RESUMEN

This document is the result of the deliberations of the Committee on Emerging Pathogens and COVID-19 of the Il lustrious Official College of Physicians of Madrid (ICOMEM) regarding the current situation of tuberculosis, particularly in Spain. We have reviewed aspects such as the evolution of its incidence, the populations currently most exposed and the health care circuits for the care of these patients in Spain. We have also discussed latent tuberculosis, the reality of extrapul monary disease in the XXI century and the means available in daily practice for the diagnosis of both latent and active forms. The contribution of molecular biology, which has changed the perspective of this disease, was another topic of discussion. The paper tries to put into perspective both the classical drugs and their resistance figures and the availability and indications of the new ones. In addition, the reality of direct observa tion in the administration of antituberculosis drugs has been discussed. All this revolution is making it possible to shorten the treatment time for tuberculosis, a subject that has also been reviewed. If everything is done well, the risk of relapse of tuberculosis is small but it exists. On the other hand, many special situations have been discussed in this paper, such as tuberculosis in pediatric age and tuberculosis as a cause for concern in surgery and intensive care. The status of the BCG vaccine and its present indications as well as the future of new vaccines to achieve the old dream of eradicating this disease have been discussed. Finally, the ethical and medicolegal impli cations of this disease are not a minor issue and our situation in this regard has been reviewed (AU)

El presente documento es el resultado de las deliberacio nes del Comité sobre Patógenos Emergentes y COVID-19 del Ilustre Colegio Oficial de Médicos de Madrid (ICOMEM) en re lación a la situación actual de la tuberculosis, particularmente en España. Hemos revisado aspectos tales como la evolución de su incidencia, las poblaciones actualmente más expuestas y los circuitos sanitarios para la atención a estos pacientes en España. Se ha discutido también la tuberculosis latente, la rea lidad de la enfermedad extrapulmonar en el siglo XXI y los me dios de que en la práctica diaria se dispone para el diagnóstico tanto de las formas latentes como de las activas. La aportación de la biología molecular que ha cambiado la perspectiva de es ta enfermedad ha constituido otro de los temas de debate. El documento trata de poner en perspectiva tanto los fármacos clásicos y sus cifras de resistencia como la disponibilidad e in dicaciones de los nuevos. Junto a esto, se ha discutido la rea lidad de la observación directa en la administración de fárma cos antituberculosos. Toda esta revolución está posibilitando el acortamiento del tiempo de tratamiento de la tuberculosis tema que ha sido igualmente revisado. Si todo se hace bien, el riesgo de recaída de la tuberculosis es pequeño pero existen te. Por otra parte, muchas situaciones especiales han merecido discusión en este documento como por ejemplo la tuberculosis en edad pediátrica y la tuberculosis como causa de preocupa ción en cirugía y cuidados intensivos. Se ha discutido tanto la situación de la vacuna BCG y sus indicaciones presentes, co mo el futuro de nuevas vacunas que permitan alcanzar el viejo sueño de erradicar esta enfermedad. Finalmente, las implica ciones éticas y medicolegales que esta enfermedad plantea no son un tema menor y se ha revisado nuestra situación en este particular (AU)

Asunto(s)

RESUMEN

Introducción: El mapa microbiológico permite conocer desde una situación infecciosa particular hasta la epidemiología de toda la institución en torno a las infecciones, así como las opciones terapéuticas. Objetivos: Crear una base de datos que analice los datos registrados mediante consultas y formularios a partir de criterios de búsqueda. Métodos: Se confeccionó una base de datos empleando Microsoft Access, y se organizó la información usando lenguajes de programación SQL y VBA mediante consultas y formularios. Resultados: Se obtuvieron tablas, consultas y formularios para proporcionar la información de acuerdo a las exigencias del laboratorio y el servicio que lo solicita. Conclusiones: El software ofrece una solución al acceso de la información de forma digital, rápida y certera, además de segura. El registro de los datos es el único proceder manual, con lo que se minimizan las jornadas dedicadas al desarrollo del informe final. Se sugiere el empleo del mapa microbiológico en Microsoft Access como herramienta en los laboratorios de microbiología.

Introduction: The microbiological map allows us to know from a particular infectious situation to the epidemiology of the entire institution regarding infections, as well as therapeutic options. Objectives: To create a database that groups the results of microorganisms isolated in the laboratory and their susceptibility (according to the antibiogram), capable of grouping queries and accounts based on search criteria. Methods: A database was created using Microsoft Access, and the information was organized using SQL and VBA programming languages, through queries and forms. Results: Tables, consultations and forms were obtained to provide information according to the requirements of the laboratory and the service that requests it. Conclusions: The software offers a solution to access information digitally, quickly, accurately, and safely. Data recording is the only manual procedure, thus minimizing the days dedicated to the development of the final report. The use of the microbiological map using Microsoft Access is suggested as a tool in microbiology laboratories.

RESUMEN

Adequate and rapid microbiological diagnosis of sepsis is essential for correct treatment, having a direct impact on patient prognosis. Clinical Microbiology Services must adapt fast circuits that allow prioritizing and individualizing the diagnosis of these patients. The measures adopted should not be based solely on the incorporation of new technologies but, to a large extent, on ensuring accurately collection and processing of samples, avoiding unnecessary losses of time in processing and ensuring that the information derived from this process adequately reaches the prescribing physician. (AU)

Asunto(s)

RESUMEN

El diagnóstico microbiológico es esencial en el conocimiento y manejo de las enfermedadesinfecciosas, tanto en los procesos habituales de la práctica clínica como en la aparición denuevos microorganismos, como en los próximos que puedan aparecer con el cambio climáticoy la nueva situación de los vectores que transmiten enfermedades en nuestro medio. El 11 de marzo 2020 la Organización Mundial de la Salud declaró la alerta por pandemiamundial por SARS-CoV-2 que se descubrió y se aisló por primera vez en Wuhan, China, en unbrote de neumonía de etiología desconocida vinculada a un mercado. Es una infección quetiene un origen zoonótico, se transmitió de un huésped animal a uno humano. Actualmente nose conoce de forma clara de dónde proviene el SARS-CoV-2. A principios de enero de 2020, científicos chinos anunciaron que habían aislado y secuenciadocompletamente el virus y lo publicaron; esto permitió disponer de técnicas de PCR para realizar eldiagnóstico de la infección por SARS Cov2 en todo el mundo. El objetivo de este trabajo es revisarel papel llevado a cabo desde el Servicio de Microbiología Clínica del Hospital Universitario deNavarra en la pandemia de COVID-19 y, en concreto, en nuestra comunidad, Navarra. Más de dos años después y, sin dejar de lado el profundo impacto sanitario, familiar y socialque ha tenido, debemos quedarnos con lo positivo del aprendizaje profesional y personaladquirido para aplicarlo en nuestro día a día, así como para las futuras pandemias que vengan.(AU)

Asunto(s)

RESUMEN

Introducción: la leche humana es el patrón oro en la nutrición de los neonatos. Por ello, los bancos de leche se convierten en elementos esenciales para garantizar su disponibilidad y seguridad cuando la leche materna no está disponible. La manipulación que se realiza de la leche es un punto crítico para asegurar la seguridad microbiológica de las muestras. Por ello, analizar la flora de la leche donada es fundamental para tomar medidas de mejora de los bancos de leche. Objetivos: analizar los resultados microbiológicos positivos en un banco de leche humana entre las muestras de leche cruda donadas y tras su pasteurización y evaluar si existe relación entre los aislamientos, el perfil de la donante y los circuitos de leche donada. Métodos: estudio observacional descriptivo que analiza las características de la leche donada y los resultados microbiológicos positivos de muestras de leche donadas en nuestro banco desde junio de 2016 hasta diciembre de 2020. Todas las donantes firmaron un consentimiento informado. (AU)

Introduction: breastfeeding is the gold standard for infant’s nutrition. Human milk bank is an essential tool to guarantee availability and safety in those situations when breastfeeding is not an option. The manipulation during the extraction of the human milk by the donors is a critical point to ensure an adequate microbiological safety. Therefore, knowing the bacterial flora that prevails in donated milk is essential to draw conclusions that can lead to taking measures in the management of the bank. Objectives: to analyze the prevalence of microorganisms in milk samples donated to the milk bank and how the bacterial flora behaves according to the profile of the donors and the donor milk circuits. Methods: the present work is a retrospective descriptive observational study that analyzes characteristics and the positive microbiological results within our milk bank samples from June 1, 2016 to December 31, 2020. All milk bank donors voluntarily signed an informed consent that authorizes the use of data to investigation. (AU)

Asunto(s)

RESUMEN

Introduction: Introduction: breastfeeding is the gold standard for infant's nutrition. Human milk bank is an essential tool to guarantee availability and safety in those situations when breastfeeding is not an option. The manipulation during the extraction of the human milk by the donors is a critical point to ensure an adequate microbiological safety. Therefore, knowing the bacterial flora that prevails in donated milk is essential to draw conclusions that can lead to taking measures in the management of the bank. Objectives: to analyze the prevalence of microorganisms in milk samples donated to the milk bank and how the bacterial flora behaves according to the profile of the donors and the donor milk circuits. Methods: the present work is a retrospective descriptive observational study that analyzes characteristics and the positive microbiological results within our milk bank samples from June 1, 2016 to December 31, 2020. All milk bank donors voluntarily signed an informed consent that authorizes the use of data to investigation. Results: during the study period, a total of 1,587 liters of raw milk were donated by 266 women, highlighting that, despite the SARS-CoV-2 virus pandemic, 2020 has been the year in which more volume of milk has been dispensed. The results show that 221 batches had at least one positive microbiological isolation (149 of them were before and 46 after pasteurization). Pre and post-pasteurization rate varies over the years with a decrease in the pre-pasteurization discard rate (3,9%) and increase in the post-pasteurization rate (5,3%). The most frequently isolated germs found in pre-pasteurization cultures were gram positive cocci and Enterobacter and a decrease in the positivity to S. aureus after establishing an eradication protocol. In post-pasteurization cultures, the most commonly found germs are Bacillus. Regarding the donor's profile, it was found a non statistically significant way that those women with the highest donation volume and/or admission of their offspring in Neonatology were associated with higher frequency of positive cultures. Conclusions: bacteriological analysis of milk samples is an essential part of quality control for a milk bank. Our results reflect a good extraction system and transportation, as well as good training from the bank's professionals. Nevertheless, improvement of processes is necessary to reduce the rate of contamination and the amount of discarded milk.

