Estudi de prevalença de la colonització per Staphylococcus aureus resistent a meticil·lina en una població humana i en una porcina

Analitzar la prevalença del MRSA i MRSA ST398 en porcs i en treballadors de granges de porcs. Estudi transversal de prevalença, a la comarca d'Osona. Es van seleccionar 16 granges. Les mostres, s'han processat al laboratori de microbiologia per identificar el MRSA ST398. Van resultar positius per MRSA, 20(64,5%) treballadors. Anys treballats en granges per als positius son 15 anys(p 0'05). De 468 frotis nasals de porcs, van resultar positius per MARSA 7(1,49). La prevalença de MRSA es elevada a la comarca d'Osona. Es importat realitzar un frotis nasal a tots els treballadors de granges de porcs que ingressen a l'Hospital

Environmental cultures and hospital-acquired Legionnaires' disease : a 5-year prospective study in 20 hospitals in Catalonia, Spain

Objective: To determine whether environmental cultures for Legionella increase the index of suspicion for legionnaires' disease (LD). Design: Five-year prospective study. Setting: Twenty hospitals in Catalonia, Spain. Methods: From 1994 to 1996, the potable water systems of 20 hospitals in Catalonia were tested for Legionella, Cases of hospital-acquired LD and availability of an "in-house" Legionella test in the previous 4 years were assessed. After the hospitals were informed of the results of their water cultures, a prospective 5-year-study was conducted focusing on the detection of new cases of nosocomial legionellosis and the availability and use of Legionella testing. Results: Before environmental cultures were started, only one hospital had conducted active surveillance of hospital-acquired pneumonia and used Legionella tests including Legionella urinary antigen in all pneumonia cases. Only one other hospital had used the latter test at all. In six hospitals, Legionella tests had been completely unavailable. Cases of nosocomial LD had been diagnosed in the previous 4 years in only two hospitals. During prospective surveillance, 12 hospitals (60%) used Legionella urinary antigen testing in house and 11 (55%) found cases of nosocomial legionellosis, representing 64.7% (11 of 17) of those with positive water cultures. Hospitals with negative water cultures did not find nosocomial LD. Conclusions: The environmental study increased the index of suspicion for nosocomial LD. The number of cases of nosocomial LD increased significantly during the prospective follow-up period, and most hospitals began using the Legionella urinary antigen test in their laboratories

Estudi de prevalença de la colonització per Staphylococcus aureus resistent a meticil•lina en una població humana i en una porcina

Analitzar la prevalença del MRSA i MRSA ST398 en porcs i en treballadors de granges de porcs. Estudi transversal de prevalença, a la comarca d’Osona. Es van seleccionar 16 granges. Les mostres, s’han processat al laboratori de microbiologia per identificar el MRSA ST398. Van resultar positius per MRSA, 20(64,5%) treballadors. Anys treballats en granges per als positius son 15 anys(p<0’05). De 468 frotis nasals de porcs, van resultar positius per MARSA 7(1,49). La prevalença de MRSA es elevada a la comarca d’Osona. Es importat realitzar un frotis nasal a tots els treballadors de granges de porcs que ingressen a l’Hospital

Prevalencia de Staphylococcus aureus resistente a meticilina CC398 en un área con una alta densidad de granjas de cerdos

