Prediction of surgical risk in patients with endocarditis: Comparison of logistic EuroSCORE, EuroSCORE II and APORTEI score / Predicción de riesgo de mortalidad quirúrgica en pacientes con endocarditis infecciosa: comparación entre EuroSCORE logístico, EuroSCORE II y APORTEI score

Objectives: APORTEI score is a new risk prediction model for patients with infective endocarditis. It has been recently validated on a Spanish multicentric national cohort of patients. The aim of the present study is to compare APORTEI performances with logistic EuroSCORE and EuroSCORE II by testing calibration and discrimination on a local sample population underwent cardiac surgery because of endocarditis. Methods: We tested three prediction scores on 111 patients underwent surgery from 2014 to 2020 at our Institution because of infective endocarditis. Area under the curves and Hosmer–Lemeshow test were used to analyze discrimination and calibration respectively of logistic EuroSCORE, EuroSCORE II and APORTEI score. Results: The overall observed one-month mortality rate was 21.6%. The observed-to-expected ratio was 1.27 for logistic EuroSCORE, 3.27 for EuroSCORE II and 0.94 for APORTEI. The area under the curve (AUC) value of APORTEI (0.88±0.05) was significantly higher than that one of logistic EuroSCORE (AUC 0.77±0.05; p 0.0001) and of EuroSCORE II (AUC 0.74±0.05; p 0.0005). Hosmer–Lemeshow test showed better calibration performance of the APORTEI, (logistic EuroSCORE: p 0.19; EuroSCORE II: p 0.11; APORTEI: p 0.56). Conclusion: APORTEI risk score shows significantly higher performances in term of discrimination and calibration compared with both logistic EuroSCORE and EuroSCORE II.(AU)

Objetivos: El APORTEI score es un nuevo sistema de predicción de riesgo para pacientes con endocarditis infecciosa. El mismo ha sido recientemente validado en una cohorte de pacientes procedentes de un estudio nacional multicéntrico español. El objetivo del presente estudio es comparar la discriminación y la calibración del APORTEI score con las del EuroSCORE logístico y del EuroSCORE II analizando una población sometida a cirugía cardiaca por endocarditis infecciosa. Métodos: Analizamos las propiedades de 3 sistemas de predicción de riesgo sobre una población de 111 pacientes sometidos a cirugía cardiaca desde 2014 hasta 2020 en un único hospital terciario por endocarditis infecciosa. El área bajo las curvas y la prueba de Hosmer-Lemeshow se usaron para analizar la discriminación y la calibración, respectivamente, del EuroSCORE logístico, del EuroSCORE II y del APORTEI score. Resultados: La mortalidad global observada a un mes fue del 21,6%. La relación mortalidad observada/mortalidad esperada fue de 1,27 para el EuroSCORE logístico, 3,27 para el EuroSCORE II y 0,94 para el APORTEI score. El valor del área bajo la curva (AUC) del APORTEI score (0,88±0,05) fue significativamente mayor que los del EuroSCORE logístico (AUC 0,77±0,05; p 0,0001) y del EuroSCORE II (AUC 0,74±0,05; p 0,0005). La prueba de Hosmer-Lemeshow mostró un mejor rendimiento en cuanto a calibración del APORTEI score, (EuroSCORE logístico: p 0,19; EuroSCORE II: p 0,11; APORTEI score: p 0,56). Conclusión: El sistema de predicción de riesgo APORTEI score muestra un rendimiento significativamente mejor en cuanto a discriminación y calibración en comparación con el EuroSCORE logístico y con el EuroSCORE II.(AU)

Prediction of surgical risk in patients with endocarditis: Comparison of logistic EuroSCORE, EuroSCORE II and APORTEI score.

OBJECTIVES: APORTEI score is a new risk prediction model for patients with infective endocarditis. It has been recently validated on a Spanish multicentric national cohort of patients. The aim of the present study is to compare APORTEI performances with logistic EuroSCORE and EuroSCORE II by testing calibration and discrimination on a local sample population underwent cardiac surgery because of endocarditis. METHODS: We tested three prediction scores on 111 patients underwent surgery from 2014 to 2020 at our Institution because of infective endocarditis. Area under the curves and Hosmer-Lemeshow test were used to analyze discrimination and calibration respectively of logistic EuroSCORE, EuroSCORE II and APORTEI score. RESULTS: The overall observed one-month mortality rate was 21.6%. The observed-to-expected ratio was 1.27 for logistic EuroSCORE, 3.27 for EuroSCORE II and 0.94 for APORTEI. The area under the curve (AUC) value of APORTEI (0.88±0.05) was significantly higher than that one of logistic EuroSCORE (AUC 0.77±0.05; p 0.0001) and of EuroSCORE II (AUC 0.74±0.05; p 0.0005). Hosmer-Lemeshow test showed better calibration performance of the APORTEI, (logistic EuroSCORE: p 0.19; EuroSCORE II: p 0.11; APORTEI: p 0.56). CONCLUSION: APORTEI risk score shows significantly higher performances in term of discrimination and calibration compared with both logistic EuroSCORE and EuroSCORE II.

Prosthetic joint infection caused by Trueperella bernardiae.

Trueperella bernardiae is a Gram-positive coryneform bacilli which role as human pathogen is unknown because it has been usually considered a contaminant. Furthermore its identification by biochemical test was difficult. We describe a prosthetic joint infection in a women who years ago underwent a total knee replacement with superinfection and necrosis of the patellar tendon as major complications. In the sample of synovial fluid collected grew a gram-positive bacilli which was identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) as T. bernardiae. The patient was treated with ciprofloxacin and currently preserves the prosthesis without signs of infection.

