Incidence, Hospitalization, Mortality and Risk Factors of COVID-19 in Long-Term Care Residential Homes for Patients with Chronic Mental Illness.

Long-term care residential homes (LTCRH) for patients with chronic mental illness have suffered the enormous impact of COVID-19. This study aimed to estimate incidence, hospitalization, mortality, and risk factors of COVID-19 to prevent future epidemics. From March 2020 to January 2021 and before vaccination anti-SARS-CoV-2 begins, cumulate incidence rate (CIR), hospitalization rate (HR), mortality rate (MR), and risk factors of COVID-19 in the 11 LTCRH of two Health Departments of Castellon (Spain) were studied by epidemiological surveillance and an ecological design. Laboratory tests confirmed COVID-19 cases, and multilevel Poisson regression models were employed. All LTCRH participated and comprised 346 residents and 482 staff. Residents had a mean age of 47 years, 40% women, and suffered 75 cases of COVID-19 (CIR = 21.7%), five hospitalizations (HR = 1.4%), and two deaths (MR = 0.6%) with 2.5% fatality-case. Staff suffered 74 cases of the disease (CIR = 15.4%), one hospitalization (HR = 0.2%), and no deaths were reported. Risk factors associated with COVID-19 incidence in residents were private ownership, severe disability, residents be younger, CIR in municipalities where LTCRH was located, CIR in staff, and older age of the facilities. Conclusion: COVID-19 incidence could be prevented by improving infection control in residents and staff and modernizing facilities with increased public ownership.

Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes.

During the period from March 2020 to January 2021, we performed an analysis of incidence, mortality, and risk factors of COVID-19 in nursing homes (NHs) in two health departments (HDs) of Castellon (Spain) 2021 through epidemiological surveillance and an ecological design. Laboratory-confirmed COVID-19 cases, cumulative incidence rate (CIR), and mortality rate (MR) of 27 NHs were collected. Information of residents, staff, and facilities was obtained by questionnaire. Multilevel Poisson regression models were applied. All NHs in the HDs participated with 2229 residents (median: 83 years old, 67.3% women) and 1666 staff. Among residents, 815 cases (CIR: 34.8 per 100) and 202 deaths (MR: 8.7 per 100, case fatality 21.0%) were reported and, among staff, 296 cases (CIR: 19.2 per 100) without deaths. Residents' CIR and MR increased with staff CIR, age of the building, residents/staff ratios, occupancy rate, and crowding index; CIR increased with private NH ownership, large NH size, large urban area, and the percentage of women residents; and MR was associated with residents' severe disabilities. In conclusion, several risk factors of COVID-19 incidence and mortality can be prevented by improving infection and quality controls, ameliorating residents/staff ratios, improving structural facilities, and increasing NH public ownership to avoid new outbreaks.

[Post-vaccination antibodies against SARS-CoV-2 in a cohort of workers of a general hospital]. / Anticuerpos postvacunales frente a SARS-CoV-2 en una cohorte de trabajadores de un hospital general.

INTRODUCTION: The aim was to estimate the evolution of the levels of anti-SARS-CoV-2 antibodies, the associated factors, and the incidence of new infections during the follow-up period.  Method: Prospective cohort study of a representative sample of workers at the General University Hospital of Castellon 8 months after receiving the second dose of Pfizer-BioNTech vaccine against SARS-CoV-2, by determining IgG-S, IgG-NP, follow-up and response to a questionnaire. The results were compared with those at the start of the cohort in February 2021. Multivariate linear regression and Poisson regression were used.  Results: A total of 253 workers participated out of the 275 in the start of the cohort. All had detectable levels of IgG-S, median 691% AU/ml, decreasing by 93.3% compared with the first study. The decline of IgG-S increased with age and obesity; and decreased with a COVID-19 previous history, regular exercise, and in smokers. IgG-NP was positively associated with a history of COVID-19, taking vitamin D, and decreased from 4.4% to 1.2%. There were 4 new cases of COVID-19 in the cohort, with and incidence rate of 1.7%. One death occurred in a participant with immunosuppressive treatment, only one case was asymptomatic and no reinfections occurred. CONCLUSIONS: A general decrease of IgG-S and IgG-NP antibodies after the second dose of Pfizer-BioNTech vaccine was observed in the cohort, as well as with new SARS-CoV-2 infections. Booster doses, maintaining protective measures and further determination of the protection threshold of vaccination are recommended.

