Effectiveness of interventions to improve adherence to antidepressant medication in patients with depressive disorders: a cluster randomized controlled trial.

Aim: To assess the effectiveness of two interventions of knowledge transfer and behavior modification to improve medication adherence in patients with depressive disorders. Methods: An open, multicenter, three-arm clinical trial with random allocation by cluster to usual care or to one of the two interventions. The intervention for psychiatrists (PsI) included an educational program based on a patient-centered care model. The intervention for patients and relatives (PtI) included a collaborative care program plus a reminder system that works using an already available medication reminder application. The primary outcome was patient adherence to antidepressant treatment assessed through the Sidorkiewicz Adherence Instrument. Secondary measures were depression severity, comorbid anxiety and health-related quality of life. Mixed regression models with repeated measures were used for data analysis. Results: Ten psychiatrists and 150 patients diagnosed with depressive disorder from eight Community Mental Health Units in the Canary Islands (Spain) were included. Compared with usual care, no differences in long-term adherence were observed in either group PsI or PtI. The PsI group had significantly improved depression symptoms (B = -0.39; 95%CI: -0.65, -0.12; p = 0.004) during the follow-up period. The PtI group presented improved depression symptoms (B = -0.63; 95%CI: -0.96, -0.30; p < 0.001) and mental quality of life (B = 0.08; 95%CI: 0.004, 0.15; p = 0.039) during the follow-up period. Conclusion: The assessed interventions to improve adherence in patients with depressive disorder were effective for depression symptoms and mental quality of life, even over the long term. However, no effect on antidepressant adherence was observed.

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.

Evaluation of Delayed Effective Discharge for Non-Medical Reasons in Patients Admitted to Acute Care Hospitals in Spain: A Scoping Review.

Delayed discharge for non-clinical reasons is defined as a period of stay that continues after a patient has been deemed medically fit to leave the hospital but is unable to do so for non-medical reasons. This circumstance overburdens the healthcare system and constitutes a major problem for healthcare systems and the patients themselves in this situation. The aim of this study was to evaluate the delay in effective discharge for non-medical reasons for patients admitted to acute care hospitals in Spain. A scoping review followed the Joanna Briggs Institute methodology guidelines to search for and synthesize studies published between 2019 and 2022. To identify potentially relevant documents, the following bibliographic databases were searched: EMBASE, CINAHL and MEDLINE. For the search, we used free terms («delayed discharges¼, «discharge delays¼, «bed-blocking¼, «timely discharge¼, «unnecessary days¼ and «inappropriate stays¼). Quantitative or qualitative studies published in scientific journals on delayed effective discharge for non-medical reasons for patients admitted to a hospital for any health issue of medical or surgical origin were selected. Information collection of the documents was performed using a structured datasheet specifically developed by the authors. The initial search strategy identified a total of 124 references, which were successively screened to a final selection of 13 studies. To conclude, delayed discharge from a hospital for non-clinical reasons is a multifactorial problem. This may be due to factors internal or external to the hospital, as well as personal factors. The main causes of the delay were similar among the studies found, as were the clinical characteristics of the patients, most of whom were elderly, frail and more dependent due to declining functional capacities. Further studies addressing the socio-familial characteristics of the patients and the perspective of the patient and families would be necessary.

Barriers and Facilitating Factors of Adherence to Antidepressant Treatments: An Exploratory Qualitative Study with Patients and Psychiatrists.

This study examines the experiences and expectations of patients with depressive disorders regarding the disease and different antidepressants, as well as examining the barriers and facilitating factors that could affect their adherence to medications. An exploratory qualitative study was carried out. The study involved two focus groups made up of patients and caregivers and six semi-structured interviews with psychiatrists. In both cases, the participants were selected by intentional theoretical sampling, seeking maximum significance variation of social types. Prejudice about the side effects of medication was relevant. The importance of patients being well informed about the disease/treatments was noteworthy. The stigmatization of antidepressants by patients was identified as a barrier to medication adherence. The involvement of family members and the motivation of patients to be actively involved in the process to recover from the disease were identified as facilitating factors. The work carried out suggests the need for patients to have rigorous information about the disease/treatment to reduce the possible prejudices generated by beliefs. Maintaining greater contact and monitoring of patients/caregivers to help therapeutic adherence in patients with depressive disorders was also identified as being of great importance.

Effectiveness of interventions to improve medication adherence in adults with depressive disorders: a meta-analysis.

BACKGROUND: Non-adherence to medication is a major obstacle in the treatment of depressive disorders. We systematically reviewed the literature to evaluate the effectiveness of interventions aimed at improving adherence to medication among adults with depressive disorders with emphasis on initiation and implementation phase. METHODS: We searched Medline, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index and Science Citation Index for randomized or non-randomized controlled trials up to January 2022. Risk of bias was assessed using the criteria of the Cochrane Collaboration. Meta-analyses, cumulative and meta-regression analyses for adherence were conducted. RESULTS: Forty-six trials (n = 24,324) were included. Pooled estimate indicates an increase in the probability of adherence to antidepressants at 6 months with the different types of interventions (OR 1.33; 95% CI: 1.09 to 1.62). The improvement in adherence is obtained from 3 months (OR 1.62, 95% CI: 1.25 to 2.10) but it is attenuated at 12 months (OR 1.25, 95% CI: 1.02 to 1.53). Selected articles show methodological differences, mainly the diversity of both the severity of the depressive disorder and intervention procedures. In the samples of these studies, patients with depression and anxiety seem to benefit most from intervention (OR 2.77, 95% CI: 1.74 to 4.42) and collaborative care is the most effective intervention to improve adherence (OR 1.88, 95% CI: 1.40 to 2.54). CONCLUSIONS: Our findings indicate that interventions aimed at improving adherence to medication among adults with depressive disorders are effective up to six months. However, the evidence on the effectiveness of long-term adherence is insufficient and supports the need for further research efforts. TRIAL REGISTRATION: International Prospective Register for Systematic Reviews (PROSPERO) number: CRD42017065723 .

Prevalence and Characterisation of Multiresistant Bacterial Strains Isolated in Pigs from the Island of Tenerife.

BACKGROUND: Antibiotic-resistant bacteria can circulate among human and animal populations through direct contact with animals, as well as via food and the environment. The purpose of this study was to examine the prevalence and characterisation of multiresistant bacteria in pig samples. METHODS: 224 samples of pig livestock were taken at the slaughterhouse on the island of Tenerife. A nasal and a rectal sample were collected from each pig. The presence of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus coagulase-negative (MRCoNS), vancomycin-resistant Enterococcus (VRE), extended-spectrum ß-lactamase-producing Enterobacteriaceae (BLEE), carbapenemase-producing Enterobacteriaceae (CPE), and colistin-resistant Enterobacteriaceae was investigated. The resistance genes of the isolated bacteria were characterised by specific PCRs depending on the microorganism to be studied, and in vitro antimicrobial resistance was determined using the broth microdilution method (Vitek®2 system bioMérieux®, Nurtingen, Germany). RESULTS: MRSA prevalence was 73.21% (164 isolates). MRCoNS prevalence was 9.8% (22 isolates), S. sciuri being the prevalent species. Six isolates presented a 2.7% prevalence of extended-spectrum ß-lactamase-producing Escherichia coli (BLEE) in the CTX-M-1 group. No vancomycin-resistant Enterococcus (VRE), carbapenemase-producing Enterobacteriaceae (CRE), or colistin-resistant Enterobacteriaceae were isolated. CONCLUSION: we found a high presence of multiresistant bacteria, suggesting the need for increased control and surveillance of this type of strains in pig livestock and a better understanding of the possible transmission routes of these microorganisms through livestock products.

Arterial Hypertension in Morbid Obesity after Bariatric Surgery: Five Years of Follow-Up, a Before-And-After Study.

BACKGROUND: Arterial hypertension (HTN) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study is to analyse the prevalence and evolution of HTN and weight loss in patients suffering from morbid obesity before and after bariatric surgery, during a follow-up period of five years. METHODS: A before-and-after study was carried out on severely obese patients undergoing Laparoscopic Roux-En-Y Gastric Bypass (LRYGB). Criteria for HTN diagnosis were current treatment with antihypertensive agents and/or systolic blood pressure (SBP) > 140 mmHg and/or diastolic (DBP) > 90 mmHg. HTN remission was defined as normalisation of blood pressure (BP) maintained after discontinuation of medical treatment, and HTN recurrence was considered when HTN diagnostic criteria reappeared after remission. Weight loss during the study period was evaluated for each patient, calculating excess weight loss percentage (% EWL) and BMI loss percentage (% BMIL) with reference to the baseline value. RESULTS: A total of 273 patients were included in the study. HTN was present in 48.2%; 29.4% of hypertensive patients showed HTN remission two years after the surgical procedure, 30.3% of them had relapsed at five years. CONCLUSION: LRYGB in obese patients is associated with a remission of HTN, and no weight loss differences were observed between the group of patients showing HTN remission at two years and the group who did not. However, differences were observed after the second follow-up year, with an increased weight loss in the remission group, which could indicate that sustained weight loss favours the control of HTN.

