A Study in a Regional Hospital of a Mid-Sized Spanish City Indicates a Major Increase in Infection/Colonization by Carbapenem-Resistant Bacteria, Coinciding with the COVID-19 Pandemic

Bacterial resistance to antibiotics has proven difficult to control over the past few decades. The large group of multidrug-resistant bacteria includes carbapenemase-producing bacteria (CPB), for which limited therapeutic options and infection control measures are available. Furthermore, carbapenemases associate with high-risk clones that are defined by the sequence type (ST) to which each bacterium belongs. The objectives of this cross-sectional and retrospective study were to describe the CPB population isolated in a third-level hospital in Southern Spain between 2015 and 2020 and to establish the relationship between the ST and the epidemiological situation defined by the hospital. CPB were microbiologically studied in all rectal and pharyngeal swabs and clinical samples received between January 2015 and December 2020, characterizing isolates using MicroScan and mass spectrometry. Carbapenemases were detected by PCR and Sanger sequencing, and STs were assigned by multilocus sequence typing (MLST). Isolates were genetically related by pulsedfield gel electrophoresis using Xbal, Spel, or Apal enzymes. The episodes in which each CPB was isolated were recorded and classified as involved or non-involved in an outbreak. There were 320 episodes with CPB during the study period: 18 with K. pneumoniae, 14 with Klebisella oxytoca, 9 with Citrobacter freundii, 11 with Escherichia coli, 46 with Enterobacter cloacae, 70 with Acinetobacter baumannii, and 52 with Pseudomonas aeruginosa. The carbapenemase groups detected were OXA, VIM, KPC, and NDM with various subgroups. Synchronous relationships were notified between episodes of K. pneumoniae and outbreaks for ST15, ST258, ST307, and ST45, but not for the other CPB. There was a major increase in infections with CPB over the years, most notably during 2020, coinciding with the COVID-19 pandemic. This study highlights the usefulness of gene sequencing techniques to control the spread of these microorganisms, especially in healthcare centers. These techniques offer faster results, and a reduction in their cost may make their real-time application more feasible. The combination of epidemiological data with real-time molecular sequencing techniques can provide a major advance in the transmission control of these CPB and in the management of infected patients. Real-time sequencing is essential to increase precision and thereby control outbreaks and target infection prevention measures in a more effective manner

Sociodemographic characteristics and risk factors associated to significative bacteriuria in a Spanish health area

Objetivo. Determinar las características epidemiológicas de las bacteriurias significativas (BS) y su relación con factores sociodemográficos, así como analizar los factores de riesgo en pacientes hospitalizados. Material y métodos. Estudio descriptivo transversal realizado sobre el conjunto de registros obtenidos a partir del procesamiento de todas las muestras de urocultivos recibidas en el laboratorio de Microbiología del Hospital Universitario Virgen de las Nieves (Granada, España) entre enero de 2016 y diciembre de 2020, diferenciando entre población infantil y adulta. Como variables dependientes se analizaron la presencia de BS, las variables independientes fueron la edad en años, sexo, año y mes de la muestra, tipo de muestra, procedencia de la muestra y número de aislamientos. En los urocultivos obtenidos de pacientes ingresados se evaluó la presencia de factores de riesgo asociados a partir del Conjunto Mínimo Básico de Datos. Resultados. Se analizaron 68.587 registros válidos (un 96,3% del total). El 40,8% (IC95%: 40,4%-41,2%) de los urocultivos en adultos y el 33,8% (IC95%: 32,9%-34,7%) en niños fueron positivos. La incidencia en adultos descendió de 18,2 casos/1.000 habitantes en el año 2016 a 14,6 casos/1.000 habitantes en 2020. Para estos mismos años, la incidencia en menores disminuyó de 21,1 a 8,4 casos/1.000 habitantes, respectivamente. Los urocultivos positivos fueron más frecuentes en niños del ámbito urbano frente al ámbito rural (OR=1,37; p<0,01), sin significación en adultos. En adultos hospitalizados, por cada año de edad transcurrido, el riesgo de BS aumentó un 2%, (OR=1,02), fue un 36% mayor en mujeres (OR=1,36), un 18% superior en obesos (OR=1,18) y un 17% más frecuente en pacientes con enfermedad renal (OR=1,17), todas ellas de forma significativa (p<0,01). No se observó relación entre BS y diagnóstico de COVID-19. Conclusión. Las características sociodemográficas de la población con BS atendida en nuestra área de salud, tanto en adultos como en niños, son similares a las encontradas en otras áreas geográficas a nivel mundial, observando una tendencia decreciente en la incidencia de BS en los años estudiados. La frecuencia de BS en niños es mayor en el ámbito urbano.Objective. To determine the epidemiological characteristics of significative bacteriuria (SB) and their relationship with sociodemographic factors and to analyze risk factors in inpatients. Material and methods. Cross-sectional descriptive study carried out on urine culture samples received between 2016- 2020 in the Microbiology laboratory, differentiating between minors and adults. The dependent variable was the presence of SB and the independent variables were age, sex, year, type of sample and source of the sample. In urine cultures of inpatients, risk factors were evaluated from the Minimum Basic Data Set. Results. A total of 68,587 valid records (96.3% of the total) were analyzed. 40.8% (95% CI: 40.4%-41.2%) of urine cultures in adults and 33.8% (95% CI: 32.9%-34.7%) in children were positive, with an incidence that ranged in adults between 18.2 cases/1,000 inhabitants in 2016 and 14.6 cases/ 1,000 inhabitants in 2020 and 21.1 and 8.4 cases/1,000 inhabitants respectively in minors. Positive urine cultures were more frequent in children from urban areas compared to rural areas (OR=1.37; p<0.01). In hospitalized adults, for each year of age the risk of SB increased by 2%, it was 36% higher in women, 18% higher in obese patients and 17% more frequent in patients with kidney disease, (p<0.01). No relationship was observed between SB and diagnosis of COVID-19. Conclusion. The sociodemographic characteristics of the population with SB in our health area are similar to those found in other geographical areas worldwide, observing a decreasing trend in incidence in the years studied. The frequency of SB in children is higher in urban areas

Tumor microenvironment gene expression profiles associated to complete pathological response and disease progression in resectable NSCLC patients treated with neoadjuvant chemoimmunotherapy

Background Neoadjuvant chemoimmunotherapy for non-small cell lung cancer (NSCLC) has improved pathological responses and survival rates compared with chemotherapy alone, leading to Food and Drug Administration (FDA) approval of nivolumab plus chemotherapy for resectable stage IB-IIIA NSCLC (AJCC 7th edition) without ALK or EGFR alterations. Unfortunately, a considerable percentage of tumors do not completely respond to therapy, which has been associated with early disease progression. So far, it is impossible to predict these events due to lack of knowledge. In this study, we characterized the gene expression profile of tumor samples to identify new biomarkers and mechanisms behind tumor responses to neoadjuvant chemoimmunotherapy and disease recurrence after surgery. Methods Tumor bulk RNA sequencing was performed in 16 pretreatment and 36 post-treatment tissue samples from 41 patients with resectable stage IIIA NSCLC treated with neoadjuvant chemoimmunotherapy from NADIM trial. A panel targeting 395 genes related to immunological processes was used. Tumors were classified as complete pathological response (CPR) and non-CPR, based on the total absence of viable tumor cells in tumor bed and lymph nodes tested at surgery. Differential-expressed genes between groups and pathway enrichment analysis were assessed using DESeq2 and gene set enrichment analysis. CIBERSORTx was used to estimate the proportions of immune cell subtypes. Results CPR tumors had a stronger pre-established immune infiltrate at baseline than non-CPR, characterized by higher levels of IFNG, GZMB, NKG7, and M1 macrophages, all with a significant area under the receiver operating characteristic curve (ROC) >0.9 for CPR prediction. A greater effect of neoadjuvant therapy was also seen in CPR tumors with a reduction of tumor markers and IFN gamma signaling after treatment. Additionally, the higher expression of several genes, including AKT1, BST2, OAS3, or CD8B; or higher dendritic cells and neutrophils proportions in post-treatment non-CPR samples, were associated with relapse after surgery. Also, high pretreatment PD-L1 and tumor mutational burden levels influenced the post-treatment immune landscape with the downregulation of proliferation markers and type I interferon signaling molecules in surgery samples. Conclusions Our results reinforce the differences between CPR and non-CPR responses, describing possible response and relapse immune mechanisms, opening the possibility of therapy personalization of immunotherapy-based regimens in the neoadjuvant setting of NSCLC

COVID-19 vaccine effectiveness against hospitalization due to SARS-CoV-2: A test-negative design study based on Severe Acute Respiratory Infection (SARI) sentinel surveillance in Spain

Background: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for acute respiratory infection (ARI) surveillance in primary care and a network of sentinel hospitals for severe ARI (SARI) surveillance in hospitals. Methods: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 vaccine effectiveness (VE) against hospitalization, by age group, vaccine type, time since vaccination, and SARS-CoV-2 variant. Results: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. Conclusions: The SiVIRA sentinel hospital surveillance network in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations and provide estimates of COVID-19 VE in the population under surveillance. Our estimates add to evidence of high effectiveness of mRNA vaccines against severe COVID-19 and waning of protection with time since vaccination in those aged 80 or older. No substantial differences were observed between SARS-CoV-2 variants (Alpha vs. Delta).The data of the study was originally collectedas part of the following projects run by the European Centre for Disease Prevention and Control:“Establishing Severe Acute Respiratory Infections (SARI) surveillance and performing hospital-based COVID-19 transmission studies”, “Developing an infrastructure and performing vaccine effectiveness studies for COVID-19 vaccines in the EU/EEA”, and the “Vaccine Effectiveness, Burden and Impact Studies(VEBIS) of COVID-19 and Influenza".S

Efficacy of a strategy for implementing a guideline for the control of cardiovascular risk in a primary healthcare setting: the SIRVA2 study a controlled, blinded community intervention trial randomised by clusters

This work describes the methodology used to assess a strategy for implementing clinical practice guidelines (CPG) for cardiovascular risk control in a health area of Madrid

Meeting Point: methods and spaces for the flipped classroom

Desarrollo de programas formativos centrados en los estudiantes gracias a la mejora de la calidad de los recursos materiales y del personal docente e investigador.Vicerrectorado de CalidadFac. de FilologíaFALSEsubmitte

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Geodivulgar: Geología y Sociedad 2018

Depto. de Geodinámica, Estratigrafía y PaleontologíaFac. de Ciencias GeológicasFALSEsubmitte

Geodivulgar: Geología y Sociedad

Con el lema “Geología para todos” el proyecto Geodivulgar: Geología y Sociedad apuesta por la divulgación de la Geología a todo tipo de público, incidiendo en la importancia de realizar simultáneamente una acción de integración social entre estudiantes y profesores de centros universitarios, de enseñanza infantil, primaria, de educación especial y un acercamiento con público con diversidad funcional