Results of a multi-faceted educational intervention to prevent peripheral venous catheter-associated bloodstream infections.

Peripheral venous catheter-associated bloodstream infections (PVC-BSIs) lead to prolonged hospitalization, morbidity and increased costs. The impact of infection-prevention measures on the rate of PVC-BSIs in a university hospital in Spain was assessed. An active surveillance programme was initiated in 2015, which revealed a high PVC-BSI incidence ratio (0.48/1000 patient-days). A bundle aimed at nurses, medical staff and patients was implemented, and a Catheter Infection Team (CIT) was set up. The intervention achieved a decrease in PVC-BSI rate: 0.34 in 2016, 0.29 in 2017, and 0.17 in 2018. The decline was greatest for Gram-negative PVC-BSIs (67.6% in 2015, 35.3% in 2018).

Sífilis en hombres que tienen sexo con hombres: una alarma para la detección de infección por VIH / Syphilis in Men Who Have Sex With Men: A Warning Sign for HIV Infection

OBJETIVOS: Describir las características clinicoepidemiológicas de la sífilis en la población de hombres que tienen sexo con hombres en un área de Mallorca. MÉTODOS: Revisión retrospectiva de los casos de sífilis en pacientes hombres que tienen sexo con hombres (HSH) entre enero de 2005 y junio de 2013 en un hospital de Mallorca. RESULTADOS: Encontramos 55 casos de sífilis en HSH, el 34,3% de los casos de sífilis del periodo de estudio. El 74,5% tenían coinfección por el virus de la inmunodeficiencia humana (VIH). El 70,7% de los diagnósticos de infección por VIH y sífilis fueron simultáneos. Los pacientes con infección por VIH tenían una mediana de CD4 de 456 (29-979). Se diagnosticaron por clínica el 49,1% y por cribado el 50,9% de los casos. La sífilis latente tardía o indeterminada fue la entidad más frecuente (41,9%). Los pacientes HSH tenían más riego de estar infectados por VIH que los varones no HSH. CONCLUSIONES: La mayoría de pacientes HSH con sífilis presentan coinfección por el VIH, siendo por lo tanto fundamental el cribado de VIH en estos pacientes, lo que incluso puede permitir un diagnóstico temprano de la misma

OBJECTIVE: To describe the clinical and epidemiological characteristics of syphilis in men who have sex with men (MSM) in an area of Mallorca, Spain. METHODS: We performed a retrospective analysis of syphilis cases in MSM seen at a hospital in Mallorca between January 2005 and June 2013. RESULTS: Fifty-five cases of syphilis were recorded in MSM during the study period (34.3% of all cases diagnosed), and 74.5% of these patients had human immunodeficiency virus (HIV) coinfection. The two diseases had been diagnosed simultaneously in 70.7% of this population. Patients with HIV coinfection had a median CD4 count of 456cells/μL (range, 29-979 cells/μL). Syphilis was diagnosed clinically in 49.1% of cases and by screening in the remaining 50.9%. The most common form of syphilis was late latent or indeterminate syphilis (41.9% of cases). In the group of men with syphilis, MSM had a higher risk of HIV infection. CONCLUSIONS: A majority of MSM with syphilis had HIV coinfection. HIV screening is therefore essential in this population and could even result in early diagnosis

Syphilis in Men Who Have Sex With Men: A Warning Sign for HIV Infection.

OBJECTIVE: To describe the clinical and epidemiological characteristics of syphilis in men who have sex with men (MSM) in an area of Mallorca, Spain. METHODS: We performed a retrospective analysis of syphilis cases in MSM seen at a hospital in Mallorca between January 2005 and June 2013. RESULTS: Fifty-five cases of syphilis were recorded in MSM during the study period (34.3% of all cases diagnosed), and 74.5% of these patients had human immunodeficiency virus (HIV) coinfection. The two diseases had been diagnosed simultaneously in 70.7% of this population. Patients with HIV coinfection had a median CD4 count of 456cells/µL (range, 29-979 cells/µL). Syphilis was diagnosed clinically in 49.1% of cases and by screening in the remaining 50.9%. The most common form of syphilis was late latent or indeterminate syphilis (41.9% of cases). In the group of men with syphilis, MSM had a higher risk of HIV infection. CONCLUSIONS: A majority of MSM with syphilis had HIV coinfection. HIV screening is therefore essential in this population and could even result in early diagnosis.

Espondilitis infecciosa en Baleares: análisis de 51 casos / Infectious spondylitis in the Balearic Islands: An analysis of 51 cases

Introducción: La espondilitis infecciosa (EI) es una entidad poco frecuente cuya incidencia ha aumentado en los últimos años. El objetivo de este estudio ha sido describir los casos con EI y realizar una comparación con el resto de series publicadas. Material y métodos: Estudio retrospectivo donde se describen datos epidemiológicos, microbiológicos y clínicos de los pacientes diagnosticados de EI durante un periodo de 10 años (2004-2014) en 2 hospitales de Mallorca. Resultados: Se incluyó un total de 51 pacientes, con una edad mediana de 66 años (rango 22-85). El 72,5% (37/51) fueron varones. El tiempo medio transcurrido desde el inicio de la clínica hasta el diagnóstico fue de 80,1 ± 125,1 días. En 36 ocasiones (70,6%) el origen fue hematógeno. El factor predisponente más frecuente fue presentar bacteriemia previa (10 [43,5%] de origen urinario). Presentaron fiebre 35 pacientes (68,8%), dolor 32 (62,7%), radiculalgia 14 (27,5%) y parálisis/paresia 10 (19,6%). La prueba diagnóstica más utilizada fue la resonancia magnética (46 [90,2%]), resultando patológica en todos los casos. El microorganismo etiológico más frecuente fue Staphylococcus aureus (23 [52,3%]). Los hemocultivos resultaron positivos en 27/41 ocasiones (65,8%) y la punción percutánea en 11/22 (50%). Veintitrés pacientes (45,1%) desarrollaron abscesos paravertebrales, epidurales o del psoas, 7 (13,7%) déficits neurológicos residuales y 6 (11,8%) dolor crónico. Un paciente (1,9%) falleció por motivos relacionados con la infección. Conclusiones: La EI es poco frecuente. Su origen usualmente es hematógeno. La bacteriemia previa es el factor predisponente más importante. El diagnóstico es habitualmente tardío, siendo Staphylococcus aureus el germen implicado con mayor frecuencia. La realización de punciones percutáneas acompañando a los hemocultivos aumenta la rentabilidad diagnóstica (AU)

Introduction: Vertebral osteomyelitis (VO) is a rare entity, although its incidence has increased in recent years. The objective is to describe the patients with this infection in our environment and a comparison with other published series. Methods: A retrospective review was conducted of epidemiological, clinical, microbiological, treatment, complications and evolution data of patients with VO during 10 years (2004-2014) in two hospitals of Mallorca. Results: 51 cases, median age 66 (range 22-85) years, 37 (72.5%) men with a mean onset of symptoms of 80.1 ± 125.1 days. In thirty-six (70.6%) cases the origin of infection was considered hematogenous, although previous bacteremia was documented in 23 (45%) cases, being of urinary in 10 (43.5%) cases. Clinically at the moment of diagnosis 35 (68.8%) had fever, 32 (62.7%) pain, 14 (27.5%) irradiated nerve pain and 10 (19.6%) paralysis/paresia. MRI was the most performed radiological test 46 (90.2%), being pathological in all cases. S. aureus 23 (52.3%) was the most common microbiological isolates. At the moment of the diagnosis, blood cultures were positive in 27 (65.8%) of 41 cases and 11 (50%) of 22 percutaneous puncture was positive. Paraspinal, epidural or psoas abscesses were observed in 23 (45.1%), neurological deficit in 7 (13.7%) and chronic pain in 6 (11.8%). One patient (1.9%) died in relation with infection. Conclusions: Diagnosis was delayed in most cases. Previous bacteremia being main predisposing factor and hematogenous origin the main source of infection. S. aureus was the most isolated. Percutaneous puncture together with blood cultures increase etiologic diagnosis. A high percentage of patients had complications or sequelae (AU)

Infectious spondylitis in the Balearic Islands: An analysis of 51 cases. / Espondilitis infecciosa en Baleares: análisis de 51 casos.

INTRODUCTION: Vertebral osteomyelitis (VO) is a rare entity, although its incidence has increased in recent years. The objective is to describe the patients with this infection in our environment and a comparison with other published series. METHODS: A retrospective review was conducted of epidemiological, clinical, microbiological, treatment, complications and evolution data of patients with VO during 10 years (2004-2014) in two hospitals of Mallorca. RESULTS: 51 cases, median age 66 (range 22-85) years, 37 (72.5%) men with a mean onset of symptoms of 80.1 ± 125.1 days. In thirty-six (70.6%) cases the origin of infection was considered hematogenous, although previous bacteremia was documented in 23 (45%) cases, being of urinary in 10 (43.5%) cases. Clinically at the moment of diagnosis 35 (68.8%) had fever, 32 (62.7%) pain, 14 (27.5%) irradiated nerve pain and 10 (19.6%) paralysis/paresia. MRI was the most performed radiological test 46 (90.2%), being pathological in all cases. S. aureus 23 (52.3%) was the most common microbiological isolates. At the moment of the diagnosis, blood cultures were positive in 27 (65.8%) of 41 cases and 11 (50%) of 22 percutaneous puncture was positive. Paraspinal, epidural or psoas abscesses were observed in 23 (45.1%), neurological deficit in 7 (13.7%) and chronic pain in 6 (11.8%). One patient (1.9%) died in relation with infection. CONCLUSIONS: Diagnosis was delayed in most cases. Previous bacteremia being main predisposing factor and hematogenous origin the main source of infection. S. aureus was the most isolated. Percutaneous puncture together with blood cultures increase etiologic diagnosis. A high percentage of patients had complications or sequelae.

