EL MILLOR DE L’ANY A LA SCMIMC

Miquel PujolServei de Malalties Infeccioses

Hospital Universitari de Bellvitge

Disculpes als autors d'excel·lents articles que

no he pogut posar

Adrian Tellez, Sara Quero, Núria Fernadez Hidalgo, Isabel Ruiz, Carme Cabellos, Oscar Murillo, Guillermo Cuervo, Aina Gomila, Carlota Gudiol,

Pedro Puerta i la Carol Vidal, Laura Escolà, Juan Ambrosini, Laura Escola i Dolors Rodriguez, Juan M. Pericàs, Oriol Gasch, Carlos Cervera.....

Infeccions de la Comunitat

OBJECTIVE:Combining a macrolide or a fluoroquinolone to beta-lactam regimens in the treatment of patients with moderate to severe community-acquired pneumonia is recommended by the international guidelines. However, the information in patients with bacteraemicpneumococcal pneumonia is limited.

Effectiveness of combination therapy versus monotherapy with a third-generation cephalosporin in bacteraemic pneumococcal pneumonia: A propensity score analysis.

• Propensity score 383 pacients amb pneumonia bacteriemiaca (69 monoteràpia i 314 combinació)

• 30-day mortality (OR 2.89; 95% CI 1.07-7.84) was significantly higher in monotherapy group.

J Infect. 2018 Apr;76(4):342-347. doi: 10.1016/j.jinf.2018.01.003

CONCLUSIONS: In bacteraemic pneumococcal pneumonia, empirical therapy with a third-generation cephalosporin plus a macrolide or a fluoroquinolone is associated with a lower mortality rate than beta-lactams in monotherapy. These results support the recommendation of combination therapy in patients requiring admission with moderate to severe disease.

C De la Calle, J Infect 2018

Resistència antibiòtica

Antimicrob Agents Chemother. 2017 Nov 22;61(12). pii: e01317-17. doi: 10.1128/AAC.01317-17.

Aim: to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility.

• La PNA es una de les infeccions més freqüents pels quals el pacients ingressen als hospitals i reben antibiòtics.

• Estudi amb un alt impacte assistencial, en un moment en que hem de combinar l’esforç per tractar adequadament als pacients i utilitzar antibiòtics d’ampli espectre quan calgui.

Estudi observacional prospectiu amb 607 episodis de pienonefritis aguda (H. Vall d’Hebrón)

Diferencies en la mortalitat entre els dos grups:• Global: 2,3%• HA: 9%• CA:1%

Our study reflects the rise of resistance to commonly used antibiotics in acute pyelonephritis.

In order to choose the adequate empirical antibiotic therapy, risk factors for resistance should be considered

Aim: to investigate the efficacy of ceftolozane-tazobactam in combination withmeropenem against an extensively drug-resistant (XDR) Pseudomonas aeruginosa high-risk clone, sequence type 175, isolated in a Spanish university hospital.

> 4 log

These data suggest that ceftolozane-tazobactam plus meropenem may be a useful combination for treating XDR P. aeruginosa.

Evaluation of Ceftolozane-Tazobactam in Combinationwith Meropenem against Pseudomonas aeruginosa Sequence Type 175 in a Hollow-Fiber Infection Model

Antimicrob Agents Chemother. 2018 May 25;62(6). pii: e02633-17. doi: 10.1128/AAC.02633-17.

Objectiu: We investigated whether the addition of fosfomycin or cloxacillin to daptomycin provides better outcomes in the treatment of methicillin-resistantStaphylococcus aureus (MRSA) experimental aortic endocarditis in rabbits.

The Combination of Daptomycin and Fosfomycin Has Synergistic, Potent, and Rapid Bactericidal Activity againstMethicillin-Resistant Staphylococcus aureus in a Rabbit Model of Experimental Endocarditis

In conclusion, for the treatment of MRSA experimental endocarditis, the combination of daptomycin plus fosfomycin showed synergistic and bactericidal activity.

C De la Maria, Antimicrob Agents Chemother2018

Infecció nosocomial

Aim: to describe the etiology and outcome of short-term peripheral venous catheter (PVC)-related blood-stream infections (PVCRBSI) in a 25-year period (1992-2016) and to identify predictive factors of gram-negative PVCRBSI

711 episodis

Short-Term Peripheral Venous Catheter-Related Bloodstream Infections: Evidence for Increasing Prevalence of Gram-Negative Microorganisms from a 25-Year Prospective Observational Study

• Significant increase in the proportion of gram-negative etiology (22.6% in 1992-1996 versus 33.2% in 2012-2016).

• Independent predictive factors of gram-negative PVCRBSI were:

• Being in the hospital for more than 7 days with a catheter in situ for more than 3 days (aOR 1.80, 95%CI 1.20-2.69),

• Surgery in the previous month (aOR 2.39, 95%CI 1.40-4.09), • Antimicrobial treatment with beta-lactams (aOR 1.80, 95%CI 1.16-

2.78)

In conclusion, we reported an increase in the prevalence of gram-negative PVCRBSI over the last 25 years. Factors associated with gram-negative etiology were being in the

hospital for more than 7 days with a catheter in situ for more than 3 days, having undergone surgery and having received

antimicrobial treatment with beta-lactams

Article seleccionat durant el ECCMID 2018 con un dels articles destacats en control d’infecció

Control of endemic multidrug-resistant Gram-negative bacteria after removal of sinks and implementing a new water-safe policy in an intensive care unit.

• La colonització de les piques rentamans de les UCIs de l’HUB, per bacils gram negatius multirresistents era la causa d’una elevada endèmia d’infeccions per aquests microorganismes

• Mesures con la retirada de les piques i canvis en els protocols d’higiene dels pacients utilitzant «aigua segura» van reduir significativament la freqüència de colonització/infecció per aquests microorganismes

• Es necessari afegir a les mesures de control d’infecció rutinàries una política d’aigües segures en els hospitals

Shaw et al JHI 2018

Shaw et al JHI 2018

Months

CONCLUSION: The implementation of a new water-safe policy, which

included the removal of sinks from all patient rooms, successfully improved the control of MDR-GNB spread in an ICU with endemic infection.

Our results support the contribution of sink use with the incidence of MDR-GNB in endemic environments.

Micobacteris

Clin Infect Dis. 2018 Jan 18;66(3):396-403. doi: 10.1093/cid/cix745.

BACKGROUND:Screening strategies based on interferon-γ release assays in tuberculosis contact tracing may reduce the need for preventive therapy without increasing subsequent active disease

RCT Multicèntric

METHODS:We conducted an open-label, randomized trial to test the noninferiority of a 2-step strategy with the tuberculin skin test (TST) followed by QuantiFERON-TB Gold In-Tube (QFT-GIT) as a confirmatory test (the TST/QFT arm) to the standard TST-alone strategy (TST arm) for targeting preventive therapy in household contacts of patients with tuberculosis.

Participants were followed for 24 months after randomization. The primary endpoint was the development of tuberculosis, with a noninferiority margin of 1.5 percentage points

RESULTS:A total of 871 contacts were randomized. Four contacts in the TST arm and 2 in the TST/QFT arm developed tuberculosis.

CONCLUSIONS:In low-incidence settings, screening household contacts with the TST and using QFT-GIT as a confirmatory test is not inferior to TST-alone for preventing active tuberculosis, allowing a safe reduction of preventive treatments.

