Long-term #impact of an #educational #antimicrobial #stewardship programme in primary care on #infections caused by #ESBL #Escherichia coli in the community… (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Long-term impact of an educational antimicrobial stewardship programme in primary care on infections caused by extended-spectrum β-lactamase-producing Escherichia coli in the community: an interrupted time-series analysis

Germán Peñalva, MSEd, Rocío Fernández-Urrusuno, PhD, José María Turmo, MD, Rocío Hernández-Soto, PhD, Ignacio Pajares, MD, Lucía Carrión, MD, Inmaculada Vázquez-Cruz, PhD, Blanca Botello, MD, Beatriz García-Robredo, PhD, Manuel Cámara-Mestres, PharmD, Juan Carlos Domínguez-Camacho, PharmD, Manuel María Aguilar-Carnerero, PharmD, José Antonio Lepe, PhD, Marina de Cueto, PhD, María Carmen Serrano-Martino, PhD, María Carmen Domínguez-Jiménez, PhD, Ana Domínguez-Castaño, MD, José Miguel Cisneros, PhD on behalf of the PIRASOA-FIS team †

Published: November 22, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30573-0




There is little evidence on the ecological effect and sustainability of antimicrobial stewardship programmes (ASPs) in primary-care settings. We aimed to determine whether a multimodal, educational ASP would be sustainable in the long-term and reduce the incidence of infections caused by extended-spectrum β-lactamase-producing Escherichia coli in the community by optimising antibiotic use.


We did this quasi-experimental intervention study in 214 primary health centres of four primary health-care districts in Andalusia, Spain. Local multidisciplinary teams, comprised of general practitioners, paediatricians, primary-care pharmacists, and epidemiologists, were created in each district and implemented a multimodal, education-based ASP. The core activity of the programme consisted of regular one-to-one educational interviews between a reference interviewing physician and prescribing physicians from each centre on the appropriateness of their most recent (same or preceding day) antibiotic prescriptions based on a structured questionnaire. Appropriate prescribing was defined as compliance of all checklist items with the reference guidelines. An average of five educational interviews were scheduled per prescriber per study year. We did an interrupted time-series analysis to assess the effect of the intervention on quarterly antibiotic use (prescription and collection by the patient) and quality of prescriptions (as defined daily doses per 1000 inhabitants per day) and incidence per 1000 inhabitants of E coli producing extended-spectrum β-lactamase (ESBL) isolated from urine samples.


The study was done between January, 2012, and December, 2017, in a pre-intervention period of 2012–13 and an intervention period of 2014–17. Throughout the study period, there were 1387 physicians (1116 general practicioners and 271 paediatricians) in the included health centres serving a mean population of 1 937 512 people (299 331 children and 1 638 181 adults). 24 150 educational interviews were done over the 4 years. Inappropriate antibiotic prescribing was identified in 1794 (36·5%) of 4917 educational interviews in 2014 compared with 1793 (26·9%) of 6665 in 2017 (p<0·0001). The intervention was associated with a sustained reduction in the use of ciprofloxacin (relative effect −15·9%, 95% CI −23·9 to −8·0) and cephalosporins (−22·6%, −35·9 to −9·2), and a sustained increase in the use of amoxicillin (22·2%, 6·4 to 38·0) and fosfomycin trometamol (6·1%, 2·6 to 9·6). The incidence density of ESBL-producing E coli decreased by −0·028 cases per 1000 inhabitants (95% CI −0·034 to −0·021) after the start of the programme, reversing the pre-intervention increase and leading to a relative reduction of −65·6% (−68·2 to −63·0) 4 years later.


Our data suggest that implementation of a multimodal ASP in primary care that is based on individual educational interviews improves the use of antibiotics and results in a sustained significant reduction of infections by ESBL-producing E coli in the community. This information should encourage the implementation of ASPs in primary care.


Instituto de Salud Carlos III, Spanish Government (PI14/01523).

Keywords: Antibiotics; Drugs Resistance; Society; Spain; E. Coli; Beta-lactams.


#Hantavirus Pulmonary Syndrome in #Traveler Returning from #Nepal to #Spain (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 1—January 2020 / Research Letter

Hantavirus Pulmonary Syndrome in Traveler Returning from Nepal to Spain

Elena Sulleiro1, Maria Luisa Aznar1, Núria Serre-Delcor, Fernando Salvador, Adrian Sanchez-Montalvá, Mateu Espasa, Daniel Molina, Fernando de Ory, M. Paz Sanchez-Seco, Israel Molina, Candido Diaz-Lagares, Miguel J. Martinez, Tomàs Pumarola, and Inés Oliveira

Author affiliations: Vall d’Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain (E. Sulleiro, M.L. Aznar, N. Serre-Delcor, F. Salvador, A. Sanchez-Montalvá, M. Espasa, D. Molina, I. Molina, C. Diaz-Lagares, T. Pumarola, I. Oliveira); Instituto de Salud Carlos III, Majadahonda, Spain (F. de Ory, M.P. Sanchez-Seco); Hospital Clínic, Barcelona (M.J. Martinez)



Most human hantavirus infections occur in Asia, but some cases have been described in Europe in travelers returning from Asia. We describe a case of hantavirus pulmonary syndrome in a previously healthy traveler occurring shortly after he returned to Spain from Nepal. Serologic tests suggested a Puumala virus–like infection.

Keywords: Hantavirus; HPS; Puumala virus; Nepal; Spain.


#Influenza #vaccine #effectiveness against laboratory-confirmed influenza in hospitalised adults aged 60 years or older, Valencia Region, #Spain, 2017/18 influenza season (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Influenza vaccine effectiveness against laboratory-confirmed influenza in hospitalised adults aged 60 years or older, Valencia Region, Spain, 2017/18 influenza season

Ainara Mira-Iglesias 1, F Xavier López-Labrador 1,2, Víctor Baselga-Moreno 1, Miguel Tortajada-Girbés 3, Juan Mollar-Maseres 4,Mario Carballido-Fernández 5,6, Germán Schwarz-Chavarri 7, Joan Puig-Barberà 1,8, Javier Díez-Domingo 1,on behalf of the Valencia Hospital Network for the Study of Influenza and Respiratory Viruses Disease 9

Affiliations: 1 Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain; 2 Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; 3 Hospital Doctor Peset, Valencia, Spain; 4 Hospital Universitario y Politécnico La Fe, Valencia, Spain; 5 Hospital General Universitario de Castellón, Castellón, Spain; 6 Universidad CEU Cardenal Herrera, Castellón, Spain; 7 Hospital General de Alicante, Alicante, Spain; 8 Centro de Salud Pública de Castellón, Castellón, Spain; 9 The Network members are acknowledged at the end of the article

Correspondence:  Javier Díez-Domingo

Citation style for this article: Mira-Iglesias Ainara, López-Labrador F Xavier, Baselga-Moreno Víctor, Tortajada-Girbés Miguel, Mollar-Maseres Juan,Carballido-Fernández Mario, Schwarz-Chavarri Germán, Puig-Barberà Joan, Díez-Domingo Javier,on behalf of the Valencia Hospital Network for the Study of Influenza and Respiratory Viruses Disease. Influenza vaccine effectiveness against laboratory-confirmed influenza in hospitalised adults aged 60 years or older, Valencia Region, Spain, 2017/18 influenza season. Euro Surveill. 2019;24(31):pii=1800461. https://doi.org/10.2807/1560-7917.ES.2019.24.31.1800461

Received: 21 Aug 2018;   Accepted: 05 Mar 2019




Influenza immunisation is recommended for elderly people each season. The influenza vaccine effectiveness (IVE) varies annually due to influenza viruses evolving and the vaccine composition.


To estimate, in inpatients ≥ 60 years old, the 2017/18 trivalent IVE, overall, by vaccine type and by strain. The impact of vaccination in any of the two previous seasons (2016/17 and 2015/16) on current (2017/18) IVE was also explored.


