Enfermedades infecciosas y microbiologia clinica最新文献

英文中文

Aspectos epidemiológicos y de manejo clínico relativos a las neumonías diagnosticadas en urgencias en pacientes mayores en España: resultados del estudio EDEN-29 西班牙老年患者在急诊科确诊肺炎的流行病学和临床管理：EDEN-29 研究结果。

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2024-10-01 DOI: 10.1016/j.eimc.2023.10.015

Objectives

To estimate the incidence of pneumonia diagnosis in elderly patients in Spanish emergency departments (ED), need for hospitalization, adverse events and predictive capacity of biomarkers commonly used in the ED.

Methods

Patients ≥ 65 years with pneumonia seen in 52 Spanish EDs were included. We recorded in-hospital and 30-day mortality as adverse events, as well as intensive care unit (ICU) admission among hospitalized patients. Association of 10 predefined variables with adverse events was calculated and expressed as odds ratio (OR) with 95% confidence interval (CI), as well as predictive capacity of 5 commonly used biomarkers in the ED (leukocytes, hemoglobin, C-reactive protein, glucose, creatinine) was investigated using area under the receiver operating characteristic curve (AUC-ROC).

Results

591 patients with pneumonia attended in the ED were included (annual incidence of 18.4 per 1,000 inhabitants). A total of 78% were hospitalized. Overall, 30-day mortality was 14.2% and in-hospital mortality was 12.9%. Functional dependency was associated with both events (OR = 4.453, 95%CI = 2.361-8.400; and OR = 3.497, 95%CI = 1.578- 7.750, respectively) as well as severe comorbidity (2.344, 1.363-4.030, and 2.463, 1.252-4.846, respectively). Admission to the ICU during hospitalization occurred in 3.5%, with no associated factors. The predictive capacity of biomarkers was only moderate for creatinine for ICU admission (AUC-ROC = 0.702, 95%CI = 0.536-0.869) and for leukocytes for post-discharge adverse event (0.669, 0.540-0.798).

Conclusions

Pneumonia is a frequent diagnosis in elderly patients consulting in the ED. Their functional dependence and comorbidity is the most frequent factor associated with adverse events. The biomarkers analyzed do not have a good predictive ability to predict adverse events.

目的估计西班牙急诊科（ED）老年患者肺炎诊断的发生率、住院需求、不良事件以及急诊科常用生物标志物的预测能力。我们记录了作为不良事件的院内死亡率和 30 天死亡率，以及住院患者入住重症监护室（ICU）的情况。我们计算了 10 个预定义变量与不良事件的相关性，并以几率比（OR）和 95% 的置信区间（CI）表示，还使用接收器操作特征曲线下面积（AUC-ROC）研究了急诊室常用的 5 种生物标志物（白细胞、血红蛋白、C 反应蛋白、葡萄糖、肌酐）的预测能力。共有 78% 的患者住院治疗。总体而言，30 天死亡率为 14.2%，住院死亡率为 12.9%。功能依赖性与两种情况（OR = 4.453，95%CI = 2.361-8.400；OR = 3.497，95%CI = 1.578-7.750）以及严重合并症（分别为 2.344，1.363-4.030；2.463，1.252-4.846）有关。住院期间入住重症监护室的比例为 3.5%，没有相关因素。生物标志物对肌酐进入重症监护室（AUC-ROC = 0.702，95%CI = 0.536-0.869）和白细胞出院后不良事件（0.669，0.540-0.798）的预测能力仅为中等。结论肺炎是急诊室就诊的老年患者的常见诊断，其功能依赖性和合并症是与不良事件相关的最常见因素。所分析的生物标志物在预测不良事件方面没有很好的预测能力。

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引用次数: 0

Trend of pediatric leprosy in an endemic area in Northeast of Brazil, 2008–2018 2008-2018年巴西东北部流行区小儿麻风病的发展趋势

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2024-10-01 DOI: 10.1016/j.eimc.2023.06.009

Background

The incidence of leprosy in children is an important indicator of the disease's tendency in the general population and suggests intense circulation and transmission of Mycobacterium leprae.

Objectives

To describe the clinical, epidemiological characteristics and temporal dynamics of leprosy cases in children under 15 years of age from 2008 to 2018 in an endemic municipality.

