SARS-CoV-2 screening of asymptomatic women admitted for delivery must be performed with a combination of microbiological techniques: an observational study
MARIA CARMEN VIÑUELA, JUAN ANTONIO DE LEÓN-LUIS, ROBERTO ALONSO, PILAR CATALÁN, SANTIAGO LIZARRAGA, PATRICIA MUÑOZ, EMILIO BOUZA, ON BEHALF OF THE GREGORIO MARAÑÓN OBSTETRICS AND GYNECOLOGY AND MICROBIOLOGY-ID COVID 19 STUDY GROUP
Introduction. The aim of this study is to assess the value of systematic screening in asymptomatic women admitted for spontaneous delivery with a combination of reverse transcription polymerase chain reaction (RT-PCR) and cycle threshold (Ct) and serum antibodies. Material and methods. Since May 6 all women admitted for spontaneous delivery underwent RT-PCR in nasopharyngeal swabs and specific antibodies IgG of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in serum that were performed as part of routine clinical care in our institution. Ct of the PCR was recorded. We analyzed the first 100 women consecutively admitted for spontaneous delivery at our institution. Results. Nine women were positive for SARS-CoV-2 in nasopharyngeal samples (9%) and 13 (13%) presented positive specific antibodies of the coronavirus. Overall, SARS-CoV-2 prior exposure was 15%. The Ct determination (RT-PCR test)
of our 9 positive patients ranged from 36 to 41 cycles with a median of 40. Vaginal delivery occurred in 94% of the cases and only 6% underwent a cesarean section, always for obstetric reasons. No fetal transmission was observed and maternal and neonatal prognosis was excellent. Conclusions. During epidemic episodes in asymptomatic women in labor, universal testing with RT-PCR (considering Ct determination), and the detection of antibodies, permits a better interpretation of the results and avoid unnecessary isolation procedures.
Evolution of treatment of syphilis through history
CRISTINA ROS-VIVANCOS, MARÍA GONZÁLEZ-HERNÁNDEZ, JUAN FRANCISCO NAVARRO-GRACIA, JOSÉ SÁNCHEZ-PAYÁ, ANTONIO GONZÁLEZ-TORGA, JOAQUÍN PORTILLA-SOGORB
In this article, we present a historical revision of syphilis treatment since the end of the XV century up until the current days. For centuries, it was understood that syphilis had been brought to Spain by Columbus after coming back from America. It became an epidemic soon after. Later on, it was spread all over Europe. The chronologic and geographic origin of this illness have been debated in recent years, however, there has been no agreement about it as yet. Mercury was the main used therapy for four and a half centuries, until the discovery of penicillin in 1943. This discovery changed the therapeutic approach to syphilis since then. Other remedies were used during this period. Guaiacum was one of them, but it was dismissed in the mid-sixteenth century. Iodides were also used, especially in the tertiary symptoms of the disease. The discovery of arsphenamine (Salvarsan) at the beginning of the XX century, used by itself at its onset and associated to mercury or bismuth later on, was a significant therapeutic contribution. Bismuth was in itself a great therapeutic asset. It displaced the use of mercury in an important way until 1943, when the appearance of penicillin became the treatment of choice.
Interleukin (IL) -1 β, IL-6 and tumor necrosis factor in patients with seasonal flu
JOSÉ M. RAMOS, MAR GARCÍA-NAVARRO, VICTORIA MORENO, PILAR GONZÁLEZ-DE-LA-ALEJA, ADELINA GIMENO-GASCÓN, ESPERANZA MERINO, JOAQUÍN PORTILLA
Introduction. The role of tumor necrosis factor (TNF), interleukin (IL)-1β and IL-6 in the pathogenicity of seasonal flu is unknown. Methods. We analyzed the profiles of these cytokines in 77 flu patients and 17 controls with non-flu respiratory infection, using molecular biology techniques (real-time polymerase chain reaction). Results. Flu patients had lower monocyte counts (p=0.029) and a slightly lower median level of IL-6 (P=0.05) than the control group. Twenty-four flu patients (31.2%) had pneumonia; this group had higher C-reactive proteins (p=0.01) and monocyte levels (p=0.009). Pro-inflammatory cytokines levels did not rise in patients with pneumonia complicating seasonal influenza Conclusion. IL-6 levels were lower in adults with influenza.
Utilisation of first-line antibiotics six years after a multifaceted intervention
JOSÉ M. MOLERO, MANUEL GÓMEZ, GLORIA GUERRA, JUAN DE DIOS ALCÁNTARA, JESÚS ORTEGA, GUILLERMO GARCÍA, VICENTA PINEDA, SUSANA MUNUERA, MARINA CID, M. JOSÉ MONEDERO, JOANA M. RIBAS, JOSEP M. COTS, ANA MORAGAS, LARS BJERRUM, CARLES LLOR, GRUPO DE TRABAJO HAPPY AUDIT 3
Introduction. No study has evaluated the impact of a multifaceted intervention on the quality of the antibiotics prescribed more than 5 years later. Material and methods. A total of 210 general practitioners (GP) from eight different regions of Spain were asked to participate in two registrations of respiratory tract infections (RTI) in 2008, before, and in 2009, just after a multifaceted intervention including prescriber feedback, clinical guidelines, training sessions focused on appropriate antibiotic prescribing, workshop on rapid tests and provision of these tests in the GP consultation. They were all again invited to participate in a similar registration in 2015. A new group of clinicians from the same areas who had never participated in antimicrobial stewardship courses were also invited to participate and acted as controls. Results. The 121 GPs who continued the study (57.6%) and the 117 control GPs registered 22,407 RTIs. The antibiotic most commonly prescribed was amoxicillin and clavulanic acid, prescribed in 1,801 cases (8.1% of the total), followed by amoxicillin (1,372 prescriptions, 6.2%), being lower among GPs just after the intervention. The third leading antibiotic among GPs just after the intervention was penicillin V (127 cases, 3.3%) whereas macrolides ranked third in the other three groups of GPs. Conclusions. The use of first-line antibiotic for RTIs wanes over time after an intervention, but their utilisation is still significantly greater among intervened clinicians six years later compared to GPs who have never been exposed to any antimicrobial stewardship programmes.
Description of Influenza B in seasonal epidemics in Spain
RAÚL ORTIZ DE LEJARAZU, JAVIER DÍEZ DOMINGO, ÁNGEL GIL DE MIGUEL, FEDERICO MARTINÓN TORRES, CARLOS GUZMÁN QUILO, JOSÉ MARÍA GUILLÉN, BLANCA PIEDRAFITA, ESTHER REDONDO MARGUELLO
Introduction. Seasonal influenza epidemics are a major public health concern. They are caused by the influenza A and B viruses; although the A virus is more prominent, influenza B virus infection causes a disease with similar characteristics. There are two phylogenetically distinct influenza B lineages (B/Victoria and B/Yamagata), only one of which is present in the trivalent vaccine formulated each season. Methods. Epidemiological data from the Spanish Influenza Surveillance System for 2007 to 2017 were reviewed to establish the relative proportion of each type of virus and the characterization of the B lineages in relation to the composition of the trivalent vaccine. Results. The median proportion of B (2007-2017) was 27.2% (0.7%-74.8%) vs. 16.3% (0.4%-98.6%) for A-H3 and 44.2% (0.1%-98.0%) for pandemic A-H1N1 (20092017). The B lineages co-circulated in 8/10 seasons and there was mismatch with the B vaccine strain in 4/10 seasons. The B virus was dominant in 2007/08 and 2012/13 throughout Spain. There was a combination of dominance/codominance of influenza B and mismatch with the vaccine lineage in at least one third of epidemic seasons reviewed. Conclusions. Epidemiological information on influenza B has been less compiled in comparison with data on the A virus. Influenza virus type B is responsible for a significant number of cases in almost all seasons. The predominant B lineage in each season is unpredictable, affecting the protection conferred by the seasonal vaccine. Spanish epidemiological data support the rationale for a quadrivalent vaccine with both B virus lineages similarly to data from other settings.
Infectious postoperative endophthalmitis after cataract surgery performed over 7 years. The role of azithromycin versus ciprofloxacin eye drops
JOSEP TUÑÍ-PICADO, ANA MARTÍNEZ-PALMER, XÈNIA FERNÁNDEZ-SALA, JAIME BARCELÓ-VIDAL, MIGUEL CASTILLA-MARTÍ, YASMIN CARTAGENA-GUARDADO, SANTIAGO GRAU
Introduction. Although topical antibiotics have been used as antimicrobial prophylaxis after ocular surgery, recent studies have determined that intracameral cefuroxime at the end of surgery significantly reduce the risk to suffer an infection and suggest that the use of topical antibiotics in the prophylaxis of infectious postoperative endophthalmitis (IPOE) is controversial. Moreover, there is no evidence to confirm the higher effectiveness of topical ciprofloxacin, considered the standard of care, or topical azithromycin in preventing IPOE of cataract surgeries. Patients and methods. IPOE topical prophylaxis was performed with two different strategies: with azithromycin from January 1st, 2010 to December 31st, 2014 (group I) and with ciprofloxacin from January 1st, 2015 to January 31st, 2017 (group II). Patient characteristics and clinical signs and symptoms of IPOE from all consecutive cataract surgeries performed over a 7-year period were collected. Results. A total of 15,146 cataract surgeries were conducted; 10,756 in group I and 4,390 in group II. Two cases of IPOE in each group were diagnosed, showing a 0.019% and 0.046% rate respectively, with no statistically significance. IPOE cases were related with aging, systemic and ocular comorbidities or with a complicated cataract surgery. Conclusions. The benefit of the application of topical antibiotics after cataract surgery is questionable when intracameral cefuroxime prophylaxis is performed and no better effectiveness with ciprofloxacin or azithromycin was observed.
