The Impact of MRSA Colonization on Healthcare-Associated Infections in Long-Term Care Facility Residents: A Whole-Genome Sequencing-Based Study.

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been considered a risk factor for the development of infection, however, there are no studies that have compared the colonizing and infecting strains using whole-genome sequencing (WGS). The aim of this study is to determine the prevalence of and risk factors for MRSA colonization among long-term care facilities (LTCF) residents of Tenerife (Spain), and to analyze the epidemiological relationship between the colonizing and infecting strains using WGS. A point-prevalence study was carried out at 14 LTCFs in Tenerife from October 2020 to May 2021. Nasal swabs were cultured for MRSA. Colonized residents were followed up for two years. A phylogenetic comparison between colonization and infection strains was performed using WGS. A total of 764 residents were included. The prevalence of colonization by MRSA was 28.1% (n = 215), of which 12 (5.6%) subsequently developed infection. A close genetic relationship between colonization and infection isolates was found in three of the four (75%) residents studied. Our study confirms that colonized residents can develop serious MRSA infections from the same nasal colonization strain. Given the high prevalence of MRSA colonization in these centers, it is necessary to implement strategies with preventive measures to avoid the development of infection and the transmission of MRSA.

Effectiveness of fosfomycin trometamol as oral step-down therapy for bacteraemic urinary tract infections due to MDR Escherichia coli: a post hoc analysis of the FOREST randomized trial.

BACKGROUND: Fosfomycin is a potentially attractive option as step-down therapy for bacteraemic urinary tract infections (BUTI), but available data are scarce. Our objective was to compare the effectiveness and safety of fosfomycin trometamol and other oral drugs as step-down therapy in patients with BUTI due to MDR Escherichia coli (MDR-Ec). METHODS: Participants in the FOREST trial (comparing IV fosfomycin with ceftriaxone or meropenem for BUTI caused by MDR-Ec in 22 Spanish hospitals from June 2014 to December 2018) who were stepped-down to oral fosfomycin (3 g q48h) or other drugs were included. The primary endpoint was clinical and microbiological cure (CMC) 5-7 days after finalization of treatment. A multivariate analysis was performed using logistic regression to estimate the association of oral step-down with fosfomycin with CMC adjusted for confounders. RESULTS: Overall, 61 patients switched to oral fosfomycin trometamol and 47 to other drugs (cefuroxime axetil, 28; amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole, 7 each; ciprofloxacin, 5) were included. CMC was reached by 48/61 patients (78.7%) treated with fosfomycin trometamol and 38/47 (80.9%) with other drugs (difference, -2.2; 95% CI: -17.5 to 13.1; P = 0.38). Subgroup analyses provided similar results. Relapses occurred in 9/61 (15.0%) and 2/47 (4.3%) of patients, respectively (P = 0.03). The adjusted OR for CMC was 1.11 (95% CI: 0.42-3.29, P = 0.75). No relevant differences in adverse events were seen. CONCLUSIONS: Fosfomycin trometamol might be a reasonable option as step-down therapy in patients with BUTI due to MDR-Ec but the higher rate of relapses would need further assessment.

Bacterial Colonization of Microplastics at the Beaches of an Oceanic Island, Tenerife, Canary Islands.

(1) Isolated systems, such as oceanic islands, are increasingly experiencing important problems related to microplastic debris on their beaches. The formation of microbial biofilm on the surface of microplastics present in marine environments provides potential facilities for microorganisms to survive under the biofilm. Moreover, microplastics act as a vehicle for the dispersion of pathogenic organisms, constituting a new route of exposure for humans. (2) In this study, the microbial content (FIO and Vibrio spp. and Staphylococcus aureus) of microplastics (fragments and pellets) collected from seven beaches of the oceanic island of Tenerife, in the Canary Islands (Spain), was determined. (3) Results showed that Escherichia coli was present in 57.1% of the fragments and 28.5% of the pellets studied. In the case of intestinal Enterococci, 85.7% of the fragments and 57.1% of the pellets tested positive for this parameter. Finally, 100% of the fragments and 42.8% of the pellets analyzed from the different beaches contained Vibrio spp. (4) This study shows that microplastics act as reservoirs of microorganisms that can increase the presence of bacteria indicating faecal and pathogenic contamination in bathing areas.

