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Comunidad de Madrid, Spain

Fernandez R.A.,National University of Cuyo | Bianco M.I.,National University of Cuyo | Bianco M.I.,Fundacion Instituto Leloir | Sartori O.J.,Area de Epidemiologia | And 3 more authors.
Clinical and Vaccine Immunology

Infant botulism is the most common form of human botulism in Argentina and the United States. BabyBIG (botulism immune globulin intravenous [human]) is the antitoxin of choice for specific treatment of infant botulism in the United States. However, its high cost limits its use in many countries. We report here the effectiveness and safety of equine botulinum antitoxin (EqBA) as an alternative treatment. We conducted an analytical, observational, retrospective, and longitudinal study on cases of infant botulism registered in Mendoza, Argentina, from 1993 to 2007. We analyzed 92 medical records of laboratory-confirmed cases and evaluated the safety and efficacy of treatment with EqBA. Forty-nine laboratory-confirmed cases of infant botulism demanding admission in intensive care units and mechanical ventilation included 31 treated with EqBA within the 5 days after the onset of signs and 18 untreated with EqBA. EqBA-treated patients had a reduction in the mean length of hospital stay of 23.9 days (P = 0.0007). For infants treated with EqBA, the intensive care unit stay was shortened by 11.2 days (P ∇ 0.0036), mechanical ventilation was reduced by 11.1 days (P = 0.0155), and tube feeding was reduced by 24.4 days (P = 0.0001). The incidence of sepsis in EqBA-treated patients was 47.3% lower (P = 0.0017) than in the untreated ones. Neither sequelae nor adverse effects attributable to EqBA were noticed, except for one infant who developed a transient erythematous rash. These results suggest that prompt treatment of infant botulism with EqBA is safe and effective and that EqBA could be considered an alternative specific treatment for infant botulism when BabyBIG is not available. Copyright © 2011, American Society for Microbiology. All Rights Reserved. Source

Dominguez A.,University of Barcelona | Dominguez A.,CIBER ISCIII | Castilla J.,CIBER ISCIII | Castilla J.,Institute Salud Publica Of Navarra | And 22 more authors.
Pediatric Infectious Disease Journal

Background: The pneumococcal conjugate vaccine (PCV) might prevent hospitalizations in children because of the role of Streptococcus pneumoniae in the complications of influenza infection. We investigated the benefit of PCV vaccination in preventing influenza hospitalization in children <5 years of age during the 2009 to 2010 pandemic wave and the 2010 to 2011 influenza epidemic in Spain. Methods: A multicenter matched case-control study was undertaken in 27 hospitals from 7 Spanish regions between July 2009 and April 2011. A case was defined as a hospitalized patient between 6 months and 5 years of age with influenza virus infection confirmed by real-time reverse-transcription polymerase chain reaction. We selected 2 matched controls for each case from patients with unplanned hospital admission for reasons other than acute respiratory infection or influenza-like illness. Cases and controls were matched according to age, date of hospitalization and province of residence. Crude and adjusted odds ratios were calculated for associations between influenza hospitalization and PCV vaccination. Results: One hundred ninety-four cases and 342 controls were included in the study. In the 2009 to 2010 pandemic wave, the adjusted benefit in preventing hospitalization was 48% (95% confidence interval: 1 to 76) in fully vaccinated children compared with -79% (95% confidence interval: -341 to 27) in the 2010 to 2011 influenza season. Conclusions: The results obtained suggest that, in children <5 years of age, PCV vaccination reduced hospitalization during the 2009 to 2010 pandemic wave. By contrast, there was no observed benefit of vaccination in the 2010 to 2011 influenza season. Copyright © 2013 by Lippincott Williams & Wilkins. Source

MacIas O.M.,Hospital Universitario Of La Ribera | Rodriguez J.C.,Hospital Universitario Of La Ribera | Marquez M.V.D.,Servivio de Microbiologia | Espejo A.G.,Hospital Universitario Of La Ribera | De La Encarnacion Armengol A.,Area de Epidemiologia
Revista Espanola de Salud Publica

Background: Listeria monocytogenes is an uncommon cause of disease, although in certain age groups (infants, elderly, pregnant women and immunocompromised) may be an important cause of meningoencephalitis, and bacteremia. The aim of this study was to detect the incidence of invasive listeriosis cases found in Valencia during a period of 3 years. Methods: A retrospective study of invasive listeriosis detected in the period 2008-2010 was carried out. The isolation of Listeria from a potentially sterile anatomical location was considered as "case". Data from the Microbiology Surveillance Network of Valencia (RedMIVA) were used as a source of information. Results: 98 cases of invasive listeriosis were detected, of which 58%were men. The largest number of diagnosed cases belonged to the age range 60-80 years (63%). Bacteremic infectious become evident in 57 cases (58%), central nervous system lesions were located in 30 cases (31%) and infectious in sterile liquids occurred in the remaining cases (11%). In 90 strains (92%of cases) could be performed the sensitivity to antibiotics and all were sensitive to ampicillin. Incidence rates were: 0,73 cases/100.000 inhabitans in 2008, 0,70 cases/100.000 inhabitans in 2009 and 0,58 cases/100.000 inhabitans 2010. Conclusions: The average rate of invasive listeriosis in Valencian Community in the period 2008 to 2010 was 0.67 cases per 100,000 inhabitants. Temporal or geographic clusters of cases were not detected. Source

Gil-Tomas J.J.,Hospital Universitario Of La Ribera | Colomina-Rodriguez J.,Hospital Universitario Of La Ribera | Martinez-Macias O.,Hospital Universitario Of La Ribera | Borras-Manez M.,Hospital Universitario Of La Ribera | Guerrero-Espejo A.,Area de Epidemiologia
Enfermedades Infecciosas y Microbiologia Clinica

Introduction Pertussis is a highly contagious vaccine-preventable disease. An increasing incidence has been reported in several countries around the world in the last few years. The aim of this study is to analyze the situation of pertussis in the Valencian Community (Spain), with the purpose of verifying the increased incidence of the illness. Methods A descriptive analysis of probable and confirmed cases detected during 2011 was conducted. Methods used for Bordetella pertussis detection from clinical samples were: culture isolation, polymerase chain reaction (PCR)-based detection of bacterial DNA, and/or detection of specific IgM antibodies. The disease incidence and other epidemiological variables were estimated. These results were compared to data collected in previous years (2008-2010). The Epidemiological Surveillance Analysis and Microbiological Surveillance Network integrated systems of the regional Department of Health were used as sources of information. Results In 2011, 249 cases of pertussis were detected (incidence rate of 4.89 × 105 inhabitants). This rate is statistically significantly higher than those reported in 2008 (0.73 × 105 inhabitants), 2009 (0.53 × 105 inhabitants), and 2010 (0.53 × 105 inhabitants). The highest incidence rate was observed in cases younger than one year old (252.97 × 105 inhabitants), with marked differences compared to the rest of age groups. More than two-thirds (69%) of reported cases were confirmed by a laboratory test. Detection of specific serum IgM antibodies was positive in 10% of cases, culture isolation was positive in 17%, and PCR-based detection of bacterial DNA in 35% of cases. Conclusions The results of this study show a clear increase of pertussis incidence in the Valencian Community during 2011. © 2013 Elsevier España, S.L. Source

Fernandez-Urrusuno R.,Servicio de Farmacia | Flores-Dorado M.,Servicio de Farmacia | Vilches-Arenas A.,Area de Epidemiologia | Serrano-Martino C.,Laboratorio Of Microbiologia | And 2 more authors.
Enfermedades Infecciosas y Microbiologia Clinica

Objective To assess the profile of patients receiving antibiotics and the appropriateness of these prescriptions for the clinical conditions. Methods Design: Cross-sectional study of prescription-indication. Setting A primary health care area in Andalusia. Subjects Patients assigned to primary care centres. Patients with antibiotic prescriptions during 2009 were selected by simple random sampling (confidence level: 95%, accuracy: 5%). Primary endpoint: appropriateness of antibiotics prescribing to recommendations included in local guidelines. Data were obtained through the billing computerised prescriptions system and medical histories. Results Twenty-five per cent of the population area received antibiotics during 2009. The 1,266 patient samples showed the following characteristics: 57.9% were women, with a mean age of 41 (± 1) years. There were 39.3% pensioners. The percentage of appropriate antibiotic prescriptions was 19.9%, with no difference due to gender. Statistically significant differences were related to age, being those over 65 years the group of patients with the highest percentage of inappropriateness. The main reasons for inappropriateness were: no recording of the infectious process (44.5%), a wrong treatment duration (15.5%), and the use of an inadequate antibiotic (11.5%). Conclusion There is a high level of inappropriateness in antibiotic prescribing in primary care. The high level of under-recording of diagnoses, mainly in elderly patients, followed by the use of wrong schedules, and the wrong type of antibiotics were the main reasons of inappropriateness. © 2013 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica.Todos los derechos reservados. Source

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