Adding vortexing to the Maki technique provides no benefit for the diagnosis of catheter colonization or catheter-related bacteremia.

BACKGROUND: A previous study compared vortexing and Maki techniques for the diagnosis of catheter-related bloodstream infection (CRBSI), and concluded that vortexing was not superior to Maki method. AIM: To determine whether the combined use of vortexing and Maki techniques provides profitability versus the Maki technique for the diagnosis of catheter tip colonization (CTC) and CRBSI. METHODS: Observational and prospective study carried out in an Intensive Care Unit. Patients with suspected catheter-related infection (CRI) and with one central venous catheter for at least 7 days were included. The area under the curve (AUC) of the Maki technique, the vortexing technique and the combination of both techniques for the diagnosis of CTC and CRBSI were compared. RESULTS: We included 136 episodes of suspected CRI. We found 21 cases of CTC of which 10 were also CRBSI cases. Of the 21 CTC episodes, 18 (85.7%) were diagnosed by Maki technique and vortexing technique, 3 (14.3%) only by the technique of Maki, and none only by technique of vortexing. Of the 10 CRBSI episodes, 9 (90.0%) were diagnosed by the techniques of Maki and vortexing, 1 (10.0%) was diagnosed only by the technique of Maki, and none only by the technique of vortexing. We no found differences in the comparison of AUC between the technique of Maki and the combination of Maki and vortexing techniques for the diagnosis of CTC (P = 0.99) and CRBSI (P = 0.99). CONCLUSION: The novel finding of our study was that the combined use of vortexing and Maki techniques did not provide profitability to the technique of Maki alone to CRBSI diagnosis of.

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)

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.

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

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

INTRODUCTION: Limited therapeutic options and high mortality make the management of OXA-48-like carbapenemase-producing Klebsiella pneumoniae (KPOXA-48) bacteraemia complicated. The aim of the study was to describe the clinical characteristics of KPOXA-48 bacteraemia between October 2013 and December 2016. MATERIAL AND METHODS: The variables to analyse were retrospectively collected from medical records. Carbapenemase production was confirmed by phenotypic and molecular methods. RESULTS: A total of 38 patients with bacteraemia were included, mainly classified as hospital-acquired (n=31). The majority of cases were secondary bacteraemia (n=26), most commonly arising from the urinary tract (n=11). All isolates presented a multidrug-resistant profile with the extended spectrum beta-lactamase CTX-M-15 and the carbapenemase OXA-48-like production. The crude mortality rate with adequate targeted antibiotic therapy was 0%, rising to 55% with inadequate treatment (p=0.0015). CONCLUSIONS: This study highlights the importance of identifying this resistance mechanism, the patient factors, type of bacteraemia and adequacy of antibiotic therapy in the outcome of bacteraemia.

Significación clínica de Cryptococcus neoformans en heces en paciente con SIDA / Clinical significance of Cryptococcus neoformans in faeces of an AIDS patient

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Risk factors associated with carbapenemase-producing Klebsiella pneumoniae fecal carriage: A case-control study in a Spanish tertiary care hospital.

Asymptomatic colonization of the gastrointestinal tract by carbapenemase-producing Enterobacteriaceae is an important reservoir for transmission that may precede infection. This prospective, observational, case-control study was designed to identify risk factors for carbapenemase-producing Klebsiella pneumoniae (CPKP) fecal carriage. This study included 87 cases and 200 controls. Multivariate analysis identified length of stay (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01-1.03; P = .03), previous hospitalization (OR, 5.89; 95% CI, 1.73-20.68; P = .01), antibiotic use (OR, 0.20; 95% CI, 0.65-0.62; P = .01), and corticosteroid use (OR, 0.33; 95% CI, 0.15-0.74; P = .007) as independent risk factors for CPKP rectal carriage. Length of hospital stay, previous hospitalization, corticosteroid use, and antimicrobial exposure are important risk factors for CPKP rectal colonization. Adherence to infection control practices and directed surveillance programs appear to be critical components for CPKP control programs.

Mieloradiculitis por reactivación del virus Epstein-Barr en paciente con Linfoma de Hodking / Myeloradiculitis due to Epstein-Barr virus reactivation in a Hodgkin's lymphoma patient

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