Humoral response to SARS-CoV-2 after vaccination and booster effect in patients undergoing dialysis.

OBJECTIVE: The aim of this study was to determine and evaluate the postvaccination variation in immunoglobulin G (IgG) receptor-binding domain (RBD) produced in non-SARS-CoV-2-infected patients with nephropathy and renal replacement therapy. METHODS: This is a follow-up study of the humoral response to the BNT162b2 messenger ribonucleic acid COVID-19 vaccine in patients with nephropathy, comparing it with itself at different times and with the healthy population. RESULTS: In patients with nephropathy, a very striking decrease in IgG RBD was observed compared with the healthy population (P<0.001) at three months after the second dose. In patients with nephropathy, the response rate ≥590 binding antibody units/ml (4154 AU/ml) was detected in 45% of patients, 15 days after the second dose, whereas at 3 months, this decreased to 9% (P<0.05) and then increased to 86% after the third dose (P<0.001). CONCLUSION: In patients with nephropathy and renal replacement therapy, it is necessary to administer a third-dose vaccination within 3 months after the second dose. It is important to continue monitoring the humoral response to obtain a better SARS-CoV-2 vaccination schedule.

[Clostridioides difficile toxin B gen amplification cycle threshold as a predictor of severity]. / Umbral del ciclo de amplificación del gen de la toxina B de Clostridioides difficile como predictor de gravedad.

BACKGROUND: Clostridioides dfficile infection (CDI) is the main cause of nosocomial diarrhea, generally associated with the use of antibiotics. This infection can cause uncomplicated diarrhea to pseudomembranous colitis or toxic megacolon. Recent studies have attempted to relate the threshold cycle (Ct) value of RT-PCR with mortality, as a fast, simple, objective and efficient method. AIM: To evaluate Ct as a predictor of poor outcome in patients with C. dfficile disease with/without clinical signs of severity. METHODS: We carried out a retrospective study between January 2015 and December 2018, including all patients in the reference area of the Hospital Universitario de Canarias in Tenerife (396,483 inhabitants) in patients with clinical criteria of severity and patients without clinical severity criteria (according to the guide for the clinical practice of CDI of the Society of Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of North America (IDSA). RESULTS: A total of 202 CDI episodes were diagnosed. 77.7% (n = 157) presented clinical severity criteria. The presence of ulcerative colitis (p < 0.001), fever (p < 0.001), leukocytosis (p < 0.001), neutrophilia (p < 0.001), creatininemia (p = 0.005) were presented as risk factors for the development of severe CDI (S-CDI). Female sex, institutionalization, previous admission and death were described more frequently in the group with S-CDI, not finding significant differences. We found no differences with respect to the days of previous stay, or of post-CDI stay, although in the latter, the mean was higher in the case of S-CDI patients. No significant differences were found in terms of Ct in both groups; being only one point lower in patients with severity criteria (Ct = 26.1) than without severity criteria (Ct = 27.4) (p = 0.326). Conclusión: Based on the results of our study, it has not been possible to systematically implement the Ct value as a predictor of severity to the clinical report, and it is not possible to extrapolate this predictive variable from S-CDI and standardize the Ct value as a predictor of severity. CONCLUSION: Basándonos en los resultados de nuestro estudio, no ha sido posible la implementación sistemática del valor Ct como predictor de gravedad al informe clínico, no siendo posible extrapolar esta variable predictora de enfermedad por C difficile-G y estandarizar el valor Ct como factor predictor de gravedad.

Sonication did not provide reliability to Maki technique for catheter related bloodstream infection diagnosis / La sonicación no proporciona rentabilidad a la técnica de Maki para el diagnóstico de bacteriemia relacionada con catéter

Objective. The aim of our study was to analyze sonicationand Maki techniques for diagnosis of catheter tip colonizationand catheter-related bloodstream infection (CRBSI) on patientsadmitted to ICU.Material and methods. Observational and prospectivestudy in one Intensive Care Unit. Patients with some centralvenous catheter (CVC) at least for 7 days and catheter-relatedinfection (CRI) suspicion (new episode of fever or sepsis) wereincluded. We performed Maki technique followed by sonication of catheter tip. We compared area under the curve (AUC)of Maki, sonication, and techniques combination to diagnosiscatheter tip colonization and CRBSI.Results. We included 94 CVC from 87 CRI suspicion episodes. We found 14 cases of catheter tip colonization and 10cases of CRBSI. Of the 14 catheter tip colonization cases, 7(50.0%) were detected by Maki and sonication techniques, 6(42.9%) were detected only by Maki technique, and 1 (7.1%)was detected only by sonication technique. Of the 10 CRBSI,6 (60.0%) were detected by Maki and sonication techniques,4 (40.0%) were detected only by Maki technique, and anyonly by sonication technique. We found higher AUC in Makitechnique than in sonication technique to diagnosis of CRBSI(p=0.02) and to diagnosis of catheter tip colonization (p=0.03).No significant differences were found in AUC between Makitechnique and combination techniques for diagnosis of catheter tip colonization (p=0.32) and of CRBSI (p=0.32).Conclusion.: Sonication did not provide reliability to Makitechnique for diagnosis of catheter tip colonization and CRBSI. (AU)

Objetivo. El objetivo de nuestro estudio fue analizar lastécnicas de sonicación y Maki para el diagnóstico de la colonización de la punta del catéter y la bacteriemia relacionada conel catéter (CRBSI) en pacientes ingresados en UCI.Material y método. Estudio observacional y prospectivoen una Unidad de Cuidados Intensivos. Se incluyeron pacientescon algún catéter venoso central (CVC) insertado al menos durante 7 días y sospecha de sospecha de infección relacionadacon el catéter (IRC) (nuevo episodio de fiebre o sepsis). Se realizó técnica de Maki y posteriormente sonicación de la puntadel catéter. Comparamos áreas bajo la curva (AUC) de Maki,sonicación y combinación de técnicas para el diagnóstico decolonización de la punta del catéter y de CRBSI.Resultados. Se incluyeron 94 CVC de 87 episodios de sospecha de IRC. Encontramos 14 casos de colonización de la puntadel catéter y 10 casos de CRBSI. De los 14 casos de colonizaciónde la punta del catéter, 7 (50,0%) fueron detectados por Maki ytécnicas de sonicación, 6 (42,9%) fueron detectados solo por latécnica de Maki y 1 (7,1%) fue detectado solo por la técnica desonicación. De los 10 CRBSI, 6 (60,0%) fueron detectados portécnicas de Maki y sonicación, 4 (40,0%) fueron detectados solopor la técnica de Maki, y ninguno solo por la técnica de sonicación. Encontramos mayor AUC con Maki que en la sonicaciónpara el diagnóstico de CRBSI (p=0.02) y para el diagnóstico decolonización de la punta del catéter (p=0.03). No encontramosdiferencias significativas en AUC entre Maki technique y combinación de técnicas para el diagnóstico de CRBSI (p=0.32) y parael diagnóstico de colonización de la punta del catéter (p=0.32).Conclusiones. La sonicación no proporcionó rentabilidada la técnica de Maki para el diagnóstico de colonización de lapunta del catéter y CRBSI. (AU)

Umbral del ciclo de amplificación del gen de la toxina B de Clostridioides difficile como predictor de gravedad / Clostridioides difficile toxin B gen amplification cycle threshold as a predictor of severity