Introducción: Introducción: la leche humana es el patrón oro en la nutrición de los neonatos. Por ello, los bancos de leche se convierten en elementos esenciales para garantizar su disponibilidad y seguridad cuando la leche materna no está disponible. La manipulación que se realiza de la leche es un punto crítico para asegurar la seguridad microbiológica de las muestras. Por ello, analizar la flora de la leche donada es fundamental para tomar medidas de mejora de los bancos de leche. Objetivos: analizar los resultados microbiológicos positivos en un banco de leche humana entre las muestras de leche cruda donadas y tras su pasteurización y evaluar si existe relación entre los aislamientos, el perfil de la donante y los circuitos de leche donada. Métodos: estudio observacional descriptivo que analiza las características de la leche donada y los resultados microbiológicos positivos de muestras de leche donadas en nuestro banco desde junio de 2016 hasta diciembre de 2020. Todas las donantes firmaron un consentimiento informado. Resultados: durante el período de estudio fueron donados 1587 litros de leche cruda por 266 mujeres destacando que, a pesar de la pandemia, 2020 ha sido el año en el que más volumen se ha dispensado (280 L). Se obtuvieron 221 lotes de leche con al menos un aislamiento microbiológico positivo (14,2 % total), de ellos 149 previos y 46 posteriores a la pasteurización. La tasa de descarte pre y pospasteurización es variable a lo largo de los años con descenso en 2020 prepasteurización (3,9%) e incremento pospasteurización (5,3%). Los gérmenes más frecuentemente aislados fueron cocos grampositivos, seguidos por Enterobacterias prepasteurización detectándose un descenso en la positividad a S. aureus tras establecerse un protocolo de erradicación. En las muestras pospasteurización predomina el género Bacillus. Se ha encontrado una relación aunque no estadísticamente significativa (p > 0,05) entre mujeres con mayor volumen de donación y/o ingreso de su hijo/a en Neonatología y una mayor frecuencia cultivos positivos. Conclusiones: el análisis bacteriológico de las muestras es parte fundamental del control de calidad. Nuestros resultados traducen una buena sistemática de extracción y transporte, así como un buen entrenamiento de los profesionales del banco. No obstante, es necesario mejorar los procesos para reducir la tasa de contaminación y la cantidad de leche desechada.

Asunto(s)

RESUMEN

Introducción: Staphylococcus aureus (S. aureus) es un germen frecuente en las infecciones bacterianas infantiles. Últimamente la tasa de S. aureus resistente a meticilina (SAMR) está aumentando.Objetivos: Principal: conocer la tasa de cultivos positivos a SAMR en los servicios de urgencias pediátricos españoles. Secundarios: analizar factores de riesgo de aislamiento de SAMR (procedencia del paciente, antecedentes de hospitalización o cirugía en los 90 días previos, de antibioterapia en los 60 días previos, presencia de comorbilidad, dispositivos invasivos, aislamiento SAMR previo) y la morbilidad de estas infecciones.Metodología: Estudio retrospectivo multicéntrico (1/07/2017-30/06/2018) con revisión de historias de pacientes con aislamiento de S. aureus en muestras de cualquier origen obtenidas en 8 servicios de urgencias pediátricos del Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría.Resultados: Durante dicho periodo se aisló S. aureus en 403 pacientes (edad media 75,8±59,2 meses; 54,8% hombres): 28,8% infecciones relacionadas con el hospital y 71,2% con la comunidad. Tasa global de SAMR: 16,6% (IC95%: 13-20,2%); 18,1% en infecciones relacionadas con el hospital y 16,2% en infecciones relacionadas con la comunidad (p>0,05). Las tasas más altas de SAMR se obtuvieron en abscesos cutáneos (29,3%; IC95%: 21,8-36,8%), pacientes no nacidos en España (52%; IC95%: 32-72%) o con una infección previa por SAMR (90%; IC95% 71,4-100%). Ingresaron 167 pacientes (41%), presentaron complicaciones 12 (3%) y secuelas 4 (1%). No hubo fallecimientos. (AU)

Introduction: Staphylococcusaureus (S. aureus) is a common germ present in bacterial infections in children. Lately, the rate of methicillin-resistant S. aureus (MRSA) is increasing.Objectives: The main aim of this study is to know the rate of positive cultures to MRSA in Spanish pediatric emergency departments. The secondary aims are to analyze the risk factors for MRSA isolation (patient origin, history of hospitalization or surgery in the previous 90 days, antibiotherapy in the previous 60 days, presence of comorbidity, invasive devices, prior MRSA isolation) and to analyze the morbidity of these infections.Methodology: Retrospective multicenter study (07/01/2017–06/30/2018) with review of patient histories with isolation of S. aureus in samples of any origin obtained in 8 pediatric emergency departments of the Infectious Diseases Working Group of the Spanish Society of Pediatric Emergencies.Results: During this period, S. aureus was detected in 403 patients (average age 75.8±59.2 months; 54.8% male): 28.8% hospital-related infections and 71.2% community-related infections. Overall, MRSA rate was 16.6% (95% CI: 13-20.2%); 18.1% in hospital-related infections and 16.2% in community-related infections (P>.05). The highest rates of MRSA were obtained in skin abscesses (29.3%, 95% CI: 21.8-36.8%), patients not born in Spain (52%; 95% CI: 32-72%) or patients with a previous MRSA infection (90%; 95% CI: 71.4-100%).167 (41%) patients were admitted, 12 (3%) had complications and 4 (1%) suffered sequels. There were no deaths. (AU)

Asunto(s)

RESUMEN

INTRODUCTION: Staphylococcus aureus is a common germ in bacterial infections in children. The rate of methicillin-resistant S. aureus (MRSA) is increasing lately. OBJECTIVES: The main aim is to know the rate of positive cultures to MRSA in Spanish pediatric emergency departments. The secondary aims are to analyse the risk factors for MRSA isolation (patient origin, history of hospitalization or surgery in the previous 90 days, antibiotherapy in the previous 60 days, presence of comorbidity, invasive devices, prior MRSA isolation) and to analyse the morbidity of these infections. METHODOLOGY: Retrospective multicenter study (07/01/2017-06/30/2018) with review of patient histories with isolation of S. aureus in samples of any origin obtained in 8 pediatric emergency departments of the Infectious Diseases Working Group of the Spanish Society of pediatric Emergencies. RESULTS: During this period, S. aureus was detected in 403 patients (average age 75.8 ± 59.2 months; 54.8% male): 28.8% hospital-related infections (HRI) and 71.2% community-related infections (CRI). Overall, MRSA rate was 16.6% (95% CI: 13-20.2%); 18.1% in HRI and 16.2% in CRI (p > 0.05). The highest rates of MRSA were obtained in skin abscesses (29.3%, CI 95%: 21.8-36.8%), patients not born in Spain (52%; CI 95%: 32-72%) or patients with a previous MRSA infection (90%; CI 95% 71.4-100%). 167 (41%) patients were admitted, 12 (3%) had complications and 4 (1%) suffered sequels. There were no deaths. CONCLUSIONS: The overall MRSA rate was one in 6 staphylococcal infections. Higher MRSA rates were detected in samples of suppurating skin injuries and in foreign children or in children with a history of previous MRSA infection. In suppurative skin lesions, early drainage is essential and the change to an antibiotic with MRSA coverage should be considered if the evolution is inadequate.

Asunto(s)

RESUMEN

Introducción: Nuestro objetivo fue evaluar la variabilidad en el procesamiento de muestras osteoarticulares para el diagnóstico microbiológico entre distintos centros nacionales. Métodos: Se diseñó una encuesta online con 13 preguntas y se difundió a través de la SEIMC a los servicios de microbiología de los distintos centros. Resultados: Obtuvimos 72 respuestas. En más de la mitad de los centros, de tercer nivel, se reciben al menos 5 muestras. Aproximadamente la mitad de los centros agitan con vórtex las muestras de hueso/implante, utilizándose la sonicación sobre todo en centros de tercer nivel. Se realizan cultivos para bacterias aerobias y anaerobias durante 6-10 días de incubación, pero con diferencias en los medios de cultivo líquidos. El diagnóstico molecular se realiza en menos del 50% de los centros, siendo la PCR universal (ARNr 16S) la técnica más empleada. Conclusiones: Existe heterogeneidad fundamentalmente en el empleo de sonicación, los medios líquidos de cultivo o el diagnóstico molecular, probablemente en relación directa con los recursos y capacidades de cada centro.(AU)

Introduction. Our aim was to evaluate the variability in the processing of osteoarticular samples for microbiological diagnosis between different national centers. Methods: An online survey with 13 questions was designed and it was sent through SEIMC to the Microbiology Departments of the different centers. Results: We obtained 72 answers. In more than half of the tertiary-care centers, at least 5 samples are received. Approximately half of the centers vortex bones/implant samples. Sonication is used mostly in tertiary-care centers. Cultures for aerobic and anaerobic bacteria are performed during 6-10 days of incubation but with differences in liquid culture media. Molecular diagnosis is performed in less than 50% of the centers. Universal PCR (16S rRNA) is the most widely used technique. Conclusion: We found heterogeneity especially in the use of sonication, liquid culture media or molecular diagnosis, probably in direct relation to the resources and capacities of each center.(AU)

Asunto(s)

RESUMEN

Resumen: Introducción: el inicio temprano de la antibioticoterapia adecuada en infecciones graves se asocia con reducción de la mortalidad. La identificación precoz del microorganismo es fundamental para realizar un tratamiento dirigido y disminuir la terapéutica inicial inapropiada. Objetivo: valorar la utilidad de una técnica de biología molecular por amplificación de ácidos nucleicos mediante reacción en cadena de polimerasa en tiempo real para diagnóstico microbiológico temprano y adecuación de la antibioticoterapia en pacientes con neumonías graves. Metodología: estudio retrospectivo observacional llevado a cabo en la unidad de cuidados intensivos del Hospital Maciel. Se analizaron muestras respiratorias de pacientes con diagnóstico o sospecha de neumonía. Se compararon los resultados microbiológicos obtenidos por técnicas convencionales y por biología molecular multiplex (panel neumonía). Resultados: se incluyeron 53 muestras obtenidas de 51 pacientes. El multiplex detectó al menos un microorganismo en 38 (71,7%) muestras frente a 30 (56.6%) desarrollos en cultivos tradicionales. La mayoría de las muestras se obtuvieron bajo antibioticoterapia previa (86.8%). El panel neumonía mostró un porcentaje de concordancia positiva combinado de 100% y un porcentaje de concordancia negativa del 94% para la identificación bacteriana en comparación con los métodos microbiológicos tradicionales. En 27 (51%) casos el resultado del panel de neumonía determinó un cambio en la conducta terapéutica. Conclusiones: la técnica de PCR permite la identificación temprana de microorganismos causantes de neumonía optimizando la terapéutica empírica inicial y racionalizando el uso de antimicrobianos. Un panel negativo aleja el planteo de infección respiratoria a gérmenes habituales y permite considerar diagnósticos diferenciales en cuanto a foco y/o etiología.

Summary: Introduction: the early initiation of the adequate antibiotic therapy in severe infections is associated to a reduction in mortality. Early identification of the microorganism is essential to define directed therapy and decrease the initial inadequate treatment. Objective: to assess usefulness of a molecular biology technique by nucleic acid amplification through a polymerase chain reaction in real time for an early microbiological diagnosis and correction of the antibiotic therapy in patients with severe pneumonias. Method: retrospective, observational study conducted in the intensive care unit of Maciel Hospital. The respiratory samples of patients with a diagnosis of pneumonia or suspicious to have pneumonia were analyzed. The microbiological results obtained were compared using conventional techniques and multiplex molecular biology (pneumonia panel). Results: 53 samples obtained from 51 patients were included in the study. Multiplex detected at least one microorganism in 38 (71.7%) samples compared to 30 (56.6%) in traditional cultures. Most samples were obtained under the previous antibiotic therapy (86.8%). The pneumonia panel showed a combined positive agreement percentage of 100% and a negative agreement of 94% for the identification of bacteria when compared to the traditional microbiological methods. In 27 cases (51%) the pneumonia panel results determined changing the therapeutic behavior. Conclusions: the PCR technique allows for the early identification of microorganisms causing pneumonia, thus optimizing initial empirical therapy and rationalizing the use of antibiotics. A negative panel reduces the suspicion of a respiratory infection caused by the usual germs and enables considering differential diagnosis in terms of etiology or cause.

Resumo: Introdução: o início precoce da antibioticoterapia adequada em infecções graves está associado à redução da mortalidade. A identificação precoce do microrganismo é essencial para realizar o tratamento dirigido e reduzir o uso inicial inadequado de antimicrobianos. Objetivo: avaliar a utilidade de uma técnica de biologia molecular para amplificação de ácidos nucleicos por reação em cadeia da polimerase em tempo real para diagnóstico microbiológico precoce e adequação da antibioticoterapia em pacientes com pneumonia grave. Metodologia: estudo observacional retrospectivo realizado na unidade de terapia intensiva do Hospital Maciel. Amostras respiratórias de pacientes com diagnóstico ou suspeita de pneumonia foram analisadas. Os resultados microbiológicos obtidos por técnicas convencionais e por biologia molecular multiplex (painel de pneumonia) foram comparados. Resultados: foram incluídas 53 amostras obtidas de 51 pacientes. O multiplex detectou pelo menos um microrganismo em 38 (71,7%) amostras em comparação com 30 (56,6%) usando culturas tradicionais. A maioria das amostras foi obtida com antibioticoterapia prévia (86,8%). O painel de pneumonia mostrou uma concordância percentual positiva combinada de 100% e uma concordância percentual negativa de 94% para identificação bacteriana em comparação com métodos microbiológicos tradicionais. Em 27 (51%) casos, o resultado do painel de pneumonia determinou mudança no comportamento terapêutico. Conclusões: a técnica de PCR permite a identificação precoce de microrganismos causadores de pneumonia, otimizando a terapia empírica inicial e racionalizando o uso de antimicrobianos. Um painel negativo afasta a suspeita de infecção respiratória pelos germes usuais e permite considerar diagnósticos diferenciais em termos de foco e/ou etiologia.

Asunto(s)

RESUMEN

Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method (AU)

Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado (AU)

Asunto(s)

RESUMEN

INTRODUCTION: Our aim was to evaluate the variability in the processing of osteoarticular samples for microbiological diagnosis between different national centers. METHODS: An online survey with 13 questions was designed and it was sent through SEIMC to the Microbiology Departments of the different centers. RESULTS: We obtained 72 answers. In more than half of the tertiary-care centers, at least 5 samples are received. Approximately half of the centers vortex bones/implant samples. Sonication is used mostly in tertiary-care centers. Cultures for aerobic and anaerobic bacteria are performed during 6-10 days of incubation but with differences in liquid culture media. Molecular diagnosis is performed in less than 50% of the centers. Universal PCR (16S rRNA) is the most widely used technique. CONCLUSION: We found heterogeneity especially in the use of sonication, liquid culture media or molecular diagnosis, probably in direct relation to the resources and capacities of each center.

Asunto(s)

RESUMEN

Introducción: Los mapas microbiológicos se consideran un marcador epidemiológico pues resumen estadísticamente las bacterias circulantes y su comportamiento frente a los antibióticos en uso. Permiten establecer una política de antibióticos que garantiza el uso más racional de los antimicrobianos y disminuye el riesgo de resistencia bacteriana. Objetivos: Identificar las bacterias aisladas con mayor frecuencia a partir de cultivos microbiológicos de pacientes hospitalizados en el Instituto de Hematología e Inmunología durante el año 2020 y determinar la resistencia de las bacterias más frecuentes a los antimicrobianos ensayados, con vista a establecer el primer mapa microbiológico de la institución. Métodos: Se realizó un estudio de corte transversal que incluyó los cultivos de pacientes hospitalizados durante el año 2020. La identificación bacteriana se realizó según métodos convencionales y para determinar los perfiles de resistencia se empleó el método de Bauer-Kirby. Resultados: El hemocultivo fue el estudio microbiológico más indicado con una positividad de 32,80 por ciento. Predominaron las bacterias Gram negativas (81,71 por ciento), siendo las más identificadas Pseudomonas spp., Enterobacter spp., Klebsiella spp. y Escherichia coli. Entre las bacterias Gram positivas predominó Staphylococcus spp. coagulasa negativa. Se obtuvieron elevados porcentajes de resistencia frente a casi todos los antimicrobianos evaluados. Conclusiones: La realización del mapa microbiológico de la institución permite actualizar la política de uso de los antimicrobianos al identificar a los bacilos Gram negativos, con elevados porcentajes de resistencia, como los principales agentes etiológicos de las infecciones registradas en este centro de salud durante el año 2020(AU)