Methods

A descriptive study with an analytical approach was carried out with data from leprosy cases registered in the Brazilian Information System on Notifiable Diseases for the municipality of Cabo de Santo Agostinho, Pernambuco, Brazil.

Results

Between 2008 and 2018, 112 new cases of leprosy were registered. Most cases were classified as paucibacillary leprosy and occurred in children living in urban areas. There was no significant difference in the incidence of leprosy during the study period. Only 4.5% of the sample presented reactional episodes, but a high number of cases were not evaluated for the occurrence of reactions.

Conclusions

The findings of this study show a high incidence of paucibacillary leprosy in children and adolescents, which reveals active transmission in the community and failures in the detection of new multibacillary cases among adults. Children between 10 and 14 years old are more vulnerable to M. leprae infection and mainly develop paucibacillary leprosy.

背景儿童麻风病的发病率是衡量该病在普通人群中发病趋势的重要指标，表明麻风分枝杆菌的流通和传播十分活跃。目的描述2008年至2018年一个麻风病流行城市中15岁以下儿童麻风病例的临床、流行病学特征和时间动态。方法利用巴西伯南布哥州Cabo de Santo Agostinho市在巴西应报告疾病信息系统中登记的麻风病例数据，采用分析方法开展描述性研究。结果2008年至2018年期间，共登记了112例新的麻风病例。大多数病例被归类为弱荫麻风病，发生在城市地区的儿童身上。研究期间，麻风病发病率没有明显差异。仅有 4.5%的样本出现反应性发作，但有大量病例未对反应的发生进行评估。结论：本研究结果显示，儿童和青少年中的麻风病发病率较高，这表明麻风病在社区中传播活跃，而且未能发现成人中新的多弧菌病例。10至14岁的儿童更容易感染麻风杆菌，并主要发展为弱碱性麻风病。

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引用次数: 0

Atypical bullae in hands and trunk: An unusual suspect 手部和躯干的非典型鼓包不寻常的嫌疑人

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2024-10-01 DOI: 10.1016/j.eimc.2023.12.010

引用次数: 0

Spatial analysis for risk assessment of dengue in Spain 西班牙登革热风险评估的空间分析

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2024-10-01 DOI: 10.1016/j.eimc.2023.06.010

Introduction

The establishment of Aedes albopictus in new areas in Europe has changed the risk of local dengue transmission represented by imported human cases. The risk of transmission is determined by the distribution of travelers arriving from dengue-endemic areas and the distribution of Ae. albopictus as potential vectors of dengue in Spain.

Methods

Environmental, entomological, epidemiological, demographic, tourism and travel data were analyzed to produce a series of maps to represent: the distribution of Ae. albopictus across municipalities; the risk of expansion of Ae. albopictus based on a species distribution model; the calculated index of travelers from dengue-endemic areas (IDVZE) per province; the percentage contribution of each municipality to the total number of cases in Spain. The maps were then added using map algebra, to profile the spatial risk of autochthonous dengue in Spain at a municipal level from 2016 to 2018.

Results

Ae. albopictus was detected in 983 municipalities. The calculated IDVZE varied from 0.23 to 10.38, with the highest IDVZE observed in Madrid. The overall risk of autochthonous cases oscillated between 0.234 and 115, with the very high risk and high risk areas detected in the Mediterranean region, mainly in the Levantine coast and some parts of the Balearic Islands. Most of the interior of the peninsula was characterized as low risk.

Conclusion

Prevention and control measures to mitigate the risk of autochthonous dengue should be prioritized for municipalities in the high risk areas integrating early detection of imported dengue cases and vector control.

导言：白纹伊蚊在欧洲新地区的出现改变了由输入性人类病例所代表的登革热在当地传播的风险。传播风险取决于从登革热流行地区来的旅行者的分布情况，以及作为登革热潜在病媒的白纹伊蚊在西班牙的分布情况。白蛉在各市的分布情况；根据物种分布模型得出的白蛉扩展风险；计算得出的各省登革热流行区游客指数（IDVZE）；各市占西班牙病例总数的百分比。然后，利用地图代数将这些地图相加，勾勒出2016年至2018年西班牙市镇一级的自体登革热空间风险。计算得出的 IDVZE 从 0.23 到 10.38 不等，马德里的 IDVZE 最高。自生病例的总体风险在 0.234 至 115 之间波动，在地中海地区发现了极高风险和高风险地区，主要在黎凡特海岸和巴利阿里群岛的部分地区。结论对于高风险地区的城市来说，应优先采取预防和控制措施，以降低自生登革热的风险，其中包括及早发现输入性登革热病例和病媒控制。