This was a multicentre prospective observational study within the Valencia Hospital Surveillance Network for the Study of Influenza and Respiratory Viruses Disease (VAHNSI, Spain). The test-negative design was applied taking laboratory-confirmed influenza as outcome and vaccination status as main exposure. Information about potential confounders was obtained from clinical registries and/or by interviewing patients; vaccine information was only ascertained by registries.


Overall, 2017/18 IVE was 9.9% (95% CI: −15.5 to 29.6%), and specifically, 48.3% (95% CI: 13.5% to 69.1%), −29.9% (95% CI: −79.1% to 5.8%) and 25.7% (95% CI: −8.8% to 49.3%) against A(H1N1)pdm09, A(H3N2) and B/Yamagata lineage, respectively. For the adjuvanted and non-adjuvanted vaccines, overall IVE was 10.0% (95% CI: −24.4% to 34.9%) and 7.8% (95% CI: −23.1% to 31.0%) respectively. Prior vaccination significantly protected against influenza B/Yamagata lineage (IVE: 50.2%; 95% CI: 2.3% to 74.6%) in patients not vaccinated in the current season. For those repeatedly vaccinated against influenza A(H1N1)pdm09, IVE was 46.4% (95% CI: 6.8% to 69.2%).


Our data revealed low vaccine effectiveness against influenza in hospitalised patients ≥60 years old in 2017/18. Prior vaccination protected against influenza A(H1N1)pdm09 and B/Yamagata-lineage.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Seasonal Influenza; H1N1pdm09; H3N2; Influenza B; Vaccines; Spain.


#Epidemiology of #Aichi virus in #fecal samples from #outpatients with acute #gastroenteritis in Northwestern #Spain (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 30 July 2019 / In Press, Journal Pre-proof

Epidemiology of Aichi virus in fecal samples from outpatients with acute gastroenteritis in Northwestern Spain

Enrique Rivadulla, Miguel F. Varela, Jesús L. Romalde

Departamento de Microbiología y Parasitología, CIBUS-Facultad de Biología, Universidade de Santiago de Compostela, 15782, Santiago de Compostela, Spain

Received 22 January 2019, Revised 21 June 2019, Accepted 29 July 2019, Available online 30 July 2019. DOI: https://doi.org/10.1016/j.jcv.2019.07.011



  • Prevalence of Aichi virus was determined in outpatients from NW Spain.
  • The virus was detected in 5.0% of the samples among all age groups.
  • Monoinfections (58.1%) were more abundant than mixed infections (41.9%).
  • Genotypes A and B were detected in all age groups.




In recent years, Aichi virus (AiV) has been involved in acute viral gastroenteritis outbreaks. However, the common pathogenesis of AiV releases more in subclinical infections underestimating the impact of AiV in human health.


The present study describes the presence and genetic diversity of AiV in patients with gastroenteritis in Northwestern Spain. Study design: A total of 2,667 stool samples, obtained between July 2010 and June 2011, from diarrheic outpatients were studied for detection and molecular characterization of AiV using PCR techniques followed by sequencing and phylogenetic analyses.


The virus was detected in 124 (5.0%) of the samples among all age groups. Coinfections were also detected, from the 124 positive samples, 72 (58.1%) were positive only for AiV, whereas mixed contaminations with Norovirus genogroup I or genogroup II, Sapovirus, or other enteric pathogens were detected in 52 (41.9%) samples. A total of 70 positive samples could be genotyped, being characterized as genotype A (58.6%) or B (41.4 %). AiV was detected from August to April, being the highest number of AiV positive samples detected during autumn and winter seasons.


This survey remarks the importance of emerging enteric viruses in patients who require medical assistance, and offers more information about the real importance of AiV as gastroenteritis agent.

Keywords: Aichi virus – genotyping – epidemiology – gastroenteritis

© 2019 Elsevier B.V. All rights reserved.

Keywords: Aichi virus; Gastroenteritis; Spain.