Introducción: Estimar la evolución de los niveles de anticuerpos anti-SARS-CoV-2 y los factores asociados, así como la incidencia de nuevas infecciones. Método: Estudio de cohorte prospectivo de una muestra representativa de trabajadores del Hospital General Universitario de Castellón a los 8 meses de recibir la 2ª dosis de la vacuna Pfizer-BioNTech contra el SARS-CoV-2, mediante la determinación de anticuerpos IgG-S y IgG-NP, y la cumplimentación de un cuestionario. Se compararon los resultados con los del inicio de la cohorte en febrero de 2021. Se usó regresión lineal múltiple y regresión de Poisson.  Resultados: Participaron 253 trabajadores de los 275 reclutados al inicio de la cohorte (92%). Todos mantenían niveles detectables de IgG-S, mediana de 691,5 UA/ml, disminuyendo un 93,3% con respecto al inicio. Los descensos de IgG-S fueron mayores con la edad y la obesidad, y menores en aquellos con historia de COVID-19, IgG-S elevada inicial, practicar ejercicio habitual y ser fumador. Tener IgG-NP se asoció positivamente con historia de COVID-19, tomar vitamina D, y disminuyeron del 4,4% al 1,2%. Se produjeron 4 casos de COVID-19 en la cohorte, con una tasa de incidencia del 1,7%, con un fallecimiento en un participante con tratamiento inmunosupresor, solo un caso fue asintomático y no hubo reinfecciones.  Conclusiones: Se produce un descenso general de los anticuerpos IgG-S e IgG-NP después de la segunda dosis de vacuna Pfizer-BioNTech, así como nuevas infecciones por SARS-CoV-2. Se recomienda dosis de recuerdo, mantener medidas protectoras y determinar el umbral de anticuerpos protectores de la vacunación.

[Comparison of postvaccinal antibodies to SARS-CoV-2 in asymptomatic cases, symptomatic cases, and non-cases in a cohort of general hospital workers]. / Comparación de anticuerpos postvacunales al SARS-CoV-2 en casos asintomáticos, casos sintomáticos, y no casos de una cohorte de trabajadores de un hospital general.

Estimada Sra. Directora: Agradecemos a los doctores Rujittika Mungmunpuntipantip y Viroj Wiwanitkit su interés por nuestra publicación(1) en la carta en la que se subrayan la importancia de los casos asintomáticos de COVID-19 en la evaluación de los efectos de la vacunación anti-SARS-CoV-2(2). Compartimos con ellos que las personas asintomáticas al COVID-19 pueden presentar unos niveles de anticuerpos anti-SARS-CoV-2 IgG-S mayores que las personas sin historia previa de COVID-19, y que pueden diferir en las reacciones a la vacunación, considerando que la prevalencia de COVID-19 asintomáticos se ha descrito como elevada(3).  En nuestra cohorte de trabajadores del Hospital General Universitario de Castellón, se detectaron 5 casos de COVID-19 asintomáticos (CA), incluyendo los dos seguimientos realizados(1,4), y 20 casos presentaron síntomas de COVID-19 (CS), con un total de 25 casos con confirmación por el laboratorio, 20 % tasa de asintomáticos (5/25). En la tabla 1 se recogen las características de los CA, CS, y de los participantes que no habían sufrido la enfermedad. Los CA eran más jóvenes que los otros 2 grupos, y la proporción de varones era significativamente mayor (p=0,027). En cuanto a los anticuerpos Anti-SARS-CoV-2 IgG-S al mes de la vacunación, los niveles de los CS fueron mayores que los de CA, y de los no casos, siendo estos últimos los que tuvieron significativamente menores niveles (p<0,001). Sin embargo, a los 8 meses de la vacunación la caída de IgG-S fue general, y los niveles de IgG-S eran mayores en los CA que en los CS y en los no casos (p<0,001). Los niveles de IgG-S considerados como protectores ? 4160 UA/ml, eran mayores en los CA y CS que el de los no casos (p=0,001). Si bien, el declive era similar en los tres grupos (p=0,084). Los síntomas y los efectos secundarios de las dos dosis de vacuna Pfizer-BioNTech no presentaron diferencias significativas entre los grupos. Estos resultados son coincidentes con númerosos estudios, en los que se constata que los casos de COVID-19 presentan niveles más elevados de IgG-S que las personas que no han sufrido la enfermedad(5), y se apreció que en valores medio no se alcanzaron los niveles de IgG-S protectores. De aquí la importancia de disponer de marcadores más efectivos de la situación de protección de la personas vacunadas tanto si han sufrido la enfermedad como sino. Además de los anticuerpos neutralizantes, la determinación de la inmunidad celular podría ser muy conveniente para conocer los niveles de protección.