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引用次数: 0

Consideraciones sobre los comentarios a las recomendaciones del Comité Español del Antibiograma (COESANT) para la realización de los informes de sensibilidad antibiótica acumulada 对西班牙抗生素图谱委员会（COESANT）关于累积抗菌药物药敏性报告建议的意见的考虑

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2024-10-01 DOI: 10.1016/j.eimc.2024.03.011

引用次数: 0

Addressing catheter lock therapy: Does heparin reduce the bioactivity of dalbavancin when together in solution during freezing? 解决导管锁定疗法：肝素与达巴万星一起在溶液中冷冻时是否会降低达巴万星的生物活性？

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2024-10-01 DOI: 10.1016/j.eimc.2024.02.005

Introduction

The possible use of dalbavancin as a catheter lock solution was previously demonstrated by our study group. However, it was needed to assess whether heparin could affect dalbavancin bioactivity during freezing storage.

Methods

We tested the bioactivity of a dalbavancin + heparin (DH) vs. dalbavancin (D) against Staphylococcal biofilms comparing DH median value of cfu counts and metabolic activity with that obtained for D before and during storage under freezing up to 6 months.

Results

Despite there was a slight decrease in the median percentage reduction of metabolic activity at month 3 in Staphylococcus epidermidis between DH and D (97.6 vs. 100, p = 0.037), considering the clinical criteria, no significant reduction in any of the variables tested was observed at the end of the experiment between D and DH solutions.

Conclusion

The addition of heparin to a dalbavancin lock solution did not affect its bioactivity against staphylococcal biofilms irrespective of its preservation time under freezing.

我们的研究小组曾证明达巴万星可用作导管锁定溶液。然而，我们需要评估肝素在冷冻储存期间是否会影响达巴万星的生物活性。我们测试了达巴万星+肝素（DH）与达巴万星（DH）对葡萄球菌生物膜的生物活性，比较了 DH 与达巴万星在冷冻储存前和冷冻储存 6 个月期间获得的 cfu 计数和代谢活性中值。尽管在第 3 个月时，DH 和 DH 溶液的代谢活性降低百分比中值略有下降（97.6 vs. 100，=0.037），但考虑到临床标准，在实验结束时，没有观察到 DH 和 DH 溶液的任何测试变量有显著降低。在达巴万星锁定溶液中添加肝素不会影响其对葡萄球菌生物膜的生物活性，无论其在冷冻条件下的保存时间长短。

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引用次数: 0

¿Cómo podemos optimizar el abordaje diagnóstico y terapéutico de la neumonía? Recomendaciones basadas en una opinión de expertos 如何优化肺炎的诊断和治疗方法？基于专家意见的建议

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2024-10-01 DOI: 10.1016/j.eimc.2024.06.003

Mario Fernández-Ruiz , Juan José Castón , José Luis del Pozo , Jordi Carratalà , Jesús Fortún , Miguel Salavert , Julián Torre-Cisneros , José María Aguado , en representación de los miembros del Grupo OPENIN (Optimización de procesos clínicos para el diagnóstico y tratamiento de infecciones)

Pneumonia continues to be one of the most frequent infectious syndromes and a relevant cause of death and health resources utilization. The OPENIN (Optimización de procesos clínicos para el diagnóstico y tratamiento de infecciones) Group is composed of infectious diseases specialists and microbiologists and aims at generating recommendations that can contribute to improve the approach to processes with high impact on the health system. Such task relies on a critical review of the available scientific evidence. The first group meeting (held in October 2023) aimed at answering the following questions: Can we optimize the syndromic and microbiological diagnosis of pneumonia? Is it feasible to safely shorten the length of antibiotic therapy? And, is there any role for the immunomodulatory strategies based on the adjuvant use of steroids, macrolides or immunoglobulins? The present review summarizes the literature reviewed for that meeting and offers a series of expert recommendations.

