Since SAR-COV-2 infection emerged and spread worldwide, little is known about its impact on people living with human immunodeficiency virus (HIV). We performed a single-center retrospective study to ...describe the potential particularities and risk factors for respiratory failure (RF) in that population. This single-center retrospective study included patients infected with HIV, whose current follow-up is run in this center, above18 years of age, with diagnosis of SARS-CoV-2 infection between March 5, 2020 and April 15, 2021. We collected data regarding HIV immunological and virological status, main epidemiological characteristics, as well as those conditions considered to potentially influence in SARS-CoV-2 evolution; and clinical, microbiological, radiological, respiratory status, and survival concerning coronavirus disease 2019 (COVID-19). We compared all that, for patients with and without RF and performed a logistic regression for suspected risk factors for RF. One hundred seventy-seven HIV patients were diagnosed from COVID-19 (mean age 53.8 years, 81.3% male). At diagnosis, 95.5% were receiving ART and 91.3% had undetectable viral load, with median CD4 count of 569 cells/μL. One hundred thirty-eight patients (78.4%) had symptoms, 44 (25%) developed RF and 53 (31%) developed bilateral pneumonia. The most commonly used treatments were: steroids (26.7%) and hydroxychloroquine (13.1%). When comparing patients with and without RF, we found statistically significant differences for 20 of the analyzed variables such as age (
< .001) and CD4 (
0.002), and route of HIV transmission by intravenous drug users IVDU (
0.002) were determined. In multivariate analysis, age odds ratio (OR) 1.095 and CD4 count less than 350 cells/μL (OR 3.36) emerged as risk factor for RF. People living with HIV whose CD4 count is <350 cells are at higher risk of developing RF when infected by SARS-CoV-2.
Culture of catheter hubs and skin surrounding the catheter entry site has a negative predictive value for catheter tip colonization. However, manipulation of the hub for culture requires the hubs to ...be swabbed, introducing potential dislodging of biofilm and subsequent migration of microorganisms. Hubs are usually closed with needleless connectors (NCs), which are replaced regularly. Our objective was to evaluate whether culture of flushed withdrawn NCs is an alternative to hub culture when investigating central venous catheter colonization.
The study population comprised 49 intensive care unit patients whose central venous catheters had been in place for at least 7 days. Cultures of NCs and skin were obtained weekly.
We included 82 catheters with more than 7 days' indwelling time. The catheter tip colonization rate was 18.3% (15/82). Analysis of skin and NC cultures revealed a 92.5% negative predictive value for catheter colonization. Three episodes of catheter-related bloodstream infection (C-RBSI) occurred in patients with colonized catheters.
Surveillance of NC and skin cultures could help to identify patients at risk for C-RBSI.
The effect of above-normal body mass index (BMI) on health outcomes is controversial because it is difficult to distinguish from the effect due to BMI-associated cardiovascular risk factors. The ...objective was to analyze the impact on 10-year incidence of cardiovascular disease, cancer deaths and overall mortality of the interaction between cardiovascular risk factors and BMI. We conducted a pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35–79years old at basal examination. Body mass index was measured at baseline being the outcome measures ten-year cardiovascular disease, cancer and overall mortality. Multivariable analyses were adjusted for potential confounders, considering the significant interactions with cardiovascular risk factors. We included 54,446 individuals (46.5% with overweight and 27.8% with obesity). After considering the significant interactions, the 10-year risk of cardiovascular disease was significantly increased in women with overweight and obesity Hazard Ratio=2.34 (95% confidence interval: 1.19–4.61) and 5.65 (1.54–20.73), respectively. Overweight and obesity significantly increased the risk of cancer death in women 3.98 (1.53–10.37) and 11.61 (1.93–69.72). Finally, obese men had an increased risk of cancer death and overall mortality 1.62 (1.03–2.54) and 1.34 (1.01–1.76), respectively. In conclusion, overweight and obesity significantly increased the risk of cancer death and of fatal and non-fatal cardiovascular disease in women; whereas obese men had a significantly higher risk of death for all causes and for cancer. Cardiovascular risk factors may act as effect modifiers in these associations.
•Obesity increases the risk of cardiovascular disease, cancer and overall death.•Cardiovascular risk factors modify the effect of obesity on adverse health outcomes.•BMI presents a dose-response pattern with no healthy pattern of increased weight.