Comparison of sporadic cases of Salmonella Typhimurium with other Salmonella serotypes in Castellon (Spain): case-case study / Comparación de casos esporádicos de Salmonella typhimurium con otros serotipos de Salmonella en Castellón (España): un estudio caso-caso

INTRODUCTION: Salmonella infections (SI) are common in Spain. The aim of this study was to appraise risk factors and the clinical characteristics of sporadic Salmonella Typhimurium infections compared with other sporadic salmonella serotype infections (OSI). METHODS: From September 2014 to August 2015, a case-case study was carried out by the Epidemiology Division of the Public Health Centre of Castellon. Case 1 consisted of patients with sporadic S. Typhimurium infections, while case 2 comprised OSI patients, assessed according to the stool cultures analyzed by the Microbiology Laboratories of Hospital General de Castellon and Hospital de La Plana in Vila-real. Patients from detected outbreaks were not included. The salmonella serotype was identified by the National Centre of Microbiology (Madrid). RESULTS: The total number of SI patients reported was 327, 242 of whom were studied (74.0%). 148 patients had sporadic S. Typhimurium infection and 64 had OSI, with median ages of 4 and 8.5 years, respectively. Sporadic S. Typhimurium infection patients presented more blood in feces and diarrhea episodes. Consumption of pork meat (OR = 2.22; 95% CI 1.12-4.43), cold pork meats (OR = 2.49; 95% CI 1.32-4.68) and playing in the dirt (OR=3.02; 95% CI 1.55-5.88), were associated with sporadic S. Typhimurium infection. In the 0-4 year-old group, the associated factors were consumption of cold pork meats, omelets and female gender. In the 5-year-old and over group, only playing in soil was associated with sporadic S. Typhimurium infection. CONCLUSIONS: The consumption of pork and omelets, as well as playing in the dirt, were the main factors associated with infection. Children were most affected by sporadic S. Typhimurium infection

INTRODUCCIÓN: Las infecciones por Salmonella son frecuentes en España. El objetivo de este estudio fue estimar factores de riesgo y características de las infecciones esporádicas por Salmonella typhimurium (IET), comparadas con infecciones esporádicas por otros serotipos de Salmonella. MÉTODOS: Desde septiembre de 2014 a agosto de 2015 se efectuó un estudio caso-caso por la Sección de Epidemiología del Centro de Salud Pública de Castellón. El caso 1 fueron los pacientes con IET y el caso 2 aquellos con infecciones esporádicas por otros serotipos de Samonella, según los coprocultivos realizados por los laboratorios de Microbiología de los hospitales General de Castellón y La Plana de Vila-real, sin incluir los pacientes de brotes detectados. El serotipo de Salmonella fue identificado en el Centro Nacional de Microbiología (Madrid). RESULTADOS: Se notificaron 327 pacientes con infección por Salmonella, de los que 242 fueron estudiados (74,0%). Ciento cuarenta y ocho pacientes tenían IET y 64, infecciones esporádicas por otros serotipos de Salmonella, con una mediana de edad de 4 y 8,5 años, respectivamente. Los pacientes IET presentaron más episodios diarreicos y sangre en las heces. El consumo de carne de cerdo (OR 2,22; IC 95% 1,12-4,43), fiambres de cerdo (OR 2,49; IC 95% 1,32-4,68) y jugar en la tierra (OR 3,02; IC 95% 1,55-5,88) fueron asociados con IET. En el grupo de 0-4 años, los factores asociados fueron consumo de fiambres de cerdo, tortillas y ser mujer. En el grupo de 5 y más años, solo jugar en la tierra fue asociado con IET. CONCLUSIONES: El consumo de productos porcinos y tortillas, así como jugar en la tierra fueron los factores asociados, y los niños, los más afectados

Comparison of sporadic cases of Salmonella Typhimurium with other Salmonella serotypes in Castellon (Spain): case-case study.

INTRODUCTION: Salmonella infections (SI) are common in Spain. The aim of this study was to appraise risk factors and the clinical characteristics of sporadic Salmonella Typhimurium infections compared with other sporadic salmonella serotype infections (OSI). METHODS: From September 2014 to August 2015, a case-case study was carried out by the Epidemiology Division of the Public Health Centre of Castellon. Case 1 consisted of patients with sporadic S. Typhimurium infections, while case 2 comprised OSI patients, assessed according to the stool cultures analyzed by the Microbiology Laboratories of Hospital General de Castellon and Hospital de La Plana in Vila-real. Patients from detected outbreaks were not included. The salmonella serotype was identified by the National Centre of Microbiology (Madrid). RESULTS: The total number of SI patients reported was 327, 242 of whom were studied (74.0%). 148 patients had sporadic S. Typhimurium infection and 64 had OSI, with median ages of 4 and 8.5 years, respectively. Sporadic S. Typhimurium infection patients presented more blood in feces and diarrhea episodes. Consumption of pork meat (OR=2.22; 95% CI 1.12-4.43), cold pork meats (OR=2.49; 95% CI 1.32-4.68) and playing in the dirt (OR=3.02; 95% CI 1.55-5.88), were associated with sporadic S. Typhimurium infection. In the 0-4 year-old group, the associated factors were consumption of cold pork meats, omelets and female gender. In the 5-year-old and over group, only playing in soil was associated with sporadic S. Typhimurium infection. CONCLUSIONS: The consumption of pork and omelets, as well as playing in the dirt, were the main factors associated with infection. Children were most affected by sporadic S. Typhimurium infection.

Influencia de la fase preanalítica en la cuantificación de la carga viral: aprendiendo de la experiencia / Influence of pre-analytical phase in viral load quantification: learning with the experience

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Effectiveness of seasonal 2008-2009, 2009-2010 and pandemic vaccines, to prevent influenza hospitalizations during the autumn 2009 influenza pandemic wave in Castellón, Spain. A test-negative, hospital-based, case-control study.

We estimate the impact of the two previous influenza seasonal vaccines and the pandemic vaccine on risk of A (H1N1) 2009 laboratory confirmed hospitalizations during the autumn 2009 pandemic wave in Castellón, Spain. We conducted a test-negative, hospital-based, case-control study. Influenza A (H1N1) 2009 infection was detected in 147 (44%) of 334 patients hospitalized for a presumptive influenza related illness. No effect was observed for the 2008-2009 and 2009-2010 seasonal influenza vaccines. However, the pandemic vaccine was associated with an adjusted vaccine effectiveness of 90% (95% CI, 48-100%). Pandemic vaccines were effective in preventing pandemic influenza associated hospitalizations.

Reactive arthritis and other musculoskeletal sequelae following an outbreak of Salmonella hadar in Castellon, Spain.

OBJECTIVE: In 2005 a large outbreak of Salmonella hadar occurred in Spain following the consumption of commercial precooked roast chicken. We estimated the incidence and risk factors for reactive arthritis (ReA) and other musculoskeletal sequelae in the patients of this outbreak in 2 health departments of Castellon province. METHODS: A prospective cohort study of the patients and their families was carried out. Clinical infection with Salmonella was considered as the exposure factor. The cohort was studied for ReA symptoms using a telephone questionnaire. Telephone interviews or medical examinations of subjects with musculoskeletal symptoms were conducted by a rheumatologist. Robust Poisson regression models were used in the analysis. RESULTS: From the cohort of 262 people, 248 (94.7%) participated in the telephone survey, 155 with clinical salmonellosis (infected), 78 noninfected, and 15 with some symptoms but not clinical salmonellosis. One hundred one infected patients (65%) reported musculoskeletal symptoms, compared to 19 noninfected (24%) (adjusted relative risk = 2.60, 95% CI 1.73-3.90). Of the infected group, 16 ReA (incidence 10%, 95% CI 6.0-16.2), 7 enthesopathies, and 2 arthralgias were detected, and zero in the noninfected group. The risk factors for ReA were age, weight loss, and duration of diarrhea. Antibiotic treatment for the infection protected against symptoms of peripheral or axial arthritis (adjusted relative risk = 0.73, 95% CI 0.55-0.98). CONCLUSION: The incidence of ReA and musculoskeletal symptoms after the infection was high. The use of antibiotics for S. hadar infection offered some protection against musculoskeletal symptoms.

