Most cases of invasive aspergillosis are caused by
, whose conidia are ubiquitous in the environment. Additionally, in indoor environments, such as houses or hospitals, conidia are frequently ...detected too. Hospital-acquired aspergillosis is usually associated with airborne fungal contamination of the hospital air, especially after building construction events.
strain typing can fulfill many needs both in clinical settings and otherwise. The high incidence of aspergillosis in COVID patients from our hospital, made us wonder if they were hospital-acquired aspergillosis. The purpose of this study was to evaluate whether the hospital environment was the source of aspergillosis infection in CAPA patients, admitted to the Hospital Universitario Central de Asturias, during the first and second wave of the COVID-19 pandemic, or whether it was community-acquired aspergillosis before admission. During 2020, sixty-nine
strains were collected for this study: 59 were clinical isolates from 28 COVID-19 patients, and 10 strains were environmentally isolated from seven hospital rooms and intensive care units. A diagnosis of pulmonary aspergillosis was based on the ECCM/ISHAM criteria. Strains were genotyped by PCR amplification and sequencing of a panel of four hypervariable tandem repeats within exons of surface protein coding genes (TRESPERG). A total of seven genotypes among the 10 environmental strains and 28 genotypes among the 59 clinical strains were identified. Genotyping revealed that only one environmental
from UCI 5 (box 54) isolated in October (30 October 2020) and one
isolated from a COVID-19 patient admitted in Pneumology (Room 532-B) in November (24 November 2020) had the same genotype, but there was a significant difference in time and location. There was also no relationship in time and location between similar
genotypes of patients. The global
environmental and clinical isolates, showed a wide diversity of genotypes. To our knowledge, this is the first study monitoring and genotyping
isolates obtained from hospital air and COVID-19 patients, admitted with aspergillosis, during one year. Our work shows that patients do not acquire
in the hospital. This proves that COVID-associated aspergillosis in our hospital is not a nosocomial infection, but supports the hypothesis of "community aspergillosis" acquisition outside the hospital, having the home environment (pandemic period at home) as the main suspected focus of infection.
A Contemporary Picture of Enterococcal Endocarditis Hernández-Meneses, Marta; Ojeda-Burgos, Guillermo; Noureddine, Mariam ...
Journal of the American College of Cardiology,
02/2020, Letnik:
75, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking.
The purpose of this study was to describe the characteristics and analyze ...the prognostic factors of EE in the GAMES cohort.
This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses.
Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse.
Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.
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Se analizan las características epidemiológicas, clínicas y la coinfección por el VIH, así como la sensibilidad a los fármacos tuberculostáticos de los casos de tuberculosis atendidos en nuestro ...centro.
Estudio retrospectivo de los casos observados de tuberculosis entre los años 1993 y 1998 en un hospital de tercer nivel.
En el período de estudio se diagnosticaron 268 casos de tuberculosis, con una disminución progresiva de la incidencia desde 1995. Entre la población penitenciaria también se halló una reducción de casos de tuberculosis, sin que se detectaran casos de resistencias. En la población estudiada, sólo presentaban resistencia a alguno de los fármacos antituberculosos estudiados (isoniazida, rifampicina, etambutol, estreptomicina) 8 aislados (3,27%). También se observó una tendencia a disminuir las resistencias desde 1995, sin que se detectaran nuevos casos en los últimos 2 años. La tasa de resistencia primaria a la isoniacida fue del 1,3% y sólo hubo 4 casos de multirresistencia, dos de los cuales fallecieron. La tasa de coinfección por VIH fue del 38,8%. En el 39% de los casos la forma de presentación fue exclusivamente pulmonar, mientras que en el 25% fue diseminada.
Se observó un descenso de casi el 50% de los casos de tuberculosis en el período de estudio. La tasa de coinfección por VIH fue del 38,8%, una de las más altas de la bibliografía, lo que hace aconsejable incluir una serología de VIH en el protocolo de estudio de la tuberculosis. Dada la baja prevalencia de resistencias detectada recomendamos un tratamiento antituberculoso con 3 fármacos.
The epidemiologic and clinical characteristics, presence of HIV coinfection, and sensitivity to tuberculostatic drugs were analyzed in a series of tuberculosis patients attended in our center.
Retrospective study of tuberculosis cases attended in a third- level hospital from 1993 to 1998.
During the study period, 268 cases of tuberculosis were diagnosed in our center. A progressive decrease in the incidence of this disease has occurred since 1995. Among the jailed population, we also found a decrease in cases of tuberculosis and there were no cases of resistance. In the total population, only 8 isolates (3.27%) showed resistance to some of the antituberculosis drugs studied (isoniazid, rifampicin, ethambutol, streptomycin). A tendency toward a decrease in resistance was also observed starting from 1995, with no new cases detected in the last two years. There was a 1.3% rate of primary resistance to isoniazid. Multiresistance was detected in only 4 patients, two of whom died. The rate of HIV coinfection was 38.8%. In 39% of cases the form of presentation was exclusively pulmonary and in 25% it was disseminated.
There was a 50% decrease in tuberculosis cases during the period studied. The rate of HIV coinfection was 38.8%, one of the highest in the literature, indicating that HIV serology should be included in the protocol for studying tuberculosis in our setting. Given the low rate of resistance detected, we recommend a three-drug regimen for antituberculosis treatment.
The epidemiologic and clinical characteristics, presence of HIV coinfection, and sensitivity to tuberculostatic drugs were analyzed in a series of tuberculosis patients attended in our center.
...Retrospective study of tuberculosis cases attended in a third- level hospital from 1993 to 1998.
During the study period, 268 cases of tuberculosis were diagnosed in our center. A progressive decrease in the incidence of this disease has occurred since 1995. Among the jailed population, we also found a decrease in cases of tuberculosis and there were no cases of resistance. In the total population, only 8 isolates (3.27%) showed resistance to some of the antituberculosis drugs studied (isoniazid, rifampicin, ethambutol, streptomycin). A tendency toward a decrease in resistance was also observed starting from 1995, with no new cases detected in the last two years. There was a 1.3% rate of primary resistance to isoniazid. Multiresistance was detected in only 4 patients, two of whom died. The rate of HIV coinfection was 38.8%. In 39% of cases the form of presentation was exclusively pulmonary and in 25% it was disseminated.
There was a 50% decrease in tuberculosis cases during the period studied. The rate of HIV coinfection was 38.8%, one of the highest in the literature, indicating that HIV serology should be included in the protocol for studying tuberculosis in our setting. Given the low rate of resistance detected, we recommend a three-drug regimen for antituberculosis treatment.
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