Posts filed under ‘Epidemiología’

Predictors of pneumonia in lower respiratory tract infections – 3C prospective cough complication cohort study.

European Respiratory Journal ERJ  November 2017 V.50 N.5

Michael Moore1, Beth Stuart 1, Paul Little1, Sue Smith2, Matthew J. Thompson3, Kyle Knox2, Anne van den Bruel2, Mark Lown1 and David Mant2

Affiliations:

1 University of Southampton, Primary Care Medical Group, Aldermoor Health Centre, Southampton, UK.

2 Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.

3 Dept of Family Medicine, University of Washington, Seattle, WA, USA.

Correspondence: Michael Moore, University of Southamptom K. E-mail: mvm198@soton.ac.uk

ABSTRACT

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care. A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009–13. Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review. The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.

Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis. The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5–4.8), crackles on auscultation (RR 1.8; 1.1–3.0), oxygen saturation <95% (RR 1.7; 1.0–3.1) and pulse >100·min–1 (RR 1.9; 1.1–3.2). Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3–23.1).

In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270). Pulse oximetry may aid the diagnosis of pneumonia in this setting.

FULL TEXT

http://erj.ersjournals.com/content/50/5/1700434?etoc

PDF

http://erj.ersjournals.com/content/erj/50/5/1700434.full.pdf

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December 7, 2017 at 8:34 am

Ceftriaxone-Resistant Neisseria gonorrhoeae, Canada, 2017.

Emerging Infectious Diseases February 15, 2018 Feb 15 V.24 N.2

Lefebvre B, Martin I, Demczuk W, Deshaies L, Michaud S, Labbé AC, Beaudoin MC, Longtin J.

Author affiliations: Institut National de Santé Publique du Québec, Québec, Québec, Canada (B. Lefebvre, J. Longtin); Public Health Agency of Canada, Winnipeg, Manitoba, Canada (I. Martin, W. Demczuk); Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec (L. Deshaies); Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec (S. Michaud); Université de Montréal, Québec (A.-C. Labbé); Centre de Recherche en Infectiologie, Université Laval, Québec (M.-C. Beaudoin, J. Longtin)

Abstract

We identified a ceftriaxone-resistant Neisseria gonorrhoeae isolate in a patient in Canada. This isolate carried the penA-60 allele, which differs substantially from its closest relative, mosaic penA XXVII (80% nucleotide identity). Epidemiologic and genomic data suggest spread from Asia. Antimicrobial susceptibility surveillance helps prevent spread of highly resistant N. gonorrhoeae strains.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/24/2/17-1756_article

December 5, 2017 at 7:10 am

Avian Influenza A(H7N2) Virus in Human Exposed to Sick Cats, New York, USA, 2016

Emerging Infectious Diseases December 2017 V.23 N.12

Atanaska Marinova-Petkova, Jen Laplante, Yunho Jang, Brian Lynch, Natosha Zanders, Marisela Rodriguez, Joyce Jones, Sharmi Thor, Erin Hodges, Juan A. De La Cruz, Jessica Belser, Hua Yang, Paul Carney, Bo Shu, LaShondra Berman, Thomas Stark, John Barnes, Fiona Havers, Patrick Yang, Susan C. Trock, Alicia Fry, Larisa Gubareva, Joseph S. Bresee, James Stevens, Demetre Daskalakis, Dakai Liu, Christopher Lee, Mia Kim Torchetti, Sandra Newbury, Francine Cigel, Kathy Toohey-Kurth, Kirsten St. George, David E. Wentworth, Stephen Lindstrom, and C. Todd Davis

Author affiliations:

Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. Marinova-Petkova, Y. Jang, B. Lynch, N. Zanders, M. Rodriguez, J. Jones, S. Thor, E. Hodges, J.A. De La Cruz, J. Belser, H. Yang, P. Carney, B. Shu, L. Berman, T. Stark, J. Barnes, F. Havers, P. Yang, S.C. Trock, A. Fry, L. Gubareva, J.S. Bresee, J. Stevens, D.E. Wentworth, S. Lindstrom, C.T. Davis); New York State Department of Health, Albany, New York, USA (J. Laplante, K. St. George); New York City Department of Health and Mental Hygiene, Long Island City, New York, USA (D. Daskalakis, D. Liu, C.T. Lee); US Department of Agriculture, Ames, Iowa, USA (M.K. Torchetti); University of Wisconsin, Madison, Wisconsin, USA (S. Newbury, F. Cigel, K. Toohey-Kurth)

An outbreak of influenza A(H7N2) virus in cats in a shelter in New York, NY, USA, resulted in zoonotic transmission. Virus isolated from the infected human was closely related to virus isolated from a cat; both were related to low pathogenicity avian influenza A(H7N2) viruses detected in the United States during the early 2000s.

PDF

https://wwwnc.cdc.gov/eid/article/23/12/pdfs/17-0798.pdf

 

December 4, 2017 at 8:14 am

Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study

European Respiratory Journal  November 22, 2017        

Michael Moore, Beth Stuart, Paul Little, Sue Smith, Matthew J. Thompson, Kyle Knox, Anne van den Bruel, Mark Lown, David Mant

Abstract

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care.

A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009–13.

Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review.

The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.

Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis.

The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5–4.8), crackles on auscultation (RR 1.8; 1.1–3.0), oxygen saturation <95% (RR 1.7; 1.0–3.1) and pulse >100·min–1 (RR 1.9; 1.1–3.2).

Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3–23.1).

In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270).

Pulse oximetry may aid the diagnosis of pneumonia in this setting.

FULL TEXT

http://erj.ersjournals.com/content/50/5/1700434

PDF

http://erj.ersjournals.com/content/erj/50/5/1700434.full.pdf

 

December 2, 2017 at 8:37 am

Outbreak of a Multiresistant Klebsiella pneumoniae Strain in an Intensive Care Unit: Antibiotic Use as Risk Factor for Colonization and Infection

Clinical Infectious Diseases January 2000 V.30 N.1 P. 55-60

Angel Asensio, Antonio Oliver, Paulino González-Diego, Fernando Baquero, Jose Claudio Pérez-Díaz, Purificación Ros, Javier Cobo, Margarita Palacios, Dolores Lasheras, and Rafael Cantón

1Servicio de Medicina Preventiva, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain

2Servicio de Microbiología, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain

3Unidad de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain

4Unidad Pediátrica de Cuidados Intensivos, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain

An observational study was undertaken to describe a nosocomial outbreak caused by multiresistant Klebsiella pneumoniae (MRKP).

Ten patients in the pediatric intensive care unit (ICU) at a hospital in Madrid were colonized by or infected with MRKP from October 1997 to April 1998.

Thirty-two patients with MRKP-negative surveillance cultures who were admitted to the ICU during the outbreak period were selected as control patients. Random amplified polymorphic DNA analysis of MRKP isolates revealed patterns that were indistinguishable from each other.

After identification of colonized patients by surveillance cultures and implementation of standard and contact precautions, the outbreak was controlled.

An age <12 weeks (odds ratio [OR], 13.1) and previous treatment with third-generation cephalosporins and aminoglycosides (OR, 31.2) were independently associated with MRKP colonization and/or infection.

Individual exposure to antibiotics, irrespective of other clinical determinants, is a risk factor for MRKP acquisition.

Screening high-risk patients during outbreaks and reducing the use of third-generation cephalosporins and amino-glycosides contribute to the control of these epidemics.

PDF

http://cid.oxfordjournals.org/content/30/1/55.full.pdf

December 2, 2017 at 7:58 am

Comparison of Clinical Presentation and Risk Factors in Diabetic and Non-Diabetic Females with Urinary Tract Infection Assessed as Per the European Association of Urology Classification.

J Clin Diagn Res. 2015 Jun;9(6):PC12-4.          

Garg V1, Bose A2, Jindal J3, Goyal A4.

