29 research outputs found
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
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
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
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
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
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries