Ferran Sanchez

Epidemiology and Predictors of Mortality in Cases of Candida Bloodstream Infection: Results from Population-Based Surveillance, Barcelona, Spain, from 2002 to 2003

ABSTRACT We conducted population-based surveillance for Candida bloodstream infections in Spain to determine its incidence, the extent of antifungal resistance, and risk factors for mortality. A case was defined as the first positive blood culture for any Candida spp. in a resident of Barcelona, from 1 January 2002 to 31 December 2003. We defined early mortality as occurring between days 3 to 7 after candidemia and late mortality as occurring between days 8 to 30. We detected 345 cases of candidemia, for an average annual incidence of 4.3 cases/100,000 population, 0.53 cases/1,000 hospital discharges, and 0.73 cases/10,000 patient-days. Outpatients comprised 11% of the cases, and 89% had a central venous catheter (CVC) at diagnosis. Overall mortality was 44%. Candida albicans was the most frequent species (51% of cases), followed by Candida parapsilosis (23%), Candida tropicalis (10%), Candida glabrata (8%), Candida krusei (4%), and other species (3%). Twenty-four isolates (7%) had decreased susceptibility to fluconazole (MIC ≥ 16 μg/ml). On multivariable analysis, early death was independently associated with hematological malignancy (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1 to 10.4). Treatment with antifungals (OR, 0.05; 95% CI, 0.01 to 0.2) and removal of CVCs (OR, 0.3; 95% CI, 0.1 to 0.9) were protective factors for early death. Receiving adequate treatment, defined as having CVCs removed and administration of an antifungal medication (OR, 0.2; 95% CI, 0.08 to 0.8), was associated with lower odds of late mortality; intubation (OR, 7.5; 95% CI, 2.6 to 21.1) was associated with higher odds. The incidence of candidemia and prevalence of fluconazole resistance are similar to other European countries, indicating that routine antifungal susceptibility testing is not warranted. Antifungal medication and catheter removal are critical in preventing mortality.

Epidemiology, risk factors, and prognosis of Candida parapsilosis bloodstream infections: case-control population-based surveillance study of patients in Barcelona, Spain, from 2002 to 2003.

ABSTRACT Candida parapsilosis has emerged as an important yeast species causing fungemia. We describe the incidence and epidemiology of C. parapsilosis fungemia. Data from active population-based surveillance in Barcelona, Spain, from January 2002 to December 2003 were analyzed. We focused on 78 episodes of C. parapsilosis fungemia, and we compared them with 175 Candida albicans controls. C. parapsilosis accounted for 23% of all fungemias. The annual incidences were 1 episode per 105 patients, 1.2 episodes per 104 discharges, and 1.7 episodes per 105 patient days. All isolates but one (99%) were fluconazole susceptible. Seventy-two isolates (92%) were inpatient candidemias. Forty-two episodes (51%) were considered catheter-related fungemia, 35 (45%) were considered primary fungemia, and 3 (4%) were considered secondary fungemia. Risk factors for candidemia were vascular catheterization (97%), prior antibiotic therapy (91%), parenteral nutrition (54%), prior surgery (46%), prior immunosuppressive therapy (38%), malignancy (27%), prior antifungal infection (26%), transplant recipient (16%), neutropenia (12%), and prior colonization (11%). Multivariate analysis of the differential characteristics showed that the factors that independently predicted the presence of C. parapsilosis fungemia were neonate patients (odds ratio [OR], 7.5; 95% confidence interval [CI], 2.1 to 26.8; P = 0.002), transplant recipients (OR, 9.2; 95% CI, 1.9 to 43.3; P = 0.005), patients with a history of prior antifungal therapy (OR, 5.4; 95% CI, 1.8 to 15.9; P = 0.002), and patients who received parenteral nutrition (OR, 2.2; 95% CI, 1.09 to 4.6; P = 0.028). The overall mortality rate was lower than that associated with C. albicans candidemia (23% versus 43%; P < 0.01). In summary, C. parapsilosis was responsible for 23% of all candidemias and was more frequent in neonates, in transplant recipients, and in patients who received parenteral nutrition or previous antifungal therapy, mainly fluconazole. The mortality rate was lower than that associated with C. albicans fungemia.

Candidemia in neonatal intensive care units: Barcelona, Spain.

Background: Candida spp. are increasingly important hospital-acquired pathogens in neonatal intensive care units (NICU) and cause considerable mortality in preterm infants. Most studies have been limited to a single institution. The aim of this study was to determine the epidemiology of candidemia in all Barcelona NICUs. Methods: We conducted prospective population-based surveillance for candidemia in Barcelona, Spain, during 2002–2003. This report focuses on the results from 5 participating hospitals with NICUs. Results: We detected 24 cases, resulting in an annual incidence of 32.6 cases per 100,000 live births and 1.1 cases per 100 NICU discharges. Median gestational age was 27.5 weeks (range, 24–40.5), and there were 21 cases among very low birth weight infants. Among the 20 (83%) cases evaluated for the presence of end organ infection, endophthalmitis occurred in 2 cases, and endocarditis, meningitis and peritonitis occurred in 1 case each. Candida parapsilosis was the most frequent species isolated (67%). All isolates were fluconazole-susceptible. Crude mortality was 21%. Conclusions: The preponderance of C. parapsilosis candidemias observed in Barcelona NICUs is similar to reports from the literature. Morbidity and mortality associated with neonatal candidemia remain high.

Predictors of candidaemia caused by non-albicans Candida species: results of a population-based surveillance in Barcelona, Spain

Although Candida albicans (CA) is the most common cause of Candida bloodstream infections (BSIs), recent studies have observed an increasing percentage of candidaemias caused by non-albicans Candida species (NAC). In the present study, we attempted to identify the predictors of candidaemia due to NAC compared to CA. We analyzed data from an active population-based surveillance in Barcelona (Spain) from January 2002 to December 2003. Factors associated with NAC fungaemia were determined by multivariate analysis. A total of 339 episodes of Candida BSI, in 336 patients (median age 63 years, interquartile range: 41-72 years), were included. CA was the most commonly isolated (52%), followed by Candida parapsilosis (23%), Candida tropicalis (10%), Candida glabrata (8.6%), Candida krusei (3.4%) and other NAC spp. (3%).Overall, 48% of cases were due to NAC spp. Multivariate logistic regression analysis identified factors associated with a risk of BSI due to NAC spp.: having received a haematologic transplant (OR 10.8; 95% CI 1.31-90.01; p 0.027), previous fluconazole exposure (OR 4.47; 95% CI 2.12-9.43; p <0.001) and neonatal age (OR 4.42; 95% CI 1.63-12.04; p 0.004). Conversely, previous CA colonization (OR 0.33; 95% CI 0.19-0.57; p 0.001) and previous antibiotic use (OR 0.42; 95% CI 0.21-0.85; p 0.017) were associated with CA fungaemia compared to NAC. In conclusion, NAC candidaemia comprised 48% of cases in our series. Predictors of NAC include having received a haematologic transplant, neonatal age and previous fluconazole use.

Declive de la incidencia de la sepsis perinatal por estreptococo del grupo B (Barcelona 1994-2001). Relación con las políticas profilácticas

Introduccion Analizar la incidencia de la sepsis perinatal por estreptococo del grupo B (EGB) y relacionarla con la aplicacion de las recomendaciones de prevencion consensuadas en 1997 por las sociedades catalanas de Obstetricia, Pediatria y Enfermedades Infecciosas y Microbiologia Clinica. Metodos El estudio se realizo desde 1994 a 2001 y en el participaron 10 hospitales del area de Barcelona, donde se registraron 157.848 nacidos vivos. Resultados Fueron diagnosticados 129 recien nacidos de sepsis perinatal por EGB. La incidencia disminuyo el 86,1%, desde el 1,92/1.000 nacidos vivos en 1994 hasta el 0,26/1.000 en 2001 (p Conclusiones En 8 anos se ha conseguido una importante disminucion de la incidencia de sepsis perinatal por EGB, coincidiendo con la aplicacion de protocolos de prevencion de esta patologia.

MEGARA spectrograph optics

MEGARA is the next optical Integral-Field Unit (IFU) and Multi-Object Spectrograph (MOS) for Gran Telescopio Canarias. The instrument offers two IFUs plus a Multi-Object Spectroscopy (MOS) mode: a large compact bundle covering 12.5 arcsec x 11.3 arcsec on sky with 100 μm fiber-core; a small compact bundle, of 8.5 arcsec x 6.7 arcsec with 70 μm fiber-core and a fiber MOS positioner that allows to place up to 100 mini-bundles, 7 fibers each, with 100 μm fiber-core, within a 3.5 arcmin x 3.5 arcmin field of view, around the two IFUs. The fibers, organized in bundles, end in the pseudo-slit plate, which will be placed at the entrance focal plane of the MEGARA spectrograph. The large IFU and MOS modes will provide intermediate to high spectral resolutions, R=6800-17000. The small IFU mode will provide R=8000-20000. All these resolutions are possible thanks to a spectrograph design based in the used of volume phase holographic gratings in combination with prisms to keep fixed the collimator and camera angle. The MEGARA optics is composed by a total of 53 large optical elements per spectrograph: the field lens, the collimator and the camera lenses plus the complete set of pupil elements including holograms, windows and prisms. INAOE, a partner of the GTC and a partner of MEGARA consortium, is responsible of the optics manufacturing and tests. INAOE will carry out this project working in an alliance with CIO. This paper summarizes the status of MEGARA spectrograph optics at the Preliminary Design Review, held on March 2012.