QuantiFERON-TB Gold In-Tube as a Confirmatory Test for Tuberculin Skin Test in Tuberculosis Contact Tracing: A Noninferiority Clinical Trial

Muñoz L, et al. CID 2018

Estudi multicèntric Salut Pública, Baix Llobregat

Clin Infect Dis. 2017 Oct 1;65(7):1136-1143. doi: 10.1093/cid/cix496

Objectiu; identificar la causa, a partir de la detecció de 3 casos inicials, d’infeccions per BCG relacionades amb la assistència sanitària, en pacients amb càncer sense instil·lació prèvia de BCG

Hospital de Barcelona

Healthcare-Associated Mycobacterium bovis-Bacille Calmette-Guérin(BCG) Infection in Cancer Patients Without Prior BCG Instillation

All patients developed pulmonary TB, either alone or with extrapulmonary disease. Catheter-related infection was considered the mechanism of acquisition based on the epidemiologic association and positive catheter cultures for BCG in patients in whom mycobacterial cultures were performed.

Meije Y, CID 2017

Esquistosomiasi

OBJECTIVE: To evaluate the usefulness of the WHO classification of ultrasound pathological changes and to establish risk factors for morbidity in a highly endemic setting.METHODS: One hundred and fifty-seven ultrasounds were performed on school-aged children previously diagnosed with urinary schistosomiasis in Cubal, Angola. RESULTS: Mean age of the children was 8.7 (SD 3.2) years. Pathological changes were found in 85.3% (84.7% in the bladder, 34.4% the ureter and 6.3% kidney lesions). The global score according to the WHO classification was 5.74. Male gender [OR 2.61 (1.04-6.58); P 0.043] and older age [OR 2.96 (1.17-7.46); P 0.023] were associated with a higher risk of developing any kind of urinary abnormality. Proteinuria was present in 61.7% of the children. Macroscopic haematuria [OR 2.48 (1.11-5.58); P = 0.02)] and a high level of proteinuria > 300 mg/dl [OR 5.70 (2.17-14.94); P 300 mg/dl)] were associated with abnormalities of the upper urinary tract and showed good positive and negative predictive values for the detection of pathology in the upper urinary tract (65.5% and 71.1%, respectively).CONCLUSIONS: Severe urinary tract pathology was found in a high percentage of the children in our setting. Microhaematuria and proteinuria were good markers of morbidity, proteinuria being more precise for severe alterations of the upper urinary tract. We suggest initial and evolutive ultrasound in children diagnosed with schistosomiasis, and close monitoring including periodic controls. As schistosomiasis control efforts are currently focused on reducing morbidity, tests that detect the presence or degree of morbidity are essential for targeting treatment and tracking the progress of control campaigns

AbstractUrinary schistosomiasis causes damage to the urological system. Ultrasound is a method that detects the burden of secondary disease, individually and in epidemiological studies. In this study, the Schistosoma haematobium-associated urinary tract pathology is analyzed before and after treatment in a short period of time. Seventy children who had previously participated in an epidemiological study on schistosomiasis in the city of Cubal, Angola, and had also performed urinary ultrasound between August 2013 and February 2014 were cited 6-8 months later to assess the possible reinfection and repeat new urinary ultrasound, analyzing changes at the level of urinary pathology. The presence of hematuria and proteinuria was also analyzed. Of the 70 children analyzed, 29 (41.4%) were girls, with an average age of 10.4 years (standard deviation 2.3). Fifty-three (75.7%) had an improvement in their bladder and/or kidney scores, whereas 12 (17.1%) had no change and five (7.1%) had progression of the disease. None of the parameters analyzed completely disappeared. After one single course of treatment with praziquantel, all the analyzed parameters showed regression. Improvement was greater in the urinary bladder than in the upper urinary tract, though these lesions also reversed; the reversion of all parameters was greater among children older than 10 years old than the younger ones. Proteinuria was the parameter with a smaller reduction. Ultrasound should be a usual tool for diagnosis and follow-up in urinary schistosomiasis, particularly in children; more accurate recommendations about follow-up in the case of children whose lesions do not reverse should be established.

Moltes graciesGaudiu força de la Jornada de la SCMIMC