Impacto de un conjunto de medidas diagnósticas y terapéuticas sobre el pronóstico de la bacteriemia por Staphylococcus aureus sensible a meticilina asociada a catéter intravascular

La bacteriemia por Staphylococcus aureus supone una causa importante de morbi-mortalidad. La bacteriemia asociada a catéter (BAC) clásicamente se ha categorizado como una infección de bajo riesgo, sin embargo, teniendo en cuenta la elevada incidencia de estos episodios, el coste tanto económico como en cuanto al deterioro en la calidad de vida, es importante.En los últimos años se han publicado múltiples trabajos que avalan la recomendación de aplicar medidas asistenciales concretas para evitar la aparición de infecciones asociadas a catéter. Sin embargo, una vez establecida la infección, la realización de ensayos clínicos aleatorizados resulta más compleja, y el manejo óptimo de estos pacientes aún no está completamente establecido. Recientemente se ha descrito una mejoría en la supervivencia al aplicar ciertas medidas asistenciales basadas en la evidencia en los casos de bacteriemia por S. aureus de cualquier foco. Sin embargo estos estudios incluyen focos heterogéneos de infección e incluyen tanto S. aureus sensible como resistente a meticilina, lo cual supone una variabilidad importante en cuanto al pronóstico..

Apreciación de estudiantes de Medicina latinoamericanos sobre la capacitación universitaria en investigación científica

Identificar la apreciación de estudiantes de medicina latinoamericanos sobre el nivel de capacitación en investigación recibido en la universidad y su nivel actual en esta área. Materiales y Métodos: Se realizó un estudio de corte transversal en 208 estudiantes de medicina latinoamericanos asistentes al Congreso Científico Internacional de estudiantes de Medicina realizado en el 2008 en Chile. Se evaluó su percepción acerca del nivel de entrenamiento en habilidades relacionadas a investigación y publicación científica recibido en la universidad y se comparó con el nivel que consideraban tener. Además, se preguntó por la percepción de la importancia y limitaciones de la publicación en el pregrado.Learning research skills should be a goal during undergraduate training of physicians. Aim: To identify Latin American medical students’ appraisal on research skills university training. Material and Methods:A self-administered survey about experience in research, self-assessment of research skills, quality of training in the area received at the university and that importance of publishing as undergraduate students, was answered by 208 medical students aged 23 ± 3 years (54% male), attending a medical students congress. Results: Seventy percent of respondents pertained to medical students’ scientific societies and 34% had published in a scientific journal. Fifty two percent considered as good or very good the training level received at their universities on information retrieval and 45% considered good the training in research methodology. Thirty two percent considered as poor or none the training received in scientific writing and 37% in the publishing process. Eighty nine percent considered student publishing as important and 61% perceived limitations in this matter. Conclusions: The university training level received by Latin American medical students on research and publication process was evaluated as deficient by these students

Latin American medical students’ appraisal on university scientific research training

Background: Learning research skills should be a goal during undergraduate training of physicians. Aim: To identify Latin American medical students’ appraisal on research skills university training. Material and Methods: A self-administered survey about experience in research, self-assessment of research skills, quality of training in the area received at the university and that importance of publishing as undergraduate students, was answered by 208 medical students aged 23 ± 3 years (54% male), attending a medical students congress. Results: Seventy percent of respondents pertained to medical students’ scientific societies and 34% had published in a scientific journal. Fifty two percent considered as good or very good the training level received at their universities on information retrieval and 45% considered good the training in research methodology. Thirty two percent considered as poor or none the training received in scientific writing and 37% in the publishing process. Eighty nine percent considered student publishing as important and 61% perceived limitations in this matter. Conclusions: The university training level received by Latin American medical students on research and publication process was evaluated as deficient by these studentsRevisión por pare

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011 June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 mu g/mL and 0.5 mu g/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2-5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1-5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications

Latin American medical students’ appraisal on university scientific research training

<p>Background: Learning research skills should be a goal during undergraduate training of physicians. Aim: To identify Latin American medical students’ appraisal on research skills university training. Material and Methods: A self-administered survey about experience in research, self-assessment of research skills, quality of training in the area received at the university and that importance of publishing as undergraduate students, was answered by 208 medical students aged 23 ± 3 years (54% male), attending a medical students congress. Results: Seventy percent of respondents pertained to medical students’ scientific societies and 34% had published in a scientific journal. Fifty two percent considered as good or very good the training level received at their universities on information retrieval and 45% considered good the training in research methodology. Thirty two percent considered as poor or none the training received in scientific writing and 37% in the publishing process. Eighty nine percent considered student publishing as important and 61% perceived limitations in this matter. Conclusions: The university training level received by Latin American medical students on research and publication process was evaluated as deficient by these students</p

Non-intravenous carbapenem-sparing antibiotics for definitive treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL) or AmpC beta-lactamase: A propensity score study

Carbapenems are considered the treatment of choice for extended-spectrum β-lactamase (ESBL)- or AmpC β-lactamase-producing Enterobacteriaceae bacteraemia. Data on the effectiveness of non-intravenous carbapenem-sparing antibiotic options are limited. This study compared the 30-day mortality and clinical failure associated with the use of carbapenems versus alternative non-intravenous antibiotics for the definitive treatment of ESBL/AmpC-positive Enterobacteriaceae bacteraemia. This 12-year retrospective study (2004–2015) included all patients with bacteraemia due to ESBL/AmpC-producing Enterobacteriaceae at a Spanish hospital. Given the lack of randomisation of initial therapies, a propensity score for receiving carbapenems was calculated. There were 1115 patients with a first episode of bacteraemia due to Escherichia coli or Klebsiella pneumoniae, of which 123 (11.0%) were ESBL/AmpC-positive. There were 101 eligible patients: 59 in the carbapenem group and 42 in the alternative treatment group (trimethoprim/sulfamethoxazole 59.5%, quinolones 21.4%). The most frequent sources of infection were urinary (63%) and biliary (15%). Compared with the carbapenem group, patients treated with an alternative regimen had a shorter hospital stay [median (IQR) 7 (5–10) days vs. 12 (9–18) days; P < 0.001]. Use of an alternative non-intravenous therapy did not increase mortality (OR = 0.27, 95% CI 0.05–1.61; P = 0.15). After controlling for confounding factors with the propensity score, the adjusted OR of carbapenem treatment was 4.95 (95% CI 0.94–26.01; P = 0.059). Alternative non-intravenous carbapenem-sparing antibiotics could have a role in the definitive treatment of ESBL/AmpC-positive Enterobacteriaceae bacteraemia, allowing a reduction in carbapenem use. Use of trimethoprim/sulfamethoxazole in this series showed favourable results.CP, NF-H and JR-B are supported by Plan Nacional de I+D+i 2013?2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0001 and 0003], which is co-financed by the European Regional Development Fund ?A way to achieve Europe?, Operative Programme Intelligent Growth 2014?2020

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011 June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 mu g/mL and 0.5 mu g/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2-5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1-5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications