Fernando González-Romo

Tos ferina en España. Situación epidemiológica y estrategias de prevención y control. Recomendaciones del Grupo de Trabajo de Tos ferina

A large increase of pertussis incidence has been observed in recent years in countries with high vaccination coverage. Outbreaks of pertussis are increasingly being reported. The age presentation has a bipolar distribution: infants younger 6months that have not initiated or completed a vaccination schedule, and adolescents and adults, due to the lost of natural or vaccine immunity over time. These epidemiological changes justify the need to adopt new vaccination strategies in order to protect young infants and to reduce pertussis incidence in all age groups. Adolescents and adults immunization must be a priority. In the first group, strategy is easy to implement, and with a very low additional cost (to replace dT vaccine by dTap one). Adult vaccination may be more difficult to implement; dT vaccine decennial booster should be replaced by dTap. The immunization of household contacts of newborn infants (cocooning) is the strategy that has a most important impact on infant pertussis. Recently, pregnant women vaccination (after 20weeks of gestation) has been recommended in some countries as the most effective way to protect the newborn.

Candidemia in the critically ill patient

The frequency of invasive fungal infections caused by yeasts has increased in intensive care units. The most commonly isolated species is Candida albicans, although the number of non-albicans species isolated has increased, and associated mortality is greater in patients infected with these species. The factors that most frequently predispose to invasive candidiasis in the intensive care unit are alterations in skin and mucous barriers (catheters, surgery, intubation, etc.), renal insufficiency, parenteral nutrition, and therapy with corticosteroids or broad-spectrum antimicrobials. Early diagnosis of invasive fungal infections by detecting fungal DNA or invasiveness factors, such as (1-->3)-beta-D-glucan or antimycelial antibodies, and scores to predict and empirically treat invasive candidiasis, have proven very useful in reducing associated morbidity and mortality. In recent years there have been important advances in the development of antifungal agents, especially the new azoles and candins. The efficacy and safety profile of the candins make them the best option for treating invasive candidiasis in the critically ill patient.

Outbreak of Acinetobacter baumannii producing OXA-66 in a Spanish hospital: epidemiology and study of patient movements.

We describe an outbreak of multidrug-resistant Acinetobacter baumannii producing OXA-66 carbapenemase and resistant to imipenem. We analyze the relationship between the spread of this strain and patient movements within the hospital. Thirty-one isolates of A. baumannii recovered from December 21, 2006, to February 18, 2007, were studied. Enterobacterial repetitive intergenic consensus PCR and randomly amplified polymorphic DNA genotyping methods were used to define clusters of clonally related isolates. Pulsed-field gel electrophoresis was used to confirm the results and to check the maintenance of the epidemic strain over the following year. Antibiotic susceptibility testing was performed by microdilution and E-test. The isolates were screened by PCR analysis with primers specific for carbapenemase genes. With the exception of colistin (0%) there were no antibiotics with good activity against these isolates. The epidemiology study revealed that the same strain was responsible for all the infections. This strain appeared to carry the bla(OXA-66) gene. ISAba1 was present upstream the oxacillinase gene. The clone responsible for the outbreak is still present in hospital.

Recomendaciones de vacunación frente a neumococo en enfermos renales en España

UNLABELLED Invasive pneumococcal disease (IPD) is a serious problem in some risk groups: patients with stage 4 and 5 chronic kidney disease, stage 3 CKD undergoing immunosuppressive treatment, nephrotic syndrome or diabetes. These individuals are more susceptible to infections and more prone to suffering more severe and worsening symptoms. Vaccination is one of the strategies for preventing IPD, although vaccination coverage in this group at present is lower than desired. Currently, there are two vaccinations for adults. The polysaccharide vaccine (PPSV23), used for decades in patients over the age of 2, includes most serotypes (23), but it does not generate immune memory, causing the immune tolerance phenomenon and it does not act on nasopharyngeal colonisation. The conjugate vaccine (VNC13) can be used from infancy until adulthood (advice in patients over 18 years old received approval from the European Medicines Agency in July 2013) and generates a more powerful immune response than PPSV23 against the majority of the 13 serotypes that it includes. The 16 scientific societies most directly associated with the groups at risk of IPD have discussed and drafted a series of vaccination recommendations based on scientific evidence related to pneumococcal vaccination in adults with underlying conditions and pathologies, which are the subject of the document “ CONSENSUS Pneumococcal vaccination in adults with underlying pathology”. This text sets out the vaccination recommendations for the chronic kidney disease population.

Update on fungal infections − Introduction

An international update symposium on fungal infections took place in Madrid, Spain, from 29 February to 1 March 2008. Organized by the Spanish Society of Chemotherapy and supported by the International Society of Chemotherapy, Infections and Cancer (ISC) and the Federation of European Societies for Chemotherapy and Infections (FESCI), this conference covered the epidemiological, clinical, and therapeutic aspects of the most typical settings of fungal infections in adults: the non-neutropenic critically ill patient and the immunosuppressed patient (neutropenic or undergoing solid organ transplantation [SOT] or hematopoietic stem cell transplantation [HSCT]). The significance of fungal infection in these settings has increased greatly in recent years. This is due to better intrinsic knowledge of the diseases that predispose a patient to fungal infection and the hemodynamic and nutritional support that increase survival, and also to more effective prophylaxis and antimicrobial treatment. This greater knowledge of the disease and its complications allows the choice of specific therapeutic targets (antilymphocyte monoclonal antibodies, therapy with a prolonged neutropenic effect), or prophylactic schedules that predispose the patient not just to fungal infection, but also to the selection of fungal subspecies such as non-albicans Candida, Aspergillus terreus, Scedosporium species, Zygomycetes, etc. At the conference, the main antifungal agents were reviewed in order to consolidate prophylaxis and treatment schedules. The guidelines of the Infectious Disease Society of America (IDSA) [1] were taken as a reference for invasive candidiasis and aspergillosis [2], with specific considerations according to the model of infection and the patient’s profile. A change in the frequency and type of yeast isolates has emerged in intensive care units [3]. The current incidence of candidemia is around 1.5 episodes per 1000 days of intensive care unit (ICU) admission, with an attributable

Recommendations for vaccination against pneumococcus in patients with kidney patients in Spain

UNLABELLED Invasive pneumococcal disease (IPD) is a serious problem in some risk groups: patients with stage 4 and 5 chronic kidney disease, stage 3 CKD undergoing immunosuppressive treatment, nephrotic syndrome or diabetes. These individuals are more susceptible to infections and more prone to suffering more severe and worsening symptoms. Vaccination is one of the strategies for preventing IPD, although vaccination coverage in this group at present is lower than desired. Currently, there are two vaccinations for adults. The polysaccharide vaccine (PPSV23), used for decades in patients over the age of 2, includes most serotypes (23), but it does not generate immune memory, causing the immune tolerance phenomenon and it does not act on nasopharyngeal colonisation. The conjugate vaccine (VNC13) can be used from infancy until adulthood (advice in patients over 18 years old received approval from the European Medicines Agency in July 2013) and generates a more powerful immune response than PPSV23 against the majority of the 13 serotypes that it includes. The 16 scientific societies most directly associated with the groups at risk of IPD have discussed and drafted a series of vaccination recommendations based on scientific evidence related to pneumococcal vaccination in adults with underlying conditions and pathologies, which are the subject of the document “ CONSENSUS Pneumococcal vaccination in adults with underlying pathology”. This text sets out the vaccination recommendations for the chronic kidney disease population.