[Epidemiological features of invasive pneumococcal disease before and after the introduction of pneumococcal conjugate vaccine in Gran Canaria (Canary Islands)]. / Aspectos epidemiológicos de la enfermedad neumocócica invasiva antes y después del uso de la vacuna neumocócica conjugada en Gran Canaria.

INTRODUCTION: The introduction of pneumococcal conjugate vaccine (PCV-7) has modified the epidemiology of invasive pneumococcal disease (IPD). Our aim was to investigate the epidemiological features of IPD before and after implementing the use of PCV-7. METHODS: All invasive Streptococcus pneumoniae strains isolated in our hospital from 2000 to 2006 were included. Serotypes were identified and antibiograms were performed in all cases. Data obtained before (2000-2001) and after (2004-2006) authorization of PCV-7 use in Spain were compared. RESULTS: There were 241 cases of IPD. None of the patients with IPD aged 2 years or younger had received PCV-7. PCV-7 coverage in children aged 5 or younger was about 48%. There was a non-significant increase in the incidence of IPD in children (from 53.8 to 57.8 cases/100 000 population), with no change in adults. When IPD incidence was adjusted by the number of blood samples collected, there was a non-significant decrease in both children and adults. Since PCV-7 came on the market, there has been a decrease in vaccine serotypes and an increase in non-vaccine serotypes. The emergent serotypes since that time include 3, 6A, 15, and 19A. Penicillin resistance decreased significantly (p<0.001) from the pre-vaccine period (87.3%) to 2003 (13.8%), and later rose from 2003 through 2006 (41.7%). Erythromycin resistance showed no changes during the study. CONCLUSIONS: The incidence of IPD in children aged 2 years and younger in Gran Canaria has not decreased despite the introduction of PCV-7. However, there has been a reduction in the number of cases related to vaccine serotypes and a significant decrease in penicillin resistance. In contrast, non-vaccine serotype IPD cases have increased. Universal vaccination and the use of new polyvalent vaccines may enhance these effects.

Aspectos epidemiológicos de la enfermedad neumocócica invasiva antes y después del uso de la vacuna neumocócica conjugada en Gran Canaria / Epidemiological features of invasive pneumococcal disease before and after the introduction of pneumococcal conjugate vaccine in Gran Canaria (Canary Islands)

Introducción: la comercialización de la vacuna neumocócica conjugada (PCV-7) ha modificado la epidemiología de la enfermedad neumocócica invasiva (ENI). Nuestro objetivo fue conocer la epidemiología de la ENI antes y después de su uso. Métodos: se incluyeron todas las cepas de Streptococcus pneumoniae causantes de ENI de 2000 a 2006. Se realizó serotipado y antibiograma. Se compararon los datos obtenidos antes (2000¿2001) y después (2004¿2006) de la comercialización de PCV-7. Resultados: hubo 241 casos de ENI. Ningún paciente menor de 2 años con ENI estaba vacunado. La cobertura vacunal en menores de 5 años fue del 48%. Hubo un incremento no significativo de ENI en niños (de 53,8 a 57,8 casos por 100.000 habitantes), manteniéndose invariable en adultos. Al corregir la incidencia según el número de hemocultivos, se observó un descenso no significativo, tanto en niños como en adultos. Tras la comercialización de PCV-7 hubo un descenso de los serotipos vacunales y un aumento de los no vacunales. Los serotipos emergentes tras la vacuna fueron: 3, 6A, 15 y 19A. La resistencia a penicilina descendió significativamente (p<0,001) desde el período prevacunal (87,3%) hasta 2003 (13,8%), y posteriormente aumentó (41,7% en 2006). La resistencia a eritromicina no varió durante el estudio. Conclusiones: la incidencia de ENI en menores de 2 años en Gran Canaria no ha disminuido a pesar de la vacuna PCV-7. Los casos debidos a serotipos vacunales han disminuido, así como la resistencia a penicilina. En cambio, han aumentado los casos debidos a serotipos no vacunales emergentes. La estrategia de vacunación universal y la adopción de nuevas vacunas polivalentes podrían potenciar estos efectos (AU)

Introduction: The introduction of pneumococcal conjugate vaccine (PCV-7) has modified the epidemiology of invasive pneumococcal disease (IPD). Our aim was to investigate the epidemiological features of IPD before and after implementing the use of PCV-7. Methods: All invasive Streptococcus pneumoniae strains isolated in our hospital from 2000 to 2006 were included. Serotypes were identified and antibiograms were performed in all cases. Data obtained before (2000¿2001) and after (2004¿2006) authorization of PCV-7 use in Spain were compared. Results: There were 241 cases of IPD. None of the patients with IPD aged 2 years or younger had received PCV-7. PCV-7 coverage in children aged 5 or younger was about 48%. There was a non-significant increase in the incidence of IPD in children (from 53.8 to 57.8 cases/100 000 population), with no change in adults. When IPD incidence was adjusted by the number of blood samples collected, there was a non-significant decrease in both children and adults. Since PCV-7 came on the market, there has been a decrease in vaccine serotypes and an increase in non-vaccine serotypes. The emergent serotypes since that time include 3, 6A, 15, and 19A. Penicillin resistance decreased significantly (p<0.001) from the pre-vaccine period (87.3%) to 2003 (13.8%), and later rose from 2003 through 2006 (41.7%). Erythromycin resistance showed no changes during the study. Conclusions: The incidence of IPD in children aged 2 years and younger in Gran Canaria has not decreased despite the introduction of PCV-7. However, there has been a reduction in the number of cases related to vaccine serotypes and a significant decrease in penicillin resistance. In contrast, non-vaccine serotype IPD cases have increased. Universal vaccination and the use of new polyvalent vaccines may enhance these effects (AU)