INTRODUCCIÓN: La infección por Clostridioides dfficile (ICD) es la principal causa de diarrea nosocomial, generalmente asociada al consumo de antimicrobianos. Esta infección puede causar desde diarrea no complicada hasta colitis pseudomembranosa o megacolon tóxico. Estudios recientes han intentado relacionar el valor el ciclo umbral (Ct) de la RT-PCR con la mortalidad, como un método rápido, sencillo, objetivo y eficaz. OBJETIVO: Evaluar el Ct como predictor de mala evolución en pacientes con y sin criterio clínico de dicha gravedad. PACIENTES Y MÉTODOS: Realizamos un estudio retrospectivo entre enero 2015 y diciembre 2018, incluyendo todos los pacientes del área de referencia del Hospital Universitario de Canarias en Tenerife (396.483 habitantes) en pacientes con criterios clínicos de gravedad (de acuerdo a la Guía para la Práctica Clínica de la enfermedad por C. dfficile de la Sociedad de Epidemiología del Cuidado de la Salud de América (SHEA) y la Sociedad de Enfermedades Infecciosas de Norteamérica (IDSA) y pacientes sin criterios clínicos de gravedad evaluando el Ct como predictor de mala evolución. RESULTADOS: Se diagnosticó un total de 202 episodios de ICD. El 77,7% (n = 157) presentó criterios clínicos de gravedad. La presencia de colitis ulcerosa (p < 0,001), fiebre (p < 0,001), leucocitosis (p < 0,001), neutrofilia (p < 0,001), creatininemia (p = 0,005) se presentaron como factores de riesgo para el desarrollo de ICD grave. El sexo femenino, la institucionalización, el ingreso previo y el exitus se describieron con mayor frecuencia en el grupo con ICD-G, no encontrando diferencias significativas. No encontramos diferencias respecto a los días de estancia previa, o de estancia post-ICD, aunque en este último, la media fue mayor en el caso de los pacientes con ICD-G. No se encontraron diferencias significativas en cuanto al Ct en ambos grupos; siendo sólo un punto menor en pacientes con criterio de gravedad (Ct = 26,1) que sin criterios de gravedad (Ct = 27,4) (p = 0,326).

BACKGROUND: Clostridioides dfficile infection (CDI) is the main cause of nosocomial diarrhea, generally associated with the use of antibiotics. This infection can cause uncomplicated diarrhea to pseudomembranous colitis or toxic megacolon. Recent studies have attempted to relate the threshold cycle (Ct) value of RT-PCR with mortality, as a fast, simple, objective and efficient method. AIM: To evaluate Ct as a predictor of poor outcome in patients with C. dfficile disease with/without clinical signs of severity. METHODS: We carried out a retrospective study between January 2015 and December 2018, including all patients in the reference area of the Hospital Universitario de Canarias in Tenerife (396,483 inhabitants) in patients with clinical criteria of severity and patients without clinical severity criteria (according to the guide for the clinical practice of CDI of the Society of Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of North America (IDSA). RESULTS: A total of 202 CDI episodes were diagnosed. 77.7% (n = 157) presented clinical severity criteria. The presence of ulcerative colitis (p < 0.001), fever (p < 0.001), leukocytosis (p < 0.001), neutrophilia (p < 0.001), creatininemia (p = 0.005) were presented as risk factors for the development of severe CDI (S-CDI). Female sex, institutionalization, previous admission and death were described more frequently in the group with S-CDI, not finding significant differences. We found no differences with respect to the days of previous stay, or of post-CDI stay, although in the latter, the mean was higher in the case of S-CDI patients. No significant differences were found in terms of Ct in both groups; being only one point lower in patients with severity criteria (Ct = 26.1) than without severity criteria (Ct = 27.4) (p = 0.326). CONCLUSION: Based on the results of our study, it has not been possible to systematically implement the Ct value as a predictor of severity to the clinical report, and it is not possible to extrapolate this predictive variable from S-CDI and standardize the Ct value as a predictor of severity. Conclusion: Basándonos en los resultados de nuestro estudio, no ha sido posible la implementación sistemática del valor Ct como predictor de gravedad al informe clínico, no siendo posible extrapolar esta variable predictora de enfermedad por C difficile-G y estandarizar el valor Ct como factor predictor de gravedad.

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections: A Randomized Clinical Trial.

Importance: The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. Objective: To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. Design, Setting, and Participants: This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. Interventions: Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or parenteral ertapenem for the comparator group after 4 days. Main Outcomes and Measures: The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. Results: Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to ∞ percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI, -∞ to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). Conclusions and Relevance: This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections. Trial Registration: ClinicalTrials.gov Identifier: NCT02142751.

Skin insertion site culture for the prediction of primary bloodstream infection.

PURPOSE: Previous studies have analyzed the capability of skin insertion site culture to predict catheter-related bloodstream infection (CRBSI). However, there has been not analyzed its capability to predict primary bloodstream infection (PBSI), that include CRBSI and bloodstream infection of unknown origin (BSIUO). The novel objective of our study was to determine the capability of insertion skin site culture to predict CRBSI and primary bloodstream infection (PBSI), that include CRBSI and bloodstream infection of unknown origin (BSIUO). MATERIAL AND METHODS: Observational and prospective study in one Intensive Care Unit. Patients with some central venous catheter (CVC) at least during 7 days and suspected catheter-related infection (CRI) (new episode of fever or sepsis) were included. Cultures of insertion skin site, paired blood samples, catheter-tip, and other clinical samples were taken. Capability of insertion skin site culture to predict CRBSI and PBSI was determined. RESULTS: We included 108 CVC from 96 CRI suspicion episodes. The causes that motivated CRI suspicion were 20 (18.5%) PBSI, 44 (40.7%) other infections, and 44 (40.7%) unknown. Among the 20 PBSI, 11 (55%) were CRBSI and 9 (45%) were BSIUO. Negative predictive value of insertion skin site culture to predict CRBSI was 95% (87-98%) and to predict PBSI was 85% (76-91%). CONCLUSIONS: The new finding of our study was that skin insertion site culture had a good negative predicted valued for the prediction of CRBSI and PBSI.

Pseudo-outbreak of Mycobacterium fortuitum in a hospital bronchoscopy unit.

BACKGROUND: Mycobacterium fortuitum survive in different environmental conditions, biofilm formation and resistance to chlorinated disinfectants makes its isolation frequent in hospital environments, even being involved in outbreaks by contamination of medical equipment such as bronchoscopes. We describe a pseudo-outbreak by M fortuitum isolated in samples from 9 patients who underwent bronchoscopy in the pneumology bronchoscopy unit of the University Hospital Complex of the Canary Islands from December 2016 to March 2017. METHODS: We proceeded to investigate the pseudo-outbreak with a combination of epidemiologic, environmental, and molecular typing data. RESULTS: The source/reservoir of pseudo-outbreak was the hospital water used by the bronchoscope automatic washing machine (without antibacterial filter), so control measures were taken. Molecular typing was performed on 7 strains from 7 patients, and a sample of water was collected from a tap in the pneumology bronchoscopy unit: all of which had the same pattern. CONCLUSIONS: Our study demonstrates the presence of nontuberculous mycobacteria in the hospital water supply, and thus the need to take measures against them because they compromise patients' health. We also suggest the need for hospital water quality guidelines in which methods to control and/or eliminate them are established.

Prevalence and characteristics of methicillin-resistant staphylococci in goats on the island of Tenerife, Spain.

The aim of this study was to determine the prevalence of methicillin-resistant Staphylococcus (MRS) in healthy goats on the Island of Tenerife, Spain, as well as to identify the phenotypic and genotypic characteristics of the strains found. A cross-sectional prevalence study was conducted. A total of 158 goats from 15 different farms were sampled between September 2017 and January 2018. The percentage of positive samples of methicillin-resistant Staphylococcus aureus (MRSA) was 15.8% (25/158) and that of methicillin-resistant coagulase-negative staphylococci (MRCoNS) was 6.9% (11/158). All MRSA isolates from goats belonged to one clonal group showing Multi-Locus Sequence type 398. All strains studied (n = 36) were resistant to non-carbapenem beta-lactam antibiotics and susceptible to teicoplanin, linezolid, vancomycin, rifampicin, quinupristin-dalfospristin and mupirocine. In MRSA isolates, the highest percentage of resistance obtained, besides beta-lactam non-carbapenem antibiotics, was to trimethoprim-sulphamethoxazole and, in the case of MRCoNS isolates, to phosphomycin and erythromycin. A total of 12 resistance patterns were obtained, presenting differences between patterns obtained for MRSA and MRCoNS, with 7 different patterns for MRSA and 5 for MRCoNS. We therefore consider it essential to expand the epidemiological study of these strains of animal origin, as well as to increase surveillance and control measures at all stages of the food chain.

