Publications by authors named "Montserrat Gimenez"

21 Publications

  • Page 1 of 1

Intervention to reduce the incidence of surgical site infection in spine surgery.

Am J Infect Control 2020 05 7;48(5):550-554. Epub 2019 Nov 7.

Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain; Preventive Medicine Department, Germans Trias i Pujol University Hospital, Badalona, Spain.

Background: This study examines the incidence, characteristics, and risk factors of surgical site infections (SSIs) after spine surgery and evaluates the efficacy of a preventive intervention.

Methods: This was a quasi-experimental pretest/posttest study in patients undergoing spinal surgery in an orthopedic surgery department from December 2014 to November 2016. Based on the results of the study, we revised the preventive protocol with modification of wound dressing, staff training, and feedback. SSI rates were compared between the pre-intervention (December 2014 to November 2015) and post-intervention (December 2015 to November 2016) periods. The risk factors were analyzed using univariate and multivariate analyses.

Results: Of the 139 patients included, 14 cases of SSI were diagnosed, with a significant decrease in the incidence of SSIs from the pre-intervention period to the post-intervention period (19.4% vs 2.6%; P = .001). The etiology was known in 13 cases, with enteric flora being predominant in the pre-intervention group. Univariate analysis showed that age, body mass index, days until sitting and ambulation, and incontinence were statistically significant risk factors. After multivariate analysis, only body mass index and days until ambulation remained significant. When the effect of intervention was adjusted with other risk factors, this variable remained statistically significant.

Conclusions: An intervention that includes modification of wound dressing and early mobilization, as well as staff awareness training, monitoring, and feedback, allowed a significant reduction in the incidence of SSI following spinal surgery, particularly infections caused by enteric flora.
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http://dx.doi.org/10.1016/j.ajic.2019.09.007DOI Listing
May 2020

Molecular diagnosis of bloodstream infections in onco-haematology patients with PCR/ESI-MS technology.

J Infect 2017 02 23;74(2):187-194. Epub 2016 Nov 23.

Microbiology Service, Germans Trias i Pujol University Hospital, Department of Genetics and Microbiology, Autonomous University of Barcelona, Badalona, Spain; CIBER in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.

Objectives: Onco-haematological patients are prone to develop infections, and antibiotic prophylaxis may lead to negative blood cultures. Thus, the microbiological diagnosis and subsequent administration of a targeted antimicrobial therapy is often difficult. The goal of this study was to evaluate the usefulness of IRIDICA (PCR/ESI-MS technology) for the molecular diagnosis of bloodstream infections in this patient group.

Methods: A total of 463 whole blood specimens from different sepsis episodes in 429 patients were analysed using the PCR/ESI-MS platform, comparing the results with those of blood culture and other clinically relevant information.

Results: The sensitivity of PCR/ESI-MS by specimen (excluding polymicrobial infections, n = 25) in comparison with blood culture was 64.3% overall, 69.0% in oncological patients, and 59.3% in haematological patients. When comparing with a clinical infection criterion, overall sensitivity rose to 74.7%, being higher in oncological patients (80.0%) than in haematological patients (67.7%). Thirty-one microorganisms isolated by culture were not detected by IRIDICA, whereas 42 clinically relevant pathogens not isolated by culture were detected moleculary.

Conclusions: PCR/ESI-MS offers a reliable identification of pathogens directly from whole blood. While additional studies are needed to confirm our findings, the system showed a lower sensitivity in onco-haematological patients in comparison with previously reported results in patients from the Intensive Care Unit.
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http://dx.doi.org/10.1016/j.jinf.2016.11.011DOI Listing
February 2017

[Blood cultures in the emergency department: Do we need a new approach?].

Med Clin (Barc) 2016 May 6;146(10):455-9. Epub 2016 Jan 6.

Servicio de Microbiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España; Centros de Investigación Biomédica en Red (CIBER), Instituto de Salud Carlos III, Madrid, España.

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http://dx.doi.org/10.1016/j.medcli.2015.11.026DOI Listing
May 2016

Evaluation of the Broad-Range PCR/ESI-MS Technology in Blood Specimens for the Molecular Diagnosis of Bloodstream Infections.

PLoS One 2015 16;10(10):e0140865. Epub 2015 Oct 16.

