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La lectura es un proceso que se ha culturalizado con el tiempo, a fin de mostrarse como reflejo de la situación de la mujer y de los condicionantes a los que se enfrenta. Por ello, el objetivo de este trabajo fue analizar variables relacionadas con el hábito lector en universitarios, desde una perspectiva de género. Por lo que se refiere al método empleado, se planificó un diseño ex post facto, prospectivo de grupo único. La muestra, estuvo formada por 277 estudiantes universitarios (Medad = 22.20, DE = 4.367) de ambos sexos (20.7% hombres; 79.3% mujeres). Los resultados mostraron la lectura como una actividad de ocio más practicada por las mujeres, especialmente en vacaciones y se observó una preferencia diferenciada estadísticamente en los tipos de lectura (libros y revistas en mujeres, y cómics y periódicos en hombres). Para las mujeres, el grupo de amigos influyó positiva y significativamente en el fomento de la lectura, y respecto a la competencia lectora, el fomento de la imaginación fue la categoría más valorada por mujeres, también con diferenciación significativa. Así, conocer el hábito lector que presentan los estudiantes universitarios diferenciados por género, contribuye a sensibilizar a los docentes de la necesidad de fomentar la lectura en este nivel educativo., Reading is one of the processes which has been cultivated over time in order to be shown as a reflection of the situation of female and all the conditioning factors that they face. Therefore, the purpose of this study was to analyse some variables in relation to the reading habits of university students, from the perspective of gender. With regard to method carried out, an ex post facto design of single group was planned. The sample was composed of 277 university students (Mage = 22.20, SE = 4.367) of both genders (20.7% male; 79.3% female). The results show reading as the leisure activity practiced the most by female, especially during holidays, and a statistically significant difference regarding the types of reading was observed (books and comics for female and comics and newspapers for male). For female, their group of friends positively influences the promotion of reading, and with respect to reading competence, the promotion of imagination was the category valued by female the most, also with statistical differences. Thus, knowing the reading habits of university students in a gender-differentiated manner, contributes to helping teachers be sensitive in this educational stage., 阅读是随着时间的推移而培养的过程之一，目的是反映女性的处境和她们所面临的所有 条件因素。因此，本研究的目的是从性别的角度分析与大学生阅读习惯相关的一些变量。 关于所使用的方法，研究计划进行事后的单组前瞻性设计。样本包括 277 名大学生（Mage = 22.20，SE = 4.367）（20.7% 为男性；79.3% 为女性）。结果表明，阅读是女性最常进行的休 闲活动，尤其是在假期中。并且在阅读类型（女性的书籍和杂志，男性的漫画和报纸）中我 们可以观察到了统计学上的显著差异。对于女性来说，朋友群对阅读的提升有显着的正向 影响，而在阅读能力方面，想象力的提升是女性最看重的类别，差异也很显着。因此，了解 不同性别的大学生所呈现的阅读习惯有助于让教师意识到在这个教育水平上促进阅读的 必要性。, Чтение - это процесс, который со временем приобрел культурный характер, с тем чтобы быть показанным как отражение положения женщин и тех обуславливающих факторов, с которыми они сталкиваются. По этой причине целью данного исследо- вания было проанализировать переменные, связанные с привычкой к чтению сре- ди студентов университета с гендерной точки зрения. Что касается используемого метода, то планировался постфактумный, проспективный, одногрупповой дизайн. Выборка состояла из 277 студентов университета ( Mean = 22.20, SD = 4.367) обоих полов (20.7% мужчин; 79.3% женщин). Результаты показали, что чтение как вид до- суга больше практикуется женщинами, особенно во время отпуска, и статистически значимое предпочтение наблюдалось в видах чтения (книги и журналы для женщин, комиксы и газеты для мужчин). Для женщин группа друзей оказала положительное и значительное влияние на продвижение чтения, а что касается компетенции чтения, то продвижение воображения было категорией, наиболее высоко оцененной женщи- нами, также со значительной дифференциацией. Таким образом, знание привычек чтения студентов университета, дифференцированных по полу, помогает повысить осведомленность преподавателей о необходимости поощрения чтения на этом уров- не образования.

Objectives: We describe the current epidemiology, causes, and outcomes of breakthrough invasive fungal infections (BtIFI) in patients with haematologic malignancies. Methods: BtIFI in patients with ≥ 7 days of prior antifungals were prospectively diagnosed (36 months across 13 Spanish hospitals) according to revised EORTC/MSG definitions. Results: 121 episodes of BtIFI were documented, of which 41 (33.9%) were proven; 53 (43.8%), probable; and 27 (22.3%), possible. The most frequent prior antifungals included posaconazole (32.2%), echinocandins (28.9%) and fluconazole (24.8%)-mainly for primary prophylaxis (81%). The most common haematologic malignancy was acute leukaemia (64.5%), and 59 (48.8%) patients had undergone a hematopoietic stem-cell transplantation. Invasive aspergillosis, principally caused by non-fumigatus Aspergillus, was the most frequent BtIFI with 55 (45.5%) episodes recorded, followed by candidemia (23, 19%), mucormycosis (7, 5.8%), other moulds (6, 5%) and other yeasts (5, 4.1%). Azole resistance/non-susceptibility was commonly found. Prior antifungal therapy widely determined BtIFI epidemiology. The most common cause of BtIFI in proven and probable cases was the lack of activity of the prior antifungal (63, 67.0%). At diagnosis, antifungal therapy was mostly changed (90.9%), mainly to liposomal amphotericin-B (48.8%). Overall, 100-day mortality was 47.1%; BtIFI was either the cause or an essential contributing factor to death in 61.4% of cases. Conclusions: BtIFI are mainly caused by non-fumigatus Aspergillus, non-albicans Candida, Mucorales and other rare species of mould and yeast. Prior antifungals determine the epidemiology of BtIFI. The exceedingly high mortality due to BtIFI warrants an aggressive diagnostic approach and early initiation of broad-spectrum antifungals different than those previously used. This work was funded by a grant from Gilead Sciences. P.P.-A. (JR20/00012, PI21/00498, and ICI21/00103) and C.G.-V. (FIS PI21/01640 and ICI21/00103) have received research grants funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union. The funders had neither a specific role in study design or collection of data, nor in writing of the paper or decision to submit. Sí

Objectives The main goal of this study was to accurately detect azole resistance in species of the Aspergillus fumigatus complex by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Methods Identification of isolates (n = 868) was done with MALDI-TOF MS using both commercial and in-house libraries. To determine azole susceptibility, the EUCAST E.Def. 9.3.2 method was applied as the reference standard. Identification of resistant isolates was confirmed by DNA sequence analysis. Protein spectra obtained by MALDI-TOF MS were analysed to differentiate species within the A. fumigatus complex and to detect azole-resistant A. fumigatus sensu stricto isolates. Results Correct discrimination of A. fumigatus sensu stricto from cryptic species was accomplished in 100% of the cases applying principal component analysis (PCA) to protein spectra generated by MALDI-TOF MS. Furthermore, a specific peak (4586 m/z) was found to be present only in cryptic species. The application of partial least squares (PLS) discriminant analysis allowed 98.43% (±0.038) discrimination between susceptible and azole-resistant A. fumigatus sensu stricto isolates. Finally, based on PLS and SVM, A. fumigatus sensu stricto isolates with different cyp51A gene mutations were correctly clustered in 91.5% of the cases. Conclusions MALDI-TOF MS combined with peak analysis is a novel tool that allows the differentiation of A. fumigatus sensu stricto from other species within the A. fumigatus complex, as well as the detection of azole-resistant A. fumigatus sensu stricto. Although further studies are still needed, the results reported here show the great potential of MALDI-TOF and machine learning for the rapid detection of azole-resistant Aspergillus fumigatus isolates from clinical origins.

Resumen Introduccion y objetivos Las infecciones relacionadas con dispositivos intracardiacos (i-DIC) son potencialmente graves y requieren un diagnostico precoz y certero. Los objetivos del estudio son analizar el rendimiento de la tomografia por emision de positrones con tomografia computarizada (PET/TC) ante sospecha de i-DIC y los cambios que induce sobre el diagnostico inicial e identificar el escenario con mayor beneficio de uso. Metodos Estudio retrospectivo de pacientes valorados mediante PET/TC por sospecha de i-DIC desde 2011 a 2018. Se calcularon valores de rendimiento diagnostico de la PET/TC y la concordancia entre diagnostico inicial y post-PET y el diagnostico definitivo. Se analizaron los cambios diagnosticos considerando la sospecha clinica inicial para identificar a los pacientes con mayor beneficio. Resultados Se incluyo a 44 pacientes. La prevalencia de endocarditis fue del 57%. La sensibilidad y la especificidad de la 18F-FDG-PET/TC para el diagnostico de endocarditis fueron 0,84 y 0,95. El diagnostico tras la PET mejoro el inicial un 45%. De los pacientes con sospecha de infeccion local, la PET/TC reclasifico adecuadamente al 57% por deteccion de infeccion profunda. Conclusiones La PET/TC muestra elevado rendimiento diagnostico ante la sospecha de i-DIC y mejora significativamente el diagnostico convencional, sobre todo en el grupo de pacientes con sospecha de infeccion limitada al bolsillo.

Introduction and objectives Cardiac device-related infections (CDRI) may be life-threatening and require early and accurate diagnosis. The aims of this study were to analyze the performance of positron emission tomography-computed tomography (PET/CT) in suspected CDRI, to assess changes to the initial diagnosis, and to identify a clinical subgroup deriving the greatest benefit from this imaging modality. Methods Retrospective study including patients evaluated by PET/CT for suspected CDRI from 2011 to 2018. We assessed PET/CT performance and the agreement between the initial, post-PET and definitive diagnoses. We also assessed changes in the diagnosis, depending on initial clinical suspicion, to identify patients deriving the greatest benefit from PET/CT. Results We included 44 patients. The prevalence of endocarditis was 57%. The sensitivity and specificity of PET/CT for the diagnosis of infective endocarditis were 0.84 and 0.95, respectively. Post-PET diagnosis improved the initial diagnosis by 45%. PET/CT correctly reclassified 57% of patients with initial suspicion of generator pocket infection by detecting lead infection. Conclusions PET/CT showed high diagnostic performance in suspected of CDRI and significantly improved the conventional diagnostic approach, especially in patients with initial suspicion of focal infection.

We have been monitoring the antifungal resistance in Candida parapsilosis isolates collected from inpatients at Madrid metropolitan area hospitals for the last 3 years. The study aimed to elucidate the presence of fluconazole-resistant C. parapsilosis genotypes in Madrid. From January 2019 to December 2021, a total of 354 C. parapsilosis isolates (n = 346 patients) from blood (76.6%) or intraabdominal samples were collected and genotyped using species-specific microsatellite markers. Antifungal susceptibilities to amphotericin B, the triazoles, micafungin, anidulafungin, and ibrexafungerp were performed according to EUCAST E.Def 7.3.2; the ERG11 gene was sequenced in fluconazole-resistant isolates. A total of 13.6% (n = 48/354) isolates (one per patient) were found to be resistant to fluconazole and non-wild-type to voriconazole but fully susceptible to ibrexafungerp. Resistant isolates were mostly sourced from blood (n = 45/48, 93.8%) and were detected in five hospitals. Two hospitals accounted for a high proportion of resistant isolates (n = 41/48). Resistant isolates harbored either the Y132F ERG11p amino acid substitution (n = 43) or the G458S substitution (n = 5). Isolates harboring the Y132F substitution clustered into a clonal complex involving three genotypes (one genotype accounted for n = 39/43 isolates) that were found in four hospitals. Isolates harboring the G458S substitution clustered into another genotype found in a fifth hospital. C. parapsilosis genotypes demonstrating resistance to fluconazole have been spreading across hospitals in Madrid, Spain. Over the last 3 years, the frequency of isolation of such isolates and the number of hospitals affected is on the rise.

El objetivo del presente trabajo fue incrementar el desarrollo moral en alumnos adultos con discapacidad intelectual, a través de un programa predeportivo y de valores. El programa se llevó a cabo a lo largo de un cuatrimestre de un título dirigido a la inserción sociolaboral de personas con discapacidad intelectual. Participaron 37 alumnos de ambos sexos, de tres promociones consecutivas (n1 = 11; n2 = 12; n3 = 14), entre los 19 y los 37 años (M = 24.49 ± 4.22). Se utilizó la versión española del Moral Competence Test (MCT), que mide los dos componentes del desarrollo moral: la competencia moral y las orientaciones o preferencias morales. Se planificó un diseño cuasiexperimental de cohorte de ciclo institucional recurrente, implicando a tres cohortes evaluadas en tres años consecutivos. Además, para asegurar la equivalencia de los grupos se realizó un estudio acerca de la influencia de variables sociodemográficas y clínicas en el cambio de la competencia moral del alumnado, a través de un diseño ex post facto prospectivo de grupo único. Los resultados mostraron un aumento del desarrollo moral, en sus dos componentes, con significación estadística en el estadio 4 de las orientaciones o preferencias morales. The aim of this study was to increase moral development of the students with intellectual disabilities, through an intervention with values learning and adapted sports. The program was developed in a training course for Social and Labor insertion of People with Intellectual Disability. The sample consisted of 37 students of three consecutive promotions (n1 = 11; n2 = 12; n3 = 14), aged from 19 to 37 years (M = 24.49 ± 4.22). Instrument used was the Spanish version of the Moral Competence Test adapted to intellectual disability (MCT) which measures the two components of moral development through two scores: moral competence and moral orientations/preferences. A quasi-experimental recurrent institutional cycle cohort design was planned. This design involved three cohorts, evaluated in three consecutive years. In addition, to ensure the equivalence of the groups, a study was carried out on the influence of sociodemographic and clinical variables in the change of students' moral competence, through a prospective ex post facto single group design. The results showed an improvement in two components of moral development, with statistically significant differences in stage 4 of moral orientations/preferences.

Introduction The aim of this study was to know, through a national survey, the methods and techniques used for the diagnosis of Helicobacter pylori (Hp) in the different Clinical Microbiology Services/Laboratories in Spain, as well as antibiotic resistance data. Methods The survey requested information about the diagnostic methods performed for H. pylori detection in Clinical Microbiology laboratories, including serology, stool antigen, culture from gastric biopsies, and PCR. In addition, the performance of antibiotic susceptibility was collected. Data on the number of samples processed in 2016, positivity of each technique and resistance data were requested. The survey was sent by email (October–December 2017) to the heads of 198 Clinical Microbiology Laboratories in Spain. Results Overall, 51 centres from 29 regions answered the survey and 48/51 provided Hp microbiological diagnostic testing. Concerning the microbiological methods used to diagnose Hp infection, the culture of gastric biopsies was the most frequent (37/48), followed by stool antigen detection (35/48), serology (19/48) and biopsy PCR (5/48). Regarding antibiotic resistance, high resistance rates were observed, especially in metronidazole and clarithromycin (over 33%). Conclusion Culture of gastric biopsies was the most frequent method for detection of Hp, but the immunochromatographic stool antigen test was the one with which the largest number of samples were analyzed. Nowadays, in Spain, it concerns the problem of increased antibiotic resistance to ‘first-line’ antibiotics.

It is unclear whether the use of clinical prediction rules is sufficient to rule out infective endocarditis (IE) in patients withWe conducted a unicentric retrospective cohort including all patients with a first SAB episode from January 2015 to December 2020. IE was defined according to modified Duke criteria. We predefined threshold cutoff points to consider that IE was ruled out by means of the mentioned scores. To assess 30-day mortality, we used a multivariable regression model considering performing an echocardiogram as covariate.Out of 404 patients, IE was diagnosed in 50 (12.4%). Prevalence of IE within patients with negative PREDICT, POSITIVE, and VIRSTA scores was: 3.6% (95% CI 0.1-6.9%), 4.9% (95% CI 2.2-7.7%), and 2.2% (95% CI 0.2-4.3%), respectively. Patients with negative VIRSTA and negative TTE had an IE prevalence of 0.9% (95% CI 0-2.8%). Performing an echocardiogram was independently associated with lower 30-day mortality (OR 0.24 95% CI 0.10-0.54,PREDICT and POSITIVE scores were not sufficient to rule out IE without TEE. In patients with negative VIRSTA score, it was doubtful if IE could be discarded with a negative TTE. Not performing an echocardiogram was associated with worse outcomes, which might be related to presence of occult IE. Further studies are needed to assess the usefulness of clinical prediction rules in avoiding echocardiographic evaluation in SAB patients.

Resumen La interpretacion y el rigor de los resultados microbiologicos siguen dependiendo en gran medida de la calidad de las muestras y el procesamiento de las mismas dentro del Servicio de Microbiologia. Conocer el tipo de muestra, el momento adecuado y la manera de obtencion, su conservacion y transporte determinara la rentabilidad de la misma en el proceso infeccioso. En este sentido, la disponibilidad de nuevas tecnicas dentro del laboratorio y el manejo, cada vez menos excepcional, de muestras con sospecha de infeccion por patogenos no habituales nos obligan a revisar y actualizar todos los pasos implicados en el procesamiento de las muestras. Hoy dia, la automatizacion del laboratorio y la amplia variedad de tecnicas rapidas utilizadas han hecho que el diagnostico microbiologico tenga la rapidez y precision necesaria para realizar un diagnostico de calidad y clinicamente relevante; sin olvidar que, en todos los casos, la informacion clinica es necesaria y de vital importancia para que el microbiologo pueda aplicar las tecnicas diagnosticas disponibles de la manera mas eficiente.

Resumen Antecedentes y objetivo La bacteriemia por Pseudomonas aeruginosa se asocia a una mortalidad muy elevada, condicionada por la comorbilidad, el origen y la gravedad del episodio y la ausencia de un tratamiento adecuado. El objetivo del estudio es conocer la mortalidad y los factores pronosticos de la bacteriemia por P. aeruginosa en nuestro hospital. Pacientes y metodos Se realizo un estudio retrospectivo de las bacteriemias por P. aeruginosa detectadas entre 2009 y 2014. Se calculo la incidencia y se describieron las caracteristicas epidemiologicas, clinicas y microbiologicas, la mortalidad y sus factores pronosticos. Resultados Se analizaron 110 episodios de bacteriemia por P. aeruginosa, frecuentemente observadas con antecedentes de hospitalizacion, comorbilidad e inmunodepresion. La mayoria fue de origen respiratorio o urinario. La presencia de resistencias fue muy elevada. El tratamiento empirico fue adecuado en el 60,0%, y el dirigido, en el 92,3%. La mortalidad global fue del 37,3%, y la atribuible, del 29,1%. Los factores pronosticos mas importantes fueron el indice Charlson ≥ 3, los antecedentes de neoplasia hematologica, neutropenia y uso de corticoides, el origen, el indice de Pitt ≥ 4, la insuficiencia renal, el tratamiento dirigido adecuado, el tratamiento empirico con piperacilina/tazobactam en pacientes graves y el control del foco. Conclusiones La bacteriemia por P. aeruginosa se asocia a una mortalidad muy elevada, posiblemente mas relacionada con las condiciones previas del paciente y la gravedad del episodio que con el tratamiento elegido. No obstante, el principal objetivo en el manejo sigue siendo optimizar el tratamiento, incluyendo el control del foco.

The interpretation and the accuracy of the microbiological results still depend to a great extent on the quality of the samples and their processing within the Microbiology laboratory. The type of specimen, the appropriate time to obtain the sample, the way of sampling, the storage and transport are critical points in the diagnostic process. The availability of new laboratory techniques for unusual pathogens, makes necessary the review and update of all the steps involved in the processing of the samples. Nowadays, the laboratory automation and the availability of rapid techniques allow the precision and turn-around time necessary to help the clinicians in the decision making. In order to be efficient, it is very important to obtain clinical information to use the best diagnostic tools.

Background Determination of the humoral response to Clostridioides difficile (CD) toxins could be of great value in the management of patients with CD infection (CDI). Methods A prospective study was conducted on the clinical characteristics and humoral response in patients with CDI. Determination of ELISA IgG CD anti-toxin B (tgcBiomics, Germany) was performed. The following dilutions were planned for each patient, 1:100, 1: 200, 1: 400, 1: 800: 1: 1600. A significant concentration of antibody was considered to be present in each dilution if an optical density 0.2 units higher than the negative control of the technique was evident. Results Eighty-five patients were included during the study period, November 2018-February 2020. The median age was 73 years (interquartile range: 62.5-85 years), with female predominance (45 patients, 52.9%). Thirty-nine patients (45.9%) had a severe infection. Seven patients (8.2%) had suffered an episode of CDI in the previous three months. Seventeen patients (20%) had one or more recurrent episodes during the three-month follow-up: No patient died during admission or required surgery for severe-complicated infection. The incidence of recurrence in patients with no antibody detected at 1:400 dilution was 25.4% (16 patients) while it was 4.3% (one patient) in patients with antibody present at that dilution (p = 0.03). Liver cirrhosis was associated with higher humoral response against CD. Conclusions Antibodies IgG CD anti-toxin B detection at a dilution of 1:400, using a B ELISA technique, effectively identified patients at increased risk of recurrence. This information could help assist in the management of patients.