El Staphylococcus aureus resistente a la meticilina (SARM) es un importante patógeno humano que causa infecciones nosocomial y adquirida en la comunidad en todo el mundo. Desde 2003, el SARM asociado a la ganadería (SARM-AG) se ha identificado tanto en animales como en seres humanos en zonas con ganadería en Europa, América del Norte y Asia. Asimismo dentro del grupo de SARM-AG están incluidas los clones CC398 y CCT9 entre otros. Estudios previos establecieron que la resistencia a la tetraciclina (tetR) podría ser un buen marcador para la determinación rápida de las cepas CC398 y CC relacionadas con otros animales entre los aislados clínicos de SARM. La exposición del ser humano a la ganadería constituye un factor de riesgo para la colonización por SARM CC398 y también para el desarrollo de una posible infección. La mayoría de infecciones producidas por SARM CC398 están relacionadas con infecciones de la piel y tejidos blandos. Sin embargo, se han reportado en Europa, Asia, y Estados Unidos infecciones graves. La comarca de Osona (Barcelona) es una comarca con una antigua tradición en la industria del cerdo y por consiguiente es una de las comarcas con mayor densidad de cerdos. Para conocer la importancia de SARM CC398 en un área con alta densidad de granjas de cerdos como es la comarca de Osona se han realizado tres estudios en diferentes poblaciones. El primero fue en granjas de cerdos, en donde se observó una alta prevalencia de SARM CC398 en granjeros (58%) y en cerdos (46%). Se observó que los granjeros de cerdos que trabajan en granjas con más de 1.250 cerdos tienen más probabilidades de ser positivos para SARM CC398. Asimismo se describe por primera vez la prevalencia de SARM CC398 en Cataluña, la región de España con mayor densidad de cerdos. El segundo trabajo se analizaron 4 años (2012-2015), en donde se observó que la prevalencia de SARM-TetRR (especialmente del linaje CC398) en la comarca de Osona (Barcelona), en pacientes hospitalizados o relacionados con la asistencia sanitaria es elevada, representando más del 50% del total de SARM aislados. El aumento de detección de SARM-TetR y especialmente CC398 durante los últimos años hace pensar que en un futuro podría ser el clon SARM comunitario en nuestra zona. Por otra parte se describen las características clínicas de los pacientes en los que se han identificado SARM-TetRR siendo más jóvenes, con menos comorbilidad, menos ingresos hospitalarios, con una adquisición extrahospitalaria y en un 50% con contacto con granjas de cerdos. Se han detectado infecciones graves por SARM ST398 y con una mortalidad similar a la de SARM-TetSS. En el tercer trabajo se analizaron seis residencias de ancianos y se observó que la prevalencia de colonización por SARM ST398 en residencias de ancianos en la Comarca de Osona ( Barcelona, España) representa el 15,6% del total de SARM. Las residencias son un reservorio conocido de SARM y en la zona estudiada también podrían ser de SARM ST398. Con estos tres trabajos se demuestra que el SARM CC398 es un linaje prevalente en la comarca de Osona y con una implicación clínica significativa. En este sentido las futuras investigaciones apuntan a conocer en otras poblaciones de riesgo como son los trabajadores de un matadero de cerdos y la población general en la comarca de Osona, la prevalencia y las implicaciones clínicas del SARM CC398.Methicillin-resistant Staphylococcus aureus (MRSA) is a major human pathogen which causes nosocomial and community-acquired infections all over the world. Since 2003 livestock-associated MRSA (LA-MRSA) has been identified in animals as well as in humans in areas of Europe, North America and Asia with livestock populations. Furthermore, the LA-MRSA group includes, amongst others, clones CC398 and CCT9. Previous studies have established that tetracycline resistance (tetR) could be a good marker for rapid determination of CC398 strains and CC strains related to other animals from amongst MRSA clinical isolates. Human exposure to livestock constitutes a risk factor for colonization with MRSA CC398 as well as for development of possible infections. The majority of infections caused by MRSA CC398 are linked to skin and soft tissue infections. Nonetheless, serious infections have been reported in Europe, Asia and the United States. The region of Osona (Barcelona) is an area which has traditionally had a large pig-breeding industry and consequently it is one of the areas with the highest pig-population densities. In order to evaluate the significance of MRSA CC398 in an area with a high density of pig farms, such as the region of Osona, three studies were carried out in different segments of the population. The first looked at pig farms, where a high prevalence of MRSA CC398 was observed in farmers (58%) and pigs (46%). Pig farmers who work on farms with more than 1,250 pigs were found to have a higher probability of being MRSA CC398 positive. Furthermore, the prevalence of MRSA CC398 in Catalonia, the region in Spain with the highest pig density, is described for the first time. The second study analyzed 4 years (2012-2015) during which the prevalence of MRSA- TetRR (especially that belonging to the clonal lineage CC398) in the area of Osona (Barcelona) was observed to be high in hospital patients and patients in contact with the health care services, accounting for more than 50% of the total of MRSA isolates. The increase in detection of MRSA-TetR and especially of CC398 in recent years suggests that it might become the MRSA community-associated clone in our area in the future. Additionally, the clinical characteristics of the patients identified as being MRSA-TetRR showed younger patients, with fewer comorbidities, fewer hospital stays, with community-acquired infections and, in 50% of cases, contact with pig farms. Serious MRSA ST398 infections with a mortality rate similar to that of MRSA-TetSS were detected. In the third study six nursing homes were analyzed and the prevalence of MRSA ST398 colonization in nursing homes in the Osona area (Barcelona, Spain) was found to account for 15.60% of the total of MRSA. Nursing homes are a well-known reservoir of MRSA and maybe also of MRSA ST398 in the area included in the study. MRSA CC398 is shown by these three studies to be a prevalent lineage in the area of Osona, with significant clinical implications. Consequently future investigations will, it seems, focus on the prevalence and the clinical implications of MRSA CC398 in other segments of the population which are at risk, such as pig slaughter-house workers and the population in general in the area of Osona

Prevalencia de Staphylococcus aureus resistente a meticilina CC398 en un área con una alta densidad de granjas de cerdos /

El Staphylococcus aureus resistente a la meticilina (SARM) es un importante patógeno humano que causa infecciones nosocomial y adquirida en la comunidad en todo el mundo. Desde 2003, el SARM asociado a la ganadería (SARM-AG) se ha identificado tanto en animales como en seres humanos en zonas con ganadería en Europa, América del Norte y Asia. Asimismo dentro del grupo de SARM-AG están incluidas los clones CC398 y CCT9 entre otros. Estudios previos establecieron que la resistencia a la tetraciclina (tetR) podría ser un buen marcador para la determinación rápida de las cepas CC398 y CC relacionadas con otros animales entre los aislados clínicos de SARM. La exposición del ser humano a la ganadería constituye un factor de riesgo para la colonización por SARM CC398 y también para el desarrollo de una posible infección. La mayoría de infecciones producidas por SARM CC398 están relacionadas con infecciones de la piel y tejidos blandos. Sin embargo, se han reportado en Europa, Asia, y Estados Unidos infecciones graves. La comarca de Osona (Barcelona) es una comarca con una antigua tradición en la industria del cerdo y por consiguiente es una de las comarcas con mayor densidad de cerdos. Para conocer la importancia de SARM CC398 en un área con alta densidad de granjas de cerdos como es la comarca de Osona se han realizado tres estudios en diferentes poblaciones. El primero fue en granjas de cerdos, en donde se observó una alta prevalencia de SARM CC398 en granjeros (58%) y en cerdos (46%). Se observó que los granjeros de cerdos que trabajan en granjas con más de 1.250 cerdos tienen más probabilidades de ser positivos para SARM CC398. Asimismo se describe por primera vez la prevalencia de SARM CC398 en Cataluña, la región de España con mayor densidad de cerdos. El segundo trabajo se analizaron 4 años (2012-2015), en donde se observó que la prevalencia de SARM-TetRR (especialmente del linaje CC398) en la comarca de Osona (Barcelona), en pacientes hospitalizados o relacionados con la asistencia sanitaria es elevada, representando más del 50% del total de SARM aislados. El aumento de detección de SARM-TetR y especialmente CC398 durante los últimos años hace pensar que en un futuro podría ser el clon SARM comunitario en nuestra zona. Por otra parte se describen las características clínicas de los pacientes en los que se han identificado SARM-TetRR siendo más jóvenes, con menos comorbilidad, menos ingresos hospitalarios, con una adquisición extrahospitalaria y en un 50% con contacto con granjas de cerdos. Se han detectado infecciones graves por SARM ST398 y con una mortalidad similar a la de SARM-TetSS. En el tercer trabajo se analizaron seis residencias de ancianos y se observó que la prevalencia de colonización por SARM ST398 en residencias de ancianos en la Comarca de Osona ( Barcelona, España) representa el 15,6% del total de SARM. Las residencias son un reservorio conocido de SARM y en la zona estudiada también podrían ser de SARM ST398. Con estos tres trabajos se demuestra que el SARM CC398 es un linaje prevalente en la comarca de Osona y con una implicación clínica significativa. En este sentido las futuras investigaciones apuntan a conocer en otras poblaciones de riesgo como son los trabajadores de un matadero de cerdos y la población general en la comarca de Osona, la