Temporal #changes in the effects of ambient #temperatures on #hospital #admissions in #Spain (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Temporal changes in the effects of ambient temperatures on hospital admissions in Spain

Èrica Martínez-Solanas, Xavier Basagaña

Published: June 13, 2019 / DOI: https://doi.org/10.1371/journal.pone.0218262




The exposure to extreme ambient temperatures has been reported to increase mortality, although less is known about its impact on morbidity. The analysis of temporal changes in temperature-health associations has also focused on mortality with no studies on hospitalizations worldwide. Studies on temporal variations can provide insights on changes in susceptibility or on effectiveness of public health interventions. We aimed to analyse the effects of temperature on cause-specific hospital admissions in Spain and assess temporal changes using two periods, the second one characterized by the introduction of a heat health prevention plan.


Daily counts of non-scheduled hospital admissions for cardiovascular, cerebrovascular and respiratory diseases and daily maximum temperature were obtained for each Spanish province for the period 1997–2013. The relationship between temperature and hospitalizations was estimated using distributed lag non-linear models. We compared the risk of hospitalization due to temperatures (cold, heat and extreme heat) in two periods (1997–2002 and 2004–2013).


Cold temperatures were associated with increased risk of cardiovascular, cerebrovascular and respiratory hospital admissions. Hot temperatures were only associated with higher hospital admissions for respiratory causes while hospitalizations for cardiovascular and cerebrovascular diseases did not increase with heat. There was a small reduction in heat-related respiratory admissions in period 2. Whereas cold-related hospitalizations for cardiovascular and cerebrovascular diseases increased in period 2, a significant reduction for respiratory hospitalizations was reported.


Our results suggested that heat had an adverse impact on hospital admissions for respiratory diseases, while cold increased the risk of the three studied cause-specific hospitalizations. Public health interventions should also focus on morbidity effects of temperature.


Citation: Martínez-Solanas È, Basagaña X (2019) Temporal changes in the effects of ambient temperatures on hospital admissions in Spain. PLoS ONE 14(6): e0218262. https://doi.org/10.1371/journal.pone.0218262

Editor: Jeffrey Shaman, Columbia University, UNITED STATES

Received: December 11, 2018; Accepted: May 29, 2019; Published: June 13, 2019

Copyright: © 2019 Martínez-Solanas, Basagaña. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data that support the findings of this study are available from the “Instituto de Información Sanitaria” (Spanish Ministry of Health, Social Services and Equity), but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. Researchers will be able to request data directly from the “Instituto de Información Sanitaria” at the email address icmbd@msssi.es.

Funding: XB was supported by a grant awarded by the Instituto de Salud Carlos III and co-funded by European Union (Project “PI14/00421″). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Heatwaves; Cold waves; Extreme weather; Spain.


Co-Occurrence of #mcr-1 and qnrS1 on an IncHI2 #Plasmid in #Clinical Isolates of #SalmonellaTyphimurium in #Spain (Vector Borne Zoo Dis., abstract)

[Source: Vector Borne and Zoonotic Diseases, full page: (LINK). Abstract, edited.]

Co-Occurrence of mcr-1 and qnrS1 on an IncHI2 Plasmid in Clinical Isolates of SalmonellaTyphimurium in Spain

Teresa Trujillo-Soto, Jesús Machuca, Jorge Arca-Suárez, Manuel Rodríguez-Iglesias, and Fátima Galán-Sánchez

Published Online: 30 May 2019 / DOI: https://doi.org/10.1089/vbz.2018.2398



Salmonella enterica is a well-adapted zoonotic bacterium associated to cases of gastroenteritis and bacteremia with increased morbidity and mortality. In this study, three isolates of Salmonella Typhimurium obtained from human clinical samples, showing colistin resistance and low-level resistance to quinolones, have been genetically characterized. We detected the co-occurrence of mcr-1 and qnrS1 on a single IncHI2 plasmid in isolates of Salmonella Typhimurium obtained from Spanish children without a travel history. The multiresistant region contained numerous resistance genes. Isolates were clonally related, which suggests the presence of these clones in the community and the potential to cause outbreaks affecting the most susceptible population. It is necessary to monitor the presence of these plasmid-mediated resistance genes in human European strains of Salmonella spp. because of the risk of producing outbreaks of community-acquired infections.

