Enfermedades causadas por micobacterias: estudio microbiológico, epidemiológico y molecular (2006-2015)

Las micobacterias poseen una gran importancia clínica, ya que son agentes causales de diversas enfermedades humanas con una importante morbilidad y mortalidad. Proponemos estudiar las enfermedades por micobacterias en el Área Sanitaria de Santiago de Compostela, con el objetivo del diagnóstico rápido y el estudio de resistencias en M.tuberculosis complex, la identificación molecular y sistematización de las micobacteriosis, la relación epidemiológica entre tuberculosis y las micobacteriosis, y el estado actual de la lepra

Oral microbiome and systemic antineoplastics in cancer treatment:a systematic review

Oral mucositis is one of the most common side effects in cancer patients receiving systemic antineoplastics. However, the underlying biological mechanisms leading to this condition are still unclear. For this reason, it has been hypothesised that systemic antineoplastics may cause an imbalance on the oral microbiota that subsequently triggers oral mucosa damage. A systematic review was performed following the PRISMA protocol and the PICO question established was: patients diagnosed with cancer, who are candidates for receiving systemic antineoplastics (P=Patients), that undergo oral microbiome determinations (I=Intervention), before and after systemic antineoplastics administration (C=Comparison), to analyse changes in the oral microbiome composition (O=Outcome). The bibliographic search was carried out in PubMed and other scientific repositories. Out of 166 obtained articles, only 5 met eligibility criteria. Acute myeloid leukaemia (AML) was the most frequent type of cancer (40 %) among the participants. Only one of the studies included a control group of healthy subjects. Heterogeneity in the protocols and approaches of the included studies hindered a detailed comparison of the outcomes. However, it was stated that a decrease in bacteria ? diversity is often associated with oral mucositis. On the other hand, fungal diversity was not associated with oral mucositis although ? diversity was lower at baseline on patients developing oral candidiasis. There is insufficient scientific evidence of oral microbiological changes in patients undergoing systemic antineoplastics. Further investigations ought to be carried out to identify microorganisms that might play a key role in the pathogenesis of oral mucosa damage in patients undergoing systemic antineoplastics

Influenza A H1N1 Community-Acquired Pneumonia: Characteristics and Risk Factors—A Case-Control Study

Introduction. Influenza A H1N1 community-acquired pneumonia (CAP) is a quite frequent respiratory disease. Despite being considered more serious than other CAPs, there are very few studies comparing its characteristics with noninfluenza CAP. We aim to establish the differences between pneumonia due to H1N1 virus and pneumonia not caused by H1N1 influenza virus and to determine the probability that a pneumonia is due to an H1N1 virus infection based on the most relevant variables. Methods. We used a case-control study where cases were H1N1 CAP patients with confirmed microbiological diagnosis and controls were patients with CAP admitted to hospital. H1N1 and other influenza types were discarded among controls. We calculated the probability of being a case or control using multivariate logistic regression. Results. We included 99 cases and 270 controls. Cases were younger than controls (53 vs 71 years, respectively). Mortality was much higher for H1N1 patients (13% vs 0.3%), and admission to intensive care unit was more frequent for H1N1 cases. The variables most associated with presenting H1N1 CAP were bilateral affectation on chest X-rays (OR: 5.70; 95% CI 2.69–10.40), followed by presence of arthromyalgias, with cases presenting close to three times more arthromyalgias compared to controls. Low leukocytes count and high AST values were also significantly associated with H1N1 CAP. H1N1 CAPs are characterized by bilateral affectation, low leukocyte count, presence of arthromyalgias, and high AST. Conclusions. A few and easy to obtain clinical parameters might be extremely useful to distinguish H1N1 CAP from CAPs of other origin.S

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

Antimicrobial susceptibility of Escherichia coli producers of community urinary tract infections in Galicia (Spain). Period: 2016-2017

OBJECTIVE: Escherichia coli (E. coli) is responsible for the majority of community urinary tract infections. The objective of the study is to know the sensitivity spectrum of E. coli in urinary tract infections to be able to recommend the appropriate empirical antibiotic treatment. DESIGN: Cross-sectional, multicentric, retrospective study. LOCATION: Galician 8 public hospitals, practically the entire population of Galicia (Spain). PARTICIPANTS: 43,137 outpatients with urinary tract infection due to E. coli isolated in urine in 2016/2017. MAIN MEASUREMENTS: Analyzed variables: demographic, minimum inhibitory concentration and interpretation of sensitivity according to CLSI criteria and resistance mechanisms. The antibiotics studied were: ampicillin, amoxicillin-clavulanic acid, ciprofloxacin, cefotaxime, cefepime, gentamicin, nitrofurantoin, fosfomycin, cotrimoxazole, imipenem and ertapenem. The identification and sensitivity were made mainly by automated methods. RESULTS: The percentages of non-sensitivity of E. coli isolates were: ampicillin 49.2%, amoxicillin-clavulanic acid 17.8%, cefotaxime 6.7%, cefepime 5.7%, ertapenem 0.04%, imipenem 0.05%, gentamicin 9,1%, ciprofloxacin 26.2%, fosfomycin 3.3%, nitrofurantoin 2.4% and cotrimoxazole 23.9%. The non-sensitivities were higher in men and as age increases. Six percent of E. coli were producers of extended-spectrum beta-lactamases. CONCLUSIONS: The empirical treatment in Galicia for uncomplicated cystitis produced by E. coli in women continues to be nitrofurantoin and fosfomycin. In men under 15 years of age, fosfomycin is indicated and in men older than 15 years, treatment in our environment should include culture and administer a 3rd generation oral cephalosporin empirically. Cotrimoxazole and ciprofloxacin are not recommended as empirical treatment because of their high resistance rates.Objetivo Escherichia coli (E. coli) es el responsable de la mayoría de las infecciones del tracto urinario comunitarias. El objetivo del estudio es conocer el espectro de sensibilidad de E. coli en infecciones del tracto urinario para recomendar el tratamiento antibiótico empírico adecuado. Diseño Estudio transversal, multicéntrico, retrospectivo. Emplazamiento Ocho hospitales públicos gallegos, prácticamente toda la población de Galicia (España). Participantes Cuarenta y tres mil ciento treinta y siete pacientes ambulatorios con infección del tracto urinario por E. coli aislados en orina en 2016/2017. Mediciones principales Variables analizadas: demográficas, concentración mínima inhibitoria e interpretación de la sensibilidad según criterios de CLSI y mecanismos de resistencia. Los antibióticos estudiados fueron: ampicilina, amoxicilina-ácido clavulánico, ciprofloxacino, cefotaxima, cefepime, gentamicina, nitrofurantoína, fosfomicina, cotrimoxazol, imipenem y ertapenem. La identificación y sensibilidad se hicieron principalmente por sistemas automatizados. Resultados Los porcentajes de no sensibilidad de los aislamientos de E. coli fueron: ampicilina 49,2%, amoxicilina-ácido clavulánico 17,8%, cefotaxima 6,7%, cefepime 5,7%, ertapenem 0,04%, imipenem 0,05%, gentamicina 9,1%, ciprofloxacino 26,2%, fosfomicina 3,3%, nitrofurantoína 2,4% y cotrimoxazol 23,9%. Las no sensibilidades fueron superiores en hombres y a medida que aumenta la edad. El 6% fueron productores de betalactamasas de espectro extendido. Conclusiones El tratamiento empírico en Galicia para cistitis no complicadas producidas por E. coli en mujeres continúa siendo nitrofurantoína y fosfomicina. En hombres menores de 15 años se indica fosfomicina y en hombres mayores de 15 años el tratamiento en nuestro medio debe incluir la realización de cultivo y administrar una cefalosporina de 3. a generación oral empíricamente. No se recomienda cotrimoxazol ni ciprofloxacino como tratamiento empírico por sus altos porcentajes de resistencia

Characteristics and predictors of death among 4035 consecutively hospitalized patients with COVID-19 in Spain

Objectives: To analyse the characteristics and predictors of death in hospitalized patients with coronavirus disease 2019 (COVID-19) in Spain. Methods: A retrospective observational study was performed of the first consecutive patients hospitalized with COVID-19 confirmed by real-time PCR assay in 127 Spanish centres until 17 March 2020. The follow-up censoring date was 17 April 2020. We collected demographic, clinical, laboratory, treatment and complications data. The primary endpoint was all-cause mortality. Univariable and multivariable Cox regression analyses were performed to identify factors associated with death. Results: Of the 4035 patients, male subjects accounted for 2433 (61.0%) of 3987, the median age was 70 years and 2539 (73.8%) of 3439 had one or more comorbidity. The most common symptoms were a history of fever, cough, malaise and dyspnoea. During hospitalization, 1255 (31.5%) of 3979 patients developed acute respiratory distress syndrome, 736 (18.5%) of 3988 were admitted to intensive care units and 619 (15.5%) of 3992 underwent mechanical ventilation. Virus- or host-targeted medications included lopinavir/ritonavir (2820/4005, 70.4%), hydroxychloroquine (2618/3995, 65.5%), interferon beta (1153/3950, 29.2%), corticosteroids (1109/3965, 28.0%) and tocilizumab (373/3951, 9.4%). Overall, 1131 (28%) of 4035 patients died. Mortality increased with age (85.6% occurring in older than 65 years). Seventeen factors were independently associated with an increased hazard of death, the strongest among them including advanced age, liver cirrhosis, low age-adjusted oxygen saturation, higher concentrations of C-reactive protein and lower estimated glomerular filtration rate. Conclusions: Our findings provide comprehensive information about characteristics and complications of severe COVID-19, and may help clinicians identify patients at a higher risk of death.Fundación SEIMC/GeSIDAPlan Nacional de I+D+i 2013-2016Instituto de Salud Carlos III (ISCIII)Ministerio de Ciencia, Innovación y UniversidadesEuropean Regional Develpment Fund (ERDF)Operative Program Intelligent Growth 2014-2020Spanish AIDS Research Network (RIS)Spanish Network for Research in Infectious Disease