[Pseudomonas aeruginosa: antimicrobial resistance in clinical isolates. Castellón 2004-2008]. / Pseudomonas aeruginosa: resistencia antimicrobiana en aislados clínicos. Castellón 2004-2008.

Retrospective study of antimicrobial susceptibility of 1.943 Pseudomonas aeruginosa clinical isolates to amikacin, tobramycin, gentamicin, ceftazidime, cefepime, meropenem, piperacillin-tazobactam and ciprofloxacin during a five year period. The percentage of resistance went from 2.07% to amikacin from 15.89% to ciprofloxacin. These percentages showed differences depending on the extra or intrahospital origin, departments and samples. Isolates from hospital patients were significantly more resistant than the ones from ambulatory patients (p < or = 0.001;tobramycin,13.74% vs 5.05%; gentamicin, 13.74% vs 8.26%; ceftazidime, 12.67% vs 4.24%; cefepime, 11.48% vs 7.07%; meropenem, 8.57% vs 2.06%), except for amikacin (1.98% vs 2.2%, p=0.74), piperacillin/ tazobactam (6.07% vs 4.55%, p=0.14) and ciprofloxacin (17.17% vs 13.97%, p=0.06).Critical care department and respiratory samples showed the highest resistance percentages while surgery department and invasive samples showed the lowest. Multidrug-resistance was found in 4.8% of the isolates. When comparing our data with those from our previous study (1992-2003), we observed a significant reduction in antibiotic resistance to amikacin (7.74% vs 2.07%, p<0.001), tobramycin (13.61% vs 10.26%, p<0.001), gentamicin (30.85% vs 14.73%, p<0,001), ceftazidime (14.63% vs 9,28%, p<0.001), cefepime (12.31% vs 9.71%, p=0.005), and meropenem (7.74% vs 2.07%, p=0.001); and there were no changes in resistance to piperacillin-tazobactam (4.26% vs 5.46%, p=0,06) and ciprofloxacin (16.02% vs 15.89%, p=0.89). In the last years, the susceptibility pattern of P. aeruginosa to antimicrobial agents has changed in our health district, and it is very different from the one described in national studies so it would be very important to monitor susceptibility of clinical isolates periodically.

Pseudomonas aeruginosa: resistencia antimicrobiana en aislados clínicos. Castellón 2004 - 2008 / Pseudomonas aeruginosa: antimicrobial resistance in clinical isolates. Castellón 2004 - 2008

Estudio retrospectivo de la resistencia de 1.943 aisladosclínicos de Pseudomonas aeruginosa a amikacina, tobramicina,gentamicina, ceftazidima, cefepima, meropenem, piperacilina-tazobactam y ciprofloxacino durante un periodo de 5años.La resistencia global osciló desde el 2,07% para amikacinaal 15,89% para ciprofloxacino con diferencias según la procedenciadel paciente, servicios y muestras: los aislamientos depacientes ingresados fueron significativamente más resistentesque los de los ambulatorios, (p≤0,001: tobramicina, 13,74%vs 5,05%; gentamicina, 13,74% vs 8,26%; ceftazidima, 12,67%vs 4,24%; cefepima, 11,48% vs 7,07%; meropenem, 8,57% vs2,06%), salvo para amikacina (1,98% vs 2,2%, p=0,74), piperacilina/tazobactam (6,07% vs 4,55%, p=0,14) y ciprofloxacino(17,17% vs 13,97%, p=0,06). Los servicios de críticos y lasmuestras respiratorias presentaron las tasas más altas de resistenciamientras que los servicios quirúrgicos y las muestras invasivaspresentaron la mejor sensibilidad. Un 4,8% de los aislamientosfueron multirresistentes.Comparado con nuestro anterior estudio (1.992-2.003)observamos un descenso significativo de resistencia a amikacina(7,74% vs 2,07%, p<0,001), tobramicina (13,61% vs10,26%, p<0,001), gentamicina (30,85% vs 14,73%, p<0,001)ceftazidima (14,63% vs 9,28%, p<0,001), cefepima (12,31% vs9,71%, p=0,005) y meropenem (8,84% vs 5,96%, p=0,001) y semantienen piperacilina/tazobactam (4,26% vs 5,46%, p=0,06)y ciprofloxacino (16,02% vs 15,89%, p=0,89).En nuestra zona se ha producido en los últimos años uncambio en los patrones de susceptibilidad de P. aeruginosa,alejado del descrito a nivel nacional, lo que incide en la importanciadel seguimiento local periódico de la susceptibilidad delos aislados clínicos(AU)

Retrospective study of antimicrobial susceptibility of1.943 Pseudomonas aeruginosa clinical isolates to amikacin,tobramycin, gentamicin, ceftazidime, cefepime,meropenem, piperacillin-tazobactam and ciprofloxacinduring a five year period.The percentage of resistance went from 2.07% toamikacin from 15.89% to ciprofloxacin. These percentagesshowed differences depending on the extra or intrahospitalaryorigin, departments and samples. Isolatesfrom hospital patients were significantly more resistantthan the ones from ambulatory patients (p≤0.001:tobramycin,13.74% vs 5.05%; gentamicin, 13.74% vs8.26%; ceftazidime, 12.67% vs 4.24%; cefepime, 11.48%vs 7.07%; meropenem, 8.57% vs 2.06%),except for amikacin(1.98% vs 2.2%, p=0.74), piperacillin/tazobactam(6.07% vs 4.55%, p=0.14) and ciprofloxacin (17.17% vs13.97%, p=0.06). Critical care department and respiratorysamples showed the highest resistance percentageswhile surgery department and invasive samples showedthe lowest. Multidrug-resistance was found in 4.8% ofthe isolates.When comparing our data with those from our previousstudy (1992-2003), we observed a significant reductionin antibiotic resistance to amikacin (7.74% vs2.07%, p<0.001), tobramycin (13.61% vs 10.26%,p<0.001), gentamicin (30,85% vs 14.73%, p<0,001), ceftazidime(14.63% vs 9,28%, p<0.001), cefepime (12,31%vs 9.71%, p=0.005), and meropenem (7.74% vs 2.07%,p=0.001); and there were no changes in resistance to piperacillin-tazobactam (4.26% vs 5.46%, p=0,06) and ciprofloxacin (16.02% vs 15.89%, p=0.89).In the last years, the susceptibility pattern of P. aeruginosato antimicrobial agents has changed in our healthdistrict, and it is very different from the one describedin national studies so it would be very important tomonitore susceptibility of clinical isolates periodically(AU)

Comentarios al artículo ¿Situación actual de las resistencias de Mycobacterium tuberculosis en la población inmigrante de la Comunidad de Madrid? / On the article ¿Resistant Mycobacterium tuberculosis strains from immigrants in the Community of Madrid: current assessment?

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Brote de infección alimentaria por Salmonella serotipo Mbandaka / Salmonella serotype Mbandaka food-borne outbreak

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[Impact of immigration on drug resistance to Mycobacterium tuberculosis in Castellon (Spain): 1995-2003]. / Impacto de la inmigración en las resistencias de Mycobacterium tuberculosis en la provincia de Castellón: 1995-2003.

BACKGROUND AND OBJECTIVE: The aim of this study was to know the frequency of resistant Mycobacterium tuberculosis in the province of Castellon (Spain) and to determine whether immigration is associated with resistance. MATERIAL AND METHOD: All culture-positive cases diagnosed in Castellon from January 1995 to December 2003 were included in this retrospective study. Susceptibility tests were performed using the Canetti's proportion method and the MB/BacT system. Risk factors associated with tuberculosis were investigated in every case. RESULTS: Six hundred and forty-four cases of tuberculosis were studied: 560 were Spaniards and 84 foreigners. The overall frequency of resistant strains was 5%. The total rate of resistance in Spaniards was 3.7% and in foreigners 13.1%. In Spanish new cases, drug resistance was 3.2% and in foreigners new cases it was 13.9%. In previously treated cases, drug resistance was 6.7% in Spaniards and 0% in immigrants. No acquired drug resistance was detected in immigrants. Of those strains with resistance, 71.9% had resistance to only one drug, 18.7% to two drugs and 9.4% to more than two drugs. Multidrug-resistance was found in 9.4% of the resistant cases, and in 0.5% of all the studied population. The presence of resistant Mycobacterium tuberculosis was associated with the fact of having a foreign nationality (OR = 3.87; p < 0.001). CONCLUSIONS: Tuberculosis has been diminishing in Spanish patients in Castellon. Nevertheless, there is an important increase in the number of cases in foreigners, which is associated with a major percentage of resistances. Epidemiological vigilance efforts should especially concentrate on this group in order to support the progressive declivity of the disease.

