Search

Summary Background. We have found clusters of Klebsiella pneumoniae with OXA48-carbepenemase cases in some hospital rooms, and decided to investigate whether bathroom siphons could be a reservoir for OXA48 bacteria, as occurs with K. oxytoca with other types of carbepenemases. Methods. We evaluated the microbial competition between strains with OXA48 and VIM carbepenemases, in diluted nutrient-broth, on a slime germ-carrier. We compared the number of colonies at 5 and 10 days on the contaminated carriers with one or two strains. We evaluated the dissemination of K. pneumoniae with carbepenemase OXA48 or VIM from thumbs and index fingers of volunteers, to standard surfaces (20 glass germ-carrier by each volunteer). After, we counted the number of microorganisms on each carrier. Microbiological weekly studies of faecal microbiota of all patients were obtained in Traumatology and Oncology. Moreover, we studied samples of the sink in their rooms. PCR and MLST sequence-type was determined in all K. pneumoniae diagnosed from patients and sinks. Results. A large possibility of diffusion from contaminated hands, which continue to transmit high numbers of microorganisms after more than 10 successive surface contacts, was highlighted; OXA bacteria were more persistent than VIM bacteria. Microbial competition studies showed that VIM bacteria are inhibited by OXA ones. These observations can explain the concentration of cases of K. pneumoniae OXA48 in some rooms in Traumatology and Oncology, producing a significant OR between rooms with OXA48-bacteria-contaminated siphons and other rooms (3.1 and 3.3 respectively). Risk was lowered after changing or disinfecting (heat plus chlorinated disinfectant) the contaminated siphons. Siphon colonization by VIM bacteria was not related with human infections by similar microorganisms. Conclusions. Bathroom siphons can be a reservoir for K. pneumoniae OXA48 and lead to outbreaks. Outbreaks can be controlled by replacement or heat plus chemical treatment of the sink-siphons.

Introduction: Religious factors have conditioned the attitude toward organ donation and transplantation (ODT) since the beginning of transplantation, despite the fact that most religions are in favor of transplantation. Objective: To assess the impact of religious beliefs of medical students on their attitude toward ODT. Method: Population under study: Medical students in Spanish universities. Study sample: Stratified by geographical area and academic course. Assessment instrument: Attitude ODT questionnaire PCID-DTO-Ríos, anonymous and self-administered. Results: Of all students, 42% (n = 3907) declare themselves atheists or agnostics. The remaining 58% (n = 5368) declare themselves to be religious, the majority being Catholic (55%, n = 5102). Of the rest, 0.2% are Muslims (n = 8), 0.1% Protestants (n = 1), and the remaining 2.7% (n = 257) indicate other religious doctrines but do not want to specify it. Regarding their attitude toward ODT, those who consider themselves atheists or agnostics have a more favorable attitude than those who consider themselves religious (84% versus 76%; P < .001). Among those who follow some kind of religion, Catholics are more in favor of ODT than non-Catholics (77% vs 64%, P < .001). Note that among the religious, only 57% (n = 3050) know which religion is in favor of transplantation, while 22% (n = 1,152) consider that it has not been pronounced on the matter, 13% (n = 723) think the religion is against donation, and the remaining 8% (n = 443) do not know. Conclusion: The religion professed by medical students conditions their attitude toward donation, with the atheists and agnostics being more in favor of donation.

Objective: We describe an outbreak of VIM-carbapenemase-K. oxytoca (VIM-Kox) in a NICU Study design: Prospective Epidemiological Surveillance: a) Systematically (weekly screening cultures) or on admission, if the patient had a history of previous colonization by VIM-Kox. b) Clinical cultures, done if infection was suspected. c) Other possible microorganism sources were investigated: their mothers (rectal microbiota), milk packages and preparation apparata in the lactodietary section, echocardiagram transductors, cribs, the sinks (faucets and drains), washing bowls, etc. Molecular typing was performed using the DiversiLab (bioMérieux) system on all VIM-Kox isolated from environment or patients (one by neonate). Results: We identified 20 VIM-Kox cases, the most only presented colonization, but 4 showed infection. Three of the ten sinks (drains) in our NICU, were positive for VIM-Kox. Another four drains harbored P.aeruginosa, S. maltophilia and/or Enterobacter sp. Nevertheless the VIM-Kox bacteria in the sinks (drains) were not the same as those in the patients, who showed three different strains Conclusions: - A VIM-Kox colonization or infection outbreak in a NICU is described. -Rather than environment, not even drains, the source of the outbreak was other patients. -The outbreak was relatively brief, as a result of the rapidness with which appropriate measures were taken and followed., Journal of Preventive Medicine and Hygiene, Vol 58, No 4 (2017): 2017584

