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1.
Carmen Aspiroz Carmen Lozano Yolanda Gilaberte Myriam Zarazaga M. José Aldea Carmen Torres 《Enfermedades infecciosas y microbiología clínica》2012
Introduction
Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) of sequence type ST398 is a genetic lineage also described in human infections.Methods
Cutaneous infections related with MRSA ST398 are described in 3 patients, two of them pig farmers. The MRSA nasal carriage by patients and their relatives was also studied. MRSA ST398 strains were typed (SCCmec, spa, agr and MLST) and the antimicrobial resistance pattern and virulence genes were determined.Results
Twenty MRSA ST398 isolates were recovered in lesions of three patients, and in nasal samples of two patients and five relatives. Isolates were typed: spa-type t011 or t108; agr-type I and SCCmec IVa or V. MRSA strains were tetracycline-resistant and 15 of them showed a phenotype and genotype of multi-resistance, but they were free of tested virulence genes.Conclusions
LA-MRSA ST398 is an emergent problem in our country, mainly associated with skin and soft tissue infections in people with professional relationships with pig farms. Tetracycline resistance is an important marker for MRSA ST398 detection. 相似文献2.
Marta Barrios-López Pablo Rojo-Conejo Carmen Gómez-González Fernando Chaves-Sánchez 《Enfermedades infecciosas y microbiología clínica》2013
Introduction
Staphylococcus aureus is a major cause of neonatal community-onset infections. The emergence of methicillin-resistant S. aureus infections in this age group has been reported in USA in the last few years; however there are no studies in Spain. The aim of this study is to describe the epidemiological, clinical and microbiological characteristics of S. aureus community-onset infections in neonates.Methods
We prospectively reviewed the S. aureus infections in neonates over a three year period (2007-2009) in the Pediatric Emergency Department of Hospital 12 de Octubre in Madrid (Spain).Results
We recorded 30 cases of neonatal S. aureus community-onset infections. Only one isolated (3.3%) was resistant to methicillin, and two (6.7%) were PVL(+).Conclusions
Despite the emergence of MRSA outside the hospital in pediatric population in Spain, CA-MRSA and SA PVL(+) infections are not frequent in neonates. 相似文献3.
Mora Obed Carolina García-Vidal Pedro Pessacq Analia Mykietiuk Diego Viasus Laura Cazzola M. Angeles Domínguez Anibal Calmaggi Jordi Carratalà 《Enfermedades infecciosas y microbiología clínica》2014
Introduction
The aim of this study is to describe the epidemiological and clinical features, treatment and prognosis of community-acquired pneumonia (CAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in two different geographic regions where community-acquired MRSA (CA-MRSA) infections have different frequencies.Methods
Observational study of patients admitted to two hospitals (one in Argentina, the other in Spain) between March 2008 and June 2012.Results
We documented 16 cases of CAP caused by MRSA. MRSA accounted for 15 of 547 (2.7%) cases of CAP in Hospital Rodolfo Rossi and 1 of 1258 (0,08%) cases at the Hospital Universitari de Bellvitge (P ≤ .001). Most patients were young and previously healthy. Multilobar infiltrates, cavitation and skin and soft tissue involvement were frequent. All patients had positive blood cultures. Five patients required admission to the intensive care unit. Early mortality (≤ 48 hours) was 19%, and overall mortality (≤ 30 days) was 25%.Conclusion
CAP caused by MRSA causes high morbidity and mortality rates. It should be suspected in areas with a high prevalence of CA-MRSA infections, and especially in young and healthy patients who present with multilobar pneumonia with cavitation. Mortality is mainly related to septic shock and respiratory failure and occurs early in most cases. 相似文献4.
