1
|
Ara-Montojo MF, Bustamante J, Sainz T, Pérez S, Jiménez-Moreno B, Ruiz-Carrascoso G, Rodríguez-Molino P, Villota J, García-López-Hortenano M, Mellado-Peña MJ. Intestinal giardiasis in children: Five years' experience in a reference unit. Travel Med Infect Dis 2021; 42:102082. [PMID: 34020030 DOI: 10.1016/j.tmaid.2021.102082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Giardiasis is highly prevalent in children and is often mildly symptomatic. First-line treatment is metronidazole, but treatment failure is not uncommon. We describe a paediatric series, to identify risk factors for treatment failure and to analyse the safety and effectiveness of other treatment strategies. METHODS Retrospective observational study, including children diagnosed with giardiasis from 2014 to 2019. Diagnosis was based on direct visualisation by microscopy after concentration using an alcohol-based fixative, antigen detection and/or DNA detection by polymerase chain reaction in stool. Treatment failure was considered when GI was detected 4 weeks after treatment. RESULTS A total of 120 patients were included, 71.6% internationally adopted, median age 4.2 (2.3-7.3) years. Only 50% presented with symptoms, mainly diarrhoea (35%) and abdominal pain (14.1%); co-parasitism was frequent (45%). First-line treatment failure after a standard dose of metronidazole was 20%, lowering to 8.3% when a higher dose was administered (p < 0.001). Quinacrine was administered in 10 patients, with 100% effectiveness. Children <2 years were at higher risk of treatment failure (OR 3.49; 95% CI 1.06-11.53; p = 0.040). CONCLUSIONS In children with giardiasis, treatment failure is frequent, especially before 2 years of age. Quinacrine can be considered as a second-line treatment. After treatment, eradication should be confirmed.
Collapse
Affiliation(s)
- M F Ara-Montojo
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain
| | - J Bustamante
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - T Sainz
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Translational Research Network in Paediatric Infectious Diseases (RITIP, Red de Investigación Translacional en Infectología Pediátrica), Spain.
| | - S Pérez
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain
| | | | - G Ruiz-Carrascoso
- Department of Microbiology, La Paz University Hospital, Madrid, Spain
| | - P Rodríguez-Molino
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain
| | - J Villota
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - M García-López-Hortenano
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Translational Research Network in Paediatric Infectious Diseases (RITIP, Red de Investigación Translacional en Infectología Pediátrica), Spain
| | - M J Mellado-Peña
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Translational Research Network in Paediatric Infectious Diseases (RITIP, Red de Investigación Translacional en Infectología Pediátrica), Spain
| |
Collapse
|
2
|
Ara-Montojo MF, Escosa-García L, Alguacil-Guillén M, Seara N, Zozaya C, Plaza D, Schuffelmann-Gutiérrez C, de la Vega Á, Fernández-Camblor C, Ramos-Boluda E, Romero-Gómez MP, Ruiz-Carrascoso G, Losantos-García I, Mellado-Peña MJ, Gómez-Gil R. Predictors of mortality and clinical characteristics among carbapenem-resistant or carbapenemase-producing Enterobacteriaceae bloodstream infections in Spanish children. J Antimicrob Chemother 2021; 76:220-225. [PMID: 33038895 DOI: 10.1093/jac/dkaa397] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging problem in the paediatric population worldwide with high mortality rates in bloodstream infection (BSI). OBJECTIVES To evaluate predictors of 30 day mortality in CRE BSI in a paediatric cohort. METHODS A retrospective observational single-centre study (December 2005-August 2018) was conducted. Cases of CRE BSI in children 0 to 16 years were included. Microbiological identification (MALDI Biotyper) and antimicrobial susceptibility testing (Vitek2® and MicroScan panel NBC44) according to EUCAST breakpoints were performed. PCR OXVIKP® was used to confirm carbapenemase genes (OXA-48, VIM, KPC, NDM). Demographic characteristics, underlying diseases, source of bacteraemia, antimicrobial therapy and outcomes were collected from medical records. Survival analysis to establish predictors of 30 day mortality was performed. RESULTS Thirty-eight cases were included; 76.3% were hospital-acquired infections and 23.7% related to healthcare. All patients had at least one underlying comorbidity and 52.6% were recipients of an organ transplant. VIM carbapenemase was the predominant mechanism (92.1%). Previous CRE colonization or infection rate was 52.6%. Intestinal tract (26.3%) and vascular catheter (21.1%) were the most common sources of infection. Crude mortality within 30 days was 18.4% (7/38); directly related 30 day mortality was 10.5%. Conditions associated with an increment in 30 day mortality were intensive care admission and inadequate empirical therapy (P < 0.05). Combination-antibiotic targeted treatment and a low meropenem MIC were not related to improved survival. CONCLUSIONS CRE BSI mortality rate is high. The most important factor related to 30 day survival in our CRE BSI cohort in children was empirical treatment that included at least one active antibiotic.
Collapse
Affiliation(s)
- M F Ara-Montojo
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - L Escosa-García
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain.,RITIP (Red de Investigación Translacional en Infectología Pediátrica), Spain
| | - M Alguacil-Guillén
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - N Seara
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - C Zozaya
- Department of Neonatology, Hospital Universitario La Paz, Madrid, Spain
| | - D Plaza
- Department of Paediatric Haematology and Oncology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Á de la Vega
- Department of Hepatology and Liver Transplantation, Hospital Universitario La Paz, Madrid, Spain
| | - C Fernández-Camblor
- Department of Nephrology and Kidney Transplantation, Hospital Universitario La Paz, Madrid, Spain
| | - E Ramos-Boluda
- Paediatric Intestinal Rehabilitation and Bowel Transplantation, Hospital Universitario La Paz, Madrid, Spain
| | - M P Romero-Gómez
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - G Ruiz-Carrascoso
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - I Losantos-García
- Department of Biostatistics, Hospital Universitario La Paz, Madrid, Spain
| | - M J Mellado-Peña
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain.,RITIP (Red de Investigación Translacional en Infectología Pediátrica), Spain
| | - R Gómez-Gil
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
3
|
Lázaro-Perona F, Ramos JC, Sotillo A, Mingorance J, García-Rodríguez J, Ruiz-Carrascoso G, Paño-Pardo JR, Arribas JR, Herruzo R, Arnalich F. Intestinal persistence of a plasmid harbouring the OXA-48 carbapenemase gene after hospital discharge. J Hosp Infect 2018; 101:175-178. [PMID: 30017896 DOI: 10.1016/j.jhin.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/05/2018] [Indexed: 11/17/2022]
Abstract
To study intestinal colonization by OXA-48-producing Klebsiella pneumoniae (KpO48) after hospital discharge, stool samples from 22 previously colonized subjects were collected. Time from discharge was 33-611 days, without readmissions. Eight subjects (36%) were identified as blaOXA-48 gene carriers. In all of them the hospital-acquired strain of KpO48 had been lost, and the gene was harboured by other strains of K. pneumoniae, Klebsiella oxytoca and/or Escherichia coli. Our findings show intestinal persistence for several months of a plasmid harbouring the OXA-48 carbapenemase gene in a significant proportion of individuals in the absence of antibiotic treatment.
Collapse
Affiliation(s)
- F Lázaro-Perona
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J C Ramos
- Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | - A Sotillo
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J Mingorance
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
| | - J García-Rodríguez
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - G Ruiz-Carrascoso
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J R Paño-Pardo
- Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | - J R Arribas
- Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | - R Herruzo
- Servicio de Medicina Preventiva, Hospital Universitario La Paz, Madrid, Spain
| | - F Arnalich
- Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
4
|
Lázaro-Perona F, Sarria-Visa A, Ruiz-Carrascoso G, Mingorance J, García-Rodríguez J, Gómez-Gil R. Klebsiella pneumoniae co-producing NDM-7 and OXA-48 carbapenemases isolated from a patient with prolonged hospitalisation. Int J Antimicrob Agents 2016; 49:112-113. [PMID: 27817973 DOI: 10.1016/j.ijantimicag.2016.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/17/2016] [Indexed: 11/16/2022]
Affiliation(s)
- F Lázaro-Perona
- Department of Clinical Microbiology, Hospital Universitario La Paz, Madrid, Spain.
| | - A Sarria-Visa
- Department of Clinical Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - G Ruiz-Carrascoso
- Department of Clinical Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - J Mingorance
- Department of Clinical Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - J García-Rodríguez
- Department of Clinical Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - R Gómez-Gil
- Department of Clinical Microbiology, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
5
|
López-Camacho E, Rentero Z, Ruiz-Carrascoso G, Wesselink JJ, Pérez-Vázquez M, Lusa-Bernal S, Gómez-Puertas P, Kingsley RA, Gómez-Sánchez P, Campos J, Oteo J, Mingorance J. Design of clone-specific probes from genome sequences for rapid PCR-typing of outbreak pathogens. Clin Microbiol Infect 2014; 20:O891-3. [PMID: 24606530 DOI: 10.1111/1469-0691.12616] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/31/2014] [Accepted: 03/03/2014] [Indexed: 01/25/2023]
Abstract
The genome sequence of one OXA-48-producing Klebsiella pneumoniae belonging to sequence type (ST) 405, and three belonging to ST11, were used to design and test ST-specific PCR assays for typing OXA-48-producing K. pneumoniae. The approach proved to be useful for in-house development of rapid PCR typing assays for local outbreak surveillance.
Collapse
Affiliation(s)
- E López-Camacho
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Navarro-San Francisco C, Mora-Rillo M, Romero-Gómez M, Moreno-Ramos F, Rico-Nieto A, Ruiz-Carrascoso G, Gómez-Gil R, Arribas-López J, Mingorance J, Paño-Pardo J. Bacteraemia due to OXA-48-carbapenemase-producing Enterobacteriaceae: a major clinical challenge. Clin Microbiol Infect 2013; 19:E72-9. [DOI: 10.1111/1469-0691.12091] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/26/2012] [Accepted: 10/26/2012] [Indexed: 11/29/2022]
|
7
|
Pano-Pardo JR, Ruiz-Carrascoso G, Navarro-San Francisco C, Gomez-Gil R, Mora-Rillo M, Romero-Gomez MP, Fernandez-Romero N, Garcia-Rodriguez J, Perez-Blanco V, Moreno-Ramos F, Mingorance J. Infections caused by OXA-48-producing Klebsiella pneumoniae in a tertiary hospital in Spain in the setting of a prolonged, hospital-wide outbreak. J Antimicrob Chemother 2012; 68:89-96. [DOI: 10.1093/jac/dks364] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|