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Marhuenda C.,Autonomous University of Barcelona | Barcelo C.,Autonomous University of Barcelona | Fuentes I.,Autonomous University of Barcelona | Guillen G.,Autonomous University of Barcelona | And 10 more authors.
Pediatrics | Year: 2014

BACKGROUND AND OBJECTIVE: Parapneumonic empyema (PPE) is a frequent complication of acute bacterial pneumonia in children. There is limited evidence regarding the optimal treatment of this condition. The aim of this study was to compare the efficacy of drainage plus urokinase versus video-assisted thoracoscopic surgery in the treatment of PPE in childhood. METHODS: This prospective, randomized, multicenter clinical trial enrolled patients aged <15 years and hospitalized with septated PPE. Study patients were randomized to receive urokinase or thoracoscopy. The main outcome variable was the length of hospital stay after treatment. The secondary outcomes were total length of hospital stay, number of days with the chest drain, number of days with fever, and treatment failures. The trial was approved by the ethics committees of all the participating hospitals. RESULTS: A total of 103 patients were randomized to treatment and analyzed; 53 were treated with thoracoscopy and 50 with urokinase. There were no differences in demographic characteristics or in the main baseline characteristics between the 2 groups. No statistically significant differences were found between thoracoscopy and urokinase in the median postoperative stay (10 vs 9 days), median hospital stay (14 vs 13 days), or days febrile after treatment (4 vs 6 days). A second intervention was required in 15% of children in the thoracoscopy group versus 10% in the urokinase group (P = .47). CONCLUSIONS: Drainage plus urokinase instillation is as effective as video-assisted thoracoscopic surgery as first-line treatment of septated PPE in children. Copyright © 2014 by the American Academy of Pediatrics. Source

Marimon J.M.,Hospital Universitario Donostia Instituto Biodonostia | Marimon J.M.,Biomedical Research Center Network for Respiratory Diseases | Ercibengoa M.,Hospital Universitario Donostia Instituto Biodonostia | Garcia-Arenzana J.M.,Hospital Universitario Donostia Instituto Biodonostia | And 4 more authors.
Clinical Microbiology and Infection | Year: 2013

The aim of this study was to determine the characteristics and shifts in serotype distribution of pneumococcal isolates causing ocular infections in a region of northern Spain in two periods: 1999-2010 for episodes of conjunctivitis (n = 612) and 1980-2010 for uncommon and more severe non-conjunctival ocular infections (n = 36). All isolates were serotyped and non-typeable isolates were confirmed as unencapsulated by multiplex-PCR of the lytA, ply and cpsA genes. Genotyping was done by pulsed-field gel electrophoresis and multi-locus sequence typing. Most conjunctivitis cases occurred in children under 5 years old (89.5%), and more severe non-conjunctival ocular infections occurred in patients older than 25 years (86.1%). Unencapsulated isolates were detected in 213 conjunctivitis episodes (34.8%) and one non-conjunctival infection (2.8%). Rates of unencapsulated isolates were similar throughout the study. Among 399 conjunctival encapsulated isolates, the most prevalent were serotypes 19A (n = 53), 15B (n = 30), 6A (n = 27), 19F (n = 25), 23F (n = 21) and 6B (n = 17). The most prevalent serotypes in non-conjunctival infections were serotype 3 (n = 4), 23F (n = 4), 6B (n = 3) and 19A (n = 3). Conjunctivitis caused by serotypes included in the hepta-valent pneumococcal conjugate vaccine steadily decreased, accounting for 34.9% (22/63) in 1999-2001, 19.7% (23/117) in 2002-04, 13.6% (33/242) in 2005-07 and 3.2% (6/190) in 2008-10. Among the 213 unencapsulated isolates, 31 different pulsed-field gel electrophoresis patterns were identified. The main clonal complexes (CC) were CC941 (ST941, ST942), CC448 (ST448) and CC344 (ST344, ST3097). CC941 was the predominant CC in 1999-2001, 2002-04 and 2005-07, being replaced by CC448 in 2008-10. The multidrug-resistant CC344 was present throughout the study. © 2013 European Society of Clinical Microbiology and Infectious Diseases. Source

Perez-Trallero E.,Servicio Of Microbiologia Instituto Biodonostia | Perez-Trallero E.,Biomedical Research Center Network for Respiratory Diseases | Perez-Trallero E.,University of the Basque Country | Marimon J.M.,Servicio Of Microbiologia Instituto Biodonostia | And 4 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2011

In the elderly, Streptococcus pneumoniae is the most common cause of pneumonia and one of the most frequently isolated pathogens in cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study was conducted to compare the pneumococcal isolates obtained during episodes of AECOPD and pneumonia in patients of ≥65 years old and to analyze whether in patients with AECOPD and pneumonia within a short interval, the same isolate caused both episodes. This laboratory-based study was performed between 2005 and 2008. Pneumococcal isolates from episodes of pneumonia (n = 401) and AECOPD (n = 398), matched one-to-one by date of isolation, were characterized. The serotypes and genotypes of other pneumococcal isolates causing pneumonia and AECOPD in the same patient were compared. In patients with pneumonia, COPD as an underlying disease was not associated with more-drug-resistant pneumococci. In contrast, isolates causing AECOPD showed higher rates of resistance than those causing pneumonia. Serotypes 1, 3, and 7F were more frequent in pneumonia. The same pneumococcus was involved in 25.7% (9/35 patients) of patients with two consecutive AECOPD episodes but in only 6.3% (2/32 patients) of COPD patients with pneumonia and exacerbation (Fisher's exact test; P = 0.047). Less invasive serotypes were isolated more often in AECOPD and were more resistant to antimicrobials. The presence of a specific pneumococcal serotype in AECOPD does not predict the etiology of subsequent pneumonia. Copyright © 2011, American Society for Microbiology. All Rights Reserved. Source

Tamayo E.,Hospital Universitario Donostia Instituto Biodonostia | Tamayo E.,Biomedical Research Center Network for Respiratory Diseases | Montes M.,Hospital Universitario Donostia Instituto Biodonostia | Montes M.,Biomedical Research Center Network for Respiratory Diseases | And 4 more authors.
Journal of Infection | Year: 2014

Objective: To know the clinical entities caused by Streptococcus pyogenes as well as the characteristics of the isolates involved in them throughout a 7-year-study. Methods: All S. pyogenes infectious episodes from the community recorded in the reference hospital of Gipuzkoa between 2005 and 2011 were included (n=11,342). A random selection of 10% of total isolates was characterized by emm-type, T-type and multilocus-sequence-type. Results: Main clinical presentations were: pharyngitis (n=9467), otitis (n=797), dermal infections (n=506), and genital infections (n=374). Highest frequency of pharyngitis and otitis was detected in children aged 2-8 years old and 1-year old, respectively. Among 29 emm-types, 8 (emm4, emm89, emm3, emm87, emm1, emm12, emm6 and emm75) grouped >70% of isolates. emm4 was significantly associated with 0-4 year-old patients, and emm89 and emm77 with patients >64 years; by infection type, emm4, emm87 and emm12 were associated with pharyngitis, emm1 and emm6 with otitis, emm89 with dermal infections, and emm77 with genital infections. Conclusions: Predominant emm-type changed every year, although the diversity was similar throughout the study period. S. pyogenes pharyngitis maximum incidence presented at earlier age than expected. emm-type associations with age and specific clinical presentations were influenced by population immunity and strain tropism. © 2013 The British Infection Association. Source

Montes M.,Hospital Universitario Donostia Instituto Biodonostia | Montes M.,Biomedical Research Center Network for Respiratory Diseases | Tamayo E.,Biomedical Research Center Network for Respiratory Diseases | Mojica C.,Hospital Universitario Donostia Instituto Biodonostia | And 5 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2014

Objectives To survey antibiotic resistance among Streptococcus pyogenes isolates collected from 2005 to 2012, to characterize those showing erythromycin resistance and to analyse the association of certain emm types with erythromycin resistance or susceptibility. Methods Resistance determinants or mutations conferring erythromycin, clindamycin, tetracycline and fluoroquinolone resistance were analysed. All erythromycin-resistant isolates and a sample of erythromycin-susceptible isolates were emm typed. Multilocus sequence typing was performed for representative emm types. Results Antimicrobial susceptibility was studied for 12346 S. pyogenes isolates. Erythromycin, clindamycin and tetracycline resistance showed a decreasing trend. In 2012, 2.8% of isolates were erythromycin resistant versus 7.5% in 2005 and 11.7% in 2006. Although 21 clones were involved, 4 clones accounted for almost 90% of erythromycin-resistant isolates. The emm12/ST36 clone, carrying the mef(A) gene, was the predominant (41.1%) erythromycin-resistant clone, with an incidence peak in 2008, followed by a gradual decline. The M phenotype predominated each year except for 2005, when two of the main erythromycin-resistant clones (emm11/ST403 and emm28/ST52) harboured an erm(B) gene. Erythromycin resistance was significantly higher in adults than in children. Skin isolates showed the highest erythromycin resistance rate; among these, perianal isolates frequently belonged to the emm28/ST52 clone. The emm type was not a predictor of erythromycin resistance; however, most emm11 and emm12 were erythromycin-resistant isolates. Macrolide consumption was similar throughout the study period. Only two isolates with a high level of levofloxacin resistance were detected. Conclusions Resistance was mainly related to the circulation of emm12/ST36, emm11/ST403, emm28/ST52 and emm4/ST39 clones, all of which declined throughout the study period. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. Source

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