Invasive disease caused by Haemophilus influenzae: the sensitivity of statutory reporting

PURPOSE The objective of the study was to investigate the sensitivity of the statutory reporting of Haemophilus influenzae invasive disease (HIID) during the period between 1996 and 1997 in Catalonia, Spain. METHODS The incidence of HIID reported passively by clinicians was compared with the cases detected by a system of microbiological surveillance. In all cases isolated, the age of the patient, the clinical form and the serotype were investigated. RESULTS Sixty-six cases were passively reported and 111 were detected by microbiological surveillance. Overall sensitivity of reporting was 59.5% (95% CI, 50.7-69.1), with differences being observed according to the variables studied. The highest values were obtained in children under 5 years (87.8%; 95% CI, 73.7-95.9), in cases with meningitis and/or sepsis (64.3%; 95% CI, 50.4-76.6) and in serotype b (73.0%; 95% CI, 60.3-83.4). In the logistical regression analysis, only age under 5 years was associated with greater reporting (OR= 9.8; 95% CI, 2.5-37.8). CONCLUSIONS Reported morbidity in children under 5 years is a good estimate of the true incidence of HIID in Catalonia (underreporting was 12.2%), but not for those above this age in whom the underreporting was 57.2%.

MEGARA focal plane subsystems

MEGARA (Multi-Espectrógrafo en GTC de Alta Resolución para Astronomía) is the future optical Integral-Field Unit (IFU) and Multi-Object Spectrograph (MOS) for GTC. The Fiber Units are placed at one Folded Cassegrain focus and feed the spectrograph located on a Nasmyth-type platform. This paper summarizes the status of the design of the MEGARA Folded Cassegrain Subsystems after the PDR (held on March 2012), as well as the prototyping that has been carried out during this phase. The MEGARA Fiber Unit has two IFUs: a Large Compact Bundle covering 12.5 arcsec x 11.3 arcsec on sky (100 microns fiber-core), and a Small Compact Bundle, of 8.5 arcsec x 6.7 arcsec (70 microns fiber-core), plus a Fiber MOS positioner, able to place up to 100 mini-bundles 7 fibers each (100 microns fiber-core) in MOS configuration within a 3.5arcmin x 3.5arcmin FOV. A field lens provides a telecentric focal plane where the fibers are located. Microlens arrays couple the telescope beam to the collimator focal ratio at the entrance of the fibers (providing the f/17 to f/3 focal ratio reduction to enter into the fibers). Finally, the fibers, organized in bundles, end in the pseudo-slit plate, which will be placed at the entrance focal plane of the MEGARA spectrographs.

Evolución de la sepsis neonatal precoz por Streptococcus agalactiae en el área de Barcelona (2004-2010). Análisis de los fallos del cumplimiento del protocolo de prevención

OBJECTIVES To study the evolution of the incidence of early-onset neonatal sepsis (EOS) by Streptococcus agalactiae in the area of Barcelona and to analyze failure of compliance with the prevention protocol. METHODS A retrospective review was carried out on EOS cases in 8 Health-Care Centers in the Barcelona area between 2004 and 2010. RESULTS Forty-nine newborns from 48 mothers were diagnosed with EOS. The incidence was 0.29‰ living newborns (0.18-0.47‰), with no significant differences in the fluctuations along the 7 years. The mortality rate was 8.16%. In 68.5% cases the maternal colonization studies were negative, and in 21% these studies were not performed. No risk factors were detected in 58.3% of pregnant women, and 22.9% of births were premature. In 58% of cases intra-partum antibiotic prophylaxis was not administered because it was not indicated, and in 42% due to failure to follow the protocol (3 strains were resistant to erythromycin). Resistance to clindamycin was 33.3%. The Streptococcus agalactiae serotypes more frequently isolated were iii, v, and ia. CONCLUSIONS No significant changes were detected in the incidence of Streptococcus agalactiae EOS in the 7 years of the study. The increased sensitivity of screening methods with the use of molecular techniques, the performance of susceptibility testing of strains isolated from pregnant women, and the improvement of communication between Health-Care Centers, can contribute to a better implementation of the protocol, as well as to reduce the incidence of EOS.

New empirical metallicity calibrations: Joint analysis of CALIFA data and literature T e -based measurements

In Marino et al. ( 2013 ) we provide revisited empirical calibrations for the oxygen abundances in HII regions based on the O3N2 and N2 indicators. This work is based on the most comprehensive compilation of both T e -based and multiple strong-line (ONS-based) ionized-gas abundance measurements in external galaxies to date in terms of all statistical significance, quality, and coverage of the parameters space. Our dataset compiles the T e -based abundances of 603 HII regions extracted from the literature but also includes new measurements from the CALIFA survey. We also present a comparison between our revisited calibrations with a total of 3423 additional CALIFA HII complexes with abundances derived using the ONS calibration. The O3N2 and N2 indicators can be empirically applied to derive oxygen abundances calibrations from either direct-abundance determinations with random errors of 0.18 and 0.16, respectively, and they show shallower abundance dependencies and statistically significant offsets compared to the classical calibrations (as the one of Pettini & Pagel ( 2004 )).