CD64 index as a marker of infection in patients with postoperative fever
NATALIA VICENTE LÓPEZ, RAFAEL FORÉS CACHÓN, REYES IRANZO VALERO, ANA LERMA VERDEJO, ELENA MÚÑEZ RUBIO, ANA ROYUELA VICENTE, ANTONIO RAMOS MARTÍNEZ
Objective. To evaluate the utility of the granulocyte CD64 index as a marker of infection in patients with postoperative fever. Methods. Prospective observational study of a cohort of patients with postoperative fever (2nd-21st day after the intervention) collected during 14 months. Obtaining blood samples during the first 24 hours after the febrile peak to determine the CD64 index (ratio of fluorescence intensity, measured, in the granulocytes of the patient with respect to healthy controls), procalcitonin and C-reactive protein (CRP). Results. During the study period, 50 patients were included, 28 patients (56%) with infection and 22 patients (44%) without evidence of infection. The PCR, procalcitonin and the CD64 index showed significantly higher values in the group of patients who suffered infection. The CD64 index showed a sensitivity of 88.9%, with a specificity of 65.2%. The positive predictive value (PPV) was 75% and the negative predictive value (NPV) was 83.3%, with an area under the curve (AUC) of 0.805 (95% CI 0.68-0.93). Procalcitonin presented a sensitivity of 53.9% and specificity of 86.4%, with NPV and PPV of 82.4% and 61.3% respectively, with AUC of 0.752 (95% CI 0.61-0.89). Regarding the PCR, it showed a sensitivity of 100%, with specificity of 4.4% with an area under the curve of 0.676 (95% CI 0.52-0.83). Conclusions. The quantification of the CD64 index in patients who develop fever in the early postoperative period is useful to distinguish post-surgical inflammatory phenomena from episodes of established infection.
In silico analysis of transferable QepA variants and related chromosomal efflux pumps
Objectives. The present study aimed to detect the presence of undescribed QepA variants in GenBank records. Material and methods. The DNA and amino acid sequences of QepA1 were compared with what is present in GenBank. Only annealings with a >80% identity were considered. No synthetic or partial sequences were included in the analyses. Results. The results showed the presence of 10 different QepA variants, 6 of them which were previously non-designated as specific allelic variants. In addition, high identity levels with chromosomal MSF efflux pumps belonging to microorganisms of the Pseudorhodoferax genus and other Comamonadaceae were detected Conclusions. The presence of undescribed QepA variants in GenBank is reported and the presence of related sequences among members of Burkholderiales order is described.
Introduction. Toxoplasma gondii is cause of a wide variety of infections in human. The aim of this study was; to evaluate the frequency of sero-positivity of the members in a family with a positive serologic person. Methods. A case-control study with 170 enrolled units which was conducted in Iran in 2017. The units were settled into two group: I: the family members of seropositive individuals and II: the family members of seronegative individuals. The level of IgG and IgM anti-toxoplasma antibodies were evaluated by ELISA qualitative manner in both groups. Results. Frequency of individuals with positive serology was 52.9% and 34.1% in group I and II, respectively (P value = 0.01). Conclusion. Clusters of toxoplasma infection would be an event in the family members. Therefore evaluation of the family members (especially high risk persons) of a patient may be necessary.
Spontaneous bacterial peritonitis caused by Listeria monocytogenes: eight case reports (1992-2017) and literature review
MARINA FERNÁNDEZ TORRES, ITZIAR ANGULO LÓPEZ, PATRICIA RUIZ BUENO, MARTA GONZÁLEZ MARTINEZ, CARLOS RUIZ DE ALEGRÍA PUIG, JESÚS RODRÍGUEZ LOZANO, JESÚS AGÜERO BALBÍN, JAVIER CRESPO GARCÍA, JORGE CALVO MONTES
Background. Spontaneous bacterial peritonitis (SBP) is a frequent and severe entity in patients with cirrhosis or ascites due to other causes. However, Listeria monocytogenes is a microorganism that has been scarcely identified as a causative agent of SBP. Methods. In this study, a descriptive analysis of cases of L. monocytogenes SBP was carried out in our center for 26 years (1992-2017). Results. A total of eight patients were diagnosed, with an average age of 58 years, with no differences in sex distribution and all of them were community acquired cases. Half of the patients had underlying liver disease, two of them active malignancies; one was undergoing continuous ambulatory peritoneal dialysis and the last one with hypertensive heart disease. Six (75%) of the patients received a third-generation cephalosporin as empirical treatment. The clinical course was favorable after receiving directed antibiotic treatment in five (62.5%) of the patients. However, three of them, under the age of 59, died. Serotyping of L. monocytogenes isolates revealed that half of them were serovar 4, two 1 / 2a and the remaining one 1 / 2c. All strains were susceptible to ampicillin, meropenem, erythromycin and cotrimoxazole. Conclusions. We conclude by emphasizing the importance of taking this etiology into account in patients with underlying liver disease and with clinical or laboratory data suggesting SBP, mainly due to the need for specific antibiotic treatment different from conventionally empirically used.
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