Microbiology Service, Germans Trias i Pujol University Hospital, Department of Genetics and Microbiology, Autonomous University of Barcelona, Badalona, Spain; CIBER in Respiratory Diseases (CIBERES), Madrid, Spain; Health Sciences Research Institute (IGTP), Badalona, Spain.

Background: Rapid identification of the etiological agent in bloodstream infections is of vital importance for the early administration of the most appropriate antibiotic therapy. Molecular methods may offer an advantage to current culture-based microbiological diagnosis. The goal of this study was to evaluate the performance of IRIDICA, a platform based on universal genetic amplification followed by mass spectrometry (PCR/ESI-MS) for the molecular diagnosis of sepsis-related pathogens directly from the patient's blood.

Methods: A total of 410 whole blood specimens from patients admitted to Emergency Room (ER) and Intensive Care Unit (ICU) with clinical suspicion of sepsis were tested with the IRIDICA BAC BSI Assay (broad identification of bacteria and Candida spp.). Microorganisms grown in culture and detected by IRIDICA were compared considering blood culture as gold standard. When discrepancies were found, clinical records and results from other cultures were taken into consideration (clinical infection criterion).

Results: The overall positive and negative agreement of IRIDICA with blood culture in the analysis by specimen was 74.8% and 78.6%, respectively, rising to 76.9% and 87.2% respectively, when compared with the clinical infection criterion. Interestingly, IRIDICA detected 41 clinically significant microorganisms missed by culture, most of them from patients under antimicrobial treatment. Of special interest were the detections of one Mycoplasma hominis and two Mycobacterium simiae in immunocompromised patients. When ICU patients were analyzed separately, sensitivity, specificity, positive and negative predictive values compared with blood culture were 83.3%, 78.6%, 33.9% and 97.3% respectively, and 90.5%, 87.2%, 64.4% and 97.3% respectively, in comparison with the clinical infection criterion.

Conclusions: IRIDICA is a promising technology that offers an early and reliable identification of a wide variety of pathogens directly from the patient's blood within 6h, which brings the opportunity to improve management of septic patients, especially for those critically ill admitted to the ICU.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140865PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608784PMC
June 2016

Septic arthritis due to methylcyllin-resistant Staphylococcus aureus in adults.

Reumatol Clin 2015 Nov-Dec;11(6):381-6. Epub 2015 Mar 4.

Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.

Introduction: Septic arthritis due to methylcyllin resistant Staphylococcus aureus (MRSA) is a serious infection that has increased in incidence in the past 10years.

Methods: We conducted a retrospective study (1984-2011) in which a description of the clinical and epidemiological characteristics of MRSA arthritis in adults was performed and then compared to native joint infections caused by MRSA vs. methylcyllin sensitive Staphylococcus aureus (MSSA).

Results: Fourteen MRSA infections were included (7 native joint, 5 prosthetic and 2 bursae). No case was polyarticular. There was significant comorbidity, although none was associated to rheumatoid arthritis. Seven patients had bacteremia. Four required surgical treatment. Six died. When comparing the 7 patients with native joint MRSA infection with the 17 cases caused by MSSA, no significant differences in risk factors were seen, except more malignancies in the MRSA group. The infection was polyarticular in 7 cases (41%) of the MSSA group. Bacteremia was more frequent in the MRSA group (71.4 vs 58.8%). Empirical antibiotic was useful in 28.6% of MRSA cases versus 100% of MSSA cases. There was a greater tendency to associated mortality in MRSA arthritis (57.1% vs 17.6%, P=.07).

Conclusions: MRSA septic arthritis is a serious condition that occurs in the elderly and patients with high comorbidity. It is usually monoarticular, with positive blood cultures and higher mortality than MSSA arthritis. In patients at risk, vancomycin empiric antibiotic therapy is indicated.
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http://dx.doi.org/10.1016/j.reuma.2014.12.009DOI Listing
January 2017

[Group B streptococcal early-onset neonatal sepsis in the area of Barcelona (2004-2010). Analysis of missed opportunities for prevention].

Enferm Infecc Microbiol Clin 2015 Aug-Sep;33(7):446-50. Epub 2014 Dec 23.

Servicio de Microbiología, Hospital Clínic, Barcelona, España.

