Duration of Treatment for Pseudomonas aeruginosa Bacteremia: a Retrospective Study

Introduction: There is no consensus regarding optimal duration of antibiotic therapy for Pseudomonas aeruginosa bacteremia. We aimed to evaluate the impact of short antibiotic course. Methods: We present a retrospective multicen ter study including patients with P. aeruginosa bacteremia during 2009–2015. We evaluated outcomes of patients treated with short (6–- 10 days) versus long (11–15 days) antibiotic courses. The primary outcome was a composite of 30-day mortality or bacteremia recurrence and/or persistence. Univariate and inverse probability treatment-weighted (IPTW) adjusted multivariate analysis for the primary outcome was performed. To avoid immortal time bias, the landmark method was used. Results: We included 657 patients; 273 received a short antibiotic course and 384 a long course. There was no significant difference in baseline characteristics of patients. The com posite primary outcome occurred in 61/384 patients in the long-treatment group (16%) versus 32/273 in the short-treatment group (12%) (p = 0.131). Mortality accounted for 41/384 (11%) versus 25/273 (9%) of cases, respectively. Length of hospital stay was signif icantly shorter in the short group [median 13 days, interquartile range (IQR) 9–21 days, versus median 15 days, IQR 11–26 days, p = 0.002]. Ten patients in the long group dis continued antibiotic therapy owing to adverse events, compared with none in the short group. On univariate and multivariate analyses, dura tion of therapy was not associated with the primary outcome. Conclusions: In this retrospective study, 6–- 10 days of antibiotic course for P. aeruginosa bacteremia were as effective as longer courses in terms of survival and recurrence. Shorter ther apy was associated with reduced length of stay and less drug discontinuation

Mural Endocarditis: The GAMES Registry Series and Review of the Literature

Introduction Mural infective endocarditis (MIE) is a rare type of endovascular infection. We present a comprehensive series of patients with mural endocarditis. Method sPatients with infectious endocarditis (IE) from 35 Spanish hospitals were prospectively included in the GAMES registry between 2008 and 2017. MIEs were compared to non-MIEs. We also performed a literature search for cases of MIE published between 1979 and 2019 and compared them to the GAMEs series. Results Twenty-seven MIEs out of 3676 IEs were included. When compared to valvular IE (VIE) or device-associated IE (DIE), patients with MIE were younger (median age 59 years, p < 0.01). Transplantation (18.5% versus 1.6% VIE and 2% DIE, p < 0.01), hemodialysis (18.5% versus 4.3% VIE and 4.4% DIE, p = 0.006), catheter source (59.3% versus 9.7% VIE and 8.8% DIE, p < 0.01) and Candida etiology (22.2% versus 2% DIE and 1.2% VIE, p < 0.01) were more common in MIE, whereas the Charlson Index was lower (4 versus 5 in non-MIE, p = 0.006). Mortality was similar.MIE from the literature shared many characteristics with MIE from GAMES, although patients were younger (45 years vs. 56 years, p < 0.001), the Charlson Index was lower (1.3 vs. 4.3, p = 0.0001), catheter source was less common (13.9% vs. 59.3%) and there were more IVDUs (25% vs. 3.7%). S. aureus was the most frequent microorganism (50%, p = 0.035). Systemic complications were more common but mortality was similar. Conclusion MIE is a rare entity. It is often a complication of catheter use, particularly in immunocompromised and hemodialysis patients. Fungal etiology is common. Mortality is similar to other IEs

Clinical Features and Outcomes of Streptococcus anginosus Group Infective Endocarditis: A Multicenter Matched Cohort Study

Streptococcus anginosus; Endocarditis infecciosa; Estreptococs del grup viridansStreptococcus anginosus; Endocarditis infecciosa; Estreptococos del grupo viridansStreptococcus anginosus; Infective endocarditis; Viridans group streptococciBackground Although Streptococcus anginosus group (SAG) endocarditis is considered a severe disease associated with abscess formation and embolic events, there is limited evidence to support this assumption. Methods We performed a retrospective analysis of prospectively collected data from consecutive patients with definite SAG endocarditis in 28 centers in Spain and Italy. A comparison between cases due to SAG endocarditis and viridans group streptococci (VGS) or Streptococcus gallolyticus group (SGG) was performed in a 1:2 matched analysis. Results Of 5336 consecutive cases of definite endocarditis, 72 (1.4%) were due to SAG and matched with 144 cases due to VGS/SGG. SAG endocarditis was community acquired in 64 (88.9%) cases and affected aortic native valve in 29 (40.3%). When comparing SAG and VGS/SGG endocarditis, no significant differences were found in septic shock (8.3% vs 3.5%, P = .116); valve disorder, including perforation (22.2% vs 18.1%, P = .584), pseudoaneurysm (16.7% vs 8.3%, P = .108), or prosthesis dehiscence (1.4% vs 6.3%, P = .170); paravalvular complications, including abscess (25% vs 18.8%, P = .264) and intracardiac fistula (5.6% vs 3.5%, P = .485); heart failure (34.7% vs 38.9%, P = .655); or embolic events (41.7% vs 32.6%, P = .248). Indications for surgery (70.8% vs 70.8%; P = 1) and mortality (13.9% vs 16.7%; P = .741) were similar between groups. Conclusions SAG endocarditis is an infrequent but serious condition that presents a prognosis similar to that of VGS/SGG.This work was 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 Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005), co‐financed by the European Development Regional Fund “A way to achieve Europe,” Operative Program Intelligent Growth 2014–2020. We thank CERCA Programme/Generalitat de Catalunya for institutional support. J. M. M. received a personal 80:20 research grant from Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–2021

Design of a school randomized trial for nudging students towards healthy diet and physical activity to prevent obesity:PAAPAS Nudge study protocol

Submitted by Janaína Nascimento ([email protected]) on 2019-06-26T13:41:43Z No. of bitstreams: 1 ve_Cunha_Diana_etal_INI_2017.pdf: 188285 bytes, checksum: 9c5af1590f81759ea357050b01c74cce (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-06-26T14:10:20Z (GMT) No. of bitstreams: 1 ve_Cunha_Diana_etal_INI_2017.pdf: 188285 bytes, checksum: 9c5af1590f81759ea357050b01c74cce (MD5)Made available in DSpace on 2019-06-26T14:10:20Z (GMT). No. of bitstreams: 1 ve_Cunha_Diana_etal_INI_2017.pdf: 188285 bytes, checksum: 9c5af1590f81759ea357050b01c74cce (MD5) Previous issue date: 2017State University of Rio de Janeiro. Social Medicine Institute. Department of Epidemiology. Rio de Janeiro, RJ, Brazil.State University of Rio de Janeiro. Social Medicine Institute. Department of Epidemiology. Rio de Janeiro, RJ, Brazil.State University of Rio de Janeiro. Social Medicine Institute. Department of Epidemiology. Rio de Janeiro, RJ, Brazil / Brazilian Navy. Naval Academy. Department of Physical Education and Sports. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Departamento de Epidemiologia e Métodos Quantitativos. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.State University of Rio de Janeiro. Social Medicine Institute. Department of Epidemiology. Rio de Janeiro, RJ, Brazil.Fluminense Federal University. Institute of Collective Health. Department of Epidemiology and Biostatistics. Niterói, RJ, Brazil.State University of Rio de Janeiro. Social Medicine Institute. Department of Epidemiology. Rio de Janeiro, RJ, Brazil.Fluminense Federal University. Institute of Collective Health. Department of Epidemiology and Biostatistics. Niterói, RJ, Brazil.State University of Rio de Janeiro. Nutrition Institute. Department of Social Nutrition. Rio de Janeiro, RJ, Brazil.State University of Rio de Janeiro. Nutrition Institute. Department of Social Nutrition. Rio de Janeiro, RJ, Brazil.University of Copenhagen. Department of Food Science. Copenhagen, Denmark.Federal University of Rio de Janeiro. Department of Social and Applied Nutrition. Rio de Janeiro, RJ, Brazil.State University of Rio de Janeiro. Social Medicine Institute. Department of Epidemiology. Rio de Janeiro, RJ, Brazil.Objective: To evaluate the effectiveness of nudge activities at school on the students’ body mass index (BMI). Design: School-based factorial randomized community trial. Setting: Eighteen public schools in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil. Participants and intervention: The 18 schools will be randomized into 4 group arms: group 1—control (without any activity); group 2—will receive educational activities in the classroom; group 3—will receive changes in the school environment (nudge strategies); group 4—will receive educational activities and changes in the school environment. Activities will occur during the 2018 school-year. Main outcomemeasure(s): The primary (BMI) and secondary (body fat percentage) outcomes will be assessed at baseline and after the study using a portable electronic scale with a segmental body composition monitor. The height will be measured by a portable stadiometer. Analysis: Statistical analyses for each outcome will be conducted through linear mixed models that took into account the missing data and cluster effect of the schools. Abbreviations: BMI = body mass index, CONSORT = Consolidated Standards of Reporting Trials, PAAPPAS = Portuguese abbreviation of parents, students, community health agents and teachers for healthy eating, Rec24-h = 24-hour recall, SLM = Smarter Lunchrooms Movement

Reappraisal of the outcome of healthcare-associated and community-acquired bacteramia: a prospective cohort study

Background: Healthcare-associated (HCA) bloodstream infections (BSI) have been associated with worse outcomes, in terms of higher frequencies of antibiotic-resistant microorganisms and inappropriate therapy than strict community-acquired (CA) BSI. Recent changes in the epidemiology of community (CO)-BSI and treatment protocols may have modified this association. The objective of this study was to analyse the etiology, therapy and outcomes for CA and HCA BSI in our area. Methods: A prospective multicentre cohort including all CO-BSI episodes in adult patients was performed over a 3-month period in 2006–2007. Outcome variables were mortality and inappropriate empirical therapy. Adjusted analyses were performed by logistic regression. Results: 341 episodes of CO-BSI were included in the study. Acquisition was HCA in 56% (192 episodes) of them. Inappropriate empirical therapy was administered in 16.7% (57 episodes). All-cause mortality was 16.4% (56 patients) at day 14 and 20% (71 patients) at day 30. After controlling for age, Charlson index, source, etiology, presentation with severe sepsis or shock and inappropriate empirical treatment, acquisition type was not associated with an increase in 14-day or 30-day mortality. Only an stratified analysis of 14th-day mortality for Gram negatives BSI showed a statically significant difference (7% in CA vs 17% in HCA, p = 0,05). Factors independently related to inadequate empirical treatment in the community were: catheter source, cancer, and previous antimicrobial use; no association with HCA acquisition was found. Conclusion: HCA acquisition in our cohort was not a predictor for either inappropriate empirical treatment or increased mortality. These results might reflect recent changes in therapeutic protocols and epidemiological changes in community pathogens. Further studies should focus on recognising CA BSI due to resistant organisms facilitating an early and adequate treatment in patients with CA resistant BSI

An overview of migratory birds in Brazil

We reviewed the occurrences and distributional patterns of migratory species of birds in Brazil. A species was classified as migratory when at least part of its population performs cyclical, seasonal movements with high fidelity to its breeding grounds. Of the 1,919 species of birds recorded in Brazil, 198 (10.3%) are migratory. Of these, 127 (64%) were classified as Migratory and 71 (36%) as Partially Migratory. A few species (83; 4.3%) were classified as Vagrant and eight (0,4%) species could not be defined due to limited information available, or due to conflicting data.Fil: Somenzari, Marina. Centro Nacional de Pesquisa e Conservação de Aves Silvestres. Instituto Chico Mendes de Conservação da Biodiversidade; BrasilFil: Amaral, Priscilla Prudente do. Centro Nacional de Pesquisa e Conservação de Aves Silvestres. Instituto Chico Mendes de Conservação da Biodiversidade; BrasilFil: Cueto, Víctor. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Centro de Investigación Esquel de Montaña y Estepa Patagóica. Universidad Nacional de la Patagonia "San Juan Bosco". Facultad de Ciencias Naturales - Sede Esquel. Centro de Investigación Esquel de Montaña y Estepa Patagónica; ArgentinaFil: Guaraldo, André de Camargo. Universidade Federal do Paraná; BrasilFil: Jahn, Alex. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Lima, Diego Mendes. Centro Nacional de Pesquisa e Conservação de Aves Silvestres. Instituto Chico Mendes de Conservação da Biodiversidade; BrasilFil: Lima, Pedro Cerqueira. Fundação BioBrasil; BrasilFil: Lugarini, Camile. Centro Nacional de Pesquisa e Conservação de Aves Silvestres. Instituto Chico Mendes de Conservação da Biodiversidade; BrasilFil: Machado, Caio Graco. Universidade Estadual de Feira de Santana; BrasilFil: Martinez, Jaime. Universidade de Passo Fundo; BrasilFil: do Nascimento, João Luiz Xavier. Centro Nacional de Pesquisa e Conservação de Aves Silvestres. Instituto Chico Mendes de Conservação da Biodiversidade; BrasilFil: Pacheco, José Fernando. Comitê Brasileiro de Registros Ornitológicos; BrasilFil: Paludo, Danielle. Centro Nacional de Pesquisa e Conservação de Aves Silvestres. Instituto Chico Mendes de Conservação da Biodiversidade; BrasilFil: Prestes, Nêmora Pauletti. Universidade de Passo Fundo; BrasilFil: Serafini, Patrícia Pereira. Centro Nacional de Pesquisa e Conservação de Aves Silvestres. Instituto Chico Mendes de Conservação da Biodiversidade; BrasilFil: Silveira, Luís Fábio. Universidade de Sao Paulo; BrasilFil: de Sousa, Antônio Emanuel Barreto Alves. Centro Nacional de Pesquisa e Conservação de Aves Silvestres. Instituto Chico Mendes de Conservação da Biodiversidade; BrasilFil: de Sousa, Nathália Alves. Centro Nacional de Pesquisa e Conservação de Aves Silvestres. Instituto Chico Mendes de Conservação da Biodiversidade; BrasilFil: de Souza, Manuella Andrade. Centro Nacional de Pesquisa e Conservação de Aves Silvestres. Instituto Chico Mendes de Conservação da Biodiversidade; BrasilFil: Telino-Júnior, Wallace Rodrigues. Universidade Federal de Pernambuco; BrasilFil: Whitney, Bret Myers. State University of Louisiana; Estados Unido

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

Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC)

Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications

Las redes sociales como herramientas de comunicación, debate y evaluación del trabajo en equipo

En la asignatura OBLII, impartida en el primer curso del Grado en Química, se desarrolla un trabajo bibliográfico en equipo supervisado por un estudiante de postgrado o cursos superiores de la titulación (estudiante-tutor). Hasta el curso 2014/15, el seguimiento de este trabajo y la comunicación entre el equipo de trabajo, profesor y estudiante-tutor se ha realizado mediante reuniones y tutorías presenciales. En el presente curso, se ha empleado la red social Facebook como herramienta de comunicación entre las diferentes figuras implicadas en el citado trabajo colaborativo; y se han llevado a cabo una serie de tutorías no presenciales y debates a través de dicha plataforma. Para llevar a cabo las citadas actividades, se han creado dos tipos de grupos privados en Facebook: un grupo general para todos los estudiantes, estudiantes-tutores y profesores; y otro grupo por cada equipo de trabajo formado por cuatro estudiantes y su estudiante-tutor. Las actividades realizadas a través de esta plataforma han sido utilizadas por los estudiantes-tutores para evaluar la competencia “trabajo en equipo”, recogida en la guía de la asignatura. En el presente trabajo, se muestran los resultados obtenidos en los citados grupos de Facebook, así como la opinión de sus miembros sobre el proyecto

OBLII_2016

En la asignatura OBLII, impartida en el primer curso del Grado en Química, se desarrolla un trabajo bibliográfico en equipo supervisado por un estudiante de postgrado o cursos superiores de la titulación (estudiante-tutor). Hasta el curso 2014/15, el seguimiento de este trabajo y la comunicación entre el equipo de trabajo, profesor y estudiante-tutor se ha realizado mediante reuniones y tutorías presenciales. En el presente curso, se ha empleado la red social Facebook como herramienta de comunicación entre las diferentes figuras implicadas en el citado trabajo colaborativo; y se han llevado a cabo una serie de tutorías no presenciales y debates a través de dicha plataforma. Para llevar a cabo las citadas actividades, se han creado dos tipos de grupos privados en Facebook: un grupo general para todos los estudiantes, estudiantes-tutores y profesores; y otro grupo por cada equipo de trabajo formado por cuatro estudiantes y su estudiante-tutor. Las actividades realizadas a través de esta plataforma han sido utilizadas por los estudiantes-tutores para evaluar la competencia “trabajo en equipo”, recogida en la guía de la asignatura. En el presente trabajo, se muestran los resultados obtenidos en los citados grupos de Facebook, así como la opinión de sus miembros sobre el proyecto