Factors for persistence of MRSA carriage one year after initial detection in individuals from various healthcare institutions / Factores de persistencia de la colonización por SARM un año más tarde de la detección inicial de portadores en distintos centros sanitarios

Introduction and objective: We studied the natural history of patients with chronic stable illnesses that are colonized by Methicillin Resistant Staphylococcus aureus (MRSA). The aim was to determine the persistence colonization 1 year after. Moreover, we intended to disclose factors that predict MRSA persistence. Material and methods: A multicentric, prospective observational study was designed. Patients from an acute-care hospital and 4 long-term healthcare facilities were included. Demographic, clinical and microbiological data (nasal and skin swabs) were obtained every 3 months during a year. MRSA carriers were decolonized with nasal mupirocin. Results: Among the 699 screened patients, 114 MRSA carriers were identified. MRSA carriage persisted in 59.4% of those who completed the follow-up. Baseline factors associated to MRSA persistence were heart failure, comorbidities, antibiotics, and ulcers. At one year: LTHF, underweight, Barthel<60, and ulcers (the two latest were independent predictors). Persistence was not associated to decolonization. Conclusion: Our study disclosed a high MRSA persistence rate and identified several associated factors (both at baseline and one year later). This information may be useful to identify individuals at high-risk of being MRSA carriers at hospital admission

Introducción y objetivo: Se estudió la evolución natural de los pacientes con enfermedades crónicas que son colonizados por Staphylococcus aureus resistente a la meticilina (SARM) para determinar la persistencia de colonización al año, e identificar factores predictores de persistencia. Material y métodos: Estudio multicéntrico, prospectivo y observacional. Se incluyeron los ingresados en un hospital y los 4 centros sociosanitarios de referencia, recogiendo datos estadísticos, clínicos y microbiológicos (muestras nasales y cutáneas), trimestralmente durante un año. Los portadores recibieron mupirocina. Resultados: Se identificaron 114 portadores de SARM entre los 699 ingresados. Fueron portadores persistentes el 59,4% de aquellos que completaron el seguimiento. Los factores basales asociados a la persistencia fueron la insuficiencia cardíaca, las comorbilidades, la antibioterapia y las úlceras. Al año: CSS, bajo peso, índice de Barthel<60, y úlceras (estos 2 últimos de forma independiente). Persistencia y descolonización no estuvieron estadísticamente relacionados. Conclusión: Se detectó una elevada persistencia de SARM al año, independientemente asociada a dependencia funcional y úlceras. Esta información es útil para detectar el riesgo de ser portador de SARM desde su ingreso

Factors for persistence of MRSA carriage one year after initial detection in individuals from various healthcare institutions.

INTRODUCTION AND OBJECTIVE: We studied the natural history of patients with chronic stable illnesses that are colonized by Methicillin Resistant Staphylococcus aureus (MRSA). The aim was to determine the persistence colonization 1 year after. Moreover, we intended to disclose factors that predict MRSA persistence. MATERIAL AND METHODS: A multicentric, prospective observational study was designed. Patients from an acute-care hospital and 4 long-term healthcare facilities were included. Demographic, clinical and microbiological data (nasal and skin swabs) were obtained every 3 months during a year. MRSA carriers were decolonized with nasal mupirocin. RESULTS: Among the 699 screened patients, 114 MRSA carriers were identified. MRSA carriage persisted in 59.4% of those who completed the follow-up. Baseline factors associated to MRSA persistence were heart failure, comorbidities, antibiotics, and ulcers. At one year: LTHF, underweight, Barthel<60, and ulcers (the two latest were independent predictors). Persistence was not associated to decolonization. CONCLUSION: Our study disclosed a high MRSA persistence rate and identified several associated factors (both at baseline and one year later). This information may be useful to identify individuals at high-risk of being MRSA carriers at hospital admission.