Mannose-binding lectin exon 1 and promoter polymorphisms in tuberculosis disease in a Mediterranean area.

Mannose-binding lectin (MBL) is a serum protein that activates the complement and mediates phagocytosis. MBL levels and MBL2 genotype may impact upon host susceptibility to tuberculosis (TB) disease but evidence to date has been conflicting. MBL2 exon 1 and promoter genotyping and serum MBL concentrations were determined in 79 patients with active tuberculosis (58 pulmonary TB and 21 extrapulmonary or miliary TB) and 120 household healthy contacts (HHC) from a Mediterranean area (Majorca Island, Spain). Significantly higher serum MBL levels were found in patients with active tuberculosis than in HHC [median MBL concentrations 3430 ng mL(-1) (10-28 415) and 2600 ng mL(-1) (5-20 000) respectively, P = 0.002]. These higher MBL levels were mainly related to the most prevalent YA/YA wild-type diplotype. There was a strong correlation between MBL2 exon 1 and promoter genotype and MBL levels. The diplotype LYQA/HYPA was present in 12 out of 57 of the pulmonary TB cases but in none of the extrapulmonary TB patients. Diplotype LXPA/HYPA, producer of high levels of MBL, was significantly more frequent in HHC than in patients (16.8% vs. 6.4%, P = 0.031) suggesting a protective role against the development of TB disease that has not been previously found.

Enfermedad por Listeria monocytogenes / Listeria monocytogenes disease

No disponible

Hepatitis C virus infection: looking for interferon free regimens.

Recent developments of new drugs' combinations are changing the treatment paradigm in hepatitis C virus infection. Due to the side effect profile of pegylated interferons, interferon-sparing regimens have become the main target in chronic hepatitis C treatment research. Recent proofs of concept studies have suggested that cure of chronic hepatitis C can be achieved without interferon. The purpose of this paper is to provide an overview of the clinical results recently reported for the treatment of hepatitis C virus infection with interferon-free regimens, focusing on the most promising new compounds and combinations.

Infección neumocócica en pacientes oncohematológicos tras la introducción de la vacuna conjugada / Pneumococcal infections in oncohematological patients after the introduction of conjugate vaccine

Objetivo. Precisar la clínica y los serotipos predominantes en las infecciones neumocócicas incidentes en pacientes oncohematológicos tras la introducción de la vacuna conjugada heptavalente. Pacientes y métodos. erie de casos prospectiva (enero 2006- mayo 2011) de la totalidad de casos de infección, incidentes en pacientes oncohematológicos de más de 17 años de edad, en los que se aisló Streptococcus pneumoniae. Resultados. Se detectaron 131 episodios de infección neumocócica, incidentes en 122 pacientes (mediana de edad: 67 años). El 50% se relacionó con atención sanitaria/nosocomial. El 39,7% fueron neumonías y el 45,1% infecciones del tracto respiratorio bajo sin condensación radiológica. Con respecto a los 803 casos de infección neumocócica, incidentes durante el mismo periodo en pacientes sin enfermedad oncohematológica, los pacientes oncohematológicos fueron más frecuentemente varones (p<0,001), presentaron neumonías con índices de FINE más altos (p<0,001), una mortalidad no atribuible a la infección menor (p<0,006) y una mayor probabilidad de sensibilidad disminuida a levofloxacino (p=0,043). Predominaron los serotipos no vacunales. Conclusiones. Las infecciones neumocócicas incidentes en pacientes oncohematológicos se presentan predominantemente en varones, afectos de cánceres de pulmón. Se relacionan con la atención sanitaria, pero no con exposición reciente a quimioterapia o neutropenia. Tras la introducción de la vacuna pediátrica heptavalente conjugada predominan los serotipos no vacunales(AU)