Manuel Raya-Cruz Ignacio Ferullo María Arrizabalaga-Asenjo Antonio Nadal-Nadal María Paz Díaz-Antolín Margarita Garau-Colom Antonio Payeras-Cifre 《Enfermedades infecciosas y microbiología clínica》2014
Introduction
Skin and soft-tissue infections (SSTIs) are a frequent cause of consultation in emergence services, and complicated cases require hospitalization. However there are few data in our setting about the clinical characteristics of these infections.Material and methods
A retrospective review of hospital admitted patients with a diagnosis of folliculitis, cellulitis, erysipelas, abscesses, hidradenitis, furuncle, impetigo, fasciitis and Fournier's gangrene. Cases were extracted from the data base of diagnostic codes of the Archive and Clinical Documentation Department of Son Llàtzer Hospital from January 2002 to November 2011.Results
We studied 996 episodes in 841 hospitalized patients with any diagnosis of SSTIs. Cellulitis/erysipelas (66.7%) was the most frequently diagnosed condition, with 77% of all SSTIs being community acquired, and the majority of patients had comorbidities, mainly diabetes (33%) and heart failure (17.7%). The most frequent isolated microorganism was S. aureus (35.1%), in 19 (12.9%) cases with methicillin-resistance (MRSA), 84.2% of them were nosocomial or health care acquired. Monotherapy with aminopenicillin with clavulanic acid was the empiric treatment most frequently used (35.5%). New antibiotics for Gram-positive cocci (linezolid, daptomycin, and tigecycline) were used in patients with comorbidities that presented more complications (P < .001) and more risk of mortality (P = .001). During admission 10.9% of patients died, but only in 2.7% of them mortality was related to the SSTIs.Conclusions
SSTIs attended most frequently in hospitalized patients are mainly cellulitis/erysipela, the majority community acquired. MRSA infections are mainly health care related. Use of new antibiotic for Gram-positive cocci was limited. 相似文献5.
Sara López-Aguilera María del Mar Goñi-Yeste Laura Barrado M. Carmen González-Rodríguez-Salinas Joaquín R. Otero Fernando Chaves 《Enfermedades infecciosas y microbiología clínica》2013
Background
Staphylococcus aureus is the main pathogen causing nosocomial infections. Health professionals, including medical students, could be a source of transmission. The aims of the study were to determine the rate of nasal carriage of S. aureus susceptible and resistant to methicillin (MRSA) and evaluate the knowledge and adherence that students had about hand hygiene.Methods
The study included medical students attached to the Hospital Universitario 12 de Octubre (Madrid, Spain). We collected samples from both nasal vestibules, and the antimicrobial susceptibility was determined on all isolates. Data collection was performed using a self-administered questionnaire that included risk factors for colonization, hygiene habits and knowledge of hand hygiene protocols.Results
Of the 140 students included, 55 (39.3%) were colonized by S. aureus, and 3 (2,1%) by MRSA. The exposure to antibiotics in the last 3 months was lower in colonized students (12.3% vs. 25.9%, P = .03). Self-assessment showed that 56.4% of students almost never washed their hands before to attending to the first patient, and only 38.6% always washed after examining patients. More than a third (35.7%) ignored the hand hygiene protocol, and 38.6% had not received specific formation.Conclusions
Medical students should be included in hospital infection control programs. Hand hygiene training should be given to students before they begin their practices in the hospital. 相似文献6.
Jesús Molina-Cabrillana Cristóbal del Rosario-Quintana Tomas Tosco-Núñez Elena Dorta-Hung Anna Quori Antonio M. Martín-Sánchez 《Enfermedades infecciosas y microbiología clínica》2013
Background
Methicillin-resistant Staphylococcus aureus (MRSA) has become an important hospital-acquired pathogen, with transfer of the organism from a carrier or infected patient to uninfected patients by the hands or clothing of staff as the main mode of transmission.Methods
Investigation of a cluster of new cases of MRSA resistant to mupirocin and fusidic acid, using epidemiological and microbiological resources.Results
From September 2010 to February 2012, sixteen patients had at least one culture positive for MRSA resistant to mupirocin and fusidic acid. Some not apparently related cases and outbreaks appeared. By analysing cultures taken from patients and staff using pulsed-field gel electrophoresis, it was demonstrated that most likely this situation was started by an auxiliary nurse who was a carrier of the MRSA. Healthcare worker decontamination using oral antibiotic therapy was unsuccessful. Eventually, the situation was controlled by placing the carrier in a different job, with no further cases to date (September, 2012).Conclusion
This report illustrates the risk of nosocomial transmission linked to care delivered by healthcare workers. 相似文献7.
José-Juan Sánchez-Cruz José J. Jiménez-Moleón Fidel Fernández-Quesada María J. Sánchez 《Revista espa?ola de cardiología》2013
Introduction and objectives
Obesity is a major cardiovascular risk factor. In Spain, few studies have physically measured height and weight to estimate the magnitude of the problem. The aim of this study was to determine the prevalence of child and adolescent obesity in Spain in 2012.Methods
We performed a cross-sectional probability sample of 1018 children, representative of the Spanish population aged between 8 and 17 years old, with objectively measured height and weight, along with other sociodemographic variables. We calculated the prevalence of overweight and obesity according to the criteria of the World Health Organization, the International Obesity Task Force, and the enKid study.Results
In the group aged 8 to 17 years old, the prevalence of overweight and obesity was 26% and 12.6%, respectively; 4 in 10 young people were overweight or obese. Excess weight was found in 45% of the group aged 8 to 13 years and in 25.5% of that aged 14 to 17 years. This cardiovascular risk factor was associated with lower social class and lower educational level.Conclusions
The prevalence of overweight and obesity in children and adolescents in Spain remains high (close to 40%), but has not increased in the last 12 years.Full English text available from:www.revespcardiol.org/en. 相似文献8.