Objectives: To study the evolution of the incidence of early-onset neonatal sepsis (EOS) by Streptococcus agalactiae in the area of Barcelona and to analyze failure of compliance with the prevention protocol.

Methods: A retrospective review was carried out on EOS cases in 8 Health-Care Centers in the Barcelona area between 2004 and 2010.

Results: Forty-nine newborns from 48 mothers were diagnosed with EOS. The incidence was 0.29‰ living newborns (0.18-0.47‰), with no significant differences in the fluctuations along the 7 years. The mortality rate was 8.16%. In 68.5% cases the maternal colonization studies were negative, and in 21% these studies were not performed. No risk factors were detected in 58.3% of pregnant women, and 22.9% of births were premature. In 58% of cases intra-partum antibiotic prophylaxis was not administered because it was not indicated, and in 42% due to failure to follow the protocol (3 strains were resistant to erythromycin). Resistance to clindamycin was 33.3%. The Streptococcus agalactiae serotypes more frequently isolated were iii, v, and ia.

Conclusions: No significant changes were detected in the incidence of Streptococcus agalactiae EOS in the 7 years of the study. The increased sensitivity of screening methods with the use of molecular techniques, the performance of susceptibility testing of strains isolated from pregnant women, and the improvement of communication between Health-Care Centers, can contribute to a better implementation of the protocol, as well as to reduce the incidence of EOS.
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http://dx.doi.org/10.1016/j.eimc.2014.10.015DOI Listing
March 2017

Improving the diagnosis of bloodstream infections: PCR coupled with mass spectrometry.

Biomed Res Int 2014 9;2014:501214. Epub 2014 Apr 9.

Servei de Microbiologia, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain ; CIBER Epidemiología y Salud Pública (CIBERESP), 08036 Barcelona, Spain.

The reference method for the diagnosis of bloodstream infections is blood culture followed by biochemical identification and antibiotic susceptibility testing of the isolated pathogen. This process requires 48 to 72 hours. The rapid administration of the most appropriate antimicrobial treatment is crucial for the survival of septic patients; therefore, a rapid method that enables diagnosis directly from analysis of a blood sample without culture is needed. A recently developed platform that couples broad-range PCR amplification of pathogen DNA with electrospray ionization mass spectrometry (PCR/ESI-MS) has the ability to identify virtually any microorganism from direct clinical specimens. To date, two clinical evaluations of the PCR/ESI-MS technology for the diagnosis of bloodstream infections from whole blood have been published. Here we discuss them and describe recent improvements that result in an enhanced sensitivity. Other commercially available assays for the molecular diagnosis of bloodstream infections from whole blood are also reviewed. The use of highly sensitive molecular diagnostic methods in combination with conventional procedures could substantially improve the management of septic patients.
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http://dx.doi.org/10.1155/2014/501214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000954PMC
December 2014

['Third day intervention': an analysis of the factors associated with following the recommendations on the prescribing of antibiotics].

Enferm Infecc Microbiol Clin 2014 Dec 9;32(10):654-61. Epub 2014 May 9.

Servicio de Enfermedades Infecciosas, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, España.

Introduction: Stewardship programs on the use of antibiotics usually include interventions based on non-compulsory recommendations for the prescribers. Factors related to the adherence to expert recommendations, and the implementation of these programmes in daily practice, are of interest.

Methods: A randomized, controlled, multicentre intervention study was performed in 32 hospitalization units. Antibiotic prescriptions were evaluated by an infectious disease specialist on the third day. We describe the implementation of the intervention, the factors associated with adherence to recommendations, and the impact of the intervention.

Results: A total of 3,192 interventions were carried out. Information sources used to prepare the recommendations varied significantly between centres. A modification was recommended in 65% of cases: withdrawal (47%), change in administration route (26%), change of drugs or number of antibiotics (27%), and change in dose (5%). Simplification of treatment accounted for 75% of all recommendations. Adherence was 68%, with significant differences between hospitals, and higher when the recommendations consisted of a dose adjustment or change of route, during the first intervention period, and also when recommendations were personally commented on, in addition to writing a note in the clinical chart. We did not find any reduction in antibiotic consumption or variation in the incidence of resistant pathogens.

Conclusions: An important proportion of antibiotic prescriptions may be susceptible to improvement, most of them towards simplification. The adherence to the intervention was high, but significant variations at different centres were observed, depending on the type of recommendation, and the study period. Those recommendations that were personally commented on were more followed more than those only written.
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http://dx.doi.org/10.1016/j.eimc.2013.09.021DOI Listing
December 2014

Serotype 5 pneumococci causing invasive pneumococcal disease outbreaks in Barcelona, Spain (1997 to 2011).

J Clin Microbiol 2013 Nov 21;51(11):3585-90. Epub 2013 Aug 21.

Microbiology Department.

In this study, we analyzed the clinical and molecular epidemiology of invasive serotype 5 (Ser5) pneumococcal isolates in four teaching hospitals in the Barcelona, Spain, area (from 1997 to 2011). Among 5,093 invasive pneumococcal isolates collected, 134 (2.6%) Ser5 isolates were detected. Although the overall incidence of Ser5-related invasive pneumococcal disease (IPD) was low (0.25 cases/100,000 inhabitants), three incidence peaks were detected: 0.63/100,000 in 1999, 1.15/100,000 in 2005, and 0.37/100,000 in 2009. The rates of Ser5 IPD were higher among young adults (18 to 64 years old) and older adults (>64 years old) in the first two peaks, whereas they were higher among children in 2009. The majority (88.8%) of the patients presented with pneumonia. Comorbid conditions were present in young adults (47.6%) and older adults (78.7%), the most common comorbid conditions being chronic obstructive pulmonary disease (20.6% and 38.3%, respectively) and cardiovascular diseases (11.1% and 38.3%, respectively). The mortality rates were higher among older adults (8.5%). All Ser5 pneumococci tested were fully susceptible to penicillin, cefotaxime, erythromycin, and ciprofloxacin. The resistance rates were 48.5% for co-trimoxazole, 6.7% for chloramphenicol, and 6% for tetracycline. Two major related sequence types (STs), ST1223 (n = 65) and ST289 (n = 61), were detected. The Colombia(5)-ST289 clone was responsible for all the cases in the Ser5 outbreak in 1999, whereas the ST1223 clone accounted for 73.8% and 61.5% of the isolates in 2005 and 2009, respectively. Ser5 pneumococci are a frequent cause of IPD outbreaks in the community and involve children and adults with or without comorbidities. The implementation of the new pneumococcal conjugated vaccines (PCV10 and PCV13) might prevent such outbreaks.
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http://dx.doi.org/10.1128/JCM.01538-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3889737PMC
November 2013

Rapid diagnosis of bloodstream infections with PCR followed by mass spectrometry.

PLoS One 2013 23;8(4):e62108. Epub 2013 Apr 23.

Microbiology Department, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.

Achieving a rapid microbiological diagnosis is crucial for decreasing morbidity and mortality of patients with a bloodstream infection, as it leads to the administration of an appropriate empiric antimicrobial therapy. Molecular methods may offer a rapid alternative to conventional microbiological diagnosis involving blood culture. In this study, the performance of a new technology that uses broad-spectrum PCR coupled with mass spectrometry (PCR/ESI-MS) was evaluated for the detection of microorganisms directly from whole blood. A total of 247 whole blood samples and paired blood cultures were prospectively obtained from 175 patients with a suspicion of sepsis. Both sample types were analyzed using the PCR/ESI-MS technology, and the results were compared with those obtained by conventional identification methods. The overall agreement between conventional methods and PCR/ESI-MS performed in blood culture aliquots was 94.2% with 96.8% sensitivity and 98.5% specificity for the molecular method. When comparing conventional methods with PCR/ESI-MS performed in whole blood specimens, the overall agreement was 77.1% with 50% sensitivity and 93.8% specificity for the molecular method. Interestingly, the PCR/ESI-MS technology led to the additional identification of 13 pathogens that were not found by conventional methods. Using the PCR/ESI-MS technology the microbiological diagnosis of bloodstream infections could be anticipated in about half of the patients in our setting, including a small but significant proportion of patients newly diagnosed. Thus, this promising technology could be very useful for the rapid diagnosis of sepsis in combination with traditional methods.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0062108PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633912PMC
November 2013

Epidemiology of invasive pneumococcal disease in older people in Spain (2007-2009): implications for future vaccination strategies.

PLoS One 2012 22;7(8):e43619. Epub 2012 Aug 22.

Department of Microbiology, Hospital Universitari de Bellvitge-University of Barcelona-IDIBELL, Barcelona, Spain.

Background: Recently, the 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended for adults. We analyzed the epidemiology of invasive pneumococcal disease (IPD) in older adults in Spain before PCV13 introduction.

Methodology/principal Findings: IPD episodes, defined as clinical findings together with an invasive pneumococcal isolate, were prospectively collected from patients aged over 65 years in three hospitals in Spain from 2007 to 2009. A total of 335 IPD episodes were collected. Pneumonia was the main clinical syndrome, while chronic obstructive pulmonary disease, diabetes mellitus and cancer were the main underlying diseases. Pneumococcal isolates were serotyped and the molecular typing was performed by PFGE/MLST. PCV13 serotypes accounted for 59.3% of isolates, the most prevalent being serotypes 19A (15.1%), 3 (9.6%), 7F (7.5%), 14 (6.9%) and 1 (5.4%). The most frequent non-PCV13 serotypes were serotypes 16F (4.5%), 22F (3.6%), 24F (3.3%) and 6C (2.1%). The most common genotypes were CC230 (8.5%, serotypes 19A and 24F), CC156 (8.2%, serotypes 9V and 14), ST191 (7.9%, serotype 7F), CC260 (6.6%, serotype 3), ST306 (5.2%, serotype 1), CC30 (4.6%, serotype 16F) and ST433 (3.6%, serotype 22F). Comparing the 335 IPD isolates to 174 invasive pneumococci collected at the same hospitals in 1999-2000, PCV7 serotypes decreased (45.4% vs 18.4%,p<0.001), non-PCV7 serotypes included in PCV13 increased (26.4% vs 41.0%,p = 0.001) and two non-PCV13 serotypes increased (serotype 6C 0% vs 2.1%, p = 0.05; serotype 24F 0.6% vs 3.3%, p = 0.04,).

Conclusion: In our older adult population two serotypes (19A and 3) included in PCV13 accounted for about a quarter of IPD episodes in people ≥65 years. Non-PCV13 emerging serotypes should be carefully monitored in future surveillance studies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0043619PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425535PMC
January 2013

Increase in invasive nonvaccine pneumococcal serotypes at two hospitals in Barcelona: was replacement disease to blame?

Acta Paediatr 2011 Dec 17;100(12):1572-5. Epub 2011 Jun 17.

Department of Paediatrics, Fundación Hospital de Manacor, Majorca, Spain.

Aim: To describe an increase in the incidence of invasive pneumococcal disease (IPD) caused by serotypes not contained in the heptavalent pneumococcal conjugate vaccine (PCV7) in children in two hospitals in Barcelona with different vaccine uptake.

Methods: Cumulative incidences of IPD, vaccine and nonvaccine serotypes (NVSTs), and main clinical presentations before (1998-2001) and after vaccine introduction (2005-2008) were compared.

Results: The incidence of IPD in children aged <2 years at Hospital Germans Trias i Pujol covering a population in which PCV7 was not widely used showed a nonsignificant increase from 29.9 to 58.8 per 100,000 child-years between both periods. Following vaccine introduction, there was a 2.5-fold increase in IPD caused by NVSTs in children aged <5 years. Analysis of trends in the almost fully vaccinated population of Hospital de Barcelona revealed a nonsignificant reduction in IPD incidence in children aged <2 years from 63.1 to 26.0 per 100,000 child-years. NVSTs in children aged <5 years showed a nonsignificant 1.7-fold increase in the vaccine period at this centre.

Conclusions: The paradoxical increase in invasive infections caused by NVSTs in these populations with different vaccine use suggests that these changes were not driven only by PCV7.
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http://dx.doi.org/10.1111/j.1651-2227.2011.02365.xDOI Listing
December 2011

[Prediction of bacteremia in patients with suspicion of infection in emergency room].

Med Clin (Barc) 2010 Nov 16;135(15):685-90. Epub 2010 Jun 16.

Unidad de Corta Estancia-Urgencias, Hospital Universitari Germans Trias i Pujol, Universitat Autonònoma de Barcelona, Badalona, Barcelona, España.