Impacto de la inmigración en las resistencias de Mycobacterium tuberculosis en la provincia de Castellón: 1995-2003 / Impact of immigration on drug resistance to Mycobacterium tuberculosis in Castellon (Spain): 1995-2003

Fundamento y objetivo: El objetivo del presente estudio es conocer la frecuencia de las resistencias de Mycobacterium tuberculosis en la provincia de Castellón y la influencia de la inmigración en su aparición. Material y método: Se ha realizado un estudio retrospectivo de todos los casos de tuberculosis con cultivo positivo diagnosticados en la provincia de Castellón entre enero de 1995 y diciembre de 2003 (9 años). El estudio de sensibilidad se ha llevado a cabo por el método de las proporciones de Canetti y por el sistema MB/BacT. Se ha investigado los factores de riesgo relacionados con la tuberculosis en cada uno de los casos. Resultados: Se ha estudiado 644 casos, 560 españoles y 84 extranjeros. Se ha detectado una tasa total de resistencia del 5%. En españoles, las resistencias totales han sido del 3,7% y en extranjeros, del 13,1%. En casos nuevos se ha encontrado un 3,2% de resistencias en españoles y un 13,9% en extranjeros, y en casos con tratamiento previo, un 6,7% en españoles y ninguno en inmigrantes. El 71,9% de las cepas con resistencia la tienen a 1 solo fármaco; el 18,7%, a 2, y el 9,4%, a más de 2. Los casos multirresistentes han supuesto un 9,4% de las resistencias y, con relación al total de la población estudiada, el 0,5%. De todas las variables analizadas, la única relacionada con la aparición de resistencias ha sido la nacionalidad extranjera (odds ratio [OR] = 3,87; p < 0,001). Conclusiones: La tuberculosis ha ido disminuyendo entre los pacientes españoles en la provincia de Castellón. Sin embargo, se aprecia un importante aumento del número de casos entre los extranjeros, que se ha relacionado con un mayor porcentaje de resistencias. Por todo ello, creemos que la vigilancia epidemiológica debe incidir especialmente en ese colectivo, a fin de mantener el progresivo declive de la enfermedad en nuestro medio

Background and objective: The aim of this study was to know the frequency of resistant Mycobacterium tuberculosis in the province of Castellon (Spain) and to determine whether immigration is associated with resistance. Material and method: All culture-positive cases diagnosed in Castellon from January 1995 to December 2003 were included in this retrospective study. Susceptibility tests were performed using the Canetti's proportion method and the MB/BacT system. Risk factors associated with tuberculosis were investigated in every case. Results: Six hundred and forty-four cases of tuberculosis were studied: 560 were Spaniards and 84 foreigners. The overall frequency of resistant strains was 5%. The total rate of resistance in Spaniards was 3.7% and in foreigners 13.1%. In Spanish new cases, drug resistance was 3.2% and in foreigners new cases it was 13.9%. In previously treated cases, drug resistance was 6.7% in Spaniards and 0% in immigrants. No acquired drug resistance was detected in immigrants. Of those strains with resistance, 71.9% had resistance to only one drug, 18.7% to two drugs and 9.4% to more than two drugs. Multidrug-resistance was found in 9.4% of the resistant cases, and in 0.5% of all the studied population. The presence of resistant Mycobacterium tuberculosis was associated with the fact of having a foreign nationality (OR = 3.87; p < 0.001). Conclusions: Tuberculosis has been diminishing in Spanish patients in Castellon. Nevertheless, there is an important increase in the number of cases in foreigners, which is associated with a major percentage of resistances. Epidemiological vigilance efforts should especially concentrate on this group in order to support the progressive declivity of the disease