Carmen Rodríguez-Avial Andrea Álvarez-Novoa Azucena Losa Juan J. Picazo 《Enfermedades infecciosas y microbiología clínica》2013
Introduction
Staphylococcus aureus is a pathogen of major concern. The emergence of methicillin-resistant S. aureus (MRSA) has increasingly complicated the therapeutic approach of hospital-acquired infections. Surveillance of MRSA and control measures must be implemented in different healthcare settings, including screening programs for carriers. Our first aim was to determine the prevalence of methicillin-susceptible S. aureus (MSSA) and MRSA nasal carriage in medical students from the Clínico San Carlos Hospital (Madrid). As the MRSA carrier rate in healthcare workers is higher than in the general population, we hypothesised that carrier rate could be increased during their clinical practice in their last three years.Methods
We performed an epidemiologic al study of the prevalence of S. aureus colonisation among a group of medical students, who were sampled in 2008 in their third-year, and in 2012 when this class was in its sixth year.Results
We have found a significant increase in MSSA carriage, from 27% to 46%. There were no MRSA colonisations in the third-year, but one was found in the sixth-year group. The large majority of strains (89%) of strains were resistant to penicillin, and 27% to erythromycin and clindamycin. As 19 coagulase-negative Staphylococcus MR were also identified, a horizontal transfer of genes, such as mecA gene to S. aureus, could have occurred.Conclusions
Medical students are both, at risk for acquiring, and a potential source of nosocomial pathogens, mainly MSSA. Therefore, they should take special care for hygienic precautions, such as frequent and proper hand washing, while working in the hospital. 相似文献9.
10.
Miriam Delgado M. Mar Álvarez Inés Carrascosa María Rodríguez-Velasco José Luis Barrios Andrés Canut 《Enfermedades infecciosas y microbiología clínica》2013
Objective
To evaluate process-of-care indicators (inappropriate hospitalisation, suitability and early antibiotic treatment) and outcome indicators (length of hospital stay, hospital readmission, ICU admission, and mortality) in the management of community-acquired pneumonia (CAP) when the SEPAR/IDSA guidelines were applied.Patients and methods
An observational retrospective study conducted on patients diagnosed with CAP during the first semester of 2007 and 2008 (186 and 161 patients, respectively) in the emergency unit of a general hospital. Differences in the process-of-care and outcome indicators between 2007 and 2008 (with and without the Pneumonia Severity Index [PSI]) were evaluated. Moreover, the indicators were compared with those obtained in 2006 (110 patients), when the current guidelines were those of SEQ/ATS.Results
The SEPAR/IDSA guidelines improved the following process-of-care indicators: appropriateness of treatment, unjustified hospital readmission (39.4% in 2006 vs. 8.5% in 2007 [P < .001], and 17,2% in 2008 [P = .005]), and early treatment. However, outcome indicators did not change. In 2008, a decrease in the mortality of the patients of risk classes IV-V in which the PSI had been estimated was observed in comparison with the patients in which the PSI was not estimated (2.3% vs. 28.3%; P < .001). Moreover, the mortality rate of the patients of risk classes IV-V in which the PSI had been estimated was lower than those measured using the SEQ/ATS guidelines (22.7%; P = .003).Conclusion
SEPAR/IDSA guidelines decreased the unjustified hospital readmission. In the second year of its application an increase in the number of patients who received early treatment, and a decrease of the mortality rate of the patients of risk classes IV-V in which the PSI had been estimated, were also observed. 相似文献11.
Beatriz Lara Gallego Ignacio Abaitua Borda Genaro Galán Gil Diego Castillo Villegas Álvaro Casanova Espinosa Esteban Cano Jiménez Iñigo Ojanguren Arranz Manuel Posada de la Paz 《Archivos de bronconeumología》2014
This report describes the general characteristics, objectives and organizational aspects of the registries of rare respiratory diseases included in the National Registry of Rare Diseases of the Research Institute for Rare Diseases (ISCIII), in order to publicize their existence and encourage the participation of professionals. 相似文献
12.