Factores de riesgo en bacteriemias nosocomiales secundarias a ITU en un hospital terciario / Risk factors to secondary nosocomial bacteremia to UTI in a tertiary hospital

INTRODUCCIÓN: Las bacteriemias nosocomiales secundarias a infecciones del tracto urinario (BNS-ITU) ocurren en un 1-4% de los episodios y la mortalidad asociada puede aumentar hasta el 33%. Sin embargo, se conoce muy poco sobre la epidemiología de estas infecciones. La determinación de los factores de riesgo modificables para desarrollar este tipo de bacteriemias podría ayudar al control de la infección y reducir el gasto sanitario. MATERIAL Y MÉTODOS: Estudio de casos y controles de las BNS-ITU diagnosticadas en el Hospital Universitario de Canarias entre 2010-2014. Se recogieron las variables clínico-epidemiológicas y los factores de riesgo potenciales intrínsecos y extrínsecos. Se utilizó la regresión logística para estudiar las variables asociadas al desarrollo de BNS-ITU. RESULTADOS: Se estudiaron 178 episodios, 85 casos y 93 controles. La estancia media fue significativamente mayor en los casos; desde el ingreso hasta la bacteriemia (p< 0,003), como desde ésta hasta el alta (p< 0,005). La insuficiencia hepática (p< 0,091), el uso de ventilación mecánica (p < 0,001), de el catéter venoso central (p < 0,043) y la cirugía en el episodio (p< 0,001) se comportaron como factores de riesgo para la adquisición de BNS-ITU. CONCLUSIONES: Los dispositivos invasivos, como el catéter venoso central y la ventilación mecánica, que no había sido estudiada previamente; así como la cirugía en el episodio, que tampoco había sido estudiada, suponen factores de riesgo. Además, la BNS-ITU causa un aumento significativo de la estancia hospitalaria. Por ello, es necesario conocer los factores de riesgo para la aparición de estas infecciones, y así, prevenir su aparición y mejorar la seguridad de los pacientes hospitalizados

INTRODUCTION: Nosocomial bacteremia secondary to urinary tract infections (NBS-UTI) occur in 1-4% of episodes and the associated mortality can increase up to 33%. However, very little is known about the epidemiology of these infections. The determination of modifiable risk factors to develop this type of bacteremia could help to control the infection and reduce health costs. MATERIAL AND METHODS: Cases-control study of NBS-UTI diagnosed at the University Hospital of Canary Islands between 2010-2014. The clinical-epidemiological variables and the intrinsic and extrinsic potential risk factors were collected. Logistic regression was used to study the variables associated with the development of NBS-UTI. RESULTS: A total of 178 episodes were studied, 85 cases and 93 controls. The average stay was significantly greater in the cases; from admission to bacteremia (p <0.003), as well as from discharge to discharge (p <0.005). Hepatic insufficiency (p <0.091), the use of mechanical ventilation (p <0.001), the central venous catheter (p <0.043) and surgery in the episode (p <0.001) behaved as risk factors for the acquisition of NBS-ITU. CONCLUSION: Invasive devices, such as central venous catheter and mechanical ventilation, that had not previously been studied; as well as the surgery in the episode, which had not been studied either, suppose risk factors. In addition, NBS-ITU causes a significant increase in hospital stay. Therefore, it is necessary to know the risk factors for the appearance of these infections, and thus prevent their appearance and improve the safety of hospitalized patients

Increased Antimicrobial Resistance of MRSA Strains Isolated from Pigs in Spain between 2009 and 2018.

