Epidemiología de los gérmenes multirresistentes.

RESUMEN: Los gérmenes multirresistentes constituyen en la actualidad una de las principales amenazas para la salud pública a nivel mundial. En los últimos años, se han producido cambios en la epidemiología de la resistencia a antimicrobianos. Este problema que antes quedaba circunscrito a los hospitales ha traspasado la barrera hospitalaria, se produce el tránsito de patógenos hospitalarios a centros sociosanitarios, lo que convierte a estos centros en reservorio de estos microorganismos; además ha aparecido alguna bacteria multirresistente, que se comporta como patógeno comunitario. Desde el año 2001 las políticas de vigilancia y control de este tipo de gérmenes se han incrementado, y eso ha hecho que en algunos casos como el estafilococo aureus resistente a la meticilina (SARM) la incidencia haya descendido.ABSTRACT: Multidrug-resistant pathogens have become one of the most important threats to public health worldwide. In recent years, there have been changes in the epidemiology of antimicrobial resistance. This problem wich was previously confined to hospitals, has crossed the hospital barriers. Transit of hospital pathogens occurs to nursing homes for the elderly, which makes these centers reservoir of these microorganisms. Some multidrug-resistant bacteria, as community pathogens, have also appeared. Since 2001, policies of surveillance and control of this type of germs have increased, and that has meant that in some cases such as Methicillinresistant staphylococcus aureus (MRSA), incidence has declined

Prevención y control de infecciones por microorganismos multirresistentes.

RESUMEN: La incidencia de infecciones causadas por microorganismos multirresistentes (MMR) y, en concreto, por enterobacterias productoras de carbapenemasas está aumentando en el mundo entero. Además, la diseminación está ocurriendo con mucha rapidez. Al empezar a escasear nuestras posibilidades terapéuticas, puesto que estas bacterias son resistentes a diferentes grupos de antibacterianos, las medidas para prevenir las infecciones antes de tener que tratarlas está teniendo un papel importante para frenar la evolución de esta situación. Se describen brevemente las principales medidas de prevención y control de MMR de probada Eficacia en el ámbito sanitario: higiene de manos, medidas de aislamiento de contacto, vigilancia activa de casos, formación del personal sanitario, limpieza ambiental “intensa” e intercambio de información entre centros asistenciales.ABSTRACT: The infection rates of multidrug-resistant organisms (MDRO), especially of carbapenemaseproducing Enterobacteriaceae, are increasing all around the world. Dissemination is occurring rapidly. Therapeutic options are becoming scarce because many of these bacteria are resistant to multiple antimicrobial groups. Prevention and control of MDRO transmission is getting more and more important to stop the evolution of this situation. The principal evidence based control interventions in healthcare settings will be described shortly in this article: hand hygiene, use of contact precautions, active surveillance cultures, staff education, enhanced environmental cleaning and sharing of information between health care organizations regarding patient MDRO-status

Comparative Study of Infliximab Versus Adalimumab in Refractory Uveitis Due to Behçet's Disease: National Multicenter Study of 177 Cases

Objective: To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as a first-line biologic drug over 1 year of treatment in a large series of patients with refractory uveitis due to Behçet's disease (BD). Methods: We conducted an open-label multicenter study of IFX versus ADA for BD-related uveitis refractory to conventional nonbiologic treatment. IFX or ADA was chosen as the first-line biologic agent based on physician and patient agreement. Patients received 3-5 mg/kg intravenous IFX at 0, 2, and 6 weeks and every 4-8 weeks thereafter, or 40 mg subcutaneous ADA every other week without a loading dose. Ocular parameters were compared between the 2 groups. Results: The study included 177 patients (316 affected eyes), of whom 103 received IFX and 74 received ADA. There were no significant baseline differences between treatment groups in main demographic features, previous therapy, or ocular sign severity. After 1 year of therapy, we observed an improvement in all ocular parameters in both groups. However, patients receiving ADA had significantly better outcomes in some parameters, including improvement in anterior chamber inflammation (92.31% versus 78.18% for IFX; P = 0.06), improvement in vitritis (93.33% versus 78.95% for IFX; P = 0.04), and best-corrected visual acuity (mean ± SD 0.81 ± 0.26 versus 0.67 ± 0.34 for IFX; P = 0.001). A nonsignificant difference was seen for macular thickness (mean ± SD 250.62 ± 36.85 for ADA versus 264.89 ± 59.74 for IFX; P = 0.15), and improvement in retinal vasculitis was similar between the 2 groups (95% for ADA versus 97% for IFX; P = 0.28). The drug retention rate was higher in the ADA group (95.24% versus 84.95% for IFX; P = 0.042). Conclusion: Although both IFX and ADA are efficacious in refractory BD-related uveitis, ADA appears to be associated with better outcomes than IFX after 1 year of follow-up

Pigmentation phototype and prostate and breast cancer in a select Spanish population-A Mendelian randomization analysis in the MCC-Spain study

INTRODUCTION: Phototype has been associated with an increased risk of prostate cancer, and it is yet unknown if it is related to other hormone-dependent cancers, such as breast cancer or whether this association could be considered causal. METHODS: We examined the association between the phototype and breast and prostate cancers using a Mendelian randomization analysis. We studied 1,738 incident cases of breast cancer and another 817 cases of prostate cancer. To perform a Mendelian randomization analysis on the phototype-cancer relationship, a genetic pigmentation score was required that met the following criteria: (1) the genetic pigmentation score was associated with phototype in controls; (2) the genetic pigmentation score was not associated with confounders in the relationship between phototype and cancer, and (3) the genetic pigmentation score was associated with cancer only through its association with phototype. Once this genetic score is available, the association between genetic pigmentation score and cancer can be identified as the association between phototype and cancer. RESULTS: The association between the genetic pigmentation score and phototype in controls showed that a higher genetic pigmentation score was associated with fair skin, blond hair, blue eyes and the presence of freckles. Applying the Mendelian randomization analysis, we verified that there was no association between the genetic pigmentation score and cancers of the breast and prostate. CONCLUSIONS: Phototype is not associated with breast or prostate cancer