prevalencia y las implicaciones clínicas del SARM CC398.Methicillin-resistant Staphylococcus aureus (MRSA) is a major human pathogen which causes nosocomial and community-acquired infections all over the world. Since 2003 livestock-associated MRSA (LA-MRSA) has been identified in animals as well as in humans in areas of Europe, North America and Asia with livestock populations. Furthermore, the LA-MRSA group includes, amongst others, clones CC398 and CCT9. Previous studies have established that tetracycline resistance (tetR) could be a good marker for rapid determination of CC398 strains and CC strains related to other animals from amongst MRSA clinical isolates. Human exposure to livestock constitutes a risk factor for colonization with MRSA CC398 as well as for development of possible infections. The majority of infections caused by MRSA CC398 are linked to skin and soft tissue infections. Nonetheless, serious infections have been reported in Europe, Asia and the United States. The region of Osona (Barcelona) is an area which has traditionally had a large pig-breeding industry and consequently it is one of the areas with the highest pig-population densities. In order to evaluate the significance of MRSA CC398 in an area with a high density of pig farms, such as the region of Osona, three studies were carried out in different segments of the population. The first looked at pig farms, where a high prevalence of MRSA CC398 was observed in farmers (58%) and pigs (46%). Pig farmers who work on farms with more than 1,250 pigs were found to have a higher probability of being MRSA CC398 positive. Furthermore, the prevalence of MRSA CC398 in Catalonia, the region in Spain with the highest pig density, is described for the first time. The second study analyzed 4 years (2012-2015) during which the prevalence of MRSA- TetRR (especially that belonging to the clonal lineage CC398) in the area of Osona (Barcelona) was observed to be high in hospital patients and patients in contact with the health care services, accounting for more than 50% of the total of MRSA isolates. The increase in detection of MRSA-TetR and especially of CC398 in recent years suggests that it might become the MRSA community-associated clone in our area in the future. Additionally, the clinical characteristics of the patients identified as being MRSA-TetRR showed younger patients, with fewer comorbidities, fewer hospital stays, with community-acquired infections and, in 50% of cases, contact with pig farms. Serious MRSA ST398 infections with a mortality rate similar to that of MRSA-TetSS were detected. In the third study six nursing homes were analyzed and the prevalence of MRSA ST398 colonization in nursing homes in the Osona area (Barcelona, Spain) was found to account for 15.60% of the total of MRSA. Nursing homes are a well-known reservoir of MRSA and maybe also of MRSA ST398 in the area included in the study. MRSA CC398 is shown by these three studies to be a prevalent lineage in the area of Osona, with significant clinical implications. Consequently future investigations will, it seems, focus on the prevalence and the clinical implications of MRSA CC398 in other segments of the population which are at risk, such as pig slaughter-house workers and the population in general in the area of Osona

Estudi de prevalença de la colonització per Staphylococcus aureus resistent a meticil·lina en una població humana i en una porcina

