Enfermedades infecciosas y microbiologia clinica最新文献

Introduction

Pneumococcal bacteraemia is a major contributor to global morbidity and mortality. Traditional culture-based methods lack sensitivity and are time-consuming. This study aimed to assess the effectiveness of two culture-independent assays, the MALDI–TOF–MS Sepsityper® module and the lateral flow inmunochromatography test (LFICT) with the Standard F® Streptococcus pneumoniae, directly from positive blood culture (BC) bottles.

Methods

A prospective study was conducted from December 2021 to July 2022. For all BC positives for S. pneumoniae a double centrifugation protocol was implemented. The resulting pellet was subsequently processed using both techniques.

Results

The LFICT showed exceptional performance with 100% sensitivity and specificity, outperforming the MALDI–TOF–MS Sepsityper® module, which achieved 85.2% sensitivity and 100% specificity. Nevertheless, the combination of these assays offers a robust and comprehensive approach to diagnosis.

Conclusions

The simultaneous use of both techniques offers a promising alternative that can be integrated into routine practices directly from BC samples.

Introduction

Water sample culturing is the reference method to detect Legionella spp. in sanitary facilities. Until 2017, UNE-EN ISO 11731 only included the GVPC medium, which inhibits interfering microbiota but hinders the growth of Legionella spp. To improve its recovery, the new standard incorporates the BCYE medium into the working protocol.

Methods

We inoculated 1,306 sanitary water samples onto BCYE and GVPC according to an accredited internal procedure. We compared the number of cfu/L of Legionella spp. detected in both media.

Results

The median in BCYE was 2,000 cfu/L higher than in GVPC (p = 0.000). In the presence of high amounts of interfering microbiota, both media were similar; in the absence or low interfering microbiota BCYE was four times more sensitive than GVPC (p = 0.000).

Conclusion

Including BCYE in the analysis of sanitary water significantly improves the recovery of Legionella spp. in low contaminated samples.

The Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Emergency Medicine (SEMES), the Spanish Society of Primary Care Physicians (SEMERGEN) and the Spanish Society of Family and Community Medicine (SEMFYC) have elaborated a consensus statement on the diagnosis and management of patients with imported febrile illnesses.

Twenty authors with different backgrounds and representing different healthcare perspectives (ambulatory primary care, travel and tropical medicine specialists, emergency medicine, hospital care, microbiology and parasitology and public health), identified 39 relevant questions, which were organized in 7 thematic blocks. After a systematic review of the literature and a thoughtful discussion, the authors elaborated 125 recommendations, as well as several tables and figures to be used as a consulting tool. The present executive summary shows a selection of some of the most relevant questions and recommendations included in the guidelines.

Objectives

To determine DBI and its relationship with polypharmacy and pharmacotherapeutic complexity (PC) in a cohort of PLWH over 50 years of age at follow-up of pharmacotherapy in a tertiary hospital.

Methods

Observational and retrospective study that included PLWH in active antiretroviral treatment over 50 years of age who have been followed up in outpatient pharmacy services. Pharmacotherapeutic complexity was estimated through Medication Regimen Complexity Index (MRCI). Collected variables included comorbidities, current prescriptions and its classification according to anticholinergic and sedative activity and associated risk of falls.

Results

Studied population included 251 patients (85.7% men; median age: 58 years, interquartile range: 54–61). There was a high prevalence of high DBI scores (49.2%). High DBI was significantly correlated with a high PC, polypharmacy, psychiatric comorbidity and substances abuse (p < 0.05). Among sedative drugs, the most prescribed were anxiolytic drugs (N05B) (n = 85), antidepressant drugs (N06A) (n = 41) and antiepileptic drugs (N03A) (n = 29). For anticholinergic drugs, alpha-adrenergic antagonist drugs (G04C) were the most prescribed (n = 18). Most frequent drugs associated with risk of falls were anxiolytics (N05B) (n = 85), angiotensin-converting enzyme inhibitors (C09A) (n = 61) and antidepressants (N06A) (n = 41).

Conclusion

The DBI score in older PLWH is high and it is related to PC, polypharmacy, mental diseases and substance abuse as is the prevalence of fall-related drugs. Control of these parameters as well as the reduction of the sedative and anticholinergic load should be included in the lines of work in the pharmaceutical care of people living with HIV+.

Objective

To assess the trend in hepatitis A, hepatitis B, pneumococcal, tetanus and seasonal influenza vaccination in people with HIV infection and to analyse associated factors.

Methods

The hospital survey of patients with HIV, an annual cross-sectional study conducted on a fixed day (2006-2021), was used. Inpatients and outpatients were included. Trends in vaccination and associated factors were analysed using logistic regression.

Results

A total of 8643 participants were included. Vaccination rates increased to 65.3% for hepatitis A, 83.7% for hepatitis B, 49.3% for tetanus, 68.9% for pneumococcal and 74.5% for seasonal influenza in 2021. Factors positively associated with vaccination were older age for pneumococcal and influenza vaccination; higher educational level for hepatitis A and tetanus; living in a closed institutions or prison for tetanus, pneumococcal and influenza; and having acquired HIV through sex between men for hepatitis A, hepatitis B and pneumococcal. In addition, being on antiretroviral treatment and having a high CD4 count were positively associated with vaccination for all these diseases. Factors inversely associated with vaccination were being older (hepatitis A, hepatitis B and tetanus), being an immigrant (tetanus and seasonal influenza) and being an injection drug user/ex-user for hepatitis A and hepatitis B.

Conclusions

Vaccination in people with HIV has increased in the study period. The results are in line with the recommendations in this population, although there is still room to reach the established vaccination indicators.

Introduction

Human respiratory syncytial virus (RSV) is the most commonly identified virus associated with lower respiratory tract infections. The monoclonal antibody nirsevimab immunization campaign began in our country in October 2023.

Methods

This study was conducted in the Pediatric Emergency Department (PED) of a tertiary care center in Madrid, Spain. The aim was to compare PED visits of patients eligible for immunization with nirsevimab who attended between weeks 40 and 52 of 2022 and 2023 and who had a confirmed diagnosis of RSV infection.

Results

During the study period, 264 out of 765 patients with confirmed RSV infection who attended the PED were eligible for immunization with nirsevimab and were selected for our analysis. The PED attendance was 80.3% in 2022 and 19.7% in 2023. The number of RSV-positive cases increased from week 42 in both analyzed periods, with a peak of maximum incidence between weeks 46 and 48. In 2022, the morphology of the case curve in the group of children eligible for immunization was similar to the overall curve. However, in 2023, we did not observe a similar increase in cases among patients eligible for immunization.

Conclusion

Immunization with nirsevimab during the 2023 RSV epidemic season had a beneficial effect, reducing the number of PED consultations for RSV infection.

Introduction

The specialty of Microbiology and Parasitology is a four-year multidisciplinary training with a central role in the diagnosis and epidemiological surveillance of infectious diseases.

The aim of this study is to analyze the degree of implementation of the official program and the degree of satisfaction of residents with their training.

Methods

We conducted an online survey distributed in eight sections to which active residents of the Specialty of Clinical Microbiology and Parasitology had access.

Results

A total of 69 responses were received, with a predominance of residents from the regions of Madrid (43.5%) and of FIR admission route (55%).

The areas in which the residents feel best prepared correspond to systematic bacteriology, antimicrobials and clinical aspects of microbiology. The areas with the worst preparation, on the other hand, are mycology, parasitology and microbiological emergencies.

There are significant differences between the clinical rotation time for residents with MIR access pathway with respect to residents with other degrees.

Respondents perceive a high degree of responsibility and a medium agreement with the quality of teaching. Attendance at clinical sessions and external rotations is frequent.

Research activity is perceived as complicated, both at the level of doctoral studies and with respect to entering research lines and the publication of scientific results.

Conclusion

Some points of improvement of the training itinerary have been identified that need to be reinforced. Likewise, it would be interesting to seek a better balance between care, teaching and research activities.