Background And Objectives: To evaluate the relationship between some clinical and analytical data and the presence of bacteremia in order to establish a clinical decision rule.

Patients And Methods: All the patients with blood cultures obtained from the emergency room in a two months period were analyzed. Patients were randomly assigned to derivation or validation sets. A logistic regression of the significant values in the univariate analysis was performed and a score obtained. The prevalence of bacteraemia for every score was calculated. The diagnostic efficacy curves and the performance of the predictive model were calculated.

Results: 412 patients were enrolled. The blood cultures were positive in 12.8% of them. The significant values in the univariate analysis were Charlson index ≥2 and PCT > 0.4ng/ml. Four groups of increasing risk of bacteraemia were designed, from 0 to 35% in the derivation set and from 2.9% to 27.2% in the validation set. In the diagnostic efficacy curve, the AUC was 0.8 in the derivation set and 0.74 in the validation set. The model presented a negative predictive value of 95.2% in the derivation set and 95.3% in the validation set.

Conclusions: A model that includes Charlson index and PCT makes possible to define a group of patients with a very low risk of bacteremia.
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http://dx.doi.org/10.1016/j.medcli.2010.04.009DOI Listing
November 2010

[Streptococcus agalactiae induced post-splenectomy fulminating infection].

Cir Esp 2008 Dec;84(6):341-2

Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain.

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http://dx.doi.org/10.1016/s0009-739x(08)75049-8DOI Listing
December 2008

[Mansonella perstans isolated on aspiration puncture of a salivary gland].

Acta Otorrinolaringol Esp 2008 Mar;59(3):145-7

Unidad de Enfermedades Infecciosas, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.

Chronic parasitosis due to nematode worms (filariae) in tissue are very common in tropical ecosystems; their larvae (microfilariae) have been isolated in lymph vessels, skin, and blood. The case reported here is of a Nigerian patient suffering severe renal failure and admitted owing to the presence of a right submandibular gland abscess. In the FNAP, the presence of a Mansonella perstans microfilaria was identified. Post-surgery examination of pathology samples from the gland reported an acute inflammatory infiltrate including abundant eosinophils and microfilariae. There are some reports in the literature of haematic or lymphatic microfilariae, especially in epithelial or glandular tissues, and, as in this case, in inflammatory or malignant conditions. Both ivermectin and mebendazol are used for treatment; the scant pathogenicity of the genus Mansonella should, however, lead to an individualized decision.
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http://dx.doi.org/10.1016/s0001-6519(08)73283-7DOI Listing
March 2008

[Bacteremia in outpatients: a 10-year period follow-up].

Med Clin (Barc) 2007 Dec;129(20):770-2

Unidad de Corta Estancia-Servicio de Urgencias, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.

Background And Objective: To know the incidence of bacteremia in outpatients (BO), their clinical and epidemiological characteristics and evolution.

Patients And Method: We have analyzed the percentage of positive blood cultures and BO in a 10 year period. We have collected year, month, age, gender, first diagnosis, risk factors for bacteremia, microrganism, final diagnosis and diagnosis concordance. The bacteremia was classified by origin in: urinary tract infection, respiratory, abdominal, venous catheter (IVC), skin, endocarditis, bacteremia without an apparent focus (BWAF) and miscellaneous. We have compared the characteristics of the patients with and without diagnosis concordance.

Results: We have collected 283 episodes. The percentage of positive blood culture remained wi-thout changes and the percentage of BO tended to decrease. The most prevalent bacteria was Escherichia coli (56.5%) and the most frequent origin was urinary (59.7%) and BWAF (19.7%). There was no concordance between diagnoses in 37.1%. 30.3% of patients were admitted. Urinary tract infection was detected in 93.5% of the cases, IVC in 6.2% and BWAF in 0%. With regard to the risk factors of bacteremia, human immunodeficiency infection tended to decrease and neoplasm to increase during the study period.

Conclusions: In our experience, BO tends to decrease. The management of urinary infection seems adequate, and IVC could be improved. The main challenge is the cases of BWAF.
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http://dx.doi.org/10.1157/13113767DOI Listing
December 2007

Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, barcelona, Spain, from 2002 to 2003.

J Clin Microbiol 2005 Apr;43(4):1829-35

Infectious Diseases Division, Hospital Universitari Vall d'Hebron, Avda. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.