Introduction: Microbiological maps are considered an epidemiological marker as statistically summarize circulating bacteria and their behavior against antibiotics in use. They allow establishing an antibiotic policy that guarantees the most rational use of antimicrobials and decreases the risk of bacterial resistance. Objectives: Identify the isolated bacteria with more frequency from microbiological crops of hospitalized patients in the Institute of Hematology and Immunology during the year 2020 and determine the resistance of the most frequent bacteria to the antimicrobials tested, with a view to establishing the first microbiological map of the institution. Methods: An observational, descriptive, cross-sectional study was performed that included cultures of patients hospitalized during the year 2020. Bacterial identification was carried out according to conventional methods and to determine the resistance profiles was used by the Bauer-Kirby method. Results: The blood culture was the most indicated microbiological study with 32.80 percent positivity. The Gram negative bacteria predominated (81.71percent), being the most identified Pseudomona spp., Enterobacter spp., Klebsiella spp. and Escherichia coli. Among the Gram positive bacteria predominate Staphylococcus spp. coagulase negative. High percentages of resistance were obtained in front of almost all antimicrobials evaluated. Conclusions: The completion of the institutional microbiological map allows updating the antimicrobial use policy by identifying the Gram negative bacilli, with high percentages of resistance, as the main etiological agents of the infections registered in this health center during 2020(AU)

Asunto(s)

RESUMEN

ABSTRAC: Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method. (AU)

RESUMO:Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado. (AU)

Asunto(s)

RESUMEN

As there is a great scarcity of studies on the importance of good compounding practices in the preparation of cosmetics, this study aimed to evaluate the quality control of cosmetics with active ingredient caffeine for the treatment of cellulite prepared by magistrals pharmacies. Microbiological analyzes, pH determination, color measurement, quantification of the percentage of the active ingredient caffeine and viscosity in creams and gels with 5% of the active ingredient caffeine were performed. In the microbiological analysis, the presence of molds and yeasts was verified above the permitted level according to the Brazilian pharmacopoeia. The pH decreased over time, contributing to the formulations becoming more acidic. In the color parameters, it was found that pharmacy F4 showed a brownish color, both for the gel and for the cream. The percentage of caffeine was within specifications in all formulations and the viscosity remained unchanged during the shelf life of the samples. It is important that the compounding pharmacies demand more effectively the commitment of the team, as well as the analysis of the raw material according to the microbiological control regulations to translate into the quality of the products prepared by the pharmacies and favor the consumer in the effective objective that the product you want to achieve.

Como há uma grande escassez de estudos sobre a importância de boas práticas de manipulação na elaboração de cosméticos, o presente estudo teve como objetivo avaliar o controle de qualidade de cosméticos com princípio ativo cafeína para o tratamento de celulite, elaborados por farmácias de manipulação de Campo Mourão. Foram realizadas análises microbiológicas, determinação do pH, mensuração da coloração, quantificação da porcentagem do princípio ativo cafeína e viscosidade em cremes e geís com 5% do princípio ativo cafeína. Nas análises microbiológicas foi verificada a presença de bolores e leveduras acima do pemitido segundo a farmacopéia brasileira. O pH diminuiu ao longo do tempo, contribuindo para que as formulações ficassem mais ácidas. Nos parâmetros de cor averiguou-se que a farmácia F4 apresentou uma coloração amarronzada, tanto para o gel quanto para o creme. A porcentagem de cafeína estava dentro das especificações em todas as formulações e a viscosidade se manteve inalterada durante o prazo de validade das amostras. Com o propósito de um melhor preparo magistral é importante que as farmácias de manipulação exijam de forma mais eficaz o comprometimento da equipe, bem como a análise da matéria-prima segundo as regulamentações de controle microbiológico. Além disso, a implementação de normas mais rígidas e o melhor controle da matéria-prima e das formulações finais fazem com que a qualidade dos produtos manipulados pelas farmácias magistrais seja aumentada significativamente, favorecendo o consumidor na efetiva finalidade a que o produto objetiva atingir.

Asunto(s)

RESUMEN

Abstract As there is a great scarcity of studies on the importance of good compounding practices in the preparation of cosmetics, this study aimed to evaluate the quality control of cosmetics with active ingredient caffeine for the treatment of cellulite prepared by magistrals pharmacies. Microbiological analyzes, pH determination, color measurement, quantification of the percentage of the active ingredient caffeine and viscosity in creams and gels with 5% of the active ingredient caffeine were performed. In the microbiological analysis, the presence of molds and yeasts was verified above the permitted level according to the Brazilian pharmacopoeia. The pH decreased over time, contributing to the formulations becoming more acidic. In the color parameters, it was found that pharmacy F4 showed a brownish color, both for the gel and for the cream. The percentage of caffeine was within specifications in all formulations and the viscosity remained unchanged during the shelf life of the samples. It is important that the compounding pharmacies demand more effectively the commitment of the team, as well as the analysis of the raw material according to the microbiological control regulations to translate into the quality of the products prepared by the pharmacies and favor the consumer in the effective objective that the product you want to achieve.

Resumo Como há uma grande escassez de estudos sobre a importância de boas práticas de manipulação na elaboração de cosméticos, o presente estudo teve como objetivo avaliar o controle de qualidade de cosméticos com princípio ativo cafeína para o tratamento de celulite, elaborados por farmácias de manipulação de Campo Mourão. Foram realizadas análises microbiológicas, determinação do pH, mensuração da coloração, quantificação da porcentagem do princípio ativo cafeína e viscosidade em cremes e geís com 5% do princípio ativo cafeína. Nas análises microbiológicas foi verificada a presença de bolores e leveduras acima do pemitido segundo a farmacopéia brasileira. O pH diminuiu ao longo do tempo, contribuindo para que as formulações ficassem mais ácidas. Nos parâmetros de cor averiguou-se que a farmácia F4 apresentou uma coloração amarronzada, tanto para o gel quanto para o creme. A porcentagem de cafeína estava dentro das especificações em todas as formulações e a viscosidade se manteve inalterada durante o prazo de validade das amostras. Com o propósito de um melhor preparo magistral é importante que as farmácias de manipulação exijam de forma mais eficaz o comprometimento da equipe, bem como a análise da matéria-prima segundo as regulamentações de controle microbiológico. Além disso, a implementação de normas mais rígidas e o melhor controle da matéria-prima e das formulações finais fazem com que a qualidade dos produtos manipulados pelas farmácias magistrais seja aumentada significativamente, favorecendo o consumidor na efetiva finalidade a que o produto objetiva atingir.

RESUMEN

As there is a great scarcity of studies on the importance of good compounding practices in the preparation of cosmetics, this study aimed to evaluate the quality control of cosmetics with active ingredient caffeine for the treatment of cellulite prepared by magistrals pharmacies. Microbiological analyzes, pH determination, color measurement, quantification of the percentage of the active ingredient caffeine and viscosity in creams and gels with 5% of the active ingredient caffeine were performed. In the microbiological analysis, the presence of molds and yeasts was verified above the permitted level according to the Brazilian pharmacopoeia. The pH decreased over time, contributing to the formulations becoming more acidic. In the color parameters, it was found that pharmacy F4 showed a brownish color, both for the gel and for the cream. The percentage of caffeine was within specifications in all formulations and the viscosity remained unchanged during the shelf life of the samples. It is important that the compounding pharmacies demand more effectively the commitment of the team, as well as the analysis of the raw material according to the microbiological control regulations to translate into the quality of the products prepared by the pharmacies and favor the consumer in the effective objective that the product you want to achieve.

Como há uma grande escassez de estudos sobre a importância de boas práticas de manipulação na elaboração de cosméticos, o presente estudo teve como objetivo avaliar o controle de qualidade de cosméticos com princípio ativo cafeína para o tratamento de celulite, elaborados por farmácias de manipulação de Campo Mourão. Foram realizadas análises microbiológicas, determinação do pH, mensuração da coloração, quantificação da porcentagem do princípio ativo cafeína e viscosidade em cremes e geís com 5% do princípio ativo cafeína. Nas análises microbiológicas foi verificada a presença de bolores e leveduras acima do pemitido segundo a farmacopéia brasileira. O pH diminuiu ao longo do tempo, contribuindo para que as formulações ficassem mais ácidas. Nos parâmetros de cor averiguou-se que a farmácia F4 apresentou uma coloração amarronzada, tanto para o gel quanto para o creme. A porcentagem de cafeína estava dentro das especificações em todas as formulações e a viscosidade se manteve inalterada durante o prazo de validade das amostras. Com o propósito de um melhor preparo magistral é importante que as farmácias de manipulação exijam de forma mais eficaz o comprometimento da equipe, bem como a análise da matéria-prima segundo as regulamentações de controle microbiológico. Além disso, a implementação de normas mais rígidas e o melhor controle da matéria-prima e das formulações finais fazem com que a qualidade dos produtos manipulados pelas farmácias magistrais seja aumentada significativamente, favorecendo o consumidor na efetiva finalidade a que o produto objetiva atingir.

Asunto(s)

RESUMEN

Resumen Introducción: Los gramnegativos continúan siendo los causantes de infecciones asociadas a la atención a la salud (IAAS). Material y métodos:: Analizamos la resistencia antimicrobiana de patógenos durante el 2013 vs. 2018 y lo comparamos con lo publicado en 2006 vs. 2012. Resultados: Identificamos nueve patógenos gramnegativos, de un total de 404 aislamientos, con una prevalencia en 2013 (N = 227 [0.22]) vs. 2018 (N = 177 [0.17]) y una incidencia por egresos (6,607 en el 2013 y 7,778 en el 2018) del 3.4 y 2.2% respectivamente. Destacaron tres patógenos: Klebsiella pneumoniae (129 [31.93%]), Pseudomonas aeruginosa (85 [21.03%]) y Escherichia coli (80 [19.80%]). Estos, llamados patógenos ESKAPE-E, prevalecieron como causantes de IAAS. Identificamos un aumento en los patrones de resistencia para muchos patógenos en 2018. Conclusión: La multirresistencia a patógenos ESKAPE-E es un serio problema de salud pública, por carecer de alternativas terapéuticas para enfrentar este reto. Los mapas de resistencia bacteriana ayudan en la prescripción antibiótica.

Abstract Background: Gram-negatives continue to be the cause of infections associated with health care (HCAI). Material and methods: We analyzed the antimicrobial resistance of pathogens during 2013 vs. 2018 and we compare it with what was published in 2006 vs. 2012. Results: We identified 9 gram-negative pathogens, out of a total of 404 isolates, with a prevalence in 2013 (N = 227 [0.22]) vs. 2018 (N = 177 [0.17]) and an incidence due to discharges (6,607 in 2013 and 7,778 in 2018) of 3.4 and 2.2%, respectively.Three pathogens stood out Klebsiella pneumoniae (129 [31.93%]), Pseudomonas aeruginosa (85 [21.03%]) and Escherichia coli (80 [19.80%]). These, called ESKAPE-E pathogens, prevailed as the cause of HCAI. We identified an increase in resistance patterns for many pathogens in 2018. Conclusion: Multi-resistance to ESKAPE-E pathogens is a serious public health problem, due to the lack of therapeutic alternatives to face this challenge. Bacterial resistance maps help in antibiotic prescription.

RESUMEN

Resumen Objetivo. Determinar la calidad del agua que abastece a la población de la Vereda Rio Suarez del municipio de Puente Nacional por medio del cálculo del índice de riesgo de la calidad del agua (IRCA). Métodos. Se tomaron 10 muestras de diferentes puntos de la red de distribución del agua veredal, se realizó análisis físico-químico y microbiológico por técnica de filtración por membrana bajo parámetros del Instituto Nacional de Salud. Resultados. El análisis físico-químico mostró cuantificación de hierro elevado y nivel de turbiedad inadecuado lo que puede afectar el sabor y el aspecto del agua. El recuento de coliformes totales fue >300 UFC/100ml., con identificación de Escherichia coli, Klebsiella oxytoca, Pseudomonas aeruginosa y Enterococcus entre otras, habitantes de suelo y aguas que pueden ser causantes de infecciones gastrointestinales e infecciones urinarias, resultados que indican que el agua no es apta para consumo humano.

Abstract Objective. To determine the quality of the water that supplies the population of the Vereda Rio Suarez of the municipality of Puente Nacional through the calculation of the risk index of water quality (IRCA). Methods. 10 samples were taken from different points of the water distribution network, physical-chemical and microbiological analysis was performed by membrane filtration technique under parameters of the National Institute of Health. Results. The physical-chemical analysis showed high iron quantification and inadequate turbidity level that can affect the taste and appearance of the water. The total coliform count> 300 CFU / 100ml., with identification of Escherichia coli, Klebsiella oxytoca, Pseudomonas aeruginosa and Enterococcus among others that inhabit soils and waters and can cause gastrointestinal infections and urinary infections and is not suitable for human consumption.

Asunto(s)

RESUMEN

RESUMEN Introducción: Las infecciones de las úlceras del pie diabético son comunes, complejas, de alto costo y constituyen la principal causa de amputación no traumática de las extremidades inferiores. Objetivo: Identificar los microorganismos aislados para estimar tanto la sensibilidad a los antibióticos como la coincidencia entre el tratamiento empírico y los resultados microbiológicos en pacientes con úlceras del pie diabético. Métodos: Se realizó una investigación descriptiva-retrospectiva. La población de estudio estuvo constituida por 210 pacientes ingresados en el Hospital Universitario Clínico Quirúrgico "Comandante Faustino Pérez Hernández" de Matanzas entre junio de 2017 y junio de 2020. Las variables de salida fueron la frecuencia y el tipo de germen, la cantidad de gérmenes por úlcera, la sensibilidad para cada tipo de antibiótico, y el porcentaje de coincidencia entre el tratamiento empírico y el resultado microbiológico. Resultados: Se identificaron 259 gérmenes y se observaron 1,23 gérmenes por úlcera. El 62,5 por ciento de los gérmenes encontrados fueron Gram negativos, pero el germen más representado fue el Staphylococcus aureus. El 58,8 por ciento de los Staphylococcus aureus se mostraron resistentes a la meticillin. La vancomicina y el linezolid resultaron efectivos en el 100 por ciento de los Gram positivos. La amikacina fue el antibiótico más efectivo para los Gram negativos. Se observó coincidencia entre el tratamiento empírico y el resultado del antibiograma en el 27,6 por ciento de los pacientes. Conclusiones: Resulta necesario un apropiado diagnóstico microbiológico de las úlceras del pie diabético para identificar los gérmenes presentes en las lesiones y diseñar algoritmos de terapia antimicrobiana adecuados(AU)

ABSTRACT Introduction: Diabetic foot ulcer infections are common, complex, high cost and are the leading cause of non-traumatic lower extremity amputation. Objective: To identify the microorganisms isolated to estimate both the sensitivity to antibiotics and the coincidence between empirical treatment and microbiological results in patients with diabetic foot ulcers. Methods: A descriptive-retrospective investigation was performed. The study population consisted of 210 patients admitted to the University Hospital "Comandante Faustino Pérez Hernández" of Matanzas between June 2017 and June 2020. The output variables were the frequency and type of germ, the number of germs per ulcer, the sensitivity for each type of antibiotic, and the percentage of coincidence between the empirical treatment and the microbiological result. Results: A total of 259 germs were identified and 1.23 germs per ulcer were observed. The 62.5 percent of the germs found were Gram negative, but the most represented germ was Staphylococcus aureus. Of the Staphylococcus aureus, 58.8 percentwere resistant to methicillin. Vancomycin and linezolid were effective in 100 percent of Gram positives. Amikacin was the most effective antibiotic for Gram-negatives. Agreement between empirical treatment and antibiogram result was observed in 27.6 percent of patients. Conclusions: An appropriate microbiological diagnosis of diabetic foot ulcers is necessary to identify the germs present in the lesions and to design adequate antimicrobial therapy algorithms(AU)

Asunto(s)