Author information

1Assistant Professor, Department of Medicine, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .

2Senior Resident, Department of Urology & Renal Transplant, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .

3Resident, Department of Medicine, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .

4Associate Professor, Department of Urology & Renal Transplant, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .

Abstract

INTRODUCTION:

Diabetes has been known to cause severe complicated UTI as a result of its various changes in the genitourinary system. This study of UTI in diabetic females enables us to know the pattern of infections, their causative organisms and severity, particularly with reference to European Association of Urology (EUA) guidelines for UTI 2015.

MATERIALS AND METHODS:

This is a prospective single centre study done over a period of one year at Dayanand Medical College and Hospital on a total of 151 diabetic (Group A) and non-diabetic (Group B) female patients with diagnosis of UTI. A thorough history of the patients was taken which included looking for the anatomical level of infections, host risk factors; extra urogenital risk factors and nephropathy disease were assessed. All patients were adequately investigated. The UTI was classified according to the EAU classification for UTI, and an effort was made to find out the frequent class of UTI in this study group.

RESULTS:

A total of 151 females which included 70 diabetic (Group A) and 81 non diabetic (Group B) females were studied. The most common symptom was fever in both the groups. UTI was classified as per the EAU grades of UTI. In group A, the number of patients having severity grade from 1 to 6 were 47, 9, 4, 2, 4, and 4 respectively. The most common clinical presentation in both the groups was cystitis followed by pyelonephritis and urosepsis. In group B, the number of patients having severity grade from 1 to 6 were 66, 4, 5, 5, 0 and 1 respectively. Most common organism was E-coli, which was susceptible to most of the antibiotics.

CONCLUSION:

UTI in diabetic and non-diabetic female patients have different patterns. Uncontrolled diabetes was more commonly associated with severe UTI like pyelonephritis and emphysematous pyelonephritis. E. coli was most common isolate in either group, followed by klebsiella and Pseudomonas. Candida was isolated only from the diabetic population. Therefore, the most common type of UTI as per the EAU classification in both diabetic and non diabetic female was CY-1R: E. coli(a): ‘simple cystitis but recurrent with susceptibility to standard antibiotics’, in our study.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525549/pdf/jcdr-9-PC12.pdf

December 2, 2017 at 7:54 am

Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children: Why, What, and How to Undertake Estimates?

Clinical Infectious Diseases November 2017 Suppl.2 S89–S99

Joy E Lawn; Fiorella Bianchi-Jassir; Neal J Russell; Maya Kohli-Lynch; Cally J Tann

Abstract

Improving maternal, newborn, and child health is central to Sustainable Development Goal targets for 2030, requiring acceleration especially to prevent 5.6 million deaths around the time of birth. Infections contribute to this burden, but etiological data are limited. Group B Streptococcus (GBS) is an important perinatal pathogen, although previously focus has been primarily on liveborn children, especially early-onset disease. In this first of an 11-article supplement, we discuss the following: (1) Why estimate the worldwide burden of GBS disease? (2) What outcomes of GBS in pregnancy should be included? (3) What data and epidemiological parameters are required? (4) What methods and models can be used to transparently estimate this burden of GBS? (5) What are the challenges with available data? and (6) How can estimates address data gaps to better inform GBS interventions including maternal immunization? We review all available GBS data worldwide, including maternal GBS colonization, risk of neonatal disease (with/without intrapartum antibiotic prophylaxis), maternal GBS disease, neonatal/infant GBS disease, and subsequent impairment, plus GBS-associated stillbirth, preterm birth, and neonatal encephalopathy. We summarize our methods for searches, meta-analyses, and modeling including a compartmental model. Our approach is consistent with the World Health Organization (WHO) Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER), published in The Lancet and the Public Library of Science (PLoS). We aim to address priority epidemiological gaps highlighted by WHO to inform potential maternal vaccination….

PDF (CLIC en PDF)

https://academic.oup.com/cid/article/65/suppl_2/S89/4589584

November 29, 2017 at 3:26 pm

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