肺炎仍然是最常见的感染综合征之一，也是导致死亡和医疗资源使用的一个重要原因。OPENIN（Optimización de procesos clínicos para el diagnóstico y tratamiento de infecciones）小组由传染病专家和微生物学家组成，旨在提出有助于改进对医疗系统影响较大的治疗方法的建议。这项任务依赖于对现有科学证据的严格审查。第一次小组会议（2023 年 10 月举行）旨在回答以下问题：我们能否优化肺炎的综合征和微生物诊断？安全缩短抗生素治疗时间是否可行？基于类固醇、大环内酯类药物或免疫球蛋白辅助使用的免疫调节策略是否有任何作用？本综述总结了此次会议的文献综述，并提出了一系列专家建议。

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引用次数: 0

Bacteriemia por Elizabethkingia anophelis en paciente con neumonía 一名肺炎患者的伊丽莎白金格氏 anophelis 菌血症

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2024-08-01 DOI: 10.1016/j.eimc.2024.03.015

引用次数: 0

Tubercular longitudinally extensive transverse myelitis: An unmissable zebra grazing the Indian medical field 结核性纵向广泛横贯性脊髓炎：印度医学界一匹不可忽视的斑马

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2024-08-01 DOI: 10.1016/j.eimc.2024.04.002

引用次数: 0

Caracterización de la reinfección de prótesis articular tras recambio en 2 tiempos (infección de la prótesis del 2.o tiempo). Un estudio multicéntrico 二期假体置换（二期假体感染）后关节置换术后再感染的特征。多中心研究

IF 2.6 4区医学 Q3 INFECTIOUS DISEASES

Enfermedades infecciosas y microbiologia clinica

Pub Date : 2024-08-01 DOI: 10.1016/j.eimc.2023.05.003

Introduction

Two-stage exchange is the gold standard in the surgical management of prosthetic joint infection (PJI). However, perioperative reinfections (RePJI) can occur to newly inserted prosthesis, which highlights the importance of an adequate antibiotic prophylaxis, although there is scarce evidence in this field. Our objective was to evaluate the characteristics of RePJI, its prognosis and the antibiotic prophylaxis that is commonly used in second-stage surgery.

Methods

Multicentric retrospective observational study in Spanish hospitals including patients with RePJI between 2009 and 2018.

Results

We included 92 patients with RePJI from 12 hospitals. The most frequent isolated microorganism was Staphylococcus epidermidis in 35 cases (38.5%); 61.1% of staphylococci were methiciliin-resistant. In 12 cases (13%), the same microorganism causing the primary PJI was isolated in RePJI. When comparing with the microbiology of primary PJI, there were more cases caused by Gram-negative bacteria (the most frequent was Pseudomonas spp.) and less by Gram-positive bacteria. Failure occurred in 69 cases (75%). There were 43 different courses of antibiotic prophylaxis after the second-stage surgery; the most frequent was a unique preoperative cefazolin dose, but most patients received prophylaxis before and after the second-stage surgery (61 cases).

Conclusions

The most frequent microorganisms in RePJI are coagulase-negative staphylococci, although Gram-negative bacteria, especially Pseudomonas spp. are also common. There is a significant heterogeneity in antibiotic prophylaxis for a second-stage surgery. ReIPJI treatment has a high failure rate.

导言两阶段置换是手术治疗人工关节感染（PJI）的黄金标准。然而，围手术期再感染（RePJI）也可能发生在新插入的假体上，这就凸显了适当的抗生素预防措施的重要性，尽管这方面的证据还很少。我们的目的是评估 RePJI 的特征、预后以及第二阶段手术中常用的抗生素预防措施。结果我们纳入了来自 12 家医院的 92 名 RePJI 患者。35例（38.5%）患者最常分离到的微生物是表皮葡萄球菌；61.1%的葡萄球菌耐甲氧西林。在 12 个病例（13%）中，导致原发性 PJI 的微生物在 RePJI 中也被分离出来。与原发性 PJI 的微生物学情况相比，革兰氏阴性菌引起的病例较多（最常见的是假单胞菌属），而革兰氏阳性菌引起的病例较少。失败病例有 69 例（75%）。结论 RePJI 中最常见的微生物是凝固酶阴性葡萄球菌，但革兰阴性菌，尤其是假单胞菌也很常见。第二阶段手术的抗生素预防存在明显的异质性。ReIPJI 治疗的失败率很高。

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