The problem of emerging resistant microorganisms such as Methicillin-Resistant Staphylococcus aureus (MRSA) associated to livestock is closely linked to improper use of antimicrobial agents. The aim of this study is to find out the prevalence and characteristics of these strains, as well as their evolution in healthy pigs on the Island of Tenerife, Spain. Between October 2009 and December 2010, 300 pigs from 15 wean-to-finishing farms were screened. Between 1 September 2017 and 31 March 2018, a new sampling was performed collecting 125 nasal swabs from pigs belonging to the same farms and under the same conditions as the previous study. MRSA antibiotic resistant patterns were studied. Results: Prevalence of MRSA isolates was 89.6%. All isolates belonged to Sequence Type 398 (ST398), a livestock related strain. All strains studied were resistant to beta-lactamic non-carbapenemic antibiotics and sensitive to teicoplanin, linezolid, vancomycin, rifampicin, quinupristin-dalfospristin, and mupirocine. Between 2009/2010-2017/2018 a significant increase in resistance to gentamicin, tobramycin, trimethoprim-sulfomethoxazole, clindamycin, Fosfomycin, and tigecycline antibiotics was observed in isolated MRSA strains compared to the previous period. We consider a major control and surveillance program of antibiotic use in veterinary care is needed in order to reduce the presence of MRSA strains in livestock and control this significant multi-resistance increase.

Onicomicosis por alga sin clorofila / Onychomycosis caused by algae without chlorophyll

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A Mycobacterium tuberculosis Beijing strain persists at high rates and extends its geographic boundaries 20 years after importation.

Transmission of Beijing Mycobacterium tuberculosis can be investigated based on genotypic analysis of clinical isolates. A Beijing strain began to spread on Gran Canaria Island, Spain, at the end of the last century. In 1996, only 3 years after its importation to the island, its frequency had increased to 27.1% of all the isolates. The strain was tracked during the following years, and the most recent data obtained corresponded to 2007-8, when its presence continued to be alarming (21%). In the current study, we updated data on the distribution of this strain 20 years (2013-2014) after it was first detected on the island and extended the analysis for the first time to all the mycobacteriology laboratories covering the population of the Canary Island archipelago. Rapid updating was enabled by means of 2 different strain-specific PCRs: one targeting a peculiar feature of the strain, which was identified based on an IS6110 copy mapping in the Rv2180c gene, and a newly defined strain-specific single nucleotide polymorphism, which was identified by whole-genome sequencing. The results showed that the strain has remained highly prevalent (20.90% of all isolates), has spread throughout the neighbouring islands, and has also reached high representativeness in them (11-32%).

Epidemiological study of secondary bloodstream infections: The forgotten issue.

OBJECTIVE: Secondary bacteraemia infections (SBI) are poorly studied. We analyse the epidemiology of nosocomial SBI, potential risk factors and mortality of affected patients. METHODS: Prospective study of patients with bacteraemia from 2009 to 2014 in a tertiary hospital. For each SBI was recorded: primary source of infection, aetiological agent, demographic data, intrinsic and extrinsic risk factors and mortality during the episode. RESULTS: 429/1918 episodes of Nosocomial Bacteraemia (NB) (22%) were SBI (average Incidence Density: 0.41% days of admission). Onco-hematological services had the highest Incidence Density of SBI. Surgical Site Infection-SBI (SSI-BSI) was the most frequent SBI (27%), followed by Urinary Tract Infection-SBI (UTI-BSI) (24%). Gram-negative bacteria were the most prevalent microorganism (61.1%). The median interval between SBI episodes to discharge was 37±59days. Mortality rate was 29%. These patients had many intrinsic and extrinsic risk factors such as urinary catheterization (68%), CVC (69%), Arterial hypertension (48%) and hospitalization in the six previous months (45%). Mean age was significantly higher in patients with UTI-BSI and SSI-BSI. Average stay from admission to the development of bacteraemia was statistically lower in patients with Intra-abdominal Infection bacteraemia (IAB-BSI). Patient with SSI-BSI had oncologic processes and had undergone for more Mechanical ventilation than UTI-SSBI and Respiratory Tract Infections Bacteraemia (RTI-BSI). The use of CVC was significantly higher in RTI-BSI. CONCLUSIONS: SBI accounts for almost a quarter of all NB. Patients has multiple comorbidities, increases hospital stay and mortality. It would be necessary to establish measures to rapidly diagnose and treat the primary infection, in order to prevent the onset of SBI.

¿Existe relación entre el ciclo umbral de la reacción en cadena de la polimerasa y el riesgo de infección grave por Clostridium difficile? / Is there a relationship between the polimerase chain reaction cycle threshold and the risk of severe Clostridium difficile infection?

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Características y evolución clínica de las bacteriemias por Klebsiella pneumoniae productora de carbapenemasa tipo OXA-48 en un hospital de tercer nivel / Clinical features and outcomes of bacteraemia due to OXA-48-like carbapenemase-producing Klebsiella pneumoniae in a tertiary hospital

INTRODUCCIÓN: El manejo de las bacteriemias por Klebsiella pneumoniae productora de carbapenemasa del tipo OXA-48 (KPOXA-48) es complicado por las escasas opciones terapéuticas y la elevada mortalidad. El objetivo del estudio fue describir las características clínicas de bacteriemia por KPOXA-48 entre octubre de 2013 y diciembre de 2016. MATERIAL Y MÉTODOS: Se recogieron retrospectivamente de las historias clínicas las variables para analizar. La producción de carbapenemasas se confirmó por métodos fenotípicos y moleculares. RESULTADOS: Se incluyeron 38 pacientes con bacteriemia, mayoritariamente de origen nosocomial (n = 31). Un alto porcentaje de las bacteriemias (n = 26) fueron secundarias, principalmente de origen urinario (n = 11). Todos los aislamientos eran multirresistentes con producción de la beta-lactamasa de espectro extendido CTX-M-15 y carbapenemasa del tipo OXA-48. La mortalidad bruta con antibioterapia dirigida adecuada fue del 0% y la inadecuada del 55% (p = 0,0015). CONCLUSIONES: Se pone de manifiesto la importancia de identificar este mecanismo de resistencia, los factores del paciente, el tipo de bacteriemia y la adecuación de la estrategia terapéutica en la evolución clínica

INTRODUCTION: Community-acquired Staphylococcus aureus (SA) bacteraemia is a common cause of hospitalisation in children. The occurrence of secondary foci (SF) of SA infection is associated with higher morbidity and mortality. OBJECTIVES: To identify risk factors for SF of infection in children with community-acquired SA bacteraemia. MATERIAL AND METHODS: Prospective cohort. All children aged from 30 days to 16 years admitted to a paediatric referral hospital between January 2010 and December 2016 for community-acquired infections, with SA isolated in blood cultures, were included. Microbiological, demographic and clinical characteristics were compared, with or without SF infection after 72 hours of hospitalisation. RESULTS: A total of 283 patients were included, 65% male (n = 184), with a median age of 60 months (IQR: 30-132). Seventeen per cent (n = 48) had at least one underlying disease and 97% (n = 275) had some clinical focus of infection, the most common being: osteoarticular 55% (n = 156) and soft tissue abscesses 27% (n = 79). A total of 65% (n = 185) were resistant to methicillin. A SF of infection was found in 16% of patients (n = 44). The SF identified were pneumonia 73% (n=32), osteoarticular 11% (n = 5), soft tissue 11% (n = 5) and central nervous system 5% (n=2). In the multivariate analysis, the persistence of positive blood cultures after the fifth day (OR: 2.40, 95%CI: 1.07-5.37, P < 0.001) and sepsis (OR: 17.23, 95%CI 5.21-56.9, P < 0.001) were predictors of SF. There was no association with methicillin sensitivity. CONCLUSIONS: In this cohort, methicillin-resistant SA infections predominated. The occurrence of SF of infection was associated with the persistence of bacteraemia after the fifth day and sepsis on admission