to erythromycin). Resistance to clindamycin was 33.3%. The Streptococcus agalactiae serotypes more frequently isolated were III, V, and ia. CONCLUSIONS: No significant changes were detected in the incidence of Streptococcus agalactiae EOS in the 7 years of the study. The increased sensitivity of screening methods with the use of molecular techniques, the performance of susceptibility testing of strains isolated from pregnant women, and the improvement of communication between Health-Care Centers, can contribute to a better implementation of the protocol, as well as to reduce the incidence of EOS

[Group B streptococcal early-onset neonatal sepsis in the area of Barcelona (2004-2010). Analysis of missed opportunities for prevention]. / Evolución de la sepsis neonatal precoz por Streptococcus agalactiae en el área de Barcelona (2004-2010). Análisis de los fallos del cumplimiento del protocolo de prevención.

OBJECTIVES: To study the evolution of the incidence of early-onset neonatal sepsis (EOS) by Streptococcus agalactiae in the area of Barcelona and to analyze failure of compliance with the prevention protocol. METHODS: A retrospective review was carried out on EOS cases in 8 Health-Care Centers in the Barcelona area between 2004 and 2010. RESULTS: Forty-nine newborns from 48 mothers were diagnosed with EOS. The incidence was 0.29‰ living newborns (0.18-0.47‰), with no significant differences in the fluctuations along the 7 years. The mortality rate was 8.16%. In 68.5% cases the maternal colonization studies were negative, and in 21% these studies were not performed. No risk factors were detected in 58.3% of pregnant women, and 22.9% of births were premature. In 58% of cases intra-partum antibiotic prophylaxis was not administered because it was not indicated, and in 42% due to failure to follow the protocol (3 strains were resistant to erythromycin). Resistance to clindamycin was 33.3%. The Streptococcus agalactiae serotypes more frequently isolated were iii, v, and ia. CONCLUSIONS: No significant changes were detected in the incidence of Streptococcus agalactiae EOS in the 7 years of the study. The increased sensitivity of screening methods with the use of molecular techniques, the performance of susceptibility testing of strains isolated from pregnant women, and the improvement of communication between Health-Care Centers, can contribute to a better implementation of the protocol, as well as to reduce the incidence of EOS.

Antifungal activity of posaconazole against Candida spp. and non-Candida clinical yeasts isolates

Se ha determinado la actividad antifúngica in vitro de posaconazol frente a 315 aislamientos clínicos de levaduras y 11 cepas ATCC por medio de un método de difusión en agar (Neosensitabs, Rosco, Dinamarca) basado en el documento CLSI M44-A2. Posaconazol presentó una excelente actividad frente a las especies de Cryptococcus y Rhodotorula, como así también, frente a la mayoría de los aislamientos de Candida estudiados. Un total de 13 aislamientos (4,1%) resultaron resistentes: Candida albicans (n=5), Candida glabrata (n=5), Candida tropicalis (n=1), Geotrichum australiensis (n=1) y Geotrichum capitatum (n=1). Nuestros resultados sugieren que posaconazol es un efectivo agente antifúngico frente a las especies de levaduras de mayor relevancia clínica (92,7% de sensibilidad). La técnica de difusión en agar aporta buenas condiciones para la realización de estudios de sensibilidad al posaconazol en la rutina del laboratorio(AU)

The in vitro antifungal activity of posaconazole was tested against 315 yeast clinical isolates and 11 ATCC reference strains by means an agar diffusion method (Neosensitabs, Rosco, Denmark) based in CLSI M44-A2 document. Posaconazole activity was excellent against Cryptococcus and Rhodotorula species studied and showed very good activity against most species of Candida tested. A total of 13 clinical isolates (4.1%) were resistant: Candida albicans (n=5), Candida glabrata (n=5), Candida tropicalis (n=1), Geotrichum australiensis (n=1) and Geotrichum capitatum (n=1). Our results suggest posaconazole is an effective antifungal agent against the most clinically important yeasts species (92.7% of susceptibility). Agar diffusion method provides good conditions for the posaconazole susceptibility study in the routine laboratory(AU)

Terbinafine susceptibility patterns for onychomycosis-causative dermatophytes and Scopulariopsis brevicaulis.

