Role of previous systemic antibiotic therapy on the probability of recurrence after an initial episode of Clostridioides difficile infection treated with vancomycin.

Objectives: To investigate the role of previous antibiotic therapy in the risk of recurrence after a Clostridioides difficile infection (CDI) treated with vancomycin. Methods: Multicentre observational study. Patients with a CDI episode achieving clinical cure with oral vancomycin and followed up 8 weeks were included. Previous antibiotic exposure up to 90 days was collected. Multivariate analysis of predictors of recurrence adjusted by the propensity score (PS) of being previously treated with each non-CDI antibiotic was performed. Results: Two hundred and forty-one patients were included; 216 (90%) had received systemic antibiotics. Fifty-three patients (22%) had a CDI recurrence. Rates of recurrence were lower in those treated with piperacillin/tazobactam in the last month when compared with those not receiving piperacillin/tazobactam [3 (7%) versus 50 (25%); P = 0.01], whereas higher rates were seen in those treated with cephalosporins in the last month [26/87 (30%) versus 27/154 (17%); P = 0.03]. In multivariate analysis controlled by the inverse probability of treatment weighting by PS, receiving ≥5 days of piperacillin/tazobactam in the last month as the last antibiotic regimen prior to CDI was independently associated with a lower risk of recurrence [adjusted OR (AOR) 0.13; 95% CI: 0.06-0.29; P < 0.0001] whereas exposure for ≥5 days to cephalosporins (versus piperacillin/tazobactam) was associated with an increased risk (AOR 10.9; 95% CI: 4.4-27.1; P < 0.0001). Conclusions: Recent use of piperacillin/tazobactam might be associated with a lower risk of CDI recurrence, while recent use of cephalosporins might promote an increased risk. These findings should be considered when treating hospitalized patients.

Comparación entre cinco técnicas de PCR para el diagnóstico del SARS-CoV-2 / Comparison between five PCR techniques for the diagnosis of SARS-CoV-2

Introducción. Desde que aparecieron los primeros casosde SARS-CoV-2 son numerosas las técnicas que se han desarrollado para el diagnóstico o seguimiento de la infección,tanto técnicas directas como serológicas. La elección de unabuena herramienta diagnóstica es fundamental para el controlepidemiológico. El objetivo ha sido comparar cinco técnicascomercializadas de RT-PCR a tiempo real, en sensibilidad, especificidad y concordancia para la detección del SARS-CoV-2.Material y métodos. Se compararon cinco kits comerciales de RT-PCR para la detección del SARS-CoV-2. Se tomaronocho muestras positivas conocidas que se sometieron a sietediluciones o concentraciones diferentes y otras 135 muestrasnegativas para determinar valores de sensibilidad, especificidad y concordancia.Resultados. La sensibilidad, especificidad, valor predictivopositivo (VPP) y valor predictivo negativo (VPN) para las técnicas de Palex, Roche y GeneXpert respecto a Seegene fueronidénticas, correspondientes a 98,21%, 100%, 100% y 99,26%respectivamente. Para Becton Dickinson la sensibilidad fue del89,28%, la especificidad del 100%, el VPP del 100% y el VPNdel 95,74%. La concordancia mediante el índice Kappa paraPalex, Roche y GeneXpert fue del 0,9892, mientras que la concordancia para Becton Dickinson fue con un índice Kappa de0,9215.Conclusión. Todos los kits de RT-PCR comerciales presentaron elevadas sensibilidades y especificidades, así como VPP,VPN y concordancia. (AU)

Introduction. Since the first cases of SARS-CoV-2appeared, there have been numerous techniques that havebeen developed for the diagnosis or monitoring of infection, both direct and serological techniques. Choosing agood diagnostic tool is essential for epidemiological control. The objective was to compare five commercializedRT-PCR techniques in real time, in sensitivity, specificityand agreement for the detection of SARS-CoV-2.Material and methods. Five commercial RT-PCR kitsfor the detection of SARS-CoV-2 were compared. Eightknown positive samples were taken and subjected to seven different dilutions or concentrations, and another 135negative samples were used to determine sensitivity, specificity, and agreement values.Results. The sensitivity, specificity, positive predictivevalue (PPV) and negative predictive value (NPV) for thePalex, Roche and GeneXpert techniques with respect toSeegene were identical, corresponding to 98.21%, 100%,100% and 99.26% respectively. For Becton Dickinson thesensitivity was 89.28%, the specificity of 100%, the PPVof 100% and the NPV of 95.74%. The agreement using theKappa index for Palex, Roche and GeneXpert was 0.9892,while the agreement for Becton Dickinson was with aKappa index of 0.9215.Conclusion. All commercial RT-PCR kits had highsensitivities and specificities, as well as PPV, NPV, andconcordance. (AU)

Reusability in visible light of titanate nanotubes for the removal of organic pollutants: role of calcination temperature.

Titanate nanotubes (NTs) were synthesised by the hydrothermal method and later calcined at temperatures between 100-500°C. The calcined NTs were characterised and evaluated in the physicochemical adsorption of the safranin dye and photocatalytic degradation of caffeine. The materials calcined at low temperatures displayed a tubular structure and the H2Ti3O7 crystalline phase, which was transformed into anatase nanoparticles at 400°C. The NTs treated at 100°C showed the highest adsorption capacity (94%). Safranin was adsorbed through an ion-exchange mechanism, following the Langmuir isotherm and a pseudo-second-order kinetic model. While NTs calcined at lower temperatures were better for adsorption, the photocatalytic degradation of caffeine increased in samples calcined at higher temperatures with a maximum removal of 72%. The photocatalytic behaviour of the NT samples confirmed that the crystalline anatase structure in conjunction with structural OH groups enhanced the photocatalytic activity. The addition of isopropanol as a scavenger confirmed the important role played by the •OH radicals in the photocatalytic process. NTs calcined at 300°C were efficient for both adsorption and photocatalytic processes. Due to its efficiency, this sample was reused after dye adsorption for the photocatalytic degradation of caffeine under visible light due to its enhanced absorbance in the visible region. This research work shows the potential of NTs for wastewater purification.

Influencia de la correcta identificación en la interpretación de las pruebas de sensibilidad en aislados de Aeromonas spp. productoras de bacteriemia / The relevance of correct identification and interpretation of susceptibility testing of Aeromonasspp. bacteremia isolates

OBJETIVO: Estudiar la importancia de la correcta identificación a nivel de especie así como la interpretación de las pruebas de sensibilidad en aislados de Aeromonas spp. productoras de bacteriemia mediante los métodos convencionales rutinarios y los nuevos métodos moleculares. MATERIAL Y MÉTODOS: El estudio incluyó a 22 pacientes con bacteriemia por Aeromonas hydrophila grupo, identificadas mediante el sistema MicroScan. La identificación posterior a nivel de especie se realizó por espectrometría de masas y se confirmó mediante la secuenciación del gen rpoB. La actividad de imipenem, cefotaxima, piperacilina/tazobactam, ciprofloxacino y cotrimoxazol se estudió por microdilución comercial y tiras de gradiente de antibiótico con bajo y alto inóculo. La detección de carbapenemasas se realizó mediante el test de Hodge modificado y su confirmación mediante la detección por PCR del gen cphA. RESULTADOS: Se identificaron 9 (40,9%) aislamientos como Aeromonas hydrophila, 8 (36,4%) como Aeromonas veronii y los 5 (22,7%) restantes como Aeromonas caviae. La resistencia a los antibióticos betalactámicos mediante microdilución comercial y tiras de gradiente de CMI fue, respectivamente, del 36-50% para imipenem; del 4-56% para cefotaxima; y de 27-56% para piperacilina/tazobactam. La concordancia entre el sistema automatizado y el sistema de difusión con tira de gradiente antibiótico fue, globalmente para las 3 especies, del 68% para imipenem, del 50% para cefotaxima y del 46% para piperacilina/tazobactam. No se detectó resistencia a cotrimoxazol y ciprofloxacino por ambos métodos, aunque el 22,7% de las cepas fueron resistentes a ácido nalidíxico. CONCLUSIONES: Es fundamental la identificación a nivel de especie de los aislamientos de Aeromonas spp. ya que la resistencia a betalactámicos es especie y método dependiente. Los altos porcentajes de resistencia antibiótica encontrados no aconsejan el uso de antibióticos betalactámicos y quinolonas como tratamiento empírico de la infección invasiva por Aeromonas ssp

OBJECTIVE: To assess the relevance of correct identification and interpretation of susceptibility testing of Aeromonas spp. bacteremia isolates using newly developed molecular methods in comparison to previous conventional methods. MATERIAL AND METHODS: The study included 22 patients with bacteremia due to Aeromonas hydrophila group, microbiologically characterized using the MicroScan system. Further identification to species level was performed by mass spectrometry, and confirmed by sequencing the rpoB gene. The MIC of imipenem, cefotaxime, piperacillin-tazobactam, ciprofloxacin and cotrimoxazole was studied using a commercial broth microdilution and antibiotic gradient strips with low and high inocula. Detection of carbapenemase production was performed using the modified Hodge test, and was confirmed by amplifying the cphA gene by PCR. RESULTS: A total of 9 (40.9%) isolates were identified as Aeromonas hydrophila, 8 (36.4%) as Aeromonas veronii, and the remaining 5 (22.7%) isolates as Aeromonas caviae. Resistance to beta-lactams according to both the commercial microdilution and MIC gradient strips methods was: 36%-50% to imipenem; 4%-56% to cefotaxime, and 27%-56% to piperacillin/tazobactam. The agreement between results generated by the automated system and the diffusion antibiotic gradient strip was, for all 3 species, 68% for imipenem, 50% to cefotaxime, and 46% to piperacillin/tazobactam. No resistance to cotrimoxazole and ciprofloxacin was found by either of the two methods, although 22.7% of the strains were resistant to nalidixic acid. CONCLUSIONS: It is essential to identify the isolates of Aeromonas spp. at the species level, due to the fact that beta-lactam resistance is species- and method-dependent. The high rate of resistance to beta-lactam and quinolones reduce their application as empiric treatments for invasive infection by Aeromonas ssp

[The relevance of correct identification and interpretation of susceptibility testing of Aeromonas spp. bacteremia isolates]. / Influencia de la correcta identificación en la interpretación de las pruebas de sensibilidad en aislados de Aeromonas spp. productoras de bacteriemia.

OBJECTIVE: To assess the relevance of correct identification and interpretation of susceptibility testing of Aeromonas spp. bacteremia isolates using newly developed molecular methods in comparison to previous conventional methods. MATERIAL AND METHODS: The study included 22 patients with bacteremia due to Aeromonas hydrophila group, microbiologically characterized using the MicroScan system. Further identification to species level was performed by mass spectrometry, and confirmed by sequencing the rpoB gene. The MIC of imipenem, cefotaxime, piperacillin-tazobactam, ciprofloxacin and cotrimoxazole was studied using a commercial broth microdilution and antibiotic gradient strips with low and high inocula. Detection of carbapenemase production was performed using the modified Hodge test, and was confirmed by amplifying the cphA gene by PCR. RESULTS: A total of 9 (40.9%) isolates were identified as Aeromonas hydrophila, 8 (36.4%) as Aeromonas veronii, and the remaining 5 (22.7%) isolates as Aeromonas caviae. Resistance to beta-lactams according to both the commercial microdilution and MIC gradient strips methods was: 36%-50% to imipenem; 4%-56% to cefotaxime, and 27%-56% to piperacillin/tazobactam. The agreement between results generated by the automated system and the diffusion antibiotic gradient strip was, for all 3 species, 68% for imipenem, 50% to cefotaxime, and 46% to piperacillin/tazobactam. No resistance to cotrimoxazole and ciprofloxacin was found by either of the two methods, although 22.7% of the strains were resistant to nalidixic acid. CONCLUSIONS: It is essential to identify the isolates of Aeromonas spp. at the species level, due to the fact that beta-lactam resistance is species- and method-dependent. The high rate of resistance to beta-lactam and quinolones reduce their application as empiric treatments for invasive infection by Aeromonas ssp.

Molecular epidemiology and antimicrobial susceptibility of Campylobacter coliclinical isolates

INTRODUCTION: Campylobacter spp. is a major cause of acute bacterial diarrhea in humans worldwide, and C. coli is responsible for 10% of the cases. Materials and methods A study was made of the antimicrobial susceptibility using the E-test®, and the clonal relationship using PCR-RFLP, of the flaA gene, as well as PFGE techniques on 43 C. coli clinical isolates. Results Only 49% and 2% of the isolates were susceptible to erythromycin and ciprofloxacin, respectively. Imipenem and clindamyicn, with 100% and 84% of the strains, respectively, being susceptible, were the most active antimicrobials. The PCR-RFLP of flaA gene technique grouped fourteen isolates into six clusters, while the PFGE technique grouped eleven isolates into five clusters. Conclusion Ciprofloxacin and erythromycin are not suitable for the treatment of C. coli infections. Clindamycin could be considered as a therapeutic alternative in cases of enteritis, while imipenem is the best alternative for extra-intestinal infections. Both PFGE and PCR-RFLP can be useful to detect clones

INTRODUCCIÓN: Campylobacter spp. es la principal causa de diarrea bacteriana en el mundo, siendo. C. coliresponsable del 10% de los casos. MATERIAL Y MÉTODOS: Hemos estudiado la sensibilidad antibiótica mediante E-test® y la relación clonal por PCR-RFLP del gen flaA y ECP de 43 cepas de C. coli. RESULTADOS: Solo el 49 y el 2% de todas las cepas estudiadas fueron sensibles a eritromicina y a ciprofloxa cino, respectivamente. El imipenem, con el 100% de cepas sensibles, y la clindamicina, con el 84%, fueron los antibióticos más activos. La técnica de PCR-RFLP del gen flaA agrupó13 cepas en 6 clones, y la ECP,11 cepas en 5 clones. CONCLUSIONES: Ciprofloxacino y eritromicina no son antimicrobianos adecuados para tratar las infecciones por C. coli. La clindamicina se puede considerar como una alternativa terapéutica en caso de enteritis, mientras que el imipenem es la mejor alternativa en la infección extraintestinal. Tanto la ECP como la PCR-RFLP del gen flaA son técnicas útiles para detectar clones

Bacteriemia espontánea del cirrótico por Campylobacter coli / Spontaneous bacteremia due to Campylobacter coli in a cirrhotic patient

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Molecular epidemiology and antimicrobial susceptibility of Campylobacter coli clinical isolates.

INTRODUCTION: Campylobacter spp. is a major cause of acute bacterial diarrhea in humans worldwide, and C. coli is responsible for 10% of the cases. MATERIALS AND METHODS: A study was made of the antimicrobial susceptibility using the E-test(®), and the clonal relationship using PCR-RFLP, of the flaA gene, as well as PFGE techniques on 43 C. coli clinical isolates. RESULTS: Only 49% and 2% of the isolates were susceptible to erythromycin and ciprofloxacin, respectively. Imipenem and clindamyicn, with 100% and 84% of the strains, respectively, being susceptible, were the most active antimicrobials. The PCR-RFLP of flaA gene technique grouped fourteen isolates into six clusters, while the PFGE technique grouped eleven isolates into five clusters. CONCLUSION: Ciprofloxacin and erythromycin are not suitable for the treatment of C. coli infections. Clindamycin could be considered as a therapeutic alternative in cases of enteritis, while imipenem is the best alternative for extra-intestinal infections. Both PFGE and PCR-RFLP can be useful to detect clones.

¿Están satisfechas las mujeres con la atención proporcionada por la matrona durante el parto? / Are women content with the traetment and care they receive from their midwivess during childbirth?

Objetivo. Describir el índice de satisfacción de las mujeres respecto a los cuidados prestados por la matrona durante el trabajo de parto y puerpero inmediato normales. Diseño. Estudio descriptivo transversal, cuya recogida de datos se realizó a través de un cuestionario que permitió valorar las percepciones y expectativas de las mujeres en relación a los cuidados proporcionados por la matrona. Muestra. 316 mujeres asistidas en el trabajo de parto normal por matronas o residentes de matrona. Resultados. Las mujeres concedieron a la mayoría de los cuidados prestados por la matrona una importancia sobresaliente. La satisfacción media con dichos cuidados fue de x=8,62 sobre 10. Los más valorados fueron "trato respetuoso", "favorecer el contacto inmediato con el RN" y "reconocimiento de los esfuerzos de la mujer", y los menos "información al acompañante", "permitir la participación en la toma de decisiones" y "ayuda en el inicio precoz de la lactancia materna". La satisfacción fue mayor con la atención emocional que con la tangible e informativa. Conclusiones. Se confirmó la importancia que tienen para las mujeres los cuidados prestados por la matrona durante el trabajo de parto para hacer frente al estrés de dicho proceso. La calidad de la atención emocional debe potenciarse para seguir proporcionando una atención integral. Es conveniente reforzar la cantidad y calidad de información dada a la mujer y al acompañante, la participación de la usuaria en la toma de decisiones, y la ayuda en el inicio precoz de la lactancia materna (AU)