Factors for persistence of MRSA carriage one year after initial detection in individuals from various healthcare institutions / Factores de persistencia de la colonización por SARM un año más tarde de la detección inicial de portadores en distintos centros sanitarios

Introduction and objective: We studied the natural history of patients with chronic stable illnesses that are colonized by Methicillin Resistant Staphylococcus aureus (MRSA). The aim was to determine the persistence colonization 1 year after. Moreover, we intended to disclose factors that predict MRSA persistence. Material and methods: A multicentric, prospective observational study was designed. Patients from an acute-care hospital and 4 long-term healthcare facilities were included. Demographic, clinical and microbiological data (nasal and skin swabs) were obtained every 3 months during a year. MRSA carriers were decolonized with nasal mupirocin. Results: Among the 699 screened patients, 114 MRSA carriers were identified. MRSA carriage persisted in 59.4% of those who completed the follow-up. Baseline factors associated to MRSA persistence were heart failure, comorbidities, antibiotics, and ulcers. At one year: LTHF, underweight, Barthel<60, and ulcers (the two latest were independent predictors). Persistence was not associated to decolonization. Conclusion: Our study disclosed a high MRSA persistence rate and identified several associated factors (both at baseline and one year later). This information may be useful to identify individuals at high-risk of being MRSA carriers at hospital admission

Introducción y objetivo: Se estudió la evolución natural de los pacientes con enfermedades crónicas que son colonizados por Staphylococcus aureus resistente a la meticilina (SARM) para determinar la persistencia de colonización al año, e identificar factores predictores de persistencia. Material y métodos: Estudio multicéntrico, prospectivo y observacional. Se incluyeron los ingresados en un hospital y los 4 centros sociosanitarios de referencia, recogiendo datos estadísticos, clínicos y microbiológicos (muestras nasales y cutáneas), trimestralmente durante un año. Los portadores recibieron mupirocina. Resultados: Se identificaron 114 portadores de SARM entre los 699 ingresados. Fueron portadores persistentes el 59,4% de aquellos que completaron el seguimiento. Los factores basales asociados a la persistencia fueron la insuficiencia cardíaca, las comorbilidades, la antibioterapia y las úlceras. Al año: CSS, bajo peso, índice de Barthel<60, y úlceras (estos 2 últimos de forma independiente). Persistencia y descolonización no estuvieron estadísticamente relacionados. Conclusión: Se detectó una elevada persistencia de SARM al año, independientemente asociada a dependencia funcional y úlceras. Esta información es útil para detectar el riesgo de ser portador de SARM desde su ingreso

Factors for persistence of MRSA carriage one year after initial detection in individuals from various healthcare institutions.

INTRODUCTION AND OBJECTIVE: We studied the natural history of patients with chronic stable illnesses that are colonized by Methicillin Resistant Staphylococcus aureus (MRSA). The aim was to determine the persistence colonization 1 year after. Moreover, we intended to disclose factors that predict MRSA persistence. MATERIAL AND METHODS: A multicentric, prospective observational study was designed. Patients from an acute-care hospital and 4 long-term healthcare facilities were included. Demographic, clinical and microbiological data (nasal and skin swabs) were obtained every 3 months during a year. MRSA carriers were decolonized with nasal mupirocin. RESULTS: Among the 699 screened patients, 114 MRSA carriers were identified. MRSA carriage persisted in 59.4% of those who completed the follow-up. Baseline factors associated to MRSA persistence were heart failure, comorbidities, antibiotics, and ulcers. At one year: LTHF, underweight, Barthel<60, and ulcers (the two latest were independent predictors). Persistence was not associated to decolonization. CONCLUSION: Our study disclosed a high MRSA persistence rate and identified several associated factors (both at baseline and one year later). This information may be useful to identify individuals at high-risk of being MRSA carriers at hospital admission.

[Prosthetic joint infection: a prospective study in five Catalonian hospitals]. / Infección de prótesis articulares: estudio prospectivo en 5 hospitales de Cataluña.