Results: With the antibiograms and MIC-dilutions for every bacteria and biocide, the bivariate analysis found that only 4.7% of the antibiotic-biocide pairs showed a significant correlation (p < 0.05%) between antibiotic resistance and decreased susceptibility to the disinfectant or antiseptic, 8.3% showed a significant inverse correlation, and the rest no correlation. Multivariate analysis of the above variables (controlling the effects of the type of microorganism and disinfectant or antiseptic used), showed that overall fit of the equation was very poor, since R 2 = 0.032. Conclusion: In a large sample of different bacteria genera there was no significant correlation between antibiotic resistance and decreased susceptibility to disinfectants and antiseptics, except in 4.7% of the antibiotic-biocide pairs. List of abbreviations: OPA: Ortho-phthalaldehyde; NFGNB: Non Fermentative Gram Negative Bacteria; ROC: Receiver Operating Characteristics; COR: Correlations with p < 0.05; Cor: Correlations with p between 0.05 and 0.1; SXT: Sulfamethoxazole trimethoprim; CPH: Cephalothin; LEVO: Levofloxacin; IPM: Imipenem; TOB: Tobramycin; CAZ: Ceftazidime; GM: Gentamicin; AN: Amikacin; FO: Phosphomycin; TZP: Tazobactam; ATM: Aztreonam; TEC: Teicoplanin

Antibiotic resistance and decreased susceptibility to disinfectants are not usually associated in microorganisms, but we have found an exception to this rule: P. aeruginosa versus orthophthalaldehyde (OPA).

Background: Neonates are very susceptible to Pseudomonas aeruginosa. Aim: To describe a P. aeruginosa outbreak in our Neonatal Intensive Care Unit (NICU), and understand the underlying individual risk factors for colonization or infection, using a case-case-control design. Methods: Microbiological studies were done routinely in our neonates to identify and instigate contact precautions if P. aeruginosa was present. If found, a search was made for possible environmental reservoirs and Random Amplification of Polymorphic DNA (RAPD) was run on all isolated P. aeruginosa. We divided our children into two cohorts, (with and without this microorganism). Finally we designed a case-case-control study to evaluate predictive factors in those infants colonized or infected by P. aeruginosa. Results: In 4 months, 14 infants were infected and 16 were only colonized by P. aeruginosa. All the P aeruginosa isolated from these children were identical on RAPD, but this organism was not found in any environment reservoirs. Separation by status into two cohorts helped to reduce new cases, but global number of cases (sum of the new and existing cases each week) took longer to fall. In the same time period another 82 NICU-patients had not P. aeruginosa, and they were used as controls. Bivariate and multivariate analysis determined the factors associated with colonization or infection by P. aeruginosa. Conclusion: Risk factors of infected neonates: fungal infection, number of cases in previous week and separation into cohorts (protection factor). In colonized, birth malformations were added to above risk or protection factors.

The decrease in the time spent in hospital of patients who have undergone surgery lessens wound observation time, and thus could underestimate the true rates of surgical wound infection (SWI). The aim of this study was to assess the use of a programme to detect SWI, by carrying out a control 30 days after patients have been discharged from hospital.A study of a prospective cohort of 2,015 patients who were operated in 6 surgical services at a general hospital, was carried out to detect the incidence of SWI. The control at one month after discharge from hospital was done through a telephone survey using a specific questionnaire.SWI incidence was observed in 134 patients (6.7%), 38% of which were detected on the month after discharge from hospital. In the postoperatory control the major SWI rates were detected in the clean procedures and in the clean-contaminated procedures with 46% and 37%, respectively. The telephone interview enabled contact with 72.3% of the patients intervened.The post-discharge control of patients who have undergone surgery enabled the detection of more than a third of SWI cases. The telephone interview system has been effective in our study as a postdischarge method of the localization of patients.

9 pages, 7 figures, 3 tables., We have investigated the effects of iodine (I) intake on urinary I excretion in preterm (PT) babies up to 2 months after birth and its effect on serum T4, free T4 (FT4), T3, TSH, and thyroglobulin (Tg) levels compared to those in term (T) newborns. Very premature and very sick infants were in negative I balance for the first weeks after birth. Later, these same infants, as well as the other PT and T newborns, were in positive balance; 75- 80% of the ingested I was not accounted for in the urine. The urinary I levels of PT and T neonates cannot be equated to their I intakes. T4, FT4, and T3 levels in PT and T neonates increased with postmenstrual age, whereas Tg decreased and TSH did not change. Serum FT4, T3, Tg, and TSH levels in PT neonates were affected negatively, independently from age, by a low I intake. PT birth also affected T4, FT4, and Tg negatively, independently from I intake and postmenstrual age, for at least 6-8 weeks after birth. Care should be taken to avoid I deficiency in PT neonates. However, even when I intake is adequate, PT newborns are hypothyroxinemic compared to T babies during an important period of brain development. This suggests the possible convenience of interventions that might mimic the intrauterine hormone environment and accelerate maturation., This work was supported by the Heinz-Koch Foundation (Milupa, Spain) and the Fondo de Investigaciones Sanitarias (FIS Grant 92/0888 and Fellowship 92/5351 to S.A.).