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1. Staphylococcus aureus Nasal Colonization in Spanish Children. The COSACO Nationwide Surveillance Study

Author

del Rosal T, Méndez-Echevarría A, Garcia-Vera C, Escosa-Garcia L, Agud M, Chaves F, Román F, Gutierrez-Fernandez J, Ruiz de Gopegui E, Ruiz-Carrascoso G, Ruiz-Gallego MC, Bernet A, Quevedo SM, Fernández-Verdugo AM, Diez-Sebastian J, and Calvo C

Subjects
s. aureus, mrsa, child, colonization, Infectious and parasitic diseases, RC109-216
Abstract

Teresa del Rosal,1,2 Ana Méndez-Echevarría,1,2 Cesar Garcia-Vera,3 Luis Escosa-Garcia,1,2 Martin Agud,1 Fernando Chaves,4 Federico Román,5 José Gutierrez-Fernandez,6 Enrique Ruiz de Gopegui,7 Guillermo Ruiz-Carrascoso,8 Maria del Carmen Ruiz-Gallego,9 Albert Bernet,10 Sara Maria Quevedo,11 Ana Maria Fernández-Verdugo,12 Jesús Díez-Sebastian,13 Cristina Calvo1,2 On behalf of the COSACO Study Group1Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain; 2Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain; 3“José Ramón Muñoz Fernández” Health Care Center, Aragón Health Service, Zaragoza, Spain; 4Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain; 5Laboratory of Nosocomial Infections, Department of Bacteriology, CNM, Instituto de Salud Carlos III, Madrid, Spain; 6Department of Microbiology, Hospital Virgen de las Nieves, Granada, Spain; 7Department of Clinical Microbiology, Hospital Universitari Son Espases. Servicio de Microbiología, Palma de Mallorca, Spain; 8Department of Clinical Microbiology, Hospital Universitario La Paz, Madrid, Spain; 9Department of Microbiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain; 10Section of Microbiology, Arnau de Vilanova University Hospital, Lleida, Spain; 11Department of Microbiology, Hospital Universitario Severo Ochoa, Leganes, Spain; 12Department of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain; 13Department of Preventive Medicine, Hospital Universitario La Paz, Madrid, SpainCorrespondence: Ana Méndez-Echevarría Pediatric Infectious and Tropical Diseases Department. Hospital La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046, SpainTel/Fax +34-917277479Email amendezes@yahoo.esObjective: To assess the prevalence and risk factors for S. aureus and methicillin-resistant S. aureus (MRSA) nasal colonization in Spanish children.Methods: Cross-sectional study of patients < 14 years from primary care centers all over Spain. Clinical data and nasal aspirates were collected from March to July 2018.Results: A total of 1876 patients were enrolled. Prevalence of S. aureus and MRSA colonization were 33% (95% CI 30.9– 35.1) and 1.44% (95% CI 0.9– 2), respectively. Thirty-three percent of the children (633/1876) presented chronic conditions, mainly atopic dermatitis, asthma and/or allergy (524/633). Factors associated with S. aureus colonization were age ≥ 5 years (OR 1.10, 95% CI 1.07– 1.12), male sex (OR 1.43, 95% CI 1.17– 1.76), urban setting (OR 1.46, 95% CI 1.08– 1.97) and the presence of asthma, atopic dermatitis or allergies (OR 1.25; 95% CI: 1.093– 1.43). Rural residence was the only factor associated with MRSA colonization (OR 3.62, 95% CI 1.57– 8.36). MRSA was more frequently resistant than methicillin-susceptible S. aureus to ciprofloxacin [41.2% vs 2.6%; p< 0.0001], clindamycin [26% vs 16.9%; p=0.39], and mupirocin [14.3% vs 6.7%; p=0.18]. None of the MRSA strains was resistant to tetracycline, fosfomycin, vancomycin or daptomycin.Conclusions: The main risk factors for S. aureus colonization in Spanish children are being above five years of age, male gender, atopic dermatitis, asthma or allergy, and residence in urban areas. MRSA colonization is low, but higher than in other European countries and is associated with rural settings.Keywords: S. aureus, MRSA, child, colonization