Keywords: Antibiotics; Drugs Resistance; Colistin; Quinolones; Salmonella Typhimurium; Spain.


Evidence for #infection but not #transmission of #Zika virus by #Aedes albopictus (Diptera: Culicidae) from #Spain (Parasit Vectors., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Parasit Vectors. 2019 May 3;12(1):204. doi: 10.1186/s13071-019-3467-y.

Evidence for infection but not transmission of Zika virus by Aedes albopictus (Diptera: Culicidae) from Spain.

Hernández-Triana LM1, Barrero E2, Delacour-Estrella S3, Ruiz-Arrondo I4, Lucientes J3, Fernández de Marco MDM2, Thorne L2, Lumley S5, Johnson N2,6, Mansfield KL2, Fooks AR2,7.

Author information: 1 Wildlife Zoonoses and Vector-borne Diseases Research Group, Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, Surrey, KT15 3NB, UK. luis.hernandez-triana@apha.gov.uk. 2 Wildlife Zoonoses and Vector-borne Diseases Research Group, Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, Surrey, KT15 3NB, UK. 3 Department of Animal Pathology, Faculty of Veterinary Medicine, University of Zaragoza, Zaragoza, Spain. 4 Center for Rickettsiosis and Vector-Borne Diseases Group, Hospital Universitario San Pedro-CIBIR, Logroño, Spain. 5 Public Health England, Porton Down, Salisbury, SP4 0JG, UK. 6 Faculty of Health and Medicine, University of Surrey, Guildford, Surrey, GU27XH, UK. 7 Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.




A number of mosquito-borne viruses such as dengue virus (DENV), Usutu virus (USUV), West Nile virus (WNV) are autochthonously transmitted in Europe and six invasive mosquito species have been detected in this temperate region. This has increased the risk for the emergence of further mosquito-borne diseases. However, there is a paucity of information on whether European populations of invasive mosquito species are competent to transmit arboviruses. In this study, the susceptibility of Aedes albopictus originating from Spain and a laboratory-adapted colony of Aedes aegypti, was assessed for infection with, and transmission of Zika virus (ZIKV). Vertical transmission in both species was also assessed.


Aedes albopictus colonised from eggs collected in Spain and an existing colony of Ae. aegypti were fed infectious blood meals containing ZIKV (Polynesian strain) at 1.6 × 107 PFU/ml. Blood-fed mosquitoes were separated and maintained at 20 °C or 25 °C. Legs, saliva and bodies were sampled from specimens at 7, 14 and 21 days post-infection (dpi) in order to determine infection, dissemination and transmission rates. All samples were analysed by real-time RT-PCR using primers targeting the ZIKV NS1 gene.


At 14 dpi and 21 dpi, ZIKV RNA was detected in the bodies of both species at both temperatures. However, live virus only was detected in the saliva of Ae. aegypti at 25 °C with a transmission rate of 44%. No evidence for virus expectoration was obtained for Ae. albopictus under any condition. Notably, ZIKV RNA was not detectable in the saliva of Ae. aegypti at 20 °C after 21 days. No vertical transmission of ZIKV was detected in this study.


Experimental infection of Ae. albopictus colonized from Spain with ZIKV did not result in expectoration of virus in saliva in contrast to results for Ae. aegypti. No evidence of vertical transmission of virus was observed in this study. This suggests that this strain of Ae. albopictus is not competent for ZIKV transmission under the conditions tested.

KEYWORDS: Aedes aegypti; Aedes albopictus; Spain; Vector competence; Zika virus

PMID: 31053164 DOI: 10.1186/s13071-019-3467-y

Keywords: Zika Virus; Mosquitoes; Aedes aegytpi; Aedes albopictus; Spain.