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Edocarditis infecciosa; Tractament antibiòtic supressiu; Cirurgia Endocarditis infecciosa; Tratamiento antibiótico supresor: Cirugía Infective endocarditis; Suppressive antibiotic treatment; Surgery Background: To date, there is little information regarding management of patients with infective endocarditis (IE) that did not undergo an indicated surgery. Therefore, we aimed to evaluate prognosis of these patients treated with a long-term antibiotic treatment strategy, including oral long term suppressive antibiotic treatment in five referral centres with a multidisciplinary endocarditis team. Methods: This retrospective, multicenter study retrieved individual patient-level data from five referral centres in Spain. Among a total of 1797, 32 consecutive patients with IE were examined (median age 72 years; 78% males) who had not undergone an indicated surgery, but received long-term antibiotic treatment (LTAT) and were followed by a multidisciplinary endocarditis team, between 2011 and 2019. Primary outcomes were infection relapse and mortality during follow-up. Results: Among 32 patients, 21 had IE associated with prostheses. Of the latter, 8 had an ascending aorta prosthetic graft. In 24 patients, a switch to long-term oral suppressive antibiotic treatment (LOSAT) was considered. The median duration of LOSAT was 277 days. Four patients experienced a relapse during follow-up. One patient died within 60 days, and 12 patients died between 60 days and 3 years. However, only 4 deaths were related to IE. Conclusions: The present study results suggest that a LTAT strategy, including LOSAT, might be considered for patients with IE that cannot undergo an indicated surgery. After hospitalization, they should be followed by a multidisciplinary endocarditis team. Antoni Bayes-Genis was supported by grants from the Ministerio de Educación y Ciencia (SAF2014–59892), Fundació La MARATÓ de TV3 (201502, 201516), CIBER Cardiovascular (CB16/11/00403), and AdvanceCat 2014. María Hernández Pérez is supported by a Juan Rodes research contract (JR17/00006) from Instituto de Salud Carlos III.

ObjectivesYoung people are a critical target group for sexually transmitted infections (STI) surveillance due to their particular behavioural and social related vulnerability. The aim of this study was to describe the epidemiological characteristics and trends in the incidence of gonorrhoea, syphilis, HIV and venereal lymphogranuloma (LGV) among 15–24-year-olds in Barcelona, and to determine factors associated with HIV coinfection.DesignWe performed a population-based incidence study covering the 2007–2015 period.ParticipantsAll new cases of STI—HIV, gonorrhoea, infectious syphilis and LGV—notified to the epidemiological surveillance system in Barcelona between 2007 and 2015. 1218 cases were studied: 84.6% were men, 19.3% were 15–19 years old and 50.6% were born in Spain. Among men, 73.7% were men who have sex with men (MSM); among women, 85.6% were women that have sex with men.Primary and secondary outcomesIncidence of HIV, gonorrhoea, infectious syphilis and LGV. HIV coinfection.ResultsThere was an increase in the incidence of gonorrhoea, from 1.9 cases per 10 000 people in 2007 to 7.6/10 000 in 2015 (p10 sexual partners (ORa=4.11, 95% CI 1.53 to 11.01) or STI diagnosis during the previous 12 months (ORa=2.06; 95% CI 1.13 to 3.77).ConclusionsThe incidence of gonorrhoea and syphilis among 15–24-year-olds increased, while HIV infection remained stable but with a high incidence among MSM. Being MSM, having sex with multiple partners and having a diagnosis of an STI in the previous 12 months were factors associated with HIV coinfection.

The aims of this study were to describe the evolution of acute hepatitis C virus (HCV) infections since 2004 and to determine its associated factors. Acute HCV infections diagnosed in Barcelona from 2004 to 2015 were included. Incidence ratios (IR) were then estimated for sex and age groups. Cases were grouped between 2004-2005, 2006-2011 and 2012-2015, and their incidence rate ratios (IRR) were calculated. In addition, risk factors for acute HCV infection were identified using multinomial logistic regression for complete, available and multiple imputed data. 204 new HCV cases were identified. Two peaks of higher IR of acute HCV infection in 2005 and 2013 were observed. Men and those aged 35-54 had higher IR. IRR for men was 2.9 times greater than in women (95% confidence intervals (CI): 1.8 ‒ 4.7). Factors related to the period 2012-2015 (versus 2006-2011) were: a) sexual risk factor for transmission versus nosocomial (relative-risk ratio (RRR): 13.0; 95% CI: 2.3 ‒ 72.1), b) higher educated versus lower (RRR: 5.4; 95% CI: 1.6 ‒ 18.7), and c) HIV co-infected versus not HIV-infected (RRR: 53.1; 95% CI: 5.7 ‒ 492.6). This is one of the few studies showing IR and RRRs of acute HCV infections and the first focused on a large city in Spain. Sexual risk for transmission between men, higher educational level and HIV co-infection are important factors for understanding current HCV epidemic. There has been a partial shift in the pattern of the risk factor for transmission from nosocomial to sexual. César Garriga developed the present study as part of his fellowship in the Spanish Field Epidemiology training Programme (FETP) (file number:12/PEAC-06. The funders had no role in study design. Sí