Surgical site infections (SSI) are very common, and represent more than 20% of all hospital-acquired infections. SSIs are associated with a higher mortality, as well as to an extended hospital stay and costs, depending on the surgical procedure and type of SSI. Advances in control practices for these infections include improvement in operating room ventilation, sterilization methods, barriers, and surgical techniques, as well as in surgical antimicrobial prophylaxis. For the latter, the antimicrobial agent should: be active against the most common pathogens, be administered in an appropriate dosage and in a time frame to ensure serum and tissue concentrations over the period of potential contamination, be safe, and be administered over the shortest effective time period to minimize adverse events, development of resistances, and cost. 相似文献
13.
Alberto Ruano-Ravina Luciana Prini-Guadalupe Juan Miguel Barros-Dios José Abal-Arca Virginia Leiro-Fernández Ana Isabel González-Silva Antonio Golpe-Gómez Francisco Javier González-Barcala Carolina Pena Carmen Montero-Martínez Cristina Martínez-González María José Mejuto-Martí Alejandro Veres-Racamonde 《Archivos de bronconeumología》2012
Introduction and objective
Residential radon is the second most important risk factor for lung cancer and the first among never-smokers. The objective of this study is to report the concentrations of residential radon in a series of never-smoker cases recruited in a multicenter study of cases and controls in northwestern Spain. In this study, all the hospitals in the Spanish province of Galicia and one from Asturias participated.Patients and methods
The present article includes a series of cases with residential radon measurements. All the subjects were personally interviewed, 3 ml of blood were taken from each, and they were each given instructions about how to place a residential radon detector in their homes.Results
Sixty-nine case subjects were recruited, 84% of whom were women with a mean age of 71, and 81% of whom had adenocarcinoma. The average concentration of residential radon in the cases was 237 Bq/m3, while the average concentration in the Galician population is 79 Bq/m3. No relationship was observed between the concentration of residential radon and either sex or age at the time of diagnosis of the cases, but there was a tendency towards having a greater concentration in those diagnosed with small-cell and large-cell carcinoma.Conclusions
The concentrations of residential radon in the cases included are very high at about three times the average concentration of residential radon to which the general population of Galicia is exposed. 相似文献14.
Olaia Sardón Eduardo G. Pérez-Yarza Ane Aldasoro Javier Korta Paula Corcuera Javier Mintegui Jose Ignacio Emparanza 《Archivos de bronconeumología》2010
Background
There have been several studies that have measured airway resistances using plethysmography without closing the occluderObjective
To investigate the differences between the total resistances (sRawTOT) and the specific resistances (sRaw) with the same technique (plethysmography) but different methodology (with and without closure of the occluder) in child subjects.Material and Methods
An observational and cross-sectional study of a consecutive sample of children between 6 and 14 years old who were seen at the Childhood Pneumology clinics from 15th January to 15th February 2009. Determination of sRawTOT, sRaw and specific conductance (sGaw) using plethysmography (MasterLab V5.1, Viasys®, Wuerzburg, Germany) without closing the occluder. The same determinations were then performed with the occluder closed. The qualitative variables were: sex, diagnosis and treatment, and the quantitative variables: age, weight, height, sRawTOT, sRaw, sGaw and respiratory rate with and without closing the occluder. The results were analysed for association and concordance between sRawTOT, sRaw and sGaw with and without closure of the occluder using paired Student t test, Bland-Altman method and a scatter plot.Results
Thirty-six cases were included and all (100%) the tests were performed successfully. The mean age was 9.91±2.37 years. There were no differences between sRawTOT, sRaw or sGaw with and without closure of the occluder. Neither were there any differences between the regression of the means obtained for sRawTOT, sRaw and sGaw with and without closure of the occluder.Conclusions
There is good agreement between the sRawTOT y sRaw obtained by plethysmography with and without closure of the occluder. 相似文献15.