We conducted population-based surveillance for Candida bloodstream infections in Spain to determine its incidence, the extent of antifungal resistance, and risk factors for mortality. A case was defined as the first positive blood culture for any Candida spp. in a resident of Barcelona, from 1 January 2002 to 31 December 2003. We defined early mortality as occurring between days 3 to 7 after candidemia and late mortality as occurring between days 8 to 30. We detected 345 cases of candidemia, for an average annual incidence of 4.3 cases/100,000 population, 0.53 cases/1,000 hospital discharges, and 0.73 cases/10,000 patient-days. Outpatients comprised 11% of the cases, and 89% had a central venous catheter (CVC) at diagnosis. Overall mortality was 44%. Candida albicans was the most frequent species (51% of cases), followed by Candida parapsilosis (23%), Candida tropicalis (10%), Candida glabrata (8%), Candida krusei (4%), and other species (3%). Twenty-four isolates (7%) had decreased susceptibility to fluconazole (MIC > or = 16 microg/ml). On multivariable analysis, early death was independently associated with hematological malignancy (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1 to 10.4). Treatment with antifungals (OR, 0.05; 95% CI, 0.01 to 0.2) and removal of CVCs (OR, 0.3; 95% CI, 0.1 to 0.9) were protective factors for early death. Receiving adequate treatment, defined as having CVCs removed and administration of an antifungal medication (OR, 0.2; 95% CI, 0.08 to 0.8), was associated with lower odds of late mortality; intubation (OR, 7.5; 95% CI, 2.6 to 21.1) was associated with higher odds. The incidence of candidemia and prevalence of fluconazole resistance are similar to other European countries, indicating that routine antifungal susceptibility testing is not warranted. Antifungal medication and catheter removal are critical in preventing mortality.
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http://dx.doi.org/10.1128/JCM.43.4.1829-1835.2005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1081396PMC
April 2005

In vitro susceptibilities of bloodstream isolates of Candida species to six antifungal agents: results from a population-based active surveillance programme, Barcelona, Spain, 2002-2003.

J Antimicrob Chemother 2005 Feb 23;55(2):194-9. Epub 2004 Dec 23.

Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid.

Objectives: The antifungal drug susceptibilities of 351 isolates of Candida species, obtained through active laboratory-based surveillance in the period January 2002-December 2003, were determined (Candida albicans 51%, Candida parapsilosis 23%, Candida tropicalis 10%, Candida glabrata 9%, Candida krusei 4%).

Methods: The MICs of amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole and caspofungin were established by means of the broth microdilution reference procedure of the European Committee on Antibiotic Susceptibility Testing.

Results And Conclusions: Amphotericin B and flucytosine were active in vitro against all strains. A total of 24 isolates (6.8%) showed decreased susceptibility to fluconazole (MIC > or = 16 mg/L) and 43 (12.3%) showed decreased susceptibility to itraconazole (MIC > or = 0.25 mg/L). Voriconazole and caspofungin were active in vitro against the majority of isolates, even those that were resistant to fluconazole.
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http://dx.doi.org/10.1093/jac/dkh548DOI Listing
February 2005

[Indications and diagnosis efficiency of lumbar puncture in emergencies].

Med Clin (Barc) 2002 Jan;118(1):10-2

Unidad de Urgencias, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.

Background: To know the frequency, indications and diagnosis efficiency of lumbar puncture (LP) in the Emergency Department (ED) when suspecting a central nervous system (CNS) infection.

Patients And Method: We analyzed all the LP performed over a 2-year period in the ED. We compared the clinical characteristics of patients with and without CNS infection. We also reviewed all the cases of CNS infection diagnosed in the hospital in the same period.

Results: A LP was performed in 0.4% of emergencies. In 76% of cases, it was performed because of CNS infection suspicion, which was confirmed in 30% of cases. Fever, headache, nuchal rigidity and chronical otitis were all clinical variables associated with CNS infection. An 80% of CNS infections that were not diagnosed in the ED corresponded to HIV-infected patients.

Conclusions: Lumbar puncture is frequently performed in the ED, mostly for suspicion of CNS infection, which is eventually confirmed in one third of cases. CNS infection cases which have not been suspected in the ED usually correspond to a subacute meningitis in a HIV-infected patient.
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January 2002