[Introduction] Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population., [Methods and analysis] A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events., [Sample size] The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2., [Ethics and dissemination] The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group for Infections in Compromised Hosts (ESGICH)., This study was supported by Ministerio de Economía y Competitividad, Instituto de Salud Carlos III—co-financed by European Development Regional Fund ‘A way to achieve Europe’ ERDF, Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015).

INTRODUCTION: Antiretroviral therapy has led to a decrease in HIV-related mortality and to the emergence of non-AIDS defining diseases as competing causes of death. This study estimates the HIV mortality rate and their risk factors with regard to different causes in a large city from January 2001 to June 2013. MATERIALS AND METHODS: We followed-up 3137 newly diagnosed HIV non-AIDS cases. Causes of death were classified as HIV-related, non-HIV-related and external. We examined the effect of risk factors on survival using mortality rates, Kaplan-Meier plots and Cox models. Finally, we estimated survival for each main cause of death groups through Fine and Gray models. MORTALITY RESULTS: 182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0-16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIV-related causes and non-HIV-related causes was the same (4.9/1000 py; CI:3.7-6.1/1000 py), external was lower [1.7/1000 py; (1.0-2.4/1000 py)]. SURVIVAL RESULTS: Kaplan-Meier estimate showed worse survival in intravenous drug user (IDU) and heterosexuals than in men having sex with men (MSM). Factors associated with HIV-related causes of death include: IDU male (subHazard Ratio (sHR):3.2; CI:1.5-7.0) and

Two hundred twelve patients with colonization/infection due to amoxicillin-clavulanate (AMC)-resistant Escherichia coli were studied. OXA-1- and inhibitor-resistant TEM (IRT)-producing strains were associated with urinary tract infections, while OXA-1 producers and chromosomal AmpC hyperproducers were associated with bacteremic infections. AMC resistance in E. coli is a complex phenomenon with heterogeneous clinical implications.

Background: The aim of this study was to determine the evolution of HIV infection, gonorrhea, syphilis and lymphogranuloma venereum (LGV), and their epidemiological characteristics in Barcelona city. Methods: Population-based incidence study of all newly occurring diagnoses of HIV infection, syphilis, gonorrhea and LGV detected in Barcelona between January 2007 and December 2011. A descriptive analysis was performed. The annual incidence rates per 100,000 inhabitants were calculated by sex, sexual conduct and educational level. To estimate global sex-specific rates we used the Barcelona city census; for the calculation of rates by sexual conduct and educational level we used estimates of the Barcelona Health Interview Survey. Trends were analysed using the chi-squared test for linear trend. Results: HIV. 66.8 % of the HIV cases were men who had sex with men (MSM). The incidence rates in MSM over the study period were from 692.67/100,000 to 909.88/100,000 inh. Syphilis. 74.2 % of the syphilis cases were MSM. The incidence rates in MSM were from 224.9/100,000 to 891.97/100,000 inh. and the MSM with a university education ranged from 196.3/100,000 to 1020.8/100,000. Gonorrhea. 45.5 % of the gonorrhea cases were MSM. The incidence rates in MSM were from 164.24/100,000 to 404.79/100,000 inh. and the MSM with university education ranged from 176.7/100,000 to 530.1/100,000 inh.. Lymphogranuloma venereum (LGV). 95.3 % of the LGV cases are MSM. The incidence rates in MSM were from 24.99/100,000 to 282.99/100,000 inh. and the MSM with university education ranged from 9.3/100,000 to 265/100,000 inh. Conclusion: An increase in cases of STI was observed. These STI mainly affected MSM with a university education. Continuing to monitor changes in the epidemiology of STI, and identifying the most affected groups should permit redesigning preventive programs, with the goal of finding the most efficient way to reach these population groups.

Introduction: Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population. Methods and analysis: A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events. Sample size: The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2. Ethics and dissemination: The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group for Infections in Compromised Hosts (ESGICH).

Background: Spontaneous meningitis caused by gram-negative bacilli in adult patients is uncommon and poorly characterized. Our objective is to describe and compare the characteristics and the outcome of adult patients with spontaneous gram-negative bacilli meningitis (GNBM) and spontaneous meningitis due to other pathogens. Methods: Prospective single hospital-based observational cohort study conducted between 1982 and 2006 in a university tertiary hospital in Barcelona (Spain). The Main Outcome Measure: In-hospital mortality. Results: Gram-negative bacilli meningitis was diagnosed in 40 (7%) of 544 episodes of spontaneous acute bacterial meningitis. The most common pathogens were Escherichia coli and Pseudomonas species. On admission, characteristics associated with spontaneous gram-negative bacilli meningitis by multivariate modeling were advanced age, history of cancer, nosocomial acquisition of infection, urinary tract infection as distant focus of infection, absence of rash, hypotension, and a high cerebrospinal fluid white-cell count. Nine (23%) episodes were acquired in the hospital and they were most commonly caused by Pseudomonas. The in-hospital mortality rate was 53%. The mortality rate was higher among patients with Gram-negative bacillary meningitis than among those with other bacterial meningitis and their risk of death was twenty times higher than among patients infected with Neisseria meningitidis (odds ratio 20.47; 95% confidence interval 4.03-103.93; p

L'implant d'una pròtesi articular té com a finalitat millorar o restaurar la funció articular i disminuir el dolor. La infecció de la pròtesi articular (IPA) constitueix una de les complicacions més temibles. Un millor coneixement de les seves causes i conseqüències pot contribuir a la seva prevenció, així com a un millor tractament i pronòstic. Els objectius d'aquest estudi van ser: 1) caracteritzar l'etiologia de les IPA d'acord amb el seu mecanisme d'adquisició i el temps des del implant de la pròtesi, i 2) avaluar el resultat funcional –pel que fa a la capacitat de deambulació– dels pacients amb pròtesis de genoll i maluc que van presentar una IPA pel que fa als que no van tenir infecció. El primer objectiu es va dur a terme mitjançant un estudi retrospectiu en 19 hospitals espanyols, incloent 2.544 IPA. Estreptococs i Staphylococcus aureus van causar gairebé un 70% de les IPA adquirides per via hematògena. Les infeccions adquirides perioperatòriament que es van presentar en el primer mes després de la cirurgia van estar causades més sovint per microorganismes virulents (com S. aureus, enterobacteris o Pseudomonas aeruginosa) i multiresistents, i van ser més freqüentment polimicrobianes. A mida que augmentaven els mesos després de l'implant de l'artroplàstia, es va observar una disminució lineal d'aquests microorganismes, amb un augment de patògens menys virulents, com els estafilococs coagulasa negative, així com un increment de les infeccions monomicrobianes. Aquestes diferències ens van permetre establir possibles pautes antimicrobianes empíriques de les IPA, depenent de la manera i moment de presentació de les mateixes. El segon objectiu es va desenvolupar a l'Hospital de la Santa Creu i Sant Pau, mitjançant un estudi retrospectiu de cohorts aparellades. Comparem el resultat funcional de 109 pacients amb pròtesis de genoll i maluc que van tenir una IPA –i es van curar amb el primer tractament mèdic-quirúrgic– amb 218 pacients que no van desenvolupar infecció. Es van aparellar 1:2 per variables rellevants (edat, sexe i característiques de l'artroplàstia). Al cap d'un any de l'última cirurgia realitzada, els pacients amb IPA van tenir un pitjor resultat funcional pel que fa a la seva capacitat de deambulació. Així, els pacients amb pròtesi total de genoll i maluc i IPA requerien més sovint algun suport per caminar (una o dues crosses o bastons), i els pacients amb pròtesi parcial de maluc necessitaven dues crosses o eren incapaços de caminar amb més freqüència que pacients similars sense IPA. Aquests resultats emfatitzen la necessitat d'invertir més esforços en la prevenció de les IPA. El implante de una prótesis articular tiene como finalidad mejorar o restaurar la función articular y disminuir el dolor. La infección de la prótesis articular (IPA) constituye una de las complicaciones más temibles. Un mejor conocimiento de sus causas y consecuencias puede contribuir a mejorar su prevención, tratamiento y pronóstico. Los objetivos de este estudio fueron: 1) caracterizar la etiología de las IPA de acuerdo con su mecanismo de adquisición y el tiempo desde el implante de la prótesis, y 2) evaluar el resultado funcional -en cuanto a la capacidad de deambulación- de los pacientes con prótesis de rodilla y cadera que presentaron una IPA con respecto a los que no tuvieron infección. El primer objetivo se llevó a cabo mediante un estudio retrospectivo en 19 hospitales españoles, incluyendo 2.544 IPA. Estreptococos y Staphylococcus aureus causaron casi un 70% de las IPA adquiridas por vía hematógena. Las infecciones adquiridas perioperatoriamente que se presentaron en el primer mes tras la cirugía estuvieron causadas más a menudo por microorganismos virulentos (como S. aureus, enterobacterias o Pseudomonas aeruginosa) y multirresistentes, y fueron más frecuentemente polimicrobianas. A medida que aumentaban los meses tras el implante de la artroplastia, se observó una disminución lineal de estos microorganismos, con un aumento de patógenos menos virulentos, como los estafilococos coagulasa negativa, así como un incremento de las infecciones monomicrobianas. Estas diferencias nos permitieron establecer posibles pautas antimicrobianas empíricas de las IPA, dependiendo del modo y momento de presentación de las mismas. El segundo objetivo se desarrolló en el Hospital de la Santa Creu i Sant Pau, mediante un estudio retrospectivo de cohortes emparejadas. Se comparó el resultado funcional de 109 pacientes con prótesis de rodilla y cadera que tuvieron una IPA –y se curaron con el primer tratamiento médico-quirúrgico- con 218 pacientes que no desarrollaron infección. Se emparejaron 1:2 por variables relevantes (edad, sexo y características de la artroplastia). Al cabo de un año de la última cirugía realizada, los pacientes con IPA tuvieron un peor resultado funcional, en cuanto a su capacidad de deambulación. Así, los pacientes con prótesis total de rodilla y cadera e IPA requerían más a menudo algún soporte para caminar (una o dos muletas o bastones), y los pacientes con prótesis parcial de cadera necesitaban dos muletas o eran incapaces de caminar con más frecuencia que pacientes similares sin IPA. The purpose of joint prosthesis replacement is to improve or restore joint function and to reduce pain. Prosthetic joint infection (PJI) is one of its most feared complications. Better knowledge of its causes and consequences can contribute to its prevention, as well as better treatment and prognosis. The objectives of this study were: 1) to characterize the etiology of PJI according to acquisition mechanism and time since arthroplasty, and 2) to evaluate functional outcome –in terms of ambulation capacity– in those patients with knee and hip prostheses who went on to develop a PJI versus those who did not. The first objective was carried out through a retrospective study in 19 Spanish hospitals, that included 2,544 PJIs. Streptococci and Staphylococcus aureus caused almost 70% of hematogenous PJI. Perioperatively acquired infections occurring in the first month after surgery were more often caused by virulent microorganisms (such as S. aureus, Enterobacteriaceae, or Pseudomonas aeruginosa) and multidrug-resistant pathogens, and were more frequently polymicrobial. In the months following arthroplasty implantation, a linear decrease in these microorganisms was observed, with an increase in less virulent pathogens, such as coagulase negative staphylococci, as well as monomicrobial infections. These differences enabled us to establish possible empirical antimicrobial guidelines for PJI in accordance with the mode and timing of their presentation. The second objective was developed through a retrospective, matched cohort study at the Hospital de la Santa Creu i Sant Pau. The functional outcome of 109 patients with knee and hip prostheses who had a PJI and were cured at the first medical or surgical treatment was compared with that of 218 patients who did not develop infection. Patients were matched 1:2 on relevant variables (age, sex, characteristics of the arthroplasty). One year after the last surgery performed, patients with PJI had a worse functional outcome in terms of their ability to walk. Patients with total knee and hip replacement and PJI more often required some kind of support to walk (one or two crutches or sticks), and patients with partial hip replacement required two crutches or were unable to walk more frequently than similar patients without PJI. These results emphasize the need to invest more effort in the prevention of PJI. Universitat Autònoma de Barcelona. Programa de Doctorat en Medicina

L'actual epidèmia del Zika va ser declarada per la OMS l'u de febrer del 2016 emergència de salut pública, degut a la seva relació amb la microcefàlia i amb la Síndrome de Guillain-Barré. En poc més de mig any, el virus del Zika s'ha expandit per tot centre i sud Amèrica i s'han detectat casos importants a molts altres països, incloent Catalunya. Tot i que actualment encara no s'ha detectat transmissió autòctona a Europa i a Estats Units, la presència del mosquit vector Aedes albopictus porta a pensar que en qualsevol moment pot succeir. A diferència d'altres arbovirus el Zika també es pot transmetre per via sexual fet que suposa un repte afegit per a la salut pública.