Sensibilidad antibiótica de Staphylococcus aureus y Streptococcus pneumoniae en personas portadoras nasales sanas en atención primaria en el área de Barcelona / Antibiotic susceptibility of Staphylococcus aureus and Streptococcus pneumoniae in healthy carrier individuals in primary care in Barcelona area

Introducción: La información existente sobre la resistencia a los antibióticos se basa habitualmente en muestras de personas hospitalizadas. El objetivo fue evaluar la prevalencia de resistencia antibiótica de cepas de Staphylococcus aureus y Streptococcus pneumoniae de personas portadores nasales atendidas en las consultas de atención primaria según edad y sexo. Diseño: Estudio transversal. Emplazamiento. Siete centros de salud del área de Barcelona. Participantes. Personas portadoras nasales a partir de 4 años de edad, sin signos de enfermedad infecciosa y que no habían tomado antibióticos ni habían estado hospitalizados en los 3 meses anteriores. Mediciones principales: Se recogieron 3.969 frotis nasales válidos para identificación entre 2010 y 2011 y fueron enviados a un laboratorio central de microbiología para el aislamiento de ambos gérmenes. La resistencia a los antibióticos se estableció según los puntos de corte actuales de la guía del European Committee on Antimicrobial Susceptibility Testing. Resultados: La prevalencia de S. aureus resistente a meticilina fue del 1,3% (IC 95%: 0,5-2,1%), con porcentajes de resistencia frente a fenoximetilpenicilina del 87,1% y a azitromicina del 11,6%, sin observar diferencias significativas según edad y sexo. Un 2,4% (IC 95%: 0,1-4,7%) de las cepas de neumococo fueron altamente resistentes a fenoximetilpenicilina y macrólidos, mientras que las mayores resistencias se observaron frente a cefaclor (53,3%), tetraciclina (20%) y cefuroxima (12,1%). Conclusiones: Estos patógenos tienen resistencias más bajas en la comunidad que las que se observan en el medio hospitalario. Es importante que se conozca la resistencia antibiótica actual para poder hacer un uso más prudente de los antibióticos (AU)

Introduction: The information available on antibiotic resistance patterns are generally based on specimens from hospitalised individuals. This study was aimed at evaluating the antibiotic resistance rate of nasal carriage strains of Staphylococcus aureus and Streptococcus pneumoniae in healthy individuals, in accordance with age and gender, attended in Primary Care Centres (PCC). Design: Cross-sectional study. Setting: Seven PCC in the Barcelona area. Participants: Healthy nasal carriers aged 4 years or more who did not present with any sign of infectious disease, and had not taken any antibiotic or had been hospitalised in the previous 3 months. Main measurements: A total of 3,969 nasal swabs valid for identification were collected between 2010 and 2011 and were sent to one central microbiological laboratory for isolation of both pathogens. Resistance to common antibiotics was determined on the basis of the current European Committee on Antimicrobial Susceptibility Testing guidelines on cut-off points. Results: The prevalence of methicillin-resistant S.aureus was 1.3% (95% CI: 0.5-2.1%), with resistance rates of 87.1% to phenoxymethylpenicillin and 11.6% to azithromycin, with no significant differences with age and gender. A total of 2.4% (95 CI%: 0.1-4.7%) of the pneumococcal strains were highly resistant to both phenoxymethylpenicillin and macrolides, whereas the highest resistance rates were to cefaclor (53.3%), followed by tetracycline (20%) and cefuroxime (12.1%). Conclusions: These pathogens have lower resistance rates in the community than in the hospital setting. Primary Care physicians must be more aware of the current antimicrobial resistance, in order to ensure prudent use of antibiotics (AU)

[Antibiotic susceptibility of Staphylococcus aureus and Streptococcus pneumoniae in healthy carrier individuals in primary care in Barcelona area]. / Sensibilidad antibiótica de Staphylococcus aureus y Streptococcus pneumoniae en personas portadoras nasales sanas en atención primaria en el área de Barcelona.

INTRODUCTION: The information available on antibiotic resistance patterns are generally based on specimens from hospitalised individuals. This study was aimed at evaluating the antibiotic resistance rate of nasal carriage strains of Staphylococcus aureus and Streptococcus pneumoniae in healthy individuals, in accordance with age and gender, attended in Primary Care Centres (PCC). DESIGN: Cross-sectional study. SETTING: Seven PCC in the Barcelona area. PARTICIPANTS: Healthy nasal carriers aged 4years or more who did not present with any sign of infectious disease, and had not taken any antibiotic or had been hospitalised in the previous 3months. MAIN MEASUREMENTS: A total of 3,969 nasal swabs valid for identification were collected between 2010 and 2011 and were sent to one central microbiological laboratory for isolation of both pathogens. Resistance to common antibiotics was determined on the basis of the current European Committee on Antimicrobial Susceptibility Testing guidelines on cut-off points. RESULTS: The prevalence of methicillin-resistant S.aureus was 1.3% (95%CI: 0.5-2.1%), with resistance rates of 87.1% to phenoxymethylpenicillin and 11.6% to azithromycin, with no significant differences with age and gender. A total of 2.4% (95CI%: 0.1-4.7%) of the pneumococcal strains were highly resistant to both phenoxymethylpenicillin and macrolides, whereas the highest resistance rates were to cefaclor (53.3%), followed by tetracycline (20%) and cefuroxime (12.1%). CONCLUSIONS: These pathogens have lower resistance rates in the community than in the hospital setting. Primary Care physicians must be more aware of the current antimicrobial resistance, in order to ensure prudent use of antibiotics.

Prevalencia de portadores nasales de Staphylococcus aureus y Streptococcus pneumoniae en atención primaria y factores asociados a la colonización / Prevalence of nasal carriage of Staphylococcus aureus and Streptococcus pneumoniae in Primary Care and factors associated with colonization

OBJETIVO: Determinar la prevalencia de portadores nasales de Staphylococcus aureus (S. aureus) y Streptococcus pneumoniae (S. pneumoniae) en personas atendidas en las consultas de Atención Primaria del área de Barcelona, así como los factores que se asocian a la condición de portador sano. MÉTODOS: Estudio transversal multicéntrico realizado entre 2010-2011, en el que participaron 27 profesionales de Atención Primaria. Se obtuvieron 3969 frotis nasales de población mayor de 4 años y sin signos de enfermedad infecciosa. Variables dependientes: ser portador de S.aureus y/o de S. pneumoniae. Variables independientes: características socio demográficas, estado de salud, estado vacunal, ocupación laboral y convivencia con niños. Se realizó el análisis descriptivo, cálculo de la prevalencia de portadores sanos de S.aureus y/o de S. pneumoniae y se ajustaron modelos de regresión logística según edad. RESULTADOS: En niños de 4 a 14 años, la prevalencia de portadores de S.aureus fue 35,7%, de S. pneumoniae del 27,1% y co-colonizados del 5,8%. En adultos mayores de 14 años fue del 17,8, del 3,5 y del 0,5% respectivamente. En niños, ser portador de S.aureus se asoció con no presentar S. pneumoniae, y ser portador de S. pneumoniae con no presentar S.aureus y menor edad. En adultos, ser portador de S.aureus se asoció con ser hombre, menor e dad y trabajar en sanidad, y ser portador de S. pneumoniae con convivir con menores de 6 años. La proporción de portadores co-colonizados es baja (1,0%). CONCLUSIONES: La prevalencia de portadores en niños es mayor que en los adultos. Salvo la edad, no se observan otros factores comunes que se asocien a la condición de portador sano de estas 2 bacterias por separado

OBJECTIVE: To determine (I) the prevalence of Staphylococcus aureus (S.aureus) and Streptococcus pneumoniae (S. pneumoniae) nasal carriage in Primary Health Care patients in area of Barcelona, and (II) the factors associated with S.aureus and S. pneumoniae colonization. METHODS: Multi-center cross-sectional study conducted in 2010-2011 with the participation of 27 Primary Health Care professionals. Nasopharyngeal swabs were obtained from 3,969 patients over 4 years of age who did not present with any sign of infection. Dependent variables: S.aureus and/or S. pneumoniae carrier state. Independent variables: socio-demographic characteristics, health status, vaccination status, occupation, and living with children. A descriptive analysis was performed. The prevalence of carriers of S.aureus and/or S. pneumoniae was calculated and logistic regression models were adjusted by age. RESULTS: In children from 4 to 14 years old, the prevalence of S.aureus carriers was 35.7%, of S.pneumoniae 27.1%, and 5.8% were co-colonized. In adults older than 14 years old, the prevalence was 17.8%, 3.5%, and 0.5%, respectively. In children, S.aureus carrier state was inversely associated with S. pneumoniae carrier state; S. pneumoniae was associated with younger age, and inversely associated with S.aureus carrier state. In adults, being a carrier of S.aureus was associated with male gender, younger age, and a health-related occupation, whereas S. pneumoniae carrier state was associated with living with children under 6 years of age. The proportion of co-colonized carriers was low (1.0%). CONCLUSIONS: The proportion of S.aureus and S. pneumoniae carriers was higher in children than in adults. Age was the only factor associated with healthy carrier status for S. aureus and for S. pneumoniae

[Prevalence of nasal carriage of Staphylococcus aureus and Streptococcus pneumoniae in Primary Care and factors associated with colonization]. / Prevalencia de portadores nasales de Staphylococcus aureus y Streptococcus pneumoniae en atención primaria y factores asociados a la colonización.

OBJECTIVE: To determine (i) the prevalence of Staphylococcus aureus (S.aureus) and Streptococcus pneumoniae (S.pneumoniae) nasal carriage in Primary Health Care patients in area of Barcelona, and (ii) the factors associated with S.aureus and S.pneumoniae colonization. METHODS: Multi-center cross-sectional study conducted in 2010-2011 with the participation of 27 Primary Health Care professionals. Nasopharyngeal swabs were obtained from 3,969 patients over 4 years of age who did not present with any sign of infection. DEPENDENT VARIABLES: S.aureus and/or S.pneumoniae carrier state. INDEPENDENT VARIABLES: socio-demographic characteristics, health status, vaccination status, occupation, and living with children. A descriptive analysis was performed. The prevalence of carriers of S.aureus and/or S.pneumoniae was calculated and logistic regression models were adjusted by age. RESULTS: In children from 4 to 14 years old, the prevalence of S.aureus carriers was 35.7%, of S.pneumoniae 27.1%, and 5.8% were co-colonized. In adults older than 14 years old, the prevalence was 17.8%, 3.5%, and 0.5%, respectively. In children, S.aureus carrier state was inversely associated with S.pneumoniae carrier state; S.pneumoniae was associated with younger age, and inversely associated with S.aureus carrier state. In adults, being a carrier of S.aureus was associated with male gender, younger age, and a health-related occupation, whereas S.pneumoniae carrier state was associated with living with children under 6 years of age. The proportion of co-colonized carriers was low (1.0%). CONCLUSIONS: The proportion of S.aureus and S.pneumoniae carriers was higher in children than in adults. Age was the only factor associated with healthy carrier status for S.aureus and for S.pneumoniae.

Larvae in a traveller's faeces. Not always what it seems / Larvas en las heces de un viajero. No siempre es lo que parece

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