Incidence of catheter-related bloodstream infection in a general hospital using two different detection methods

Introduction: The aim of this study was to determine the incidence of central venous catheter-related bloodstream infection (CRBSI) in a general hospital, using two different assessment methods. Methods Method A: One observer prospectively followed up all patients with central venous catheters (CVCs) placed in our hospital over a period of 1 year, recording all CRBSI episodes. Incidence was calculated in two ways, in relation to the total number of catheter days, and in relation to the total number of hospital days of all patients hospitalized during this period. Method B: Another observer recorded all CRBSI episodes diagnosed during the same time period using microbiology data in which blood culture and catheter culture were positive for the same microorganism. Incidence was calculated in relation to the total number of hospital days of all hospitalized patients. The patient's demographic characteristics and the catheter-related variables were recorded and analysed. Based on clinical and microbiological criteria, catheters were classified as uninfected, colonized, or CRBSI. Results Over the study period, 878 central venous catheters were placed in 704 patients. The total number of catheter days was 7357, and the mean duration of catheter use was 8.15 days (1-86). The total number of hospital stays in this period was 92,167.Method A: 15 episodes of CRBSI were detected, yielding an overall incidence of 2.03 episodes/1000 catheter days or 0.16 episodes/1000 hospital days. Method B: 11 episodes of CRBSI, with an incidence of 0.12 episodes/1000 hospital days. Conclusion The two methods studied yielded different CRBSI rates, with a higher incidence reported by prospective follow-up (Method A). In addition, this method enabled a better assessment to be made of CRBSI risk as the calculation could be performed in relation to the days patients were catheterized (AU)

Introducción: El objetivo de nuestro estudio es medir la incidencia de bacteriemia por catéter venoso central (BRC) en un hospital general mediante dos métodos de valoración diferentes. Métodos: Método A: seguimiento prospectivo de todos los pacientes con catéteres venosos centrales(CVC) insertados en nuestro hospital durante 1 año, registrando los episodios de BRC. Datos referidos al total de días de catéter y al total de estancias hospitalarias en este período. Método B: registro de los episodios de BRC por otro observador a partir de hemocultivos y de cultivo de catéter positivos al mismo microorganismo durante el mismo periodo de tiempo, datos proporcionados por microbiología y referidos al total de estancias hospitalarias. Se registraron las características (..) (AU)

Incidence of catheter-related bloodstream infection in a general hospital using two different detection methods.

INTRODUCTION: The aim of this study was to determine the incidence of central venous catheter-related bloodstream infection (CRBSI) in a general hospital, using two different assessment methods. METHODS: Method A: One observer prospectively followed up all patients with central venous catheters (CVCs) placed in our hospital over a period of 1 year, recording all CRBSI episodes. Incidence was calculated in two ways, in relation to the total number of catheter days, and in relation to the total number of hospital days of all patients hospitalized during this period. Method B: Another observer recorded all CRBSI episodes diagnosed during the same time period using microbiology data in which blood culture and catheter culture were positive for the same microorganism. Incidence was calculated in relation to the total number of hospital days of all hospitalized patients. The patient's demographic characteristics and the catheter-related variables were recorded and analysed. Based on clinical and microbiological criteria, catheters were classified as uninfected, colonized, or CRBSI. RESULTS: Over the study period, 878 central venous catheters were placed in 704 patients. The total number of catheter days was 7357, and the mean duration of catheter use was 8.15 days (1-86). The total number of hospital stays in this period was 92,167. Method A: 15 episodes of CRBSI were detected, yielding an overall incidence of 2.03 episodes/1000 catheter days or 0.16 episodes/1000 hospital days. Method B: 11 episodes of CRBSI, with an incidence of 0.12 episodes/1000 hospital days. CONCLUSION: The two methods studied yielded different CRBSI rates, with a higher incidence reported by prospective follow-up (Method A). In addition, this method enabled a better assessment to be made of CRBSI risk as the calculation could be performed in relation to the days patients were catheterized.

[Legionnaire's disease outbreak]. / Estudio de un brote de infección por Legionella pneumophila.