Ana Triviño Miguel Congregado Jesús Loscertales Rafael Jiménez-Merchán Nathalie Pinos-Vélez Fernando Cózar Patricia Carmona-Soto 《Archivos de bronconeumología》2014
Background
Surgical treatment of stage I non-small cell lung cancer (NSCLC) can be performed either by thoracotomy or by employing video-assisted thoracic surgery (VATS). The aim of this study was to compare long and short-term results of conventional surgery (CS) vs. VATS lobectomy in the treatment of stage I NSCLC.Materials and methods
We performed a retrospective, analytical study of patients undergoing surgery for stage I NSCLC during the period January 1993 to December 2005. The variables analyzed were overall survival, recurrence, distant metastasis, morbidity, mortality and hospital stay. During this period, 256 anatomic lung resections were performed: 141 by CS and 115 by VATS.Results
There were statistically significant differences in: (i) mean hospital stay in patients with no complications (VATS group: 4.3 days vs. CS group: 8.7 days, P = .0001); (ii) mean hospital stay in patients with complications (VATS: 7.2 days vs. CS: 13.7 days, P = .0001), and (iii) morbidity (VATS: 15.6% vs. CS: 36.52%, P = .0001). No statistically significant differences were found in: (i) mortality (VATS: 2.17% vs. CS: 1.7%, P = .88); (ii) 5-year overall survival (VATS: 68.1% vs. CS: 63.8%), and (iii) local recurrence and distant metastasis (P = .82).Conclusions
VATS lobectomy is a safe and effective approach, with a shorter hospital stay and lower morbidity than CS; no statistically significant differences were observed in survival in patients undergoing surgery for stage I NSCLC. 相似文献16.
Pil Sang Song Young Bin Song Jeong Hoon Yang Joo-Yong Hahn Seung-Hyuk Choi Jin-Ho Choi Bon-Kwon Koo Ki Bae Seung Seung-Jung Park Hyeon-Cheol Gwon 《Revista espa?ola de cardiología》2014
Introduction and objectives
It is uncertain whether side branch predilatation before main vessel stenting is necessary. We evaluated the effect of side branch predilatation on outcomes in percutaneous coronary intervention for true nonleft main bifurcation determined by the Medina classification using the provisional approach.Methods
Target vessel failures (composite of cardiac death, myocardial infarction, or target vessel revascularization) were compared between patients who underwent side branch predilatation (predilatation group, n = 175) and those who did not (nonpredilatation group, n = 662).Results
Final kissing-balloon inflation (57.1% vs 35.8%; P < .001) was performed more frequently and the cross-over rate to a 2-stent technique (14.9% vs 5.1%; P < .001) was higher in the predilatation group. During a median follow-up of 21 months, the predilatation group had a higher incidence of target vessel failures (14.3% vs 6.8%; P = .002) and target vessel revascularization (12.0% vs 5.6%; P = .003), but not of cardiac death or myocardial infarction compared with the nonpredilatation group. On multivariate analysis, side branch predilatation was associated with a higher occurrence of target vessel failures (adjusted hazard ratio = 2.11; 95% confidence interval, 1.27-3.50; P = .004). These results remained consistent after a propensity score-matched population analysis (for target vessel failures, adjusted hazard ratio = 2.63; 95% confidence interval, 1.09-6.34; P = .0031) and they were also constant among the various subgroups, according to the bifurcation angle, calcification, and diameter stenosis of the side branch.Conclusions
Side branch predilatation before main vessel stenting may be associated with an increased risk of repeat revascularization in patients with true nonleft main bifurcation treated by the provisional approach.Trial registration: ClinicalTrials.gov number: NCT00851526.Full English text available from: www.revespcardiol.org/en 相似文献17.
As access to antiretroviral treatment increases in the developing countries, efforts towards making it easier and less costly to collect, store, and deliver the biological samples to reference laboratories, where the serological and genetic diagnosis techniques are performed, have become a high priority. Blood sampling on filter papers is an inexpensive and practical alternative to plasma for antiretroviral treatment monitoring in countries with limited resources and no access to cold chains or refrigeration. The main clinical applications and uses of blood-sampling onto filter papers (dried blood spots [DBS]) are reviewed, focusing on how these can be applied in monitoring HIV infection, particularly for use in National Health Programs in developing countries, or in resource-limited settings. A review is presented of studies that have used the DBS technique for quantifying viral load, analysis of antiretroviral drug-resistance mutations, early infant diagnosis, adult serological diagnosis, detection of viral p24 antigen, and molecular epidemiology of HIV-1, in different geographical locations. Those variables that could affect the use of DBS, particularly in the HIV field, as well as explaining how these procedures can be optimised to increase their sensitivity are also reviewed. The aim of this study was to review the advantages of implementing the DBS technique in the HIV field, especially in resource-constrained regions. 相似文献
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19.
Doroteo Acero Fernández María José Ferri Iglesias Carme López Nuñez René Louvrie Freire Xavier Aldeguer Manté 《Gastroenterologia y hepatologia》2013