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Del Carmen Valero-Ubierna M, Benavente-Fernández A, Pérez de Rojas J, Moreno-Verdejo F, López-Gómez J, Fernández-Ontiveros S, Chueca-Porcuna N, García-Marín C, Jiménez-Moleón JJ, Rivera-Izquierdo M. Social and clinical predictors of perianal colonisation by multidrug-resistant bacteria for geriatric patients in the internal medicine service. Infection 2024; 52:231-241. [PMID: 38109027 DOI: 10.1007/s15010-023-02153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/18/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Colonisation by multidrug-resistant (MDR) bacteria is a global health issue. The identification of patients with a higher risk of colonisation is essential. Patients admitted to internal medicine services might represent a vulnerable population with a high risk of colonisation. This study was the first to assess social and clinical variables associated with a higher risk of perianal colonisation by MDR bacteria in a Spanish cohort of patients admitted to internal medicine service. METHODS Patients admitted to an internal medicine service during 12 months of recruitment (1 March 2022 to 1 March 2023) were included in the study. Perianal swabs were performed at admission to identify the presence of MDR bacteria. Social and clinical variables were collected following a directed acyclic graph. A cluster analysis was performed to identify clinical profiles of higher risk. Bivariate analyses and multivariable logistic regression models were fitted to identify potential predictors of MDR bacteria colonisation. RESULTS A total of 245 patients, according to the required sample size, were included. Of them, 46 (18.8%) were colonised by MDR bacteria in perianal swabs. Female sex, age > 80 years, dependency on activities of daily living, cognitive deterioration and living in long-term care facilities constituted the highest risk clinical profile. After adjustments, living in long-term care facilities and malnutrition remained the main risk factors identified. CONCLUSION Patients admitted to internal medicine services presented a high frequency of perianal colonisation by MDR bacteria. Social and clinical variables associated with bio-psycho-social susceptibility were associated with colonisation. Special surveillance is needed in internal medicine services to control the transmission.
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Affiliation(s)
- María Del Carmen Valero-Ubierna
- Service of Preventive Medicine and Public Health, Hospital Universitario San Cecilio, Avenida de la Investigación s/n, 18016, Granada, Spain
| | | | - Javier Pérez de Rojas
- Service of Preventive Medicine and Public Health, Hospital Universitario San Cecilio, Avenida de la Investigación s/n, 18016, Granada, Spain
| | - Fidel Moreno-Verdejo
- Service of Internal Medicine, Hospital Universitario San Cecilio, Granada, Spain
| | - Jairo López-Gómez
- Service of Internal Medicine, Hospital Universitario San Cecilio, Granada, Spain
| | | | - Natalia Chueca-Porcuna
- Service of Microbiology, Hospital Universitario San Cecilio, Granada, Spain
- Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain
- CIBERINFEC - Centre for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | - Cristina García-Marín
- Service of Preventive Medicine and Public Health, Hospital Universitario San Cecilio, Avenida de la Investigación s/n, 18016, Granada, Spain
- Service of Preventive Medicine and Public Health, Hospital Universitario La Paz, Madrid, Spain
| | - José Juan Jiménez-Moleón
- Service of Preventive Medicine and Public Health, Hospital Universitario San Cecilio, Avenida de la Investigación s/n, 18016, Granada, Spain
- Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mario Rivera-Izquierdo
- Service of Preventive Medicine and Public Health, Hospital Universitario San Cecilio, Avenida de la Investigación s/n, 18016, Granada, Spain.
- Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain.
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Toral M, Romero M, Rodríguez-Nogales A, Jiménez R, Robles-Vera I, Algieri F, Chueca-Porcuna N, Sánchez M, de la Visitación N, Olivares M, García F, Pérez-Vizcaíno F, Gálvez J, Duarte J. Lactobacillus fermentum Improves Tacrolimus-Induced Hypertension by Restoring Vascular Redox State and Improving eNOS Coupling. Mol Nutr Food Res 2018; 62:e1800033. [PMID: 29851248 DOI: 10.1002/mnfr.201800033] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 01/11/2018] [Revised: 04/12/2018] [Indexed: 01/24/2023]
Abstract
SCOPE The aim is to analyze whether the probiotic Lactobacillus fermentum CECT5716 (LC40) can prevent endothelial dysfunction and hypertension induced by tacrolimus in mice. METHODS AND RESULTS Tacrolimus increases systolic blood pressure (SBP) and impairs endothelium-dependent relaxation to acetylcholine and these effects are partially prevented by LC40. Endothelial dysfunction induced by tacrolimus is related to both increased nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX2) and uncoupled endothelial nitric oxide synthase (eNOS)-driven superoxide production and Rho-kinase-mediated eNOS inhibition. LC40 treatment prevents all the aortic changes induced by tacrolimus. LC40 restores the imbalance between T-helper 17 (Th17)/regulatory T (Treg) cells induced by tacrolimus in mesenteric lymph nodes and the spleen. Tacrolimus-induced gut dysbiosis, that is, it decreases microbial diversity, increases the Firmicutes/Bacteroidetes (F/B) ratio and decreases acetate- and butyrate-producing bacteria, and these effects are prevented by LC40. Fecal microbiota transplantation (FMT) from LC40-treated mice to control mice prevents the increase in SBP and the impaired relaxation to acetylcholine induced by tacrolimus. CONCLUSION LC40 treatment prevents hypertension and endothelial dysfunction induced by tacrolimus by inhibiting gut dysbiosis. These effects are associated with a reduction in vascular oxidative stress, mainly through NOX2 downregulation and prevention of eNOS uncoupling, and inflammation possibly because of decreased Th17 and increased Treg cells polarization in mesenteric lymph nodes.
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Affiliation(s)
- Marta Toral
- Department of Pharmacology, School of Pharmacy, University of Granada, 18071, Granada, Spain
| | - Miguel Romero
- Department of Pharmacology, School of Pharmacy, University of Granada, 18071, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), 18012, Granada, Spain
| | - Alba Rodríguez-Nogales
- Department of Pharmacology, School of Pharmacy, University of Granada, 18071, Granada, Spain.,CIBER-ehd, Center for Biomedical Research (CIBM), 18100, Granada, Spain
| | - Rosario Jiménez
- Department of Pharmacology, School of Pharmacy, University of Granada, 18071, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), 18012, Granada, Spain.,CIBER-Enfermedades Cardiovasculares (CiberCV), 18071, Granada, Spain
| | - Iñaki Robles-Vera
- Department of Pharmacology, School of Pharmacy, University of Granada, 18071, Granada, Spain
| | - Francesca Algieri
- Department of Pharmacology, School of Pharmacy, University of Granada, 18071, Granada, Spain.,CIBER-ehd, Center for Biomedical Research (CIBM), 18100, Granada, Spain
| | - Natalia Chueca-Porcuna
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), 18012, Granada, Spain.,Department of Microbiology, Complejo Hospitalario Universitario de Granada, 18100, Granada, Spain
| | - Manuel Sánchez
- Department of Pharmacology, School of Pharmacy, University of Granada, 18071, Granada, Spain
| | - Néstor de la Visitación
- Department of Pharmacology, School of Pharmacy, University of Granada, 18071, Granada, Spain
| | - Mónica Olivares
- Laboratorio de Descubrimiento y Preclínica, Departamento de Investigación BIOSEARCH S.A., 18004, Granada, Spain
| | - Federico García
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), 18012, Granada, Spain.,Department of Microbiology, Complejo Hospitalario Universitario de Granada, 18100, Granada, Spain
| | - Francisco Pérez-Vizcaíno
- Department of Pharmacology, School of Medicine, Complutense University of Madrid, 28040, Spain.,Ciber Enfermedades Respiratorias (Ciberes) and Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), 28007, Madrid, Spain
| | - Julio Gálvez
- Department of Pharmacology, School of Pharmacy, University of Granada, 18071, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), 18012, Granada, Spain.,CIBER-ehd, Center for Biomedical Research (CIBM), 18100, Granada, Spain
| | - Juan Duarte
- Department of Pharmacology, School of Pharmacy, University of Granada, 18071, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), 18012, Granada, Spain.,CIBER-Enfermedades Cardiovasculares (CiberCV), 18071, Granada, Spain
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Pérez-Parra S, Chueca-Porcuna N, Álvarez-Estevez M, Pasquau J, Omar M, Collado A, Vinuesa D, Lozano AB, García-García F. [Study of human immunodeficiency virus transmission chains in Andalusia: analysis from baseline antiretroviral resistance sequences]. Enferm Infecc Microbiol Clin 2015; 33:603-8. [PMID: 25648468 DOI: 10.1016/j.eimc.2014.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 06/03/2014] [Revised: 11/19/2014] [Accepted: 11/24/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE Protease and reverse transcriptase HIV-1 sequences provide useful information for patient clinical management, as well as information on resistance to antiretrovirals. The aim of this study is to evaluate transmission events, transmitted drug resistance, and to georeference subtypes among newly diagnosed patients referred to our center. METHODS A study was conducted on 693 patients diagnosed between 2005 and 2012 in Southern Spain. Protease and reverse transcriptase sequences were obtained for resistance to cART analysis with Trugene(®) HIV Genotyping Kit (Siemens, NAD). MEGA 5.2, Neighbor-Joining, ArcGIS and REGA were used for subsequent analysis. RESULTS The results showed 298 patients clustered into 77 different transmission events. Most of the clusters were formed by pairs (n=49), of men having sex with men (n=26), Spanish (n=37), and below 45 years of age (73.5%). Urban areas from Granada, and the coastal areas of Almeria and Granada showed the greatest subtype heterogeneity. Five clusters were formed by more than 10 patients, and 15 clusters had transmitted drug resistance. CONCLUSIONS The study data demonstrate how the phylogenetic characterization of transmission clusters is a powerful tool to monitor the spread of HIV, and may contribute to design correct preventive measures to minimize it.
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Affiliation(s)
- Santiago Pérez-Parra
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, España.
| | - Natalia Chueca-Porcuna
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, España
| | - Marta Álvarez-Estevez
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, España
| | - Juan Pasquau
- Servicio de Infecciosas, Hospital Virgen de las Nieves, Granada, España
| | - Mohamed Omar
- Servicio de Infecciosas, Hospital Ciudad de Jaén, Jaén, España
| | - Antonio Collado
- Servicio de Medicina Interna, Hospital de Torrecárdenas, Almería, España
| | - David Vinuesa
- Servicio de Infecciosas, Hospital Universitario San Cecilio, Granada, España
| | | | - Federico García-García
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, España
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Alvarez Estévez M, Chueca-Porcuna N, Guillot-Suay V, Peña-Monje A, García-García F, García-García F. [Low prevalence of hepatitis B virus primary drug resistance in Southern Spain]. Enferm Infecc Microbiol Clin 2013; 31:520-2. [PMID: 23602529 DOI: 10.1016/j.eimc.2013.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/19/2012] [Revised: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To know the prevalence of primary resistance in chronic hepatitis B naïve patients is essential to decide on the need of routine laboratory testing. PATIENTS AND METHODS The genetic sequence of the HBV polymerase from 105naïve patients was analysed. RESULTS rtV173L, a lamivudine compensatory mutation, was detected in two patients (1.9%), rtI233V in one patient, and another one carried the sG145R vaccine escape mutation. CONCLUSION Our study shows that studying HBV resistance in naïve patients should not be recommended in the routine laboratory setting, for the time being.
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Conde-Sánchez M, Roldán-Fontana E, Chueca-Porcuna N, Pardo S, Porras-Gracia J. Analytical performance evaluation of a particle-enhanced turbidimetric cystatin C assay on the Roche COBAS 6000 analyzer. Clin Biochem 2010; 43:921-5. [PMID: 20416293 DOI: 10.1016/j.clinbiochem.2010.04.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 04/13/2010] [Accepted: 04/14/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cystatin C is a low molecular protein that has been proposed to estimate the glomerular filtration rate. Here we investigated the performance of the Roche cystatin C assay on the COBAS 6000 analyzer. DESIGN AND METHODS We studied the imprecision, recovery, limit of detection and quantification, linearity and interferences. For method comparison, split sample aliquots were assayed using the described method and a Siemens cystatin C assay. RESULTS The assay displayed a low total imprecision and a good linearity over the entire range tested. Bilirubin and triglycerides did not interfere with the assay, and only a haemoglobin concentration higher than 6g/dl interfered with the assay. The assay agreed well with the Siemens assay. CONCLUSION The Roche cystatin C assay is an acceptable method for determining the cystatin C and the glomerular filtration rate estimate. On a COBAS 6000, the assay improves and simplifies the laboratory's workload.
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Affiliation(s)
- Manuel Conde-Sánchez
- U.G.C. Laboratorio Clínico, Hospital Nuestra Señora de la Merced, Avda. De la Constitución, 2. 41640-Osuna, Seville, Spain.
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