Aplicaciones móviles para mejorar la adherencia a la medicación: revisión y análisis de calidad / Mobile applications to improve drug adherence: Review and quality analysis

Objetivo: Revisar las aplicaciones móviles en español para mejorar la adherencia farmacológica y evaluar sus características y calidad con el fin de identificar aplicaciones de alta calidad. Médoto: Se ha hecho una revisión siguiendo un procedimiento por pasos similar a una revisión sistemática de la literatura. La fuente de los datos han sido plataformas de distribución digital de aplicaciones móviles Apple Apps Store y Google Play Store. Se han seleccionado aquellas aplicaciones dirigidas a apoyar la autogestión de los medicamentos, capaces de generar recordatorios, en español, actualizadas en los últimos 2 años y gratuitas. Los análisis de las aplicaciones se han hecho según un conjunto de características consideradas deseables y evaluación de la calidad con la herramienta Mobile App Rating Scale. Resultados: De 708 aplicaciones, se seleccionaron 3. Las aplicaciones Medisafe y Mytherapy presentaron el 89% y el 78% de las características deseables, respectivamente. La aplicación de Sergio Licea presentó el 56%. La mayor puntuación global de calidad la obtuvo MyTherapy (3,79/5; RIQ: 3-4), seguida de Medisafe (3,72/5; RIQ: 3-4) y, por último, Sergio Licea (2,87/5; RIQ: 2-4). La valoración de la calidad es coincidente con la hecha por los usuarios. Hay muchas aplicaciones disponibles, sin embargo, la mayoría no cumplieron los criterios de selección establecidos. Conclusiones: Através de un proceso sistemático por pasos, identificamos la aplicación de mayor calidad en español para que sea probada en un estudio futuro, que proporcionará evidencia sobre el uso de una intervención multicomponente para mejorar la adherencia a la medicación.(AU)

Objective: To review the mobile apps in the Spanish market to improve adherence to medications and evaluate their characteristics and quality to identify high-quality applications. Method: A review was carried out following a stepwise procedure similar to a systematic review of the scientific literature. Apple Apps Store and Google Play Store mobile application digital distribution platforms. Applications aimed at supporting self-management of treatment, which generate reminders, in Spanish, updated in the last 2 years and free. We evaluate the applications according to a set of characteristics considered desirable and the quality with the Mobile App Rating Scale tool. Results: Out of 708 applications, 3 applications were selected. The Medisafe and Mytherapy applications had 89% and 78% of the desirable characteristics, respectively. Sergio Licea's application only had 56%. The highest global quality score was obtained by the MyTherapy application (3.79/5, IQR: 3-4), followed by Medisafe (3.72/5, (IQR: 3-4) and, finally, Sergio Licea (2.87/5, IQR: 2-4). The quality assessment coincides with the user assessment. There are many available applications, however, most did not meet the selection criteria. Conclusions: A systematic stepwise process was able to identify the quality application to be tested in a future study that will provide evidence on the use of a multicomponent inter.(AU)

[Mobile applications to improve drug adherence: Review and quality analysis]. / Aplicaciones móviles para mejorar la adherencia a la medicación: revisión y análisis de calidad.

OBJECTIVE: To review the mobile apps in the Spanish market to improve adherence to medications and evaluate their characteristics and quality to identify high-quality applications. METHOD: A review was carried out following a stepwise procedure similar to a systematic review of the scientific literature. Apple Apps Store and Google Play Store mobile application digital distribution platforms. Applications aimed at supporting self-management of treatment, which generate reminders, in Spanish, updated in the last 2 years and free. We evaluate the applications according to a set of characteristics considered desirable and the quality with the Mobile App Rating Scale tool. RESULTS: Out of 708 applications, 3 applications were selected. The Medisafe and Mytherapy applications had 89% and 78% of the desirable characteristics, respectively. Sergio Licea's application only had 56%. The highest global quality score was obtained by the MyTherapy application (3.79/5, IQR: 3-4), followed by Medisafe (3.72/5, (IQR: 3-4) and, finally, Sergio Licea (2.87/5, IQR: 2-4). The quality assessment coincides with the user assessment. There are many available applications, however, most did not meet the selection criteria. CONCLUSIONS: A systematic stepwise process was able to identify the quality application to be tested in a future study that will provide evidence on the use of a multicomponent intervention to improve medication adherence.