Background Recently, several scores to quantify compliance with the guidelines in candidaemia management (EQUAL, GEMICOMED, Valerio) have been developed. Evidence supporting the association of these scores to the prognosis is scarce. We aim to evaluate the performance of these candidaemia guideline adherence scores to predict candidaemia outcome. Methods We recorded retrospectively data from candidaemia episodes (January 2017-December 2018). We analysed adherence to guidelines for candidaemia management according to EQUAL, GEMICOMED and Valerio scores, and we correlated those to outcome. Results Fifty-four first episodes of candidaemia were retrieved. Five patients who died in the first 48 hours after blood cultures were not included. Thirty-day mortality in evaluable patients was 18.4%. Median adherence to guidelines according to EQUAL score was 17 (interquartile range [IQR]: 15-19), and according to GEMICOMED was 86% (IQR: 72.5%-100%). According to Valerio score, adequacy of antifungal prescription was 8.5/10 (SD: 1.9). A cut-off of ≥17 for EQUAL or compliance >70% for GEMICOMED was associated with inferior 30-day mortality (7.1% vs 33.3%, P = .028 and 7.9% vs 54.5%, P = .002, respectively). Infectious diseases (ID) evaluated cases obtained a better EQUAL score (>17; 82.1% vs 42.9%, P = .006), had inferior 30-day mortality (9.4% vs 35.3%, P = .049) and a better antifungal prescription adequacy (Valerio score 9.0 vs 7.5, P = .011). Conclusion Adherence to guidelines for candidaemia management evaluated by means of EQUAL and GEMICOMED score was associated with a decreased 30-day mortality. Adequacy of antifungal prescription can be ameliorated. ID consultation improved guideline adherence and was associated with decreased 30-day mortality.

Background Staphylococcus aureus is the leading cause of prosthetic joint infection (PJI). Beyond the antibiogram, little attention has been paid to the influence of deep microbiological characteristics on patient prognosis. Our aim was to investigate whether microbiological genotypic and phenotypic features have a significant influence on infection pathogenesis and patient outcome. Methods A prospective multicenter study was performed, including all S. aureus PJIs (2016–2017). Clinical data and phenotypic (agr functionality, β-hemolysis, biofilm formation) and genotypic characteristics of the strains were collected. Biofilm susceptibility to antimicrobials was investigated (minimal biofilm eradication concentration [MBEC] assay). Results Eighty-eight patients (39.8% men, age 74.7 ± 14.1 years) were included. Forty-five had early postoperative infections (EPIs), 21 had chronic infections (CPIs), and 19 had hematogenous infections (HIs). Twenty (22.7%) were caused by methicillin-resistant S. aureus. High genotypic diversity was observed, including 16 clonal complexes (CCs), with CC5 being the most frequent (30.7%). agr activity was greater in EPI than CPI (55.6% vs 28.6%; P = .041). Strains causing EPI were phenotypically and genotypically similar, regardless of symptom duration. Treatment failure (36.5%) occurred less frequently among cases treated with implant removal. In cases treated with debridement and implant retention, there were fewer failures among those who received combination therapy with rifampin. No genotypic or phenotypic characteristics predicted failure, except vancomycin minimal inhibitory concentration ≥1.5 mg/L (23.1% failure vs 3.4%; P = .044). MBEC50 was >128 mg/L for all antibiotics tested and showed no association with prognosis. Conclusions S. aureus with different genotypic backgrounds is capable of causing PJI, showing slight differences in clinical presentation and pathogenesis. No major microbiological characteristics were observed to influence the outcome, including MBEC.

The EUCAST EDef 9.3.2 procedure recommends visual readings of azole and amphotericin B MICs against Aspergillus spp. Visual determination of MICs may be challenging. In this work, we aim to obtain and compare visual and spectrophotometric MIC readings of azoles and amphotericin B against Aspergillus fumigatus sensu lato isolates. A total of 847 A. fumigatus sensu lato isolates (A. fumigatus sensu stricto [n = 828] and cryptic species [n = 19]) were tested against amphotericin B, itraconazole, voriconazole, posaconazole, and isavuconazole using the EUCAST EDef 9.3.2 procedure. Isolates were classified as susceptible or resistant/non-wild type according to the 2020 updated breakpoints. The area of technical uncertainty for the azoles was defined in the updated breakpoints. Visual and spectrophotometric (fungal growth reduction of >95% compared to the control, read at 540 nm) MICs were compared. Essential (±1 2-fold dilution) and categorical agreements were calculated. Overall, high essential (97.1%) and categorical (99.6%) agreements were found. We obtained 100% categorical agreements for amphotericin B, itraconazole, and posaconazole, and consequently, no errors were found. Categorical agreements were 98.7 and 99.3% for voriconazole and isavuconazole, respectively. Most of the misclassifications for voriconazole and isavuconazole were found to be associated with MIC results falling either in the area of technical uncertainty or within one 2-fold dilution above the breakpoint. The resistance rate was slightly lower when the MICs were obtained by spectrophotometric readings. However, all relevant cyp51A mutants were correctly classified as resistant. Spectrophotometric determination of azole and amphotericin B MICs against A. fumigatus sensu lato isolates may be a convenient alternative to visual endpoint readings.