The Maki technique is the standard method for detecting catheter tip (CT) colonization. However, some “multi-lumen” catheters finish in a vaulted fornix and end at different distances from the CT. ...Therefore, we compared the traditional Maki technique with the sonication method using several cross-cut fragments of the CT. Our objective was to assess the yield of the Maki technique followed by sonication in the detection of adult CT colonization and catheter-related bloodstream infection (C-RBSI). For 3months, we prospectively performed CT cultures of polyurethane catheters from adult patients admitted to our institution. First, we performed CT culture using the Maki technique on blood agar plates and then sonicated small fragments of CTs in 5ml of BHI followed by culture of 100μl of the sonicate. We included a total of 252 CVCs, with overall colonization and C-RBSI rates of 14.3% (36/252) and 5.9% (15/252). Of the 36 colonized CVCs, 21 (58.3%) were detected both by Maki and sonication, 6 (16.7%) were detected only by Maki technique, and 9 (25.0%) only by sonication method. Among 15 episodes with concomitant bacteremia, both techniques were positive and concordant in 9 cases (60.0%), the result of the Maki was positive in only 1 (6.7%), and sonication in 5 (33.3%).
Our study shows that both techniques are complementary. We recommend sonicating fragments of the CT from patients with bacteremia of unknown origin and a negative CT culture by the Maki technique.
•We assessed in 252 CVC tips the yield of Maki and sonication (after slicing) to predict colonization and C-RBSI.•Maki and sonication were both positive only in 58.3% and 60.0% of the colonized catheters, respectively.•Sonication recovered >25.0% of the colonized catheters and C-RBSI episodes that would have gone undetected by Maki.•We recommend performing both techniques in the Microbiology laboratory to detect catheter tip colonization.
Staphylococcus aureus is a well-known biofilm-producing pathogen that is capable of causing chronic infections owing to its ability to resist antibiotic treatment and obstruct the immune response. ...However, the possible association between high biofilm production and infective endocarditis (IE) has not been assessed. Our objective was to compare production of biofilm by S. aureus strains isolated from patients with bacteremia and IE, catheter-related bloodstream infection (C-RBSI), or non-device associated bacteremia.
We isolated 260 S. aureus strains from the blood of patients with bacteremia who were diagnosed during hospital admission between 2012 and 2015. Patients were divided into 3 groups according to whether they had IE, C-RBSI, or non-device associated bacteremia. Biofilm production was measured in terms of biomass and metabolic activity using the crystal violet and XTT assays, respectively. High biomass and metabolic activity rates (based on tertile ranks classification) were compared between the 3 groups.
The high biomass and metabolic activity rates of each group were 41.9% and 37.2% for IE, 32.5% and 35.0%, for C-RBSI, and 29.0% and 33.3% for non-device associated bacteremia (p=0.325 and p=0.885, respectively).
High biomass and metabolic activity levels for S. aureus isolates from IE were similar to those of S. aureus isolates from C-RBSI or non-device associated bacteremia.
Staphylococcus aureus es un conocido microorganismo productor de biofilm, capaz de causar infecciones crónicas debido a su capacidad de resistir el tratamiento antibiótico y dificultar la respuesta inmunitaria. Sin embargo, no se ha evaluado la posible asociación entre una elevada producción de biofilm y la endocarditis infecciosa (EI). Nuestro objetivo fue comparar la producción de biofilm por parte de cepas de S.aureus aisladas de pacientes con bacteriemia y EI, bacteriemia relacionada con el catéter (BRC) o bacteriemia no asociada a dispositivos.
Se aislaron 260 cepas de S.aureus de sangre de pacientes con bacteriemia que fueron diagnosticados durante su ingreso hospitalario entre 2012 y 2015. Los pacientes se dividieron en tres grupos según tuvieran EI, BRC o bacteriemia no asociada a dispositivos. La producción de biofilm se midió en términos de biomasa y de actividad metabólica utilizando los ensayos de cristal violeta y XTT, respectivamente. Se compararon los índices de alta biomasa y actividad metabólica (basadas en clasificación por terciles) entre los tres grupos.