[Acute poisoning by chemical products: analysis of the first 15 years of the Spanish Toxic Surveillance System (SETv)]. / Intoxicaciones agudas por productos químicos: análisis de los primeros 15 años del Sistema Español de Toxicovigilancia (SETv).

OBJECTIVE: There are few epidemiological studies on acute poisonings from pesticides, industrials and household products in Spain. The objective of this work is to describe the epidemiological and clinical profile of acute poisonings by chemical products in our country, and analyze their annual evolution. METHODS: The Spanish Toxicovigilance System (SETv) is a prospective registry that includes 32 Emergency Departments and Intensive Care Units in Spain. An observational descriptive study of acute poisoning by chemical agents (excluding pharmacological products and illicit drugs) was carried out, within 1999-2014. Statistical analysis was performed using Chi-square or exact Fisher's tests. Non-parametric continuous variables were compared using the Mann-Whitney U test. P-value less than 0.05 were considered significant. RESULTS: The 10,548 cases studied had a mean age of 38.41 (±22.07) years, being significantly higher in women (p=0.0001). 67.7% of the poisonings occurred at home, and the most frequent routes of exposure were respiratory (48.3%), digestive (35.3%) and ocular (13.1%). The most frequent toxic groups were toxic gases (31%), caustics (25.6%) and irritant gases (12.1%). Of the patients that required treatment (76.2%), antidotes were used in 27.2%. 20.6% of the patients were admitted at Hospital, with a median stay of 32 (±151.94) days, with significant differences for pesticides and solvents (p=0.02). Sequelae were presented at discharge in 2.1% of patients. Mortality was 1.4% (146 patients) with a mean age of 62.08 years (±19.58) (p=0.0001). CONCLUSIONS: The reduction of chemical poisonings should be prevented in the domestic environment, taking into account the sources of exposure to carbon monoxide and the handling of household cleaning products, both caustic liquids and the generation of irritating gases when mixed.

OBJETIVO: Existen pocos estudios epidemiológicos, sobre todo de tipo multicéntrico, sobre las intoxicaciones agudas a causa de productos químicos agroindustriales y del hogar en España. El objetivo de este trabajo fue describir el perfil epidemiológico y clínico de estas intoxicaciones en nuestro país, y analizar su evolución temporal. METODOS: El Sistema Español de Toxicovigilancia (SETv) es un registro prospectivo que incluye a 32 Servicios de Urgencias y Unidades de Cuidados intensivos de España. Se realizó un estudio descriptivo observacional de las intoxicaciones agudas por agentes químicos (excluyendo drogas y fármacos) en sus primeros 15 años de funcionamiento (1999-2014). Las comparaciones de proporciones se realizaron mediante las pruebas de Chi-cuadrado o exacta de Fisher, y entre pares de grupos independientes con la prueba de Mann-Whitney. Se consideraron significativos los valores de probabilidad menores de 0,05. RESULTADOS: Los 10.548 casos estudiados presentaban una edad media de 38,41 (±22,07) años, siendo significativamente superior en las mujeres (p=0,0001). El 67,7% de las intoxicaciones ocurrieron en el hogar, y las vías de entrada más frecuentes fueron la respiratoria (48,3%), la digestiva (35,3%) y la ocular (13,1%). Los grupos tóxicos más frecuentes fueron los gases tóxicos (31%), los cáusticos (25,6%) y los gases irritantes (12,1%). Un 76,2% de los casos requirieron tratamiento (27,2% con antídotos). Ingresó en un centro hospitalario un 20,6% de las personas, con una estancia media de 32 (±151,94) días, con diferencias significativas para los plaguicidas y disolventes (p=0,02). Presentaron secuelas al alta un 2,1%. La mortalidad fue del 1,4% (146 pacientes), con una edad media de 62,08 años (±19,58; p=0,0001). CONCLUSIONES: En las intoxicaciones por productos químicos, las medidas preventivas deben centrarse fundamentalmente en el ámbito doméstico, controlando las fuentes de exposición al monóxido de carbono y la manipulación de los productos de limpieza, fundamentalmente los líquidos cáusticos y la generación de gases irritantes al mezclarlos.

Metabolic syndrome after Roux-en-Y gastric bypass in patients with morbid obesity: Five years of follow-up, a before and after study.

