BACKGROUND: SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding among patient's basal clinical conditions. METHODS: We have evaluated all 513 patients attended in our hospital between March 1 and July 1. We have selected all 18 patients with prolonged viral shedding, and compared them with 36 sex-matched randomly selected controls. Demographic, treatment and clinical data were systematically collected. RESULTS: Global median duration of viral clearance was 25.5 days (n=54; IQR, 22-39.3 days), 48.5 days in cases (IQR 38.7-54.9 days) and 23 days in controls (IQR 20.2-25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups. Chronic rhino-sinusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (p<0.001 and p=0,003). The use of inhaled corticosteroids was also more frequent in case group (p=0.007). Multivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI],3.89 - 90.59; p<0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. CONCLUSION: We found that chronic rhino-sinusitis and atopy might be ass

Objetive. The aim of this study was to analyze the activity of the imipenem-relebactam combination (IMI/REL) against a collection of multidrug-resist Enterobacterales, Pseudomonas aeruginosa and Acinetobacter baumannii clinical isolates. Material and methods. The study was conducted in two tertiary hospitals in Spain and included 192 clinical isolates of these 3 genera (139 resistant and 53 susceptible to IMI). The MICs for IMI with and without REL (at a fixed concentration of 4 mg/L) were determined by a standard broth microdilution method according to international recommendations. Results. All IMI-susceptible E. coli strains were also susceptible to IMI/REL. Enterobacterales resistant to IMI due to the production of carbapenemases, the MIC50 and MIC90 decreased from 64/256 with IMI to 8/64 mg/L with IMI/REL. This high activity was principally detected among isolates with KPC enzymes. Enterobacterales with class B carbapenemases, P. aeruginosa carrying VIM carbapenemase and A. baumannii strains showed no changes on IMI MIC50 or MIC90 after adding REL. Among P. aeruginosa strains without carbapenemase the MIC for IMI/REL was reduced between 1 to 5 dilutions. Conclusions. IMI/REL showed high activity against the strains that carry Klebsiella pneumoniae carbapenemase (KPC) and against carbapenem-resistant P. aeruginosa unrelated to the VIM enzyme, mainly AmpC beta lactamase associated with impermeability. Against strains carrying oxacillinase 48 (OXA-48) associated with extended-spectrum beta-lactamase (ESBL), IMI/REL presented activity only slightly better than IMI and had no beneficial effect superior to IMI against A. baumannii.

Introducción Los bacilos Gram negativos no fermentadores constituyen un complejo conjunto de microorganismos aerobios estrictos, de distribución universal, con gran resistencia a factores ambientales severos, lo que les permite propagarse rápidamente y desarrollar resistencia a todos los antimicrobianos convencionales. Factores de riesgo Dentro de estos, Pseudomonas aeruginosa, Acinetobacter baumanii y Stenotrophomonas maltophilia son los que tienen mayor implicación clínica. Se consideran microorganismos oportunistas, ya que afectan principalmente a pacientes hospitalizados en unidades de críticos, inmunodeprimidos, portadores de material protésico, ampliamente instrumentados y tratados previamente con antibióticos. También se caracterizan por causar brotes en los hospitales. Manifestaciones clínicas Destacan como patógenos del tracto respiratorio inferior, siendo la principal causa de neumonía asociada a ventilación mecánica e infección respiratoria en pacientes con fibrosis quística. Tratamiento El tratamiento de las infecciones causadas por estos microorganismos es complicado, ya que no sólo presentan resistencia natural a diferentes familias de antibióticos sino que además tienen una gran capacidad para adquirir nuevos mecanismos de resistencia durante el tratamiento, por lo que a menudo presentan patrones de multirresistencia.

La gastroenteritis aguda es una de las principales causas de morbilidad a nivel mundial y mortalidad en países en vías de desarrollo. La presentación del cuadro clínico, según sea una gastroenteritis inflamatoria o no inflamatoria, marcará la actitud diagnóstica y terapéutica. Tratamiento La mayoría de las diarreas infecciosas del adulto inmunocompetente son episodios autolimitados que no requieren estudio de laboratorio específico y evolucionan favorablemente con solo un tratamiento sintomático. De modo general, no se recomienda el uso empírico de antibióticos y estos quedan reservados para los casos de diarrea inflamatoria aguda, pacientes menores de 2 años o mayores de 70 años, pacientes inmunodeprimidos y pacientes con patología vascular. En el caso de instaurar tratamiento empírico, este se seleccionará en función del cuadro clínico y la información obtenida en la anamnesis del paciente.

Introducción La mayoría de las infecciones de la cavidad bucal son odontogénicas, aunque también pueden afectar a las estructuras extradentales (infecciones no odontogénicas). La faringitis es la inflamación y/o la infección de la faringe y/o área periamigdalar. Tratamiento Ambas infecciones tienen una prevalencia muy alta en la población, siendo uno de los motivos más frecuentes de consulta y prescripción de antibióticos en las consultas de Atención Primaria. El tratamiento de ambas infecciones suele ser empírico, basado en el diagnóstico clínico y la prevalencia y sensibilidad antibiótica de los microorganismos implicados con más frecuencia.

Urinary tract infections (UTI) are highly prevalent in nosocomial and community settings, and their diagnosis is costly and time-consuming. Screening methods represent an important advance towards the final UTI diagnosis, diminishing inappropriate treatment or clinical complications. Automated analyzers have been developed and commercialized to screen and rule out negative urine samples. The aim of this study was to evaluate two of these automated analyzers (SediMax, an automatic sediment analyzer and UF-1000i a flow cytometer) to predict negative urine cultures. A total of 1934 urine samples were analyzed. A very strong correlation for white blood cells (WBC) (rs: 0.928) and a strong correlation for bacteria (BAC) (rs: 0.693) were obtained. We also calculated optimal cut-off points for both autoanalyzers: 18 WBC/¿L and 97 BAC/¿L for SediMax (sensitivity=96.25%, specificity=63.04%, negative predictive value=97.97%), and 40 WBC/¿L and 460 BAC/¿L for UF-1000i (sensitivity=98.13%, specificity=79.16%, negative predictive value=99.18%). The use of SediMax and UF-1000i resulted in a 46.33% and 57.19% reduction of all samples cultured, respectively. In conclusion, both analyzers are good UTI screening tools in our setting.

The purpose of this study is to evaluate the diagnostic performance of the novel 2-photon excitation-based mariPOC© Assay (ArcDia Laboratories, Turku, Finland) for antigen detection of respiratory viruses versus real-time polymerase chain reaction (PCR). The mariPOC Assay and 2 multiplex real-time PCR techniques were performed on nasopharyngeal samples from pediatric patients with suspicion of acute respiratory infection admitted to a children's hospital in Spain during October 2011 to January 2013. A total of 233 samples were studied. Sensitivities and specificities (95% confidence interval) of the mariPOC Assay were for respiratory syncytial virus (RSV), 78.4% (69.7-85.6) and 99.2% (96.3-100.0); influenza virus (IFV) A, 66.7% (26.2-94.0) and 99.6% (97.9-100.0); IFV-B, 63.6% (33.6-87.2) and 100.0% (98.7-100.0); human metapneumovirus (hMPV), 60.0% (34.5-81.9) and 100.0% (98.6-100.0); adenovirus (ADV), 12.5% (0.6-48.0) and 100.0% (98.7-100.0), respectively. The mariPOC Assay is a highly specific method for simultaneous detection of 8 respiratory viruses but has sensitivities that range from moderately high for RSV to moderate for IFV and hMPV and low for ADV.

Candida species have two distinct lifestyles: planktonic, and surface-attached communities called biofilms. Mature C. albicans biofilms show a complex three-dimensional architecture with extensive spatial heterogeneity, and consist of a dense network of yeast, hyphae, and pseudohyphae encased within a matrix of exopolymeric material. Several key processes are likely to play vital roles at the different stages of biofilm development, such as cell-substrate and cell-cell adherence, hyphal development, and quorum sensing. Biofilm formation is a survival strategy, since biofilm yeasts are more resistant to antifungals and environmental stress. Antifungal resistance is a multifactorial process that includes multidrug efflux pumps, target proteins of the ergosterol biosynthetic pathway. Most studies agree in presenting azoles as agents with poor activity against Candida spp. biofilms. However, recent studies have demonstrated that echinocandins and amphotericin B exhibit remarkable activity against C. albicans and Candida non-albicans biofilms. The association of Candida species with biofilm formation increases the therapeutic complexity of foreign body-related yeast infections. The traditional approach to the management of these infections has been to explant the affected device. There is a strong medical but also economical motivation for the development of novel anti-fungal biofilm strategies due to the constantly increasing resistance of Candida biofilms to conventional antifungals, and the high mortality caused by related infections. A better description of the extent and role of yeast in biofilms may be critical for developing novel therapeutic strategies in the clinical setting.

Bacterial endotoxins (lipopolysaccharides (LPS)) are strong elicitors of the human immune system by interacting with serum and membrane proteins such as lipopolysaccharide-binding protein (LBP) and CD14 with high specificity.