Los índices altos de biomasa y actividad metabólica de cada grupo fueron del 41,9 y del 37,2% para EI, del 32,5 y del 35,0% para BRC, y del 29,0 y del 33,3% para bacteriemia no asociada a dispositivos (p=0,325 y p=0,885, respectivamente).
Los niveles altos de biomasa y actividad metabólica de los aislados de S.aureus procedentes de EI fueron similares a los de los aislados de BRC o de bacteriemia no asociada a dispositivos.
OBJECTIVESStaphylococcus aureus is a well-known biofilm-producing pathogen that is capable of causing chronic infections owing to its ability to resist antibiotic treatment and obstruct the immune ...response. However, the possible association between high biofilm production and infective endocarditis (IE) has not been assessed. Our objective was to compare production of biofilm by S. aureus strains isolated from patients with bacteremia and IE, catheter-related bloodstream infection (C-RBSI), or non-device associated bacteremia. METHODSWe isolated 260 S. aureus strains from the blood of patients with bacteremia who were diagnosed during hospital admission between 2012 and 2015. Patients were divided into 3 groups according to whether they had IE, C-RBSI, or non-device associated bacteremia. Biofilm production was measured in terms of biomass and metabolic activity using the crystal violet and XTT assays, respectively. High biomass and metabolic activity rates (based on tertile ranks classification) were compared between the 3 groups. RESULTSThe high biomass and metabolic activity rates of each group were 41.9% and 37.2% for IE, 32.5% and 35.0%, for C-RBSI, and 29.0% and 33.3% for non-device associated bacteremia (p=0.325 and p=0.885, respectively). CONCLUSIONSHigh biomass and metabolic activity levels for S. aureus isolates from IE were similar to those of S. aureus isolates from C-RBSI or non-device associated bacteremia.
Background Clear differentiation of arterial and intravenous (IV) lines is a safety strategy recommended by the World Health Organization, and signaling stickers attached to IV lines are implemented ...in many institutions. However, the risk of colonization of the stickers' surface has not been evaluated. Our objective was to assess the colonization rate of stickers used for IV lines identification in an in vitro model using 3 different contamination degrees. Methods A set of 30 stickers used for IV lines identification were exposed to low, medium, and high contamination degrees for up to 15 days. Twice a day, a single manipulator vigorously touched the surface of the stickers simulating the daily handling. Surface cultures of all stickers were performed daily. The microorganisms recovered were counted and identified by phenotypic characteristics. Results Colonization occurred after 5 days in low and medium manipulation models and after 3 days in the high manipulation model. Nonadhesive sticker sides were associated with greater significant numbers of colony forming units when manipulation was performed without gloves. Conclusion Stickers used for the identification of IV lines may become potential reservoirs of catheter colonization. Clinical studies to validate these data and design policies of stickers' changes are required.
The Maki technique is the standard method for detecting catheter tip (CT) colonization. However, some “multi-lumen” catheters finish in a vaulted fornix and end at different distances from the CT. ...Therefore, we compared the traditional Maki technique with the sonication method using several cross-cut fragments of the CT. Our objective was to assess the yield of the Maki technique followed by sonication in the detection of adult CT colonization and catheter-related bloodstream infection (C-RBSI). For 3months, we prospectively performed CT cultures of polyurethane catheters from adult patients admitted to our institution. First, we performed CT culture using the Maki technique on blood agar plates and then sonicated small fragments of CTs in 5ml of BHI followed by culture of 100μl of the sonicate. We included a total of 252 CVCs, with overall colonization and C-RBSI rates of 14.3% (36/252) and 5.9% (15/252). Of the 36 colonized CVCs, 21 (58.3%) were detected both by Maki and sonication, 6 (16.7%) were detected only by Maki technique, and 9 (25.0%) only by sonication method. Among 15 episodes with concomitant bacteremia, both techniques were positive and concordant in 11 cases (73.3%) and in 4 cases (26.7%) sonication was the only positive technique.
Our study shows that both techniques are complementary. We recommend sonicating fragments of the CT from patients with bacteremia of unknown origin and a negative CT culture by the Maki technique.
We assessed agreement between the crystal violet binding assay and the XTT assay in the classification of biofilm production in 492 Staphylococcus aureus strains from bacteremic patients. We found ...that the overall correlation between the procedures was 46.5%. Biomass production and metabolic activity must be assessed simultaneously.
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