Objectives. To know the symptoms and predominant serotypes of pneumococcal infection in patients with oncohematological illness after introduction of 7-valent pneumococcal conjugate vaccine. Patients and methods. A prospective study (january 2006-may 2011) was made of all the incident cases of infection in oncohematological patients over 17 years of age in whom Streptococcus pneumoniae was isolated. Results. A total of 131 episodes of incident cases of pneumococcal infection in 122 patients (median age of 67 years) were detected. Of these, 50% were related to health/nosocomial care (P<.001), 39.7% pneumonias and 45.1% lower respiratory tract infections, without radiological condensation. In comparison to the 803 incident cases of pneumococcal infection during the same period as in patients without oncohematological disease, the oncohematological patients were more frequently males (P<.001), had pneumonia episodes with higher FINE scores (P<.001), lower risk of death non-directly associated with pneumococcal infection (P=.006) and showed reduced susceptibility to levofloxacin (P=.043). Non-vaccine serotypes predominated. Conclusions. Pneumococcal infections in oncohematological patients are more frequent in males, mainly with lung neoplasms. They are heath care related, but not related to chemotherapy or neutropenia. After the introduction of heptavalent conjugate vaccines in pediatrics, the non-vaccine serotypes predominate(AU)

Pneumococcal infections in oncohematological patients after the introduction of conjugate vaccine.

OBJECTIVES: To know the symptoms and predominant serotypes of pneumococcal infection in patients with oncohematological illness after introduction of 7-valent pneumococcal conjugate vaccine. PATIENTS AND METHODS: A prospective study (january 2006-may 2011) was made of all the incident cases of infection in oncohematological patients over 17 years of age in whom Streptococcus pneumoniae was isolated. RESULTS: A total of 131 episodes of incident cases of pneumococcal infection in 122 patients (median age of 67 years) were detected. Of these, 50% were related to health/nosocomial care (P<.001), 39.7% pneumonias and 45.1% lower respiratory tract infections, without radiological condensation. In comparison to the 803 incident cases of pneumococcal infection during the same period as in patients without oncohematological disease, the oncohematological patients were more frequently males (P<.001), had pneumonia episodes with higher FINE scores (P<.001), lower risk of death non-directly associated with pneumococcal infection (P=.006) and showed reduced susceptibility to levofloxacin (P=.043). Non-vaccine serotypes predominated. CONCLUSIONS: Pneumococcal infections in oncohematological patients are more frequent in males, mainly with lung neoplasms. They are heath care related, but not related to chemotherapy or neutropenia. After the introduction of heptavalent conjugate vaccines in pediatrics, the non-vaccine serotypes predominate.

Evaluation of progressive multifocal leukoencephalopathy treatments in a Spanish cohort of HIV-infected patients: do protease inhibitors improve survival regardless of central nervous system penetration-effectiveness (CPE) score?

OBJECTIVES: The aim of the study was to investigate whether survival after progressive multifocal leukoencephalopathy (PML) diagnosis in HIV-1-infected patients was associated with central nervous system penetration-effectiveness (CPE) score and the presence or absence of protease inhibitors in the treatment regimen. METHODS: In the absence of treatments demonstrated to be effective for PML in HIV-1-infected patients and in the light of the controversy surrounding the use of CPE scores to make decisions on treatment after diagnosis, we determined whether there were differences in survival at 1 year depending on the type and characteristics of treatment. A multicentre retrospective observational study including three Spanish hospitals was carried out for the period from 1 January 1994 to 31 December 2009. Patients with a PML diagnosis were included in the study if they were symptomatic and met at least two of the following three criteria: (1) compatible radiological findings; (2) a positive polymerase chain reaction for John Cunningham virus (JCV) in the cerebrospinal fluid (CSF); (3) an absence of findings suggesting another infection in the central nervous system, after general CSF cultures for virus, bacteria and mycobacteria. RESULTS: A total of 98 patients were included in the study; 24.5% were diagnosed in the period 1994-1999, 39.8% in 2000-2004 and 35.7% in 2005-2009. The median follow-up time was 363 days (interquartile range 108-1946 days). The median CD4 count was 76 cells/uL (interquartile range 30-166 cells/uL) and 62% of patients had an HIV viral load >50 HIV-1 RNA copies/ml. Thirty-eight per cent of patients received high-penetrance treatment, and 58% received treatment that included protease inhibitors. In the analysis of survival at 1 year, a higher CPE score did not result in an improvement in survival, but the presence of protease inhibitors in the regimen was associated with a statistically significant (P = 0.03) reduction in mortality (hazard ratio 0.40; 95% confidence interval 0.18-0.91). CONCLUSIONS: We consider that the lower mortality observed in the protease inhibitor group may be clinically relevant, and, if this is the case, a treatment based on protease inhibitors may be indicated for patients diagnosed with PML.

[Usefulness of a new fast technique for detection of pneumococcal antigen in the diagnosis of community pneumonia]. / Utilidad de una nueva técnica rápida de detección de antígeno neumocócico en el diagnóstico de la neumonía comunitaria.

With the objective of analyzing the usefulness of a new technique of fast detection of pneumococcal antigen in urine (Binax NOW Streptococcus pneumoniae urinary antigen test) 163 community pneumonia episodes were reviewed. The test was positive in 30 cases, and gave rise to therapeutic implications in 12 patients. The global sensitivity was 57%, being superior in patients with HIV infection (70%), and the specificity was 91.6%. In 16 episodes it was the only diagnostic test of pneumococcal infection. The determination of pneumococcal antigen through this technique is a useful tool for the diagnosis of community pneumonia, mainly due its high specificity.

Utilidad de una nueva técnica rápida de detección de antígeno neumocócico en el diagnóstico de la neumonía comunitaria / Usefulness of a new fast technique for detection of pneumococcal antigen in the diagnosis of community pneumonia

Con el objetivo de analizar la utilidad de una nueva técnica de detección rápida de antígeno neumocócico en orina (Binax NOW Streptococcus pneumoniae urinary antigen test) se revisaron 163 episodios de neumonía comunitaria. La prueba fue positiva en 30 casos, con implicaciones terapéuticas en 12. La sensibilidad global fue del 57 por ciento, siendo superior en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) (70 por ciento) y la especificidad del 91,6 por ciento.En 16 episodios fue la única prueba diagnóstica de infección neumocócica. La determinación de antígeno neumocócico mediante esta técnica es una herramienta útil en el diagnóstico de la neumonía comunitaria, principalmente por su alta especificidad (AU)

[Resistant Mycobacterium tuberculosis: its relation with coinfection with human immunodeficiency virus. 5-year study]. / Mycobacterium tuberculosis resistente: su relación con la coinfección por el virus de la inmunodeficiencia humana. Estudio de cinco años.

BACKGROUND: To analyze the situation of resistance to antituberculous drugs among strains of Mycobacterium tuberculosis recovered in our environment during a five-year period and its relationship with HIV co-infection. PATIENTS AND METHODS: Review of the Mycobacterium tuberculosis strains recovered from patients aged older than 14 years in Hospital Joan March from 1992 to 1996 of which a susceptibility testing study by means of the multiple proportions method was available. The initial or secondary resistance was considered according to the previous antituberculosis treatment antecedent. RESULTS: The susceptibility testing was available from 179 cases (136 males and 43 females) out of a total of 214. The overall resistance rate to any of the tested drugs was 10.1% (18 cases) with a 4% (6 cases) of initial and 38.7% (12 cases) secondary resistances. Co-infection with HIV showed not to be a risk factor for the development of resistance. No significant increase was observed analyzing the temporal trend through the five years studied. CONCLUSIONS: At present, the situation of resistance to Mycobacterium tuberculosis seems not to be alarming in our environment. Co-infection with HIV has not been shown to be associated with an increase in resistance rates.

[Hepatitis C viral infection and the consumption of intravenous drugs]. / Infección por el virus de la hepatitis C y consumo de drogas por vía parenteral.

BACKGROUND: To know the antibodies seroprevalence against hepatitis C virus (HCV), as well as other factors associated to these antibodies presence in a group of intravenous drug users (IVDU) in Baleares. To know what screening test would be the most adequate to detect antibodies against HCV in this group. METHODS: The presence of HCV antibodies in serum was determined in 110 IVDU patients, admitted to hospital during 1990 in a unit of opium detoxifying, by techniques enzyme immunotesting (ELISA) and immunoblotting (RIBA); the drug abuse history as well as serologies against human immunodeficiency virus (HIV), hepatitis B (HBV) and syphilis. RESULTS: The seroprevalence found by techniques ELISA is 71% and 95% respectively for the tests of first and second generation; using the method RIBA the seroprevalence is 86%. The HIV seroprevalence was 36% and a 53% were anti-HBs positive. No significative differences were found between the positive and negative anti HCV in relation with drug use variables: as first year of consumption and time of addiction, nor with the presence of HIV and HBV markers. CONCLUSIONS: The HCV seroprevalence among IVDU of the sample studied is similar to those described for this risk group by other authors in other zones. Such infection is not statistically associated with other variables of the drug abuse history nor with the infection by HBV and HIV. Despite the discordances of the HCV seroprevalence with the three test used in the study, the technique ELISA of second generation could be the ideal method of screening of antibodies against the HCV in this risk group.