BACKGROUND: Prosthetic joint infections are a cause of increasing morbidity and medical expenditure. OBJECTIVES: To determine the incidence and the clinical and the epidemiological characteristics of knee and hip prosthetic infections (PI) in patients undergoing elective surgery in five Catalonian hospitals. To determine the predictive factors of PI. METHODS: A total of 425 patients operated on between 8 January and 8 July 2001 were prospectively followed for a period of two years. The cumulative incidence, incidence rate and effect measures were determined. Logistic regression was used to identify variables associated with PI. RESULTS: Average age was 71 years and 63.1% were women. Antibiotic prophylaxis with cefazolin was given to 44.7% of the patients, with a mean duration of two days. Prophylaxis was administered during anesthesia induction in 75.6% of the patients. Among the total, 63.4% of the patients were ASA 2. Microbiological confirmation was obtained in all the infected patients; Staphylococcus epidermidis was found in 58%. Fourteen PI were diagnosed, 71% during the first 3 months, with a cumulative incidence of 3.29% and a 3-month incidence rate of 63 patients/10,000 patients/month. Diabetes mellitus was the only variable related to PI in the multivariate analysis: 3.18, 95% CI (1.1-9.9). CONCLUSIONS: The cumulative incidence of PI was slightly higher than that seen in other studies. Variations were observed in the antibiotic used for prophylaxis, and the place where it was administered. PI occurred 3.18 times more frequently in diabetic patients.

[Legionnaire's disease outbreak]. / Estudio de un brote de infección por Legionella pneumophila.

BACKGROUND AND OBJECTIVE: To describe an outbreak of Legionella pneumophila serogroup 1 in Mataró, Catalunya, Spain, in August 2002. The source of the microorganism was a cooling tower. PATIENTS AND METHOD: Prospective and observational study with analysis of epidemiological, clinical, and microbiological data. RESULTS: 151 patients were affected (62% male), with a mean age of 58.4 years old. Seven patients were classified as Pontiac Fever and 144 suffered from pneumonia. The diagnosis of pneumonia was confirmed in 79% of cases, was considered suspicious in 14% and probable in 7%. Forty per cent of patients were smokers and 53.5% had comorbidities, mainly diabetes mellitus (22%). Chief symptoms were fever (97%), chills and muscular pain (63% respectively), headache (54%) and cough (53%). Pulmonary condensation was the more frequent radiological feature (71%). Normal pulmonary exploration was observed in 38%. Forty-three per cent of cases were severely ill, and 16% of patients belonged to Fine's IV and V class. Antigenuria was the most important test for diagnosis, which confirmed 76% of cases. Legionella spp. was obtained in respiratory secretions of 10 patients. Molecular analysis confirmed clonality between respiratory microorganisms and that obtained in the cooling tower. CONCLUSION: The outbreak involved an important number of subjects in a short period of time. Antigenuria was the most useful test. However, the isolation of L. pneumophila from patients permitted the prompt identification of microorganism's source in a cooling tower. The low mortality observed probably relates to a rapid diagnosis and its target treatment.

Infección de prótesis articulares: estudio prospectivo en 5 hospitales de Cataluña / Prosthetic joint infection: A prospective study in five Catalonian hospitals

Antecedentes. Las infecciones de prótesis (IP) articulares son causa de morbilidad y aumento del gasto. Objetivos. Conocer la incidencia y características clínicas y epidemiológicas de las IP de cadera y rodilla, en pacientes intervenidos en cinco hospitales. Identificar factores predictores. Métodos. Se identificaron prospectivamente 425 pacientes intervenidos entre el 8 de enero y el 8 de julio de 2001. Se realizó un seguimiento de 2 años. Se determinaron la incidencia acumulada (IA), tasa de incidencia (TI) y medidas de efecto. Para identificar variables relacionadas con la IP se realizó una regresión logística. Resultados. La edad media fue de 71 años; el 63,1% fueron mujeres. En el 44,7% se realizó profilaxis antibiótica con cefazolina, con una duración media de 2 días. Se administró durante la inducción anestésica en el 75,6%. El 63,4% de los pacientes tenían un ASA 2. Se obtuvo confirmación microbiológica en todos, aislándose Staphylococcus epidermidis en el 58%. Se diagnosticaron 14 IP, 71% de ellas en el primer trimestre; con una IA acumulada a los 2 años del 3,29%, una tasa de incidencia a los 3 meses de 63 casos por 10.000 sujetos/mes de exposición. En el análisis multivariado la diabetes mellitus fue la única variable relacionada con la IP (OR: 3,18; IC 95%: 1,1-9,9). Conclusiones. La IA de la IP es algo superior que en otros estudios. Se evidencia una variabilidad en el antibiótico utilizado en la profilaxis y en el lugar de administración. La IP es 3,18 veces más frecuente en pacientes diabéticos (AU)

Background. Prosthetic joint infections are a cause of increasing morbidity and medical expenditure. Objectives. To determine the incidence and the clinical and the epidemiological characteristics of knee and hip prosthetic infections (PI) in patients undergoing elective surgery in five Catalonian hospitals. To determine the predictive factors of PI. Methods. A total of 425 patients operated on between 8 January and 8 July 2001 were prospectively followed for a period of two years. The cumulative incidence, incidence rate and effect measures were determined. Logistic regression was used to identify variables associated with PI. Results. Average age was 71 years and 63.1% were women. Antibiotic prophylaxis with cefazolin was given to 44.7% of the patients, with a mean duration of two days. Prophylaxis was administered during anesthesia induction in 75.6% of the patients. Among the total, 63.4% of the patients were ASA 2. Microbiological confirmation was obtained in all the infected patients; Staphylococcus epidermidis was found in 58%. Fourteen PI were diagnosed, 71% during the first 3 months, with a cumulative incidence of 3.29% and a 3-month incidence rate of 63 patients/10,000 patients/month. Diabetes mellitus was the only variable related to PI in the multivariate analysis: 3.18, 95% CI (1.1-9.9). Conclusions. The cumulative incidence of PI was slightly higher than that seen in other studies. Variations were observed in the antibiotic used for prophylaxis, and the place where it was administered. PI occurred 3.18 times more frequently in diabetic patients (AU)

Estudio de un brote de infección por Legionella pneumophila / Legionnaire's disease outbreak

Fundamento y objetivo: Describir un brote comunitario de neumonía por Legionella pneumophila serogrupo 1 ocurrido en la ciudad de Mataró en agosto de 2002, cuyo origen fue una torre de refrigeración. Pacientes y método: Estudio observacional y prospectivo. Se analizan aspectos epidemiológicos, factores de riesgo, hallazgos clínicos, radiológicos y microbiológicos. Resultados: El brote de infección afectó a 151 pacientes: un 62% eran varones y la edad media fue de 58,4 años. Se diagnosticó a 7 de fiebre de Pontiac y a 144 casos de neumonía (un 79% confirmadas, un 14% sospechosas y un 7% probables). Un 40% de los pacientes eran fumadores, un 53,5% tenía alguna enfermedad subyacente y un 22% eran diabéticos. Los síntomas predominantes fueron fiebre (97%), escalofríos y mialgias (ambos en el 63%), cefalea (54%) y tos (53%). La imagen radiológica más frecuente fue la condensación unilobular (71%). La semiología respiratoria fue normal en el 38%. Un 43% de los pacientes tenían criterios clínicos de gravedad. Un 16% se clasificó en los grupos IV-V de Fine. El diagnóstico se efectuó por antigenuria en el 76%; 10 pacientes tenían cultivo de muestras respiratorias positivo. El estudio molecular mostró coincidencia entre las cepas de las muestras clínicas y las de la torre de refrigeración. El tratamiento en el 95,6% de los casos fue con claritromicina. La mortalidad fue del 1,4%. Conclusiones: El brote de infección por L. pneumophila afectó a muchas personas en un período muy breve. La prueba diagnóstica más útil fue la antigenuria. El aislamiento de Legionella en muestras respiratorias fue fundamental para establecer la fuente de la infección. La baja mortalidad está relacionada probablemente con la rapidez del diagnóstico y el tratamiento adecuado

Background and objective: To describe an outbreak of Legionella pneumophila serogroup 1 in Mataró, Catalunya, Spain, in August 2002. The source of the microorganism was a cooling tower. Patients and method: Prospective and observational study with analysis of epidemiological, clinical, and microbiological data. Results: 151 patients were affected (62% male), with a mean age of 58.4 years old. Seven patients were classified as Pontiac Fever and 144 suffered from pneumonia. The diagnosis of pneumonia was confirmed in 79% of cases, was considered suspicious in 14% and probable in 7%. Forty per cent of patients were smokers and 53.5% had comorbidities, mainly diabetes mellitus (22%). Chief symptoms were fever (97%), chills and muscular pain (63% respectively), headache (54%) and cough (53%). Pulmonary condensation was the more frequent radiological feature (71%). Normal pulmonary exploration was observed in 38%. Forty-three per cent of cases were severely ill, and 16% of petients belonged to Fine's IV or V class. Antigenuria was the most important test for diagnosis, which confirmed 76% of cases. Legionella spp. was obtained in respiratory secretions of 10 patients. Molecular analysis confirmed clonality between respiratory microorganisms and that obtained in the cooling tower. Conclusion: The outbreak involved an important number of subjects in a short period of time. Antigenuria was the most useful test. However, the isolation of L. pneumophila from patients permitted the prompt identification of microorganism's source in a cooling tower. The low mortality observed probably relates to a rapid diagnosis and its target treatment