Analitzar la prevalença del MRSA i MRSA ST398 en porcs i en treballadors de granges de porcs. Estudi transversal de prevalença, a la comarca d'Osona. Es van seleccionar 16 granges. Les mostres, s'han processat al laboratori de microbiologia per identificar el MRSA ST398. Van resultar positius per MRSA, 20(64,5%) treballadors. Anys treballats en granges per als positius son 15 anys(p 0'05). De 468 frotis nasals de porcs, van resultar positius per MARSA 7(1,49). La prevalença de MRSA es elevada a la comarca d'Osona. Es importat realitzar un frotis nasal a tots els treballadors de granges de porcs que ingressen a l'Hospital

Safety and Tolerability of More than Six Days of Tedizolid Treatment.

Tedizolid has demonstrated its efficacy and safety in clinical trials; however, data concerning its tolerability in long-term treatments are scarce. The aim of the study was to assess the indications and to describe the long-term safety profile of tedizolid. A multicentric retrospective study of patients who received tedizolid for more than 6 days was conducted. Adverse events (AEs) were identified from patients' medical records and laboratory data. The World Health Organization causality categories were used to discern AEs that were probably associated with tedizolid. Eighty-one patients, treated with tedizolid 200 mg once daily for a median (interquartile range [IQR]) duration of 28 (14 to 59) days, were included; 36 (44.4%) had previously received linezolid. The most common reasons for selecting tedizolid were to avoid linezolid potential toxicities or interactions (53.1%) or due to previous linezolid-related toxicities (27.2%). The most common indications were off-label, including prosthetic joint infections, osteomyelitis, and respiratory infections (77.8%). Overall, 9/81 patients (11.1%) experienced a probably associated AE. Two patients (2.5%) developed gastrointestinal disorders, 1 (1.2%) developed anemia, and 6 developed thrombocytopenia (7.4%) after a median (IQR) duration of treatment of 26.5 (17 to 58.5) days. Four (5%) patients discontinued tedizolid due to AEs. Among 23 patients with chronic renal failure (CRF), the rate of myelotoxicity was 17.4%, and only 8.7% had to stop tedizolid; 20 out of 22 with previous linezolid-associated toxicity had no AE. Long-term tedizolid treatments had good tolerance with rates of gastrointestinal AE and hematological toxicity lower than those reported with linezolid, particularly in patients with CRF and in those with a history of linezolid-associated toxicity

Pneumonia treated in the internal medicine department: Focus on healthcare-associated pneumonia

Patients with pneumonia treated in the internal medicine department (IMD) are often at risk of healthcare-associated pneumonia (HCAP). The importance of HCAP is controversial. We invited physicians from 72 IMDs to report on all patients with pneumonia hospitalized in their department during 2weeks (one each in January and June 2010) to compare HCAP with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). We analysed 1002 episodes of pneumonia: 58.9% were CAP, 30.6% were HCAP and 10.4% were HAP. A comparison between CAP, HCAP and HAP showed that HCAP patients were older (77, 83 and 80.5years; p<0.001), had poorer functional status (Barthel 100, 30 and 65; p<0.001) and had more risk factors for aspiration pneumonia (18, 50 and 34%; p<0.001). The frequency of testing to establish an aetiological diagnosis was lower among HCAP patients (87, 72 and 79; p<0.001), as was adherence to the therapeutic recommendations of guidelines (70, 23 and 56%; p<0.001). In-hospital mortality increased progressively between CAP, HCAP and HAP (8, 19 and 27%; p<0.001). Streptococcus pneumoniae was the main pathogen in CAP and HCAP. Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) caused 17 and 12.3% of HCAP. In patients with a confirmed aetiological diagnosis, the independent risk factors for pneumonia due do difficult-to-treat microorganisms (Enterobacteriaceae, P. aeruginosa or MRSA) were HCAP, chronic obstructive pulmonary diseases and higher Port Severity Index. Our data confirm the importance of maintaining high awareness of HCAP among patients treated in IMDs, because of the different aetiologies, therapy requirements and prognosis of this population. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases