Linfangitis nodular por Nocardia asteroides tras pinchazo con cactus.

We present a case of skin infection with progression to nodular lymphangitis caused by Nocardia asteroides in an immunocompetent patient after accidental trauma with the spike of a cactus that required admission for therapeutic management due to the lack of improvement with conservative treatment and antibiotic therapy with amoxicillin / clavulanic acid. Before that, he presented analytical data of invasive infection. Treatment was carried out by surgical debridement and prolonged treatment with trimethoprim / sulfamethoxazole for 3 months. After this, the patient recovered completely.Presentamos un caso de infección cutánea con progresión a linfangitis nodular causada por Nocardia asteroides en un paciente inmunocompetente tras traumatismo accidental con la púa de un cactus, que requirió ingreso para manejo terapéutico por ausencia de mejoría con tratamiento conservador y antibioterapia con amoxicilina/ácido clavulánico. Previo al ingreso presentaba datos analíticos de infección invasiva. El tratamiento se realizó mediante desbridamiento quirúrgico y tratamiento prolongado con trimetoprim/sulfametoxazol 160/800mg, dos comprimidos cada 8h durante 3 meses. Tras esto, el paciente presentó total recuperación del episodio

Emerging Presence of Culturable Microorganisms in Clinical Samples of the Genitourinary System: Systematic Review and Experience in Specialized Care of a Regional Hospital

The detection of emerging pathogens responsible for genitourinary infections has increased with technological advances. We conducted a systematic review of publications on the involvement of these microorganisms in genitourinary samples, and we also investigated their presence and antibiotic susceptibility in samples from patients at our regional hospital (Granada, Spain). The MEDLINE database was searched up to 31 December 2020, and a cross-sectional descriptive study was performed of results obtained in urine samples and genital exudates from January 2016 through December 2019. The review highlighted the frequent involvement of Neisseria meningitidis in genital infections, while the data on other microorganisms were consistent with findings in our patient series. The emerging microorganisms most often responsible for urinary tract infections were Streptococcus bovis (58.5%) and Gardnerella vaginalis (23.6%) in females, and S. bovis (32.3%), Aerococcus urinae (18.6%), and Corynebacterium spp. (16.9%) in males; those most frequently reported in genital infections were S. viridans (36.4%) in females and C. glucuronolyticum (32.2%) and G. vaginalis (35.6%) in males. In general, emerging pathogens are resistant to conventional antibiotics such as penicillin. However, there has also been an increase in beta-lactam resistance by the S. bovis group and Corynebacterium spp. The systematic review showed that emerging microorganisms are responsible for only a small percentage of genitourinary infections but are of major clinical interest, with a predominance of the S. bovis group, G. vaginalis, Lactobacillus spp., Aerococcus spp., and Corynebacterium spp. in urine samples and of G. vaginalis and C. glucuronolyticum in genital samples. Given the increasing resistance to antibiotics empirically prescribed in patients with genitourinary infections, it is recommended to create an antibiogram in all cases

Urinary tract infection by Acinetobacter baumannii and Pseudomonas aeruginosa: evolution of antimicrobial resistance and therapeutic alternatives

Parts of this work were supported by the CTS-521 research group.Purpose. Acinetobacter baumannii and Pseudomonas aeruginosa are responsible for numerous nosocomial infections. The objective of this study was to determine the development of their susceptibility to ten antibiotics and the antibiotic consumption of patients with suspicion of urinary tract infection (UTI).Methodology. A retrospective study was conducted on the susceptibility profiles of A. baumannii and P. aeruginosa isolates from 749 urine samples gathered between January 2013 and December 2016, and on the consumption of imipenem, meropenem and piperacillin-tazobactam between 2014 and 2016.Results. Hospital patients were the source of 82 (91.1 %) of the 90 A. baumannii isolates detected and 555 (84.2 %) of the 659 P. aeruginosa isolates. Globally, the lowest percentage susceptibility values were found for fosfomycin, aztreonam and ciprofloxacin, while colistin continued to be the most active antibiotic in vitro. In 2016, the susceptibility of A. baumannii to carbapenem and piperacillin-tazobactam decreased to very low values, while the susceptibility of P. aeruginosa to carbapenem remained stable but its susceptibility to piperacillin-tazobactam decreased. There was a marked increase in the consumption of piperacillin-tazobactam.Conclusion. In our setting, it is no longer possible to use carbapenems and piperacillin-tazobactam for empirical treatment of UTI due to A. baumannii or to use piperacillin-tazobactam for empirical treatment of UTI due to P. aeruginosa. Colistin was found to be the most active antibiotic in vitro. There was a marked increase in the consumption of piperacillin-tazobactam.Andalusian regional government CTS-521 research grou