BACKGROUND: Metabolic syndrome (MetS) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study is to analyse prevalence and evolution of MetS in patients suffering from morbid obesity, before and after bariatric surgery, during a follow-up period of 5 years. METHODS: A before-after study was carried out including 156 patients with MetS. The definition of metabolic syndrome according to the Joint Interim Statement (JIS) definition was used. Demographic, as well as anthropometric, biochemical, and clinical analyses were assessed before, as well as 2 and 5 years after performing laparoscopic Roux-en-Y gastric bypass (RYGB). RESULTS: High BMI (100%), elevated blood pressure (78%) and low levels of high density lipoprotein (70%) were the most prevalent criteria for MetS. The percentage of people with MetS decreased significantly to 48.9% at 2 years and 24.1% at 5 years. The weight was also significantly reduced at 2 years, although at 5 years a rebound effect is already observed. Percentage of total weight loss (%TWL) and excess BMI loss (%EBMIL) were. 49.7 ± 19.4% and 68.2 ± 18.9%, respectively, at 2 years and 29.3 ± 11.6% and 62.0 ± 24.9 at 5 years, both presenting significant differences (p < 0.001). CONCLUSION: RYGB in obese patients is associated with a significant improvement of MetS and its comorbidities. Insufficient weight loss is the main factor related to the prevalence of MetS.

Intoxicaciones agudas por productos químicos: análisis de los primeros 15 años del Sistema Español de Toxicovigilancia (SETV) / Acute poisoning by chemical products: analysis of the first 15 years of the Spanish Toxic Surveillance System (SETv)

OBJETIVO: Existen pocos estudios epidemiológicos, sobre todo de tipo multicéntrico, sobre las intoxicaciones agudas a causa de productos químicos agroindustriales y del hogar en España. El objetivo de este trabajo fue describir el perfil epidemiológico y clínico de estas intoxicaciones en nuestro país, y analizar su evolución temporal. METODOS: El Sistema Español de Toxicovigilancia (SETv) es un registro prospectivo que incluye a 32 Servicios de Urgencias y Unidades de Cuidados intensivos de España. Se realizó un estudio descriptivo observacional de las intoxicaciones agudas por agentes químicos (excluyendo drogas y fármacos) en sus primeros 15 años de funcionamiento (1999-2014). Las comparaciones de proporciones se realizaron mediante las pruebas de Chi-cuadrado o exacta de Fisher, y entre pares de grupos independientes con la prueba de Mann-Whitney. Se consideraron significativos los valores de probabilidad menores de 0,05. RESULTADOS: Los 10.548 casos estudiados presentaban una edad media de 38,41 (+/-22,07) años, siendo significativamente superior en las mujeres (p=0,0001). El 67,7% de las intoxicaciones ocurrieron en el hogar, y las vías de entrada más frecuentes fueron la respiratoria (48,3%), la digestiva (35,3%) y la ocular (13,1%). Los grupos tóxicos más frecuentes fueron los gases tóxicos (31%), los cáusticos (25,6%) y los gases irritantes (12,1%). Un 76,2% de los casos requirieron tratamiento (27,2% con antídotos). Ingresó en un centro hospitalario un 20,6% de las personas, con una estancia media de 32 (+/-151,94) días, con diferencias significativas para los plaguicidas y disolventes (p=0,02). Presentaron secuelas al alta un 2,1%. La mortalidad fue del 1,4% (146 pacientes), con una edad media de 62,08 años (+/-19,58; p=0,0001). CONCLUSIONES: En las intoxicaciones por productos químicos, las medidas preventivas deben centrarse fundamentalmente en el ámbito doméstico, controlando las fuentes de exposición al monóxido de carbono y la manipulación de los productos de limpieza, fundamentalmente los líquidos cáusticos y la generación de gases irritantes al mezclarlos

OBJECTIVE: There are few epidemiological studies on acute poisonings from pesticides, industrials and household products in Spain. The objective of this work is to describe the epidemiological and clinical profile of acute poisonings by chemical products in our country, and analyze their annual evolution. METHODS: The Spanish Toxicovigilance System (SETv) is a prospective registry that includes 32 Emergency Departments and Intensive Care Units in Spain. An observational descriptive study of acute poisoning by chemical agents (excluding pharmacological products and illicit drugs) was carried out, within 1999-2014. Statistical analysis was performed using Chi-square or exact Fisher's tests. Non-parametric continuous variables were compared using the Mann-Whitney U test. P-value less than 0.05 were considered significant. RESULTS: The 10,548 cases studied had a mean age of 38.41 (+/-22.07) years, being significantly higher in women (p=0.0001). 67.7% of the poisonings occurred at home, and the most frequent routes of exposure were respiratory (48.3%), digestive (35.3%) and ocular (13.1%). The most frequent toxic groups were toxic gases (31%), caustics (25.6%) and irritant gases (12.1%). Of the patients that required treatment (76.2%), antidotes were used in 27.2%. 20.6% of the patients were admitted at Hospital, with a median stay of 32 (+/-151.94) days, with significant differences for pesticides and solvents (p=0.02). Sequelae were presented at discharge in 2.1% of patients. Mortality was 1.4% (146 patients) with a mean age of 62.08 years (+/-19.58) (p=0.0001). CONCLUSIONS: The reduction of chemical poisonings should be prevented in the domestic environment, taking into account the sources of exposure to carbon monoxide and the handling of household cleaning products, both caustic liquids and the generation of irritating gases when mixed

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.

Impact of the Case Management Model through Community Liaison Nurses.

The objective of the present study is to assess the model's impact on patients and their families in terms of outcomes and the efficiency results for the health system in Tenerife, Canary Islands, selecting a period of eight years from the time interval 2002-2018. The employed indicators were collected on a monthly basis. They referred to home care and its impact on clinical outcomes and on the use of resources. The comparison between the indicators' tendencies with and without the liaison nurse model was done with the F-test by Snedecor. All these tests are bilateral, with a level of significance of p < 0.05. In those areas with community liaison nurse (CLN), improvements have been found in indicators that describe: (1) the management of the clinical status of patients, (2) the efficiency of the use of resources, and (3) the quality and compliance with the process that also includes home visits and social risk detection and management. It can be said that in the basic areas of primary health care where the work of the CLN develops there are improvements in the management of the patients' clinical condition as well as in the quality and efficiency of care.

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.

El servicio de urgencias hospitalario como factor de riesgo de colonización por Staphylococcus aureus resistente a meticilina de los residentes en centros de larga estancia / Hospital emergency health service care as a risk factor for methicillin-resistant Staphylococcus aureus in residents of long-term care facilities

OBJETIVOS: Los residentes de centros de larga estancia (CLE) son población de riesgo para la colonización por Staphylococcus aureus resistente a meticilina (SARM) debido a la morbilidad asociada a la edad y la alta tasa de contactos hospitalarios, especialmente en el servicio de urgencias hospitalario (SUH). El objetivo del estudio fue determinar la prevalencia y los factores asociados a la colonización por SARM en los residentes de CLE. MÉTODO: Se realizó un estudio descriptivo transversal entre abril y junio de 2014. Como criterio de inclusión se consideró ser residente de un CLE del área norte de la isla de Tenerife. Se recogieron variables clínico-epidemiológicas y muestras nasales que se sembraron en agar chromID®MRSA, que discrimina entre colonizados por SARM o no. El tipado molecular se realizó mediante electroforesis en campo pulsante. Se realizó un análisis de regresión logística sobre la variable SARM como dependiente. RESULTADOS: Se incluyeron 624 residentes. La prevalencia de SARM fue del 25,8%. Un total de 64 residentes necesitaron ser atendidos en el SUH en los tres meses previos al estudio. En el análisis multivariante se observó que ser atendido en el SUH en los tres meses previos [odss ratio (OR): 2,05 IC 95%: 1,29-3,26, p = 0,002] y la presencia de lesiones en la piel [OR: 1,65; IC 95% (1,11-2,44), p = 0,013] fueron las variables relacionadas con la colonización por SARM. El clon predominante fue ST-5 SARM-IVa (75,8%), estrechamente relacionado con la asistencia sanitaria. CONCLUSIONES: Los CLE de nuestra área constituyen un importante reservorio de SARM. Haber sido atendido en el SUH se comportó como factor predictor de colonización por SARM, por lo que es necesario de reforzar las medidas preventivas de transmisión cruzada de microorganismos multirresistentes e implantar sistemas vigilancia activa de SARM en el SUH