Objective. To describe the epidemiology of Enterobactera-les producing carbapenemases (EPC) in a tertiary hospital. Material and methods. A retrospective observational study, all patients with a positive sample for EPC treated in hospitalization or in the Emergency Department were included, between January 1, 2014 and December 31, 2016. Results. A total of 272 patients (316 samples) were in-cluded: 155 (57%) male. Mean age of 70.4 years (95% CI 68.2-72.7). Mean Charlson index was 3.6 (95% CI 3.4-3.8). In 63.2% the acquisition was nosocomial, in 35.3% it was health-care associated (HA). 55.1% presented infection, the most frequent infection was urinary tract infection (UTI) (58.7%). The most frequent species were Klebsiella pneumoniae (62.7%) and Enterobacter cloacae (10.1%). The most frequent types of carbapenemase were OXA-48 (53.8%) and VIM (43%). The nosocomial acquisition was associated with the male gender, transplantation, immunosuppression, admission to the Intensi-ve Care Unit (ICU) or surgical service, prior antibiotic treatment, Enterobacter, VIM, respiratory and intra-abdominal infections. The HA acquisition was associated with age and comorbidity, nursery home origin, bladder catheterization, greater number of outpatient procedures, previous hospital admission, K. pneu-moniae and E. coli, OXA-48, coproduction of extended spectrum betalactamases, UTI and sepsis. Conclusions. Patients who acquire EPC in nursery homes frequently have an infection. Patients with nosocomial acquisition are colonized by EPC in the ICU, in relation to invasive procedures and transplantation. This population has a higher mortality due to developing respiratory infections by EPC.

GAMES Investigators., [Background] Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking., [Objectives] The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort., [Methods] This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses., [Results] Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse., [Conclusions] Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.

Some of the more protective and favorable factors for the development and health in children and teenagers are family and sport, so family involvement in the children&rsquo, s sports activities is vital in their sports process. The purpose of this study was to analyze the verbal behavior (positive, negative, and neutral comments) of family spectators of school-age athletes regarding sociodemographic and sporting variables. The sample consisted of 190 family spectators of 215 male and female (Mage = 11.66, SD = 1.60) football, basketball, and volleyball players. The Parents&rsquo, Observation Instrument at Sport Events (POISE) was used for the observation and LINCE was used to codify the verbal comments made. After registering 38,829 comments, the results showed statistically significant differences in relation to the comments made and the gender of athletes, geographical area, kind of sport, and the sporting category. The findings highlight that in a competitive environment, the comments made by spectators related to athletes do not seem to be initiators of potentially violent situations but rather are dependent on the atmosphere in question. Further research is required in this area to foster positive conduct relating to grassroots sports.

Engagement is a psychological construct that was originally defined in an organizational context to refer to the emotional, cognitive and physical components that drive people to get actively involved in their occupational duties. In sports science, the Athlete Engagement Questionnaire conceptualizes engagement as a multidimensional construct comprising four factors: confidence, vigor, dedication and enthusiasm. The purpose of this study was to analyze the measurement model invariance of the Athlete Engagement Questionnaire across different competitive levels and to provide evidence of construct validity in relation to burnout. To this end, we recruited 1157 athletes of both sexes, aged between 12 and 35 years, to complete the Athlete Engagement Questionnaire and Athlete Burnout Questionnaire. The results provided evidence of Athlete Engagement Questionnaire measurement model invariance and its validity with respect to burnout.

En este trabajo se presenta un programa para el desarrollo moral en personas con discapacidad intelectual a través de actividades predeportivas realizadas en un contexto educativo dirigido a su inserción sociolaboral. El programa diseñado se basa en la teoría del desarrollo moral de Kohlberg con el fin de aumentar la competencia moral del alumnado trabajando distintos valores combinando tareas motrices con la discusión de dilemas morales en actividades deportivas. Participaron 23 estudiantes (11 hombres y 12 mujeres) con edades comprendidas entre los 21 y los 31 años (M=25.96; D.T.=3.15) en un diseño pretest-postest con grupo de control. El sistema de evaluación utilizado fue la adaptación al español para discapacidad intelectual del Test de Competencia Moral (MCT). El grupo que recibe el programa de predeporte y desarrollo de valores reflejó un aumento en la competencia moral, aunque no llegó a ser estadísticamente significativa. Los resultados alientan a seguir investigando en esta línea en pro del desarrollo moral y condición física de estas personas. This work presents a program to development moral reasoning in people with intelectual disabilities through pre-sport activities in an educational context for their social integration into the workplace. The program is inspired principally by Kohlberg’s theory. Its aim was increase the moral competence of the students with intellectual disabilities through the combination of motor skill tasks with the discussion of moral dilemmas in sport. 23 students participated (11 males, 12 females) aged between 21 and 31 (M = 25.96; SD = 3.15) in a non-equivalent group quasi-experimental design. A Spanish version of the Moral Competence Test (MCT) was measurement instrument of moral reasoning. The experimental group showed an increase in the means of the C-Index after the application of the pre-sport program, although no statistically significant differences were detected (F = .16, p = .69). In addition, the comparison between means of the C-Index of the control group and the group that received the program showed an improvement in the score of the latter. Although no statistically significant differences were detected (F = .34, p = .56). Similar results can be observed in the scores of moral development levels. After intervention, there were improvements in the preconventional (stage 1 and 2) and conventional (stage 3 and 4) levels. Postconventional level (stage 5 and 6) had a lower mean. Comparing control group and group that received the program, the latter showed improvements in the scores of all stages. It encourages further research in the area of moral development and the physical condition of people with intellectual disabilities.

The aim of the present investigation was to analyse the relation between parental behaviour and other socio-demographic and sportive variables with their children’s sports performance. A sample of 223 parents (46.2% men; 53.4% women) of 223 youth athletes (77.13% boys; 22.87% girls; Mage = 11.66 years; DE = 1.60) were asked. All of them belonged to 13 grassroots teams: football (soccer) (48.9%), basketball (13.5%), volleyball (34.1%) and handball (3.6%) of different categories: U-12 (36.8%), U-13 (48%) and U-15 (15.2%). A retrospective ex post facto design of unique group was planned. The questionnaire Análisis del Comportamiento y Actuación de los Padres y Madres en el Deporte (ACAPMD) was used. Differences statistically significant were detected between parental behaviour to the sports, socio-demographic variables (age and athlete’s gender, parents’ gender and geographical zone) and sports variables (sports category and sport played) with the sports performance. An age increase above the mean, it will make more probable a high sports performance. The clubs of out of Palma registered the highest percentage of sports performance and low sports performance. The highest percentage of high performance was registered in men and women highlighted in medium and low performance. The highest percentages of high and medium performance were registered when the mothers answered the questionnaire. The highest percentage of high and low performance was registered in basketball. And, the highest percentage of sports performance was in U-12’s category, U-13’s category highlighted in low performance and U-15’s category highlighted in medium performance. This research was conducted, in part, thanks to a grant (Values in sport) from Conselleria de Transparència, Cultura i Esport. Govern de les Illes Balears (Spain). Project number (06605).

Objective: To investigate the rate of colorectal neoplasms (CRNs) in patients who have Enterococcus faecalis infective endocarditis (EFIE) with available colonoscopies and to assess whether this is associated with the identification of a focus the infection. Patients and Methods: Retrospective analysis of data from a prospective multicenter study involving 35 centers who are members of the Grupo de Apoyo para el Manejo de la Endocarditis en Espana [Support Group for the Management of Infective Endocarditis in Spain] cohort. A specific set of queries regarding information on colonoscopy and histopathology of colorectal diseases was sent to each participating center. Four-hundred sixty-seven patients with EFIE were included from January 1, 2008, to December 31, 2017, from whom data on colonoscopy performance and results were available in 411 patients. Results: One hundred forty-two (34.5%) patients had a colonoscopy close to the EFIE episode. The overall rate of colorectal diseases was 70.4% (100 of 142), whereas the prevalence of CRN (advanced adenomas and colorectal carcinoma) was 14.8% (21 of 142), with no significant differences between the group of EFIE of unknown focus and that with an identified focus. Conclusion: Our study adds to prior evidence suggesting a much higher rate of CRN among patients with EFIE than in the general population of the same age and sex. In addition, our findings suggest that this phenomenon might take place both in EFIE with an unknown and an identified source of infection.

The aim of this study was to know, through a national survey, the methods and techniques used for the diagnosis of Helicobacter pylori (Hp) in the different Clinical Microbiology Services/Laboratories in Spain, as well as antibiotic resistance data.The survey requested information about the diagnostic methods performed for Hp detection in Clinical Microbiology laboratories, including serology, stool antigen, culture from gastric biopsies, and PCR. In addition, the performance of antibiotic susceptibility was collected. Data on the number of samples processed in 2016, positivity of each technique and resistance data were requested. The survey was sent by email (October-December 2017) to the heads of 198 Clinical Microbiology Laboratories in Spain.Overall, 51 centers from 29 regions answered the survey and 48/51 provided Hp microbiological diagnostic testing. Concerning the microbiological methods used to diagnose Hp infection, the culture of gastric biopsies was the most frequent (37/48), followed by stool antigen detection (35/48), serology (19/48) and biopsy PCR (5/48). Regarding antibiotic resistance, high resistance rates were observed, especially in metronidazole and clarithromycin (over 33%).Culture of gastric biopsies was the most frequent method for detection of Hp, but the immunochromatographic stool antigen test was the one with which the largest number of samples were analyzed. Nowadays, in Spain, it concerns the problem of increased antibiotic resistance to 'first-line' antibiotics.

Cardiac device-related infections (CDRI) may be life-threatening and require early and accurate diagnosis. The aims of this study were to analyze the performance of positron emission tomography-computed tomography (PET/CT) in suspected CDRI, to assess changes to the initial diagnosis, and to identify a clinical subgroup deriving the greatest benefit from this imaging modality.Retrospective study including patients evaluated by PET/CT for suspected CDRI from 2011 to 2018. We assessed PET/CT performance and the agreement between the initial, post-PET and definitive diagnoses. We also assessed changes in the diagnosis, depending on initial clinical suspicion, to identify patients deriving the greatest benefit from PET/CT.We included 44 patients. The prevalence of endocarditis was 57%. The sensitivity and specificity of PET/CT for the diagnosis of infective endocarditis were 0.84 and 0.95, respectively. Post-PET diagnosis improved the initial diagnosis by 45%. PET/CT correctly reclassified 57% of patients with initial suspicion of generator pocket infection by detecting lead infection.PET/CT showed high diagnostic performance in suspected of CDRI and significantly improved the conventional diagnostic approach, especially in patients with initial suspicion of focal infection.

