Javier Colomina

Risk Factors and Prognosis of Nosocomial Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Escherichia coli

ABSTRACT Extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs) caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.4 to 15.7), the previous use of oxyimino-β-lactams (OR = 6.0; 95% CI = 3.0 to 11.8), and unknown BSI source (protective; OR = 0.4; 95% CI = 0.2 to 0.9), and duration of hospital stay (OR = 1.02; 95% CI = 1.00 to 1.03). The variables independently associated with mortality were a Pitt score of >1 (OR = 3.9; 95% CI = 1.2 to 12.9), a high-risk source (OR = 5.5; 95% CI = 1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR = 6.5; 95% CI = 1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-β-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality.

Human rotavirus G9 and G3 as major cause of diarrhea in hospitalized children, Spain.

A major shift in the predominant strains of rotavirus was detected.

Diversity of Group A Human Rotavirus Types Circulating over a 4-Year Period in Madrid, Spain

ABSTRACT The incidence and distribution of human rotavirus G types among children under 5 years old with acute gastroenteritis were determined over a 4-year period (1998 to 2002) by using monoclonal antibodies and reverse transcription-PCR methods. Rotavirus was detected in 1,155 (31%) of 3,760 specimens tested. Rotavirus was studied in every month of the 48-month survey period. Rotavirus activity occurred mainly (51%) in the typically cooler months in Spain (November to February). The age distribution of rotavirus-positive cases showed that 90% of patients (1,038 of 1,155) were under 2 years old. Rotavirus types were determined for 576 of 1,155 patients (50%). G1 was the main genotype detected (53%), and the second most common was G4 (24%). The G2, G9, and G3 rotavirus types were detected in 14, 6, and 2% of the cases, respectively. Dual infections were detected in only 0.6%. The seasonal distribution of genotypes showed a significant genotypic shift: whereas G4 strains predominated (57%) during the 1998 to 2000 seasons, the G1 gradually increased to account for 75% in the 2000 to 2002 seasons. In addition, the present study reports the first detection of the G9 genotype in human fecal samples in Spain. Therefore, additional types may be required for vaccine development strategies that currently target only types G1 to G4.

Surveillance of human calicivirus in Spain.

To the Editor: Human caliciviruses (HuCVs) are an important cause of acute viral gastroenteritis in young children worldwide (1,2). In Spain, norovirus infections are not subject to specific surveillance; few data exist about sporadic cases (3,4) and none about outbreaks across the country. We have conducted a surveillance study of acute gastroenteritis epidemics to determine the prevalence of HuCV infections. Our goal was to gain insight into the epidemiology of these infections in Spain and consider new directions to prevent them and control improvements in food and water quality and sanitary practices.

Low Incidence of Tick-Borne Rickettsiosis in a Spanish Mediterranean Area

Abstract:  The aim of this study was to know the incidence of tick‐borne rickettsial disease in a Mediterranean area. The incidence in 5 years for 100,000 inhabitants was 1.7 for tick‐borne‐lymphadenopathy (TIBOLA) and 0.4 for Mediterranean spotted fever (MSF). MSH incidence during the last few years has been lower than expected; in contrast TIBOLA seems to be an emerging disease. At the present time our data suggest a low tick‐borne rickettsiosis incidence of MSF and a superior incidence of TIBOLA than MSF in the Spanish Mediterranean area.

Brote de meningitis por echovirus serotipo 30 en la Comunidad Valenciana

BACKGROUND AND OBJECTIVE Aseptic meningitis can be caused by several agents, and in many cases the etiology remains unknown. The aim of this study to analyze the clinical and epidemiological characteristics of a meningitis outbreak detected in Health Department 11 of the Valencian Community (Spain). MATERIAL AND METHODS The study was performed in children hospitalized between November and December 2006 with meningitis symptoms, CSF pleocytosis, and negative CSF bacteriological culture. An epidemiological survey was conducted among cases and family members. Virus detection and phylogenetic analysis were performed with molecular biology techniques. RESULTS The outbreak affected at least 44 children, with a mean age (standard deviation) of 5.5 years (2.9). The average hospital stay was 3.1 days and outcome was favorable in all cases. In 24 patients the CSF specimen sufficed for viral detection by PCR; enteroviruses ultimately serotyped as echovirus 30 were detected in 12 of them (50%). This serotype has been recently found in other parts of our country. CONCLUSIONS Detection of echovirus 30 in CSF and the epidemiological presentation of cases enabled determination of the etiology of the outbreak. This finding coincided in time with other outbreaks of echovirus 30 in Spain, a fact that may explain the epidemic situation in the Valencian Community during 2006. Establishment of a national surveillance network for monitoring systemic enterovirus infection would provide data on the circulation patterns and identify new emerging serotypes.

OriginalBrote de meningitis por echovirus serotipo 30 en la Comunidad ValencianaMeningitis outbreak caused by Echovirus serotype 30 in the Valencian Community

BACKGROUND AND OBJECTIVE Aseptic meningitis can be caused by several agents, and in many cases the etiology remains unknown. The aim of this study to analyze the clinical and epidemiological characteristics of a meningitis outbreak detected in Health Department 11 of the Valencian Community (Spain). MATERIAL AND METHODS The study was performed in children hospitalized between November and December 2006 with meningitis symptoms, CSF pleocytosis, and negative CSF bacteriological culture. An epidemiological survey was conducted among cases and family members. Virus detection and phylogenetic analysis were performed with molecular biology techniques. RESULTS The outbreak affected at least 44 children, with a mean age (standard deviation) of 5.5 years (2.9). The average hospital stay was 3.1 days and outcome was favorable in all cases. In 24 patients the CSF specimen sufficed for viral detection by PCR; enteroviruses ultimately serotyped as echovirus 30 were detected in 12 of them (50%). This serotype has been recently found in other parts of our country. CONCLUSIONS Detection of echovirus 30 in CSF and the epidemiological presentation of cases enabled determination of the etiology of the outbreak. This finding coincided in time with other outbreaks of echovirus 30 in Spain, a fact that may explain the epidemic situation in the Valencian Community during 2006. Establishment of a national surveillance network for monitoring systemic enterovirus infection would provide data on the circulation patterns and identify new emerging serotypes.