The aim of this study was to determine the clinical significance of Streptococcus salivarius isolates recovered from blood cultures and compare them with isolates of Streptococcus bovis biotypes I and II. Seventeen of the 52 (32%) S. salivarius isolates recovered were considered clinically significant, compared with 62 of the 64 (97%) S. bovis isolates (p<0.0001). Bacteremia caused by S. salivarius occurred mostly in patients who showed relevant disruption of the mucous membranes and/or serious underlying diseases. Patients with S. salivarius bacteremia were younger than those with S. bovis bacteremia (57 vs. 67 years; p<0.01). Patients with S. salivarius bacteremia and patients with S. bovis II bacteremia had similar rates of endocarditis, colon tumors, and non-colon cancer. On the other hand, when compared with S. bovis I bacteremia, S. salivarius bacteremia was associated with lower rates of endocarditis (18% vs. 74%, respectively) (p<0.01) and colon tumors (0% vs. 57%, respectively) (p<0.005) and higher rates of non-colon cancer (53% vs. 9.5%, respectively) (p<0.01). Bacteremia caused by S. bovis II had a hepatobiliary origin in 50% of the patients, while, in contrast, that due to S. salivarius or S. bovis I was less frequently associated with a hepatobiliary origin (12% and 5%, respectively) (p<0.00001). The rate of penicillin resistance was 31% among S. salivarius isolates and 0% among S. bovis isolates (p<0.0001). In conclusion, the clinical characteristics of S. salivarius bacteremia and S. bovis II bacteremia are similar, and the isolation of S. salivarius in blood should not be systematically regarded as contamination.

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A multicentre, prospective, controlled study compared the clinical efficacy, safety and economic impact of a pharmacist intervention to promote sequential intravenous to oral clindamycin conversion. A total of 473 patients receiving intravenous clindamycin for at least 72 hours were included in the study. Two groups were established: an intervention group (204 patients) in which an informative sheet recommending the sequential treatment was provided, and a control group (269 patients). Clindamycin was prescribed for respiratory infections in 38.9% and for prophylaxis in surgery in 25.4% of the patients (71% were contaminated surgery). No difference between groups regarding sex, infection severity, health status or clinical progress was observed. Both the step-down treatments after 72 hours of intravenous clindamycin and the change to the oral route later on, were significantly increased with the intervention (p < 0.001, p < 0.001 respectively). No significant differences between both groups were found in the number of patients with adverse effects associated with the i.v. therapy, although the incidence tended to be lower in the intervention group (49/204 intervention versus 85/269 control, p = 0.07). Compliance with the recommended clindamycin dosing regimen was significantly higher in the intervention group, in which 1.3 days reduction of intravenous therapy provided an average cost savings of PTA5246 (95% CI 2556-7935) per treatment. A higher reduction of 1.7 days was achieved in those patients candidates for switch therapy on the third day of intravenous clindamycin. A sequential program with clindamycin may provide a cost-effective alternative to conventional therapy and the introduction of an information sheet is a cost-effective strategy to promote it.

IntroductionBackground cross-reactivity with other coronaviruses may reduce the specificity of COVID-19 rapid serologic tests. Blood collected during prenatal care is a unique source of population-based samples appropriate for validation studies. We used stored 2018 serum samples from an existing pregnancy cohort study to evaluate the specificity of COVID-19 serologic rapid diagnostic tests. MethodsWe randomly selected 120 stored serum samples from pregnant women enrolled in a cohort in 2018, at least one year before the COVID-19 pandemic. We used stored serum to evaluate four lateral flow rapid diagnostic tests, following manufacturers’ instructions. Pictures were taken for all tests and read by two blinded trained evaluators. Results We evaluated 120, 80, 90, and 90 samples, respectively. Specificity for both IgM and IgG was 100% for the first two tests. The third test had a specificity of 98.9% for IgM and 94.4% for IgG. The fourth test had a specificity of 88.9% for IgM and 100% for IgG.Discussion COVID-19 serologic rapid tests are of variable specificity. Blood specimens from sentinel prenatal clinics provide an opportunity to validate serologic tests with population-based samples.

Background and Aims Acute kidney injury (AKI) is a complication that affects more than 5% of all hospital admissions and up to one third of patients admitted to critical care units. This entity, whose incidence is on the rise, remains a major cause of morbidity and mortality. In addition, AKI has been linked as an independent risk factor for mortality, especially in severe forms, and of those patients who survive, a percentage will develop chronic kidney disease (CKD) during follow-up. We conducted this study to analyse the incidence of CKD at 6 and 12 months follow-up in hospitalized patients with AKI, to identify possible risk factors leading to its development and to determine mortality in this group of patients. Method This is a retrospective study of a cohort of cases with AKI (baseline eGFR &gt;60 mL/min/1.73 m2 without previous structural damage) from our hospital, taking place from June 2020 to February 2021. Regarding the evolution of the AKI, four possibilities were considered: recovery of normal kidney function, development of CKD at 6 months, development of CKD at 12 months or death during follow-up. Results We studied 148 patients (55% male), with a median age of 83 years (74-87). Thirty-six patients (24.3%) developed CKD at 6 months follow-up and 30 patients (20.3%) at 12 months. Forty-one patients (27.7%) died within the first 12 months following de episode of AKI. The risk factors identified for development of CKD at 12 months were older age (85 vs 77; p = 0.03), higher serum lactate dehydrogenase levels at admission (246 U/L vs 201 U/L; p = 0.04) and at 3 months (252 U/L vs 192,5 U/L; p = 0.039), and eGFR &lt; 60 mL/min/1.73 m2 at 1 week (74,5 vs 57; p = 0.004) and at 3 months (79 vs 50; p &lt; 0.001) of follow-up. Identified risk factors and predictors of AKI-associated mortality were older age (84 vs 80,5; p = 0.018), concomitant oncological pathology (10,8% vs 7,4%; p = 0,018), higher Charlson index (6 vs 5, p &lt;0.001), higher AKI stage (p = 0.042), lower serum albumin levels at first (3.35 g/dL vs 3.90 g/dL; p = 0.014) and at third month (3,2 g/dL vs 4 g/dL; p &lt; 0.001) of follow-up. Conclusion Our study showed a high incidence of CKD in patients who have had an episode of AKI. Several risk factors for development of CKD were identified, being the older age and the greater length of recovery period from AKI the most useful predictors in the clinical practice. AKI-associated mortality was very high in those older patients with higher comorbidity and persistence of AKI. Despite advances, we need non-classical biomarkers for early diagnosis and more effective therapeutic measures to avoid this high prevalence of CKD and mortality.