The purpose of the present research was to analyze the mediating role of motivational regulation between the satisfaction of basic psychological needs and burnout and engagement in athletes. From different sports 1011 young Spanish athletes participated in the study. Participants completed several measurement instruments concerning: the Basic Needs Satisfaction in Sport Scale, Behavioral Regulation in Sport Questionnaire, Athlete Burnout Questionnaire and Athlete Engagement Questionnaire. The results of structural equation modeling showed that the satisfaction of basic psychological needs has direct effects on burnout and engagement: a negative effect on athlete burnout (&ndash, 0.49, p &lt, 0.001) and a positive effect on engagement (0.54, p &lt, 0.001). In addition, the satisfaction of basic psychological needs has a partial indirect effect over these variables in the same direction mediated by the self-determined degree of motivation. Thus, low levels of self-regulated motivation are positively related to burnout, but high levels of self-determined motivation are not. The same was observed with engagement, but vice versa: high levels of self-determined motivation are positively related to athlete engagement, but low levels of self-determined motivation are not. The proposed model explained 37% of the variance of burnout and 51% of the variance of engagement.

El objetivo del presente trabajo es analizar la importancia otorgada a los valores por alumnos adultos con discapacidad intelectual, tras la implementacion de un programa educativo para promover valores a traves de predeportes y dilemas morales. Participaron 26 alumnos de dos promociones diferentes ( n 1 = 12; n 2 = 14), con edades comprendidas entre los 19 y los 37 anos ( M = 24.08 ± 4.57). El instrumento utilizado fue una adaptacion para discapacidad intelectual de la version espanola del Sport Value Questionnaire (SVQ-E). Se planifico un diseno cuasiexperimental, concretamente un diseno pre-post con cuasicontrol en una cohorte anterior. Se observaron diferencias estadisticamente significativas en la valoracion del alumnado hacia el valor fair play /honestidad en la primera promocion. Ademas, se detectaron diferencias estadisticamente significativas entre la importancia otorgada por los alumnos a los valores trabajados en el programa respecto a los no trabajados. Normal 0 21 false false false ES X-NONE X-NONE

In this outbreak, 12 patients in intensive care units acquired a Chryseobacterium indologenes infection. Cultures from sinkholes and air samples were positive for C. indologenes. After removing wash basins, no new cases appeared. Sinkholes, potentially contaminated, can act as a reservoir for C. indologenes and other microorganisms. Thus, patients and equipment should be protected from sink splashes to avoid contamination.

Presentamos un estudio observacional prospectivo en 112 pacientes con heridas crónicas de diferentes etiologías y con diagnóstico clínico de sospecha de infección. Se comparan los resultados microbiológicos obtenidos mediante dos tipos de toma de muestra: el frotis superficial y la aspiración percutánea. El número medio de microorganismos aislados por muestra fue de 2,1 en frotis superficial y de 1,8 en aspiración percutánea. El porcentaje de concordancia efectiva total (CET) en el diagnóstico microbiológico para los dos métodos estudiados fue del 62,5%. La CET obtenida para los dos grupos mayoritarios de heridas crónicas fue del 80% (p = 0,219) para las úlceras por presión y del 54% (p < 0,001) para las úlceras venosas. La concordancia entre los dos métodos para Staphylococcus aureus fue del 69,4%, del 73,3% para bacilos gramnegativos y del 88,9% para microorganismos anaerobios. En nuestro trabajo, el aspirado produjo falsos negativos importantes en patógenos de gran relevancia clínica en infección de piel y partes blandas como Streptococcus pyogenes. No podemos decir que la torunda muestre mayoritariamente colonización, sino que si la toma de muestra está basada en la sospecha de infección y el procesamiento se realiza mediante un recuento semicuantitativo, los aislados pueden reflejar realmente infección.

Background and objectives Pseudomonas aeruginosa bacteraemia is associated with a very high mortality, conditioned by comorbidity, source, severity of the episode and lack of adequate treatment. The aim of the study is to know the mortality and prognostic factors of bacteraemia by P. aeruginosa in our hospital. Patients and methods We conducted a retrospective study of P. aeruginosa bacteraemia detected between 2009 and 2014. Epidemiological, clinical and microbiological characteristics were described. A risk factor analysis for mortality was performed. Results We analysed 110 episodes of bacteraemia, which was more frequent in men of advanced age and with a history of hospitalisation, comorbidity and immunosuppression. Most of the bacteraemias were secondary (mainly of respiratory or urinary source) and led to a significant clinical deterioration. The presence of antibiotic resistance was very high, with 27.3% of multiresistant strains. Empirical treatment was adequate in 60.0% and 92.3% for definite treatment. Overall mortality was 37.3% and attributable mortality was 29.1%. The most important prognostic factors were Charlson index ≥3, history of haematologic malignancy, neutropenia and previous use of corticosteroids, source of bacteraemia, Pitt index ≥4, renal insufficiency, adequate definite treatment, empiric treatment with piperacillin/tazobactam in severe episodes and focus control. Conclusion P. aeruginosa bacteraemia is associated with a very high mortality, possibly more related to previous comorbidity and severity of the episode than to the treatment chosen. However, the main goal in management remains to optimise treatment, including focus control.