The in vitro antifungal activity of terbinafine against 521 clinical isolates of seven species of dermatophytes, including four onychomycosis-causative species, as well as five Scopulariopsis brevicaulis isolates was determined by a modified Clinical and Laboratory Standards Institute microdilution method. Results showed a high antifungal activity of terbinafine against all dermatophyte isolates (geometric minimal inhibitory concentration (MIC)=0.026 microg/mL; concentration inhibiting 50% of mycological growth (MIC50)=0.03 microg/mL; and concentration inhibiting 90% of mycological growth (MIC90)=0.06 microg/mL). The geometric mean MICs against onychomycosis-causative dermatophyte species was lower (0.024 microg/mL) than the global MIC. However, the in vitro activity of terbinafine against S. brevicaulis was considerably lower (geometric mean MIC=1.38 microg/mL) in comparison with dermatophytes. The antifungal activity of itraconazole was lower than that of terbinafine against these fungi. These data confirm the high in vitro antifungal activity of terbinafine against dermatophytes, under standardised conditions.

[Decreasing incidence of perinatal group B streptococcal disease (Barcelona 1994-2002). Relation with hospital prevention policies]. / Declive de la incidencia de la sepsis perinatal por estreptococo del grupo B (Barcelona 1994-2001). Relación con las políticas profilácticas.

INTRODUCTION: To analyze the incidence of perinatal sepsis due to group B streptococcus (GBS) as related to compliance with recommendations for its prevention issued by the Catalan Societies for Obstetrics, for Pediatrics, and for Infectious Diseases and Clinical Microbiology in 1997. METHODS: The study was conducted from 1994 to 2001 in 10 Barcelona-area hospitals, where 157,848 live infants were born. RESULTS: GBS disease was diagnosed in 129 neonates. Incidence decreased by 86.1% over the study period, from 1.92 cases per 1000 live births in 1994 to 0.26 per 1000 in 2001 (p < 0.001). Changes in the characteristics of perinatal GBS disease were observed in the 18 cases diagnosed in the last 3 years, the time when prevention policies were operative. The incidence was lower (0.28 per 1000 vs. 1.19 for the previous 5 years, p <.00006), the proportion of mothers without risk factors was greater (77.8% vs. 55.9%, p 5 0.009), and premature neonates were not affected (0% vs. 12.6%, p 5 0.003); nevertheless, mortality was similar (5.5% vs. 4.5%, p 5 0.8). Among these 18 cases of sepsis, 9 can be considered failures inherent to the prevention policy and 9 failures of compliance. Only 3 hospitals had prevention policies in 1994, whereas all 10 used intrapartum prophylaxis based on screening results in 2001. CONCLUSIONS: A substantial decrease in the incidence of perinatal GBS disease coinciding with the application of prevention measures for this pathology has been registered in 10 participating hospitals over the 1994-2001 period.

Declive de la incidencia de la sepsis perinatal por estreptococo del grupo B (Barcelona 1994-2001).Relación con las políticas profilácticas / Decreasing incidence of perinatal group B streptococcal disease (Barcelona 1994-2002). Relation with hospital prevention policies

INTRODUCCIÓN. Analizar la incidencia de la sepsis perinatal por estreptococo del grupo B (EGB) y relacionarla con la aplicación de las recomendaciones de prevención consensuadas en 1997 por las sociedades catalanas de Obstetricia, Pediatría y Enfermedades Infecciosas y Microbiología Clínica. MÉTODOS. El estudio se realizó desde 1994 a 2001 y en él participaron 10 hospitales del área de Barcelona, donde se registraron 157.848 nacidos vivos. RESULTADOS. Fueron diagnosticados 129 recién nacidos de sepsis perinatal por EGB. La incidencia disminuyó el 86,1 por ciento, desde el 1,92/1.000 nacidos vivos en 1994 hasta el 0,26/1.000 en 2001 (p < 0,001). Las características de la sepsis perinatal por EGB son distintas en los 18 casos diagnosticados en los últimos 3 años, cuando las políticas profilácticas estaban consolidadas, puesto que su incidencia es menor (0,28/1.000 frente al 1,19 de los 5 años anteriores, p < 0,00006), el porcentaje de madres sin factores de riesgo es mayor (77,8 por ciento frente a 55,9 por ciento, p 0,009), no afecta a prematuros (0 por ciento frente a 12,6 por ciento, p 0,003), siendo similar la mortalidad (5,5 por ciento frente a 4,5 por ciento, p 0,8). De estas 18 sepsis, 9 podrían considerarse fallos inherentes a la política profiláctica y 9 fallos en la cumplimentación de ésta. En 1994, sólo 3 hospitales practicaban políticas de prevención mientras que en 2001 los diez utilizan profilaxis intraparto basada en estudio de colonización. CONCLUSIONES. En 8 años se ha conseguido una importante disminución de la incidencia de sepsis perinatal por EGB, coincidiendo con la aplicación de protocolos de prevención de esta patología (AU)