Published
2020

2. Position statement of the Spanish Society of Paediatric Infectious Diseases on the introduction, implementation and assessment of antimicrobial stewardship programmes in paediatric hospitals

Author

Goycochea-Valdivia, Walter Alfredo, Melendo Perez, Susana, Aguilera Alonso, David, Escosa-García, Luis, Baquero-Artigao, Fernando, Sociedad Española de Infectología Pediátrica (SEIP). Grupo de Trabajo PROA, Martinez Campos, Leticia, Institut Català de la Salut, [Goycochea-Valdivia WA] Servicio de Infectología, Reumatología e Inmunología Pediátrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain. [Melendo Pérez S] Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Servei de Pediatria, Vall d'Hebron Hospital Universitari, Barcelona, Spain. [Aguilera-Alonso D] Sección de Enfermedades Infecciosas, Servicio de Pediatría, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital Universitario Gregorio Marañón, Madrid. CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain. [Escosa-Garcia L, Baquero-Artigao F] Servicio de Pediatría Hospitalaria, Enfermedades Infecciosas y Tropicales, Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid. CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain. [Martínez Campos L] Unidad de Infectología Pediátrica, Hospital Universitario Torrecárdenas, Almería, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
infecciones bacterianas y micosis::infección::enfermedades transmisibles [ENFERMEDADES], administración de los servicios de salud::organización y administración::administración farmacéutica::utilización de medicamentos::revisión de la utilización de medicamentos::programas de optimización del uso de los antimicrobianos [ATENCIÓN DE SALUD], Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores], acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antibacterianos [COMPUESTOS QUÍMICOS Y DROGAS], Hospitals, Pediatric, Other subheadings::Other subheadings::/drug therapy [Other subheadings], Communicable Diseases, Anti-Bacterial Agents, Antimicrobial Stewardship, Anti-Infective Agents, Management of Technology and Innovation, Health Services Administration::Organization and Administration::Pharmacy Administration::Drug Utilization::Drug Utilization Review::Antimicrobial Stewardship [HEALTH CARE], Humans, Medicaments antibacterians - Ús terapèutic, Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents [CHEMICALS AND DRUGS], Bacterial Infections and Mycoses::Infection::Communicable Diseases [DISEASES], Child, Malalties transmissibles - Tractament
Abstract

Pediatría; Resistencia antibiótica Paediatrics; Antimicrobial resistance Pediatria; Resistència antibiòtica In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately. The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential. The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country. Durante los últimos años ha habido un aumento en la aparición de resistencias antimicrobianas, lo cual supone un grave problema de salud pública. El mal uso de antimicrobianos es un factor determinante en su desarrollo. La población pediátrica no queda exenta de dicha problemática ya que la prescripción de antibióticos en pediatría es elevada y en muchas ocasiones inadecuada. La incorporación de los programas de optimización de uso de antimicrobianos (PROA) ha resultado ser una medida crucial para disminuir el riesgo en la aparición de resistencias antibióticas. A nivel internacional se reconoce la necesidad de crear PROAs específicos en pediatría (PROA-P) debido a las diferencias existentes entre pacientes adultos y pediátricos en referencia a las infecciones, así como al abordaje tanto diagnóstico como terapéutico de las mismas. Por esta misma razón, los PROA-P deben ser programas multidisciplinares liderados por especialistas en infecciones pediátricas y trabajar con indicadores específicos pediátricos (DOT, patrones de sensibilidad antibiótica de población pediátrica, indicadores clínicos…) que permitan detectar puntos de mejora y establecer estrategias dirigidas eficaces. Por otro lado, es imprescindible el apoyo y liderazgo por parte de las distintas sociedades científicas implicadas. El objetivo de este documento es dar a conocer el posicionamiento de la Sociedad Española de Infectología Pediátrica (SEIP) sobre la implementación de los PROA pediátricos hospitalarios en nuestro territorio así como aportar herramientas que ayuden en la aplicación de dichos programas en los diferentes hospitales de las distintas regiones sanitarias del país.

Published
2022

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