BACKGROUND AND OBJECTIVE: To describe an outbreak of Legionella pneumophila serogroup 1 in Mataró, Catalunya, Spain, in August 2002. The source of the microorganism was a cooling tower. PATIENTS AND METHOD: Prospective and observational study with analysis of epidemiological, clinical, and microbiological data. RESULTS: 151 patients were affected (62% male), with a mean age of 58.4 years old. Seven patients were classified as Pontiac Fever and 144 suffered from pneumonia. The diagnosis of pneumonia was confirmed in 79% of cases, was considered suspicious in 14% and probable in 7%. Forty per cent of patients were smokers and 53.5% had comorbidities, mainly diabetes mellitus (22%). Chief symptoms were fever (97%), chills and muscular pain (63% respectively), headache (54%) and cough (53%). Pulmonary condensation was the more frequent radiological feature (71%). Normal pulmonary exploration was observed in 38%. Forty-three per cent of cases were severely ill, and 16% of patients belonged to Fine's IV and V class. Antigenuria was the most important test for diagnosis, which confirmed 76% of cases. Legionella spp. was obtained in respiratory secretions of 10 patients. Molecular analysis confirmed clonality between respiratory microorganisms and that obtained in the cooling tower. CONCLUSION: The outbreak involved an important number of subjects in a short period of time. Antigenuria was the most useful test. However, the isolation of L. pneumophila from patients permitted the prompt identification of microorganism's source in a cooling tower. The low mortality observed probably relates to a rapid diagnosis and its target treatment.

Estudio de un brote de infección por Legionella pneumophila / Legionnaire's disease outbreak

Fundamento y objetivo: Describir un brote comunitario de neumonía por Legionella pneumophila serogrupo 1 ocurrido en la ciudad de Mataró en agosto de 2002, cuyo origen fue una torre de refrigeración. Pacientes y método: Estudio observacional y prospectivo. Se analizan aspectos epidemiológicos, factores de riesgo, hallazgos clínicos, radiológicos y microbiológicos. Resultados: El brote de infección afectó a 151 pacientes: un 62% eran varones y la edad media fue de 58,4 años. Se diagnosticó a 7 de fiebre de Pontiac y a 144 casos de neumonía (un 79% confirmadas, un 14% sospechosas y un 7% probables). Un 40% de los pacientes eran fumadores, un 53,5% tenía alguna enfermedad subyacente y un 22% eran diabéticos. Los síntomas predominantes fueron fiebre (97%), escalofríos y mialgias (ambos en el 63%), cefalea (54%) y tos (53%). La imagen radiológica más frecuente fue la condensación unilobular (71%). La semiología respiratoria fue normal en el 38%. Un 43% de los pacientes tenían criterios clínicos de gravedad. Un 16% se clasificó en los grupos IV-V de Fine. El diagnóstico se efectuó por antigenuria en el 76%; 10 pacientes tenían cultivo de muestras respiratorias positivo. El estudio molecular mostró coincidencia entre las cepas de las muestras clínicas y las de la torre de refrigeración. El tratamiento en el 95,6% de los casos fue con claritromicina. La mortalidad fue del 1,4%. Conclusiones: El brote de infección por L. pneumophila afectó a muchas personas en un período muy breve. La prueba diagnóstica más útil fue la antigenuria. El aislamiento de Legionella en muestras respiratorias fue fundamental para establecer la fuente de la infección. La baja mortalidad está relacionada probablemente con la rapidez del diagnóstico y el tratamiento adecuado

Background and objective: To describe an outbreak of Legionella pneumophila serogroup 1 in Mataró, Catalunya, Spain, in August 2002. The source of the microorganism was a cooling tower. Patients and method: Prospective and observational study with analysis of epidemiological, clinical, and microbiological data. Results: 151 patients were affected (62% male), with a mean age of 58.4 years old. Seven patients were classified as Pontiac Fever and 144 suffered from pneumonia. The diagnosis of pneumonia was confirmed in 79% of cases, was considered suspicious in 14% and probable in 7%. Forty per cent of patients were smokers and 53.5% had comorbidities, mainly diabetes mellitus (22%). Chief symptoms were fever (97%), chills and muscular pain (63% respectively), headache (54%) and cough (53%). Pulmonary condensation was the more frequent radiological feature (71%). Normal pulmonary exploration was observed in 38%. Forty-three per cent of cases were severely ill, and 16% of petients belonged to Fine's IV or V class. Antigenuria was the most important test for diagnosis, which confirmed 76% of cases. Legionella spp. was obtained in respiratory secretions of 10 patients. Molecular analysis confirmed clonality between respiratory microorganisms and that obtained in the cooling tower. Conclusion: The outbreak involved an important number of subjects in a short period of time. Antigenuria was the most useful test. However, the isolation of L. pneumophila from patients permitted the prompt identification of microorganism's source in a cooling tower. The low mortality observed probably relates to a rapid diagnosis and its target treatment