White Paper on Digital and Complex Information

Information is one of the main traits of the contemporary era. Indeed there aremany perspectives to define the present times, such as the Digital Age, the Big Dataera, the Fourth Industrial Revolution, the fourth Paradigm of science, and in all ofthem information, gathered, stored, processed and transmitted, plays a key role.Technological developments in the last decades such as powerful computers, cheaperand miniaturized solutions as smartphones, massive optical communication, or theInternet, to name few, have enabled this shift to the Information age. This shift hasdriven daily life, cultural and social deep changes, in work and personal activities,on access to knowledge, information spreading, altering interpersonal relations orthe way we interact in public and private sphere, in economy and politics, pavingthe way to globalizationPeer reviewe

Jardins per a la salut

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia. Assignatura: Botànica farmacèutica. Curs: 2014-2015. Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són el recull de les fitxes botàniques de 128 espècies presents en el Jardí Ferran Soldevila de l’Edifici Històric de la UB. Els treballs han estat realitzats manera individual per part dels estudiants dels grups M-3 i T-1 de l’assignatura Botànica Farmacèutica durant els mesos de febrer a maig del curs 2014-15 com a resultat final del Projecte d’Innovació Docent «Jardins per a la salut: aprenentatge servei a Botànica farmacèutica» (codi 2014PID-UB/054). Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pels professors de l’assignatura. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica. També s’ha pretès motivar els estudiants a través del retorn de part del seu esforç a la societat a través d’una experiència d’Aprenentatge-Servei, deixant disponible finalment el treball dels estudiants per a poder ser consultable a través d’una Web pública amb la possibilitat de poder-ho fer in-situ en el propi jardí mitjançant codis QR amb un smartphone

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Nuevas aportaciones microbiológicas al diagnóstico y tratamiento de las infecciones del tracto urinario

Hasta el 10% de las visitas a atención primaria se deben a infecciones del tracto urinario (ITU), aunque esta patología suele ser de carácter leve, supone un gran impacto sanitario debido al elevado consumo de antibióticos, que no siempre se utilizan de la forma más adecuada, favoreciendo la aparición de resistencias, como las mediadas por enzimas betalactamasas de espectro extendido (BLEE) o de tipo AmpC, que complican el tratamiento y pueden aumentar la morbilidad y mortalidad. La mayoría de episodios de ITU ocurre en mujeres premenopáusicas sin factores de riesgo y cuyo uropatógeno principal es E. coli, con una alta probabilidad de recurrencia en los siguientes 6 meses, lo cual se incrementa si se establece un tratamiento antibiótico inadecuado. La mayoría de los patógenos: enterobacterias, enterococos y Staphylococcus saprophyticus son bien conocidos y su epidemiología está bien estudiada, sin embargo, existen microorganismos pertenecientes a la flora genital o periuretral, que bajo condiciones de susceptibilidad especial del paciente pueden dar lugar a infecciones con un diagnóstico más complejo. Aún es más complicado cuando la ITU ocurre dentro del contexto de una infección nosocomial, donde microorganismos per se muy resistentes como Acinetobacter baumannii o Pseudomonas aeruginosa suelen ser causa frecuente de ITU, acumulando cada vez más mecanismos de resistencia, o bien la aparición de candiduria, cuya interpretación es compleja, cuyo tratamiento depende en gran parte de la especie implicada, y si el tratamiento es inadecuado aumenta la mortalidad, sobretodo en servicios como las unidades de pacientes críticos. MÉTODOS En este proyecto se llevó a cabo, a partir de la práctica diaria de procesamientos de orina para su cultivo, la comparación del diagnóstico convencional, con los valores de fluorescencia de la citometría de flujo, para la identificación presuntiva del uropatógeno. Además, se diseñó y se validó un test rápido de detección de cefotaximasas, que se basa en el cambio de pH por la degradación del antibiótico. Por otro lado, para conocer mejor la situación epidemiológica actual de nuestro entorno, se estudiaron la prevalencia y perfiles de resistencia de los uropatógenos de más difícil tratamiento, como los portadores de BLEE, AmpC, las cándidas o los bacilo gramnegativos no fermentadores, así como de otros uropatógenos menos frecuentes que afectan a pacientes con factores predisponentes, mediante la presentación de series de casos. RESULTADOS Los estudios de predicción de la morfología del uropatógeno mediante los valores de fluorescencia por el citómetro fueron capaces de distinguir entre bacilos gramnegativos y cocos grampositivos de forma aproximada, pues los valores de especificidad obtenidos fueron bajos. El test colorimétrico basado en el pH probado, que detectaba cefotaximasas, resultó útil para la detección de estas enzimas presentes en las enterobacterias de nuestro medio, sobretodo cuando se trataron de betalactamasas de espectro extendido, ya que los fenotipos BLEE en E. coli y K . pneumoniae son los más prevalentes. En cuanto a los pacientes hospitalizados, no es posible a día de hoy seguir utilizando los carbapenemes, (sólo para A. baumannii) o piperacilina/tazobactam como tratamiento empírico para la ITU causada por P. aeruginosa, relacionándose la aparición de resistencias con un aumento del consumo intrahospitalario de piperacilina/tazobactam. En el urocultivo de pacientes hospitalizados ha de considerarse la posible presencia de candiduria, más prevalente en los pacientes procedentes de los Servicios de Medicina Interna, portadores de sonda urinaria y con una edad superior a los 65 años. En pacientes ancianos con patología urológica de base no debemos olvidar que ciertos microorganismos poco frecuentes, como Lactobacillus spp., Aerococcus spp. o estreptococos del grupo bovis pueden ser responsables de ITU. CONCLUSIÓN GLOBAL Aun así, es necesario seguir realizando estudios de este tipo a diferentes niveles poblacionales para frenar la dispersión global de las resistencias antibióticas desde una de las infecciones más frecuentes y que suele tratarse de forma empírica, la infección del tracto urinarioTesis Univ. Granada

Comparison between urine culture profile and morphology classification using fluorescence parameters of the Sysmex UF-1000i urine flow cytometer

Aims: To determine the usefulness of the fluorescence parameters generated by Sysmex UF-1000i flow cytometer for the rapid diagnosis of urinary tract infection by bacilli or cocci. Methods and results: Urine samples (n = 1924) were studied by culture and microbiology and subsequently by cytometry, using BACT-Morph software and considering forward-scattered light (FSC) and fluorescent light scatter fluorescence parameters. BACT-Morph software showed moderate diagnostic accuracy (78·4%) to detect rod-shaped bacteria, with sensitivity of 82·4% and specificity of 62·5%. Forward-scattered (B_FSC) values of the bacterial channel were significant higher for the Gram-positive cocci category (P < 0·001). A cut-off of B_FSC ≥24·2, expressed in arbitrary units (analytical channel, ch), provided higher sensitivity (90·0%) but lower specificity (38·9%), and the diagnostic accuracy for Gram-positive cocci classification reached 62·0%. Conclusions: Utilization of BACT-Morph software and bacterial channel fluorescence parameters (B_FSC ≥24·2 ch) offered an approximate discrimination of bacilli and cocci but the specificity was low, especially for FSC. Significance and impact of the study: Further research is needed to establish the usefulness of flow cytometry for aetiological diagnosis