Community-onset extended-spectrum ß-lactamase producing Escherichia coli in urinary tract infections in children from 2015 to 2016: Prevalence, risk factors, and resistances.

Over the past 10 years, the resistances among microbes are increasing gradually in Europe and greater resistances are seen in southern countries. We studied the prevalence of community-onset ESBL-producing Escherichia coli urinary tract infections in children.As secondary objectives, we analyzed associated risk factors and the resistance patterns in ESBL-producing E coli isolates.Retrospective observational study in a tertiary care hospital about children ≤14 years old with community-onset E coli urinary tract infection. The variables studied were age, sex, ESBL-producing, antibiotic therapy 7 to 30 days before the infection, hospitalization 7 to 30 days before the infection, nefrourologic pathology, and vesicoureteral reflux.Between January 1st, 2015 and December 31st, 2016, 229 isolates of E coli were obtained, of whom 21 (9.2%) where ESBL-producing E coli. Median age in non-ESBL-producing was 18 months versus 7 months in ESBL-producing group. Fourteen (66%) of the ESBL-producing group were men (P = .001), 5 (23.8%) were hospitalized 30 days before the infection (P = .001), 12 (57.1%) had nefrourological pathology (P = .003), 6 (28.5%) had vesicoureteral reflux (P = .032). Previous antibiotic therapy was not statistically significant. Multiple regression analyses between sex and 30 days previous hospitalization were r = 3.51 (P = .0001). Multidrug resistant isolates among ESBL-producing E coli was 12 (57%).The retrospective study allowed assessing the problem of ESBL-producing isolates in the outpatient settings. Some risk factors from past studies were confirmed and a combined risk is suggested. The resistant spectrum should be taken into account when choosing antibiotic regimens.

Comparación de un método de point of care para la medida de troponina I cardiaca en sangre total frente a dos inmunoensayos en plasma / Comparison of the new point of care method for measuring cardiac troponin i in whole blood versus two plasma immunoassays

Introducción. El equipo AQT90 FLEX es un analizador de sobremesa para inmunoanálisis que presenta características que lo hacen útil para su empleo a la cabecera del paciente. En el presente trabajo comparamos el método de la troponina I en sangre total en este equipo frente a la medida en plasma con 2 inmunoanálisis usados en los laboratorios centrales, como son Stratus® CS y Dimension(R) EXL. Material y métodos. Se obtuvieron 68 muestras de sangre recogidas en tubo de heparina litio. Las muestras se analizaron primero en el AQT90 FLEX y una vez liberados los tubos se centrifugaron, analizándose el plasma resultante por Stratus(R) CS y Dimension(R) EXL. Resultados. El análisis de regresión arrojó los siguientes ecuaciones: AQT = 0,006 + 0,22*Dimension con un coeficiente de correlación de 0,90 y AQT = 0,001 + 0,29*Stratus, siendo el coeficiente de correlación de 0,97, aunque se observaron diferencias constantes y proporcionales. Para la comparación entre los 2 métodos usados como referencia frente al método a evaluar se obtuvo la siguiente ecuación: Stratus = 0,0026 + 0,98*Dimension con un coeficiente de correlación de 0,99 en ausencia de errores (AU)

Background. AQT90 FLEX is a new bench top analyzer with performance characteristics that make it suitable for use in Point of Care. In this work we compare troponin I measured in whole blood with this analyzer and the plasma measurement using two immunoassays frequently used in core laboratories, such as Dimension(R) EXL and Stratus(R) CS. Methods. We collected 68 samples into lithium heparin tubes, which were analyzed on the AQT90 FLEX and then centrifuged and the plasma used for the measurement of troponin I using the Dimension(R) EXL and Stratus(R) CS. Results. The regression analysis yielded the following equations: AQT = 0.006 + 0.22*Dimension (r = 0.90) and AQT = 0.001 + 0.29*Stratus (r=0.97), although constant and proportional differences were observed in both comparisons. The comparison between Stratus(R) and Dimension(R) yielded the following equation: Stratus = 0.0026 + 0.98*Dimension (r = 0.99) with no constant errors in either of them (AU)

Interferencia de la bilirrubina en la medición del paracetamol por el método del indofenol en el analizador Dimension (R) EXL(TM) / Bilirubin interference in the measurement of paracetamol by the indophenol method on the Dimension (R) EXL(TM)

Introducción. Los niveles de paracetamol se miden habitualmente en los laboratorios de urgencias ante la evidencia o sospecha de una intoxicación para predecir la posible hepatotoxicidad aguda por este fármaco. Sin embargo varios estudios han reportado un falso incremento en la concentración de paracetamol medida por métodos enzimáticos en plasmas ictéricos, circunstancia que ocurre frecuentemente en casos de fracaso hepático. Material y métodos. Para evaluar la influencia de la bilirrubina en la medición de paracetamol en el analizador Dimension(R) EXL(TM) (Siemens Healthcare Diagnostics Inc.(R)) se preparó una solución primaria de interferente a una concentración de 800 mg/dl (13.680 μmol/l) que se añadió a una solución de control comercial con altos niveles de paracetamol hasta obtener una mezcla con una concentración de bilirrubina de 40 mg/dl (684 μmol/l) realizando la medición de paracetamol en esta mezcla y en una de referencia. Comprobada la existencia de interferencia se procedió a cuantificarla diluyendo la solución primaria hasta obtener mezclas con 20; 10; 5; 2,5; 1,25 y 0,625 mg/dl de bilirrubina (342; 171; 85,5; 42,75; 21,37 y 19,69 μmol/l). Se obtuvo el interferograma representando la desviación de la medida frente a la mezcla de referencia frente a las distintas concentraciones de interferente. Resultados. Las distribuciones fueron gaussianas, por lo que se pudo aplicar la t de Student para el cálculo de las significaciones estadísticas. Se demostró la existencia de una interferencia significativa negativa a partir de 5 mg/dl (85,5 μmol/l) de bilirrubina, lo que muestra que las mediciones de paracetamol deben interpretarse con cautela en casos de hiperbilirrubinemia (AU)

Background. Blood levels of acetaminophen (paracetamol) are measured routinely in large acetaminophen overdoses or when poisoning is suspected, in order to predict the likelihood of hepatotoxicity. However some cases of spurious acetaminophen levels have been reported in jaundiced patients. Material and methods. The interference of bilirubin in acetaminophen measurements was studied on the Dimension(R) EXL(T)M by preparing a primary mixture of bilirubin at 800 mg/dL, which was spiked to a quality control solution with high acetaminophen concentration in order to get a bilirrubin concentration of 40 mg/dl on the mixture. Acetaminophen concentration was measured in the mixture with bilirubin and in reference solution without bilirubin. Interference was assessed and quantified by diluting the bilirubin solution to achieve final concentrations of 20, 10, 5, 2.5, 1.25 and 0.625 mg/dl (342, 171, 85.5, 42.75, 21.37 and 19.69 μmol/l). A graph of the interference was obtained showing the bias of acetaminophen concentrations with reference solution vs. increasing bilirubin concentrations. Results. Acetaminophen concentrations in both solutions followed Gaussian distributions. The t test showed significant negative interference at bilirubin concentrations higher to 5 mg/dl (85.5 μmol/l), which means that blood acetaminophen concentrations must be interpreted with caution in cases of hyperbilirubinemia (AU)