OBJECTIVES: Residents of long-term care facilities (LTCFs) are at risk for methicillin-resistant Staphylococcus aureus (MRSA) colonization because of age-related illnesses and high rates of hospital use, in particular, of visits to the emergency department (ED). We aimed to determine the prevalence of and risk factors for MRSA colonization in LTCF residents. METHODS: A descriptive cross-sectional study was carried out in 2014 (April-June). LTCF residents in the northern part of the island of Tenerife were eligible for enrolment. We collected clinical and epidemiologic data and took nasal swabs for culture (chromID MRSA agar) to screen for MRSA colonization. Molecular typing was established by pulsed field gel electrophoresis. MRSA colonization was the dependent variable in logistic regression analysis. RESULTS: A total of 624 residents were enrolled. MRSA was detected in 25.8%. Sixty-four of the residents had received care in a hospital ED in the 3 months prior to enrolment. Multivariant regression analysis detected 2 risk factors for MRSA colonization: hospital ED care in the last 3 months (odds ratio [OR], 2.05; 95% CI, 1.29-3.26; P=.002) and the presence of skin lesions (OR, 1.65; 95% CI, 1.11-2.44); P=.013). The health-care-associated, ST5 MRSA-IVa, was the most prevalent (75.8%). CONCLUSIONS: LTCF residents in our area are a significant reservoir of MRSA colonization. Hospital ED care was a predictor of MRSA colonization. We believe that stronger measures to prevent cross-contamination of multidrug resistant microorganisms must be implemented, along with active vigilance systems to detect MRSA in hospitals (AU)

[Hospital emergency health service care as a risk factor for methicillin-resistant Staphylococcus aureus in residents of long-term care facilities]. / El servicio de urgencias hospitalario como factor de riesgo de colonización por Staphylococcus aureus resistente a meticilina de los residentes en centros de larga estancia.

OBJECTIVES: Residents of long-term care facilities (LTCFs) are at risk for methicillin-resistant Staphylococcus aureus (MRSA) colonization because of age-related illnesses and high rates of hospital use, in particular, of visits to the emergency department (ED). We aimed to determine the prevalence of and risk factors for MRSA colonization in LTCF residents. MATERIAL AND METHODS: A descriptive cross-sectional study was carried out in 2014 (April­June). LTCF residents in the northern part of the island of Tenerife were eligible for enrollment. We collected clinical and epidemiologic data and took nasal swabs for culture (chromID MRSA agar) to screen for MRSA colonization. Molecular typing was established by pulsedfield gel electrophoresis. MRSA colonization was the dependent variable in logistic regression analysis. RESULTS: A total of 624 residents were enrolled. MRSA was detected in 25.8%. Sixty-four of the residents had received care in a hospital ED in the 3 months prior to enrollment. Multivariant regression analysis detected 2 risk factors for MRSA colonization: hospital ED care in the last 3 months (odds ratio [OR], 2.05; 95% CI, 1.29­3.26; P=.002) and the presence of skin lesions (OR, 1.65; 95% CI, 1.11­2.44); P=.013). The health-care-associated, ST5 MRSA-IVa, was the most prevalent (75.8%). CONCLUSION: LTCF residents in our area are a significant reservoir of MRSA colonization. Hospital ED care was a predictor of MRSA colonization. We believe that stronger measures to prevent cross-contamination of multidrug resistant microorganisms must be implemented, along with active vigilance systems to detect MRSA in hospitals.

OBJETIVO: Los residentes de centros de larga estancia (CLE) son población de riesgo para la colonización por Staphylococcus aureus resistente a meticilina (SARM) debido a la morbilidad asociada a la edad y la alta tasa de contactos hospitalarios, especialmente en el servicio de urgencias hospitalario (SUH). El objetivo del estudio fue determinar la prevalencia y los factores asociados a la colonización por SARM en los residentes de CLE. METODO: Se realizó un estudio descriptivo transversal entre abril y junio de 2014. Como criterio de inclusión se consideró ser residente de un CLE del área norte de la isla de Tenerife. Se recogieron variables clínico-epidemiológicas y muestras nasales que se sembraron en agar chromID®MRSA, que discrimina entre colonizados por SARM o no. El tipado molecular se realizó mediante electroforesis en campo pulsante. Se realizó un análisis de regresión logística sobre la variable SARM como dependiente. RESULTADOS: Se incluyeron 624 residentes. La prevalencia de SARM fue del 25,8%. Un total de 64 residentes necesitaron ser atendidos en el SUH en los tres meses previos al estudio. En el análisis multivariante se observó que ser atendido en el SUH en los tres meses previos [odss ratio (OR): 2,05 IC 95%: 1,29-3,26, p = 0,002] y la presencia de lesiones en la piel [OR: 1,65; IC 95% (1,11-2,44), p = 0,013] fueron las variables relacionadas con la colonización por SARM. El clon predominante fue ST­5 SARM-IVa (75,8%), estrechamente relacionado con la asistencia sanitaria. CONCLUSIONES: Los CLE de nuestra área constituyen un importante reservorio de SARM. Haber sido atendido en el SUH se comportó como factor predictor de colonización por SARM, por lo que es necesario de reforzar las medidas preventivas de transmisión cruzada de microorganismos multirresistentes e implantar sistemas vigilancia activa de SARM en el SUH

First isolation of Mycobacterium canariasense from municipal water supplies in Tenerife, Canary Islands, Spain.

BACKGROUND: Nontuberculous mycobacteria (NTM) are common bacteria in water and especially water supply distribution systems. Some species can cause infections, especially in immunocompromised patients and other risk groups. This study examined the frequency of occurrence of NTM in 135 household potable water samples collected from household water taps in Tenerife Island. METHODS: Mycobacteria species were identified by polymerase chain reaction targeting the 16S rRNA and 16S-23S rRNA regions, and by double-reverse hybridization on a dipstick using colloidal gold-bound and membrane-bound probes (Speed-Oligo(®) Mycobacteria). Some species were identified by sequencing the gene that encodes the 16S rRNA region. RESULTS: NTM were present in 47.4% of the samples. Mycobacterium fortuitum was the NTM isolated most frequently (70.3%), followed by Mycobacterium canariasense (6.3%) and Mycobacterium chelonae (6.3%). Other species were isolated at lower percentage frequencies. CONCLUSION: We isolated and identified the species M. canariasense in water supplies for public consumption. This species has previously been reported only in hospital settings. The elevated presence of NTM in the water supply indicates that it may be a reservoir for infections caused by recently described species of mycobacteria.

Descriptive analysis of antibiotic-resistant patterns of methicillin-resistant Staphylococcus aureus (MRSA) st398 isolated from healthy swine.

BACKGROUND: Livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) such as the MRSA ST398 strain has spread all over the world and the most worrying aspect of this fact appears to be its capacity to easily spread to humans. The excessive use of antibiotics has made swine a reservoir of MRSA. The aim of the present study was to determine the antibiotic resistance profile of MRSA samples isolated from healthy swine of the island of Tenerife (Spain). METHODS: A total of 256 MRSA isolates from swine samples and five MRSA isolates from pig worker samples were investigated for MRSA antibiotic resistant patterns. RESULTS: Analysis of the susceptibility status of MRSA pig isolates revealed that 39 isolates were resistant to one antibiotic, 71 isolates were resistant to two antibiotics and 96 isolates were resistant to three or more antibiotics. SCCmec typing revealed the presence of types IV and V. Isolates having SCCmec IV had an increased resistance to the antimicrobial agents tested than those having SCCmec V. We observed significant differences when comparing the most common resistance patterns and SCCmec type. CONCLUSIONS: MRSA isolated from humans showed similar resistance to those isolated from pigs, excepting erythromycin, since all the workers' isolates were sensitive to this antibiotic. The evolution of new MRSA clones has emphasized the need for infection control practices in animals and humans in close contact.

Prevalence of CTX-M-Type extended-spectrum ß-lactamases in Escherichia coli strains isolated in poultry farms.

The aim of the study was to detect the prevalence of CTX-M-type extended-spectrum ß-lactamases (ESBL) in Escherichia coli strains isolated in healthy chickens at poultry farms in Tenerife, Spain. From November 2012 to February 2013, 260 live chickens were screened. Samples were cultured in chromogenic media. Suspect strains were identified by Vitek 2 system and ESBL production was confirmed by the double-disk synergy test. Pulsed-field gel electrophoresis (PFGE) was performed with XbaI (Promega, Madison, WI) to ESBL-E. coli isolates. The presence of CTX-M-type was detected by real-time polymerase chain reaction. Of 260 rectal swabs, 237 (91.1%) were ESBL-E. coli, 196 (75.38%) strains were characterized by PFGE, and CTX-M-type was detected in 116 (59.1%) of these strains. With respect to the susceptibility patterns of E. coli blaCTX-M strains, 7.8% showed resistance to more than two non-ß-lactam antibiotics. In our area, the prevalence of CTX-M-type in E. coli isolated in chicken was even higher than those found in other countries. The impact of food animals as a possible reservoir for ESBL-E. coli, especially CTX-M-type ESBL, and the dissemination of such strains into the food production chain need to be assessed.