Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008-2018): Epidemiology, Clinical Characteristics and Outcomes.

BACKGROUND: The epidemiology of community-acquired pneumonia (CAP) has changed, influenced by sociosanitary conditions and vaccination status. We aimed to analyze the recent epidemiology of bacterial CAP in hospitalized children in a setting with high pneumococcal vaccination coverage and to describe the clinical characteristics of pediatric Staphylococcus aureus CAP. METHODS: Children <17 years old hospitalized from 2008 to 2018 with bacterial CAP in 5 tertiary hospitals in Spain were included. Cases with pneumococcal CAP were randomly selected as comparative group following a case-control ratio of 2:1 with S. aureus CAP. RESULTS: A total of 313 bacterial CAP were diagnosed: Streptococcus pneumoniae CAP (n = 236, 75.4%), Streptococcus pyogenes CAP (n = 43, 13.7%) and S. aureus CAP (n = 34, 10.9%). Throughout the study period, the prevalence of S. pyogenes increased (annual percentage change: +16.1% [95% CI: 1.7-32.4], P = 0.031), S. pneumoniae decreased (annual percentage change: -4.4% [95 CI: -8.8 to 0.2], P = 0.057) and S. aureus remained stable. Nine isolates of S. aureus (26.5%) were methicillin-resistant. Seventeen cases (50%) with S. aureus CAP had some pulmonary complication and 21 (61.7%) required intensive care. S. pneumoniae CAP showed a trend toward higher prevalence of pulmonary complications compared with S. aureus CAP (69.1% vs. 50.0%, P = 0.060), including higher frequency of pulmonary necrosis (32.4% vs. 5.9%, P = 0.003). CONCLUSIONS: The incidence of S. aureus CAP in children remained stable, whereas the prevalence of pneumococcal CAP decreased and S. pyogenes CAP increased. Patients with S. aureus presented a high frequency of severe outcomes, but a lower risk of pulmonary complications than patients with S. pneumoniae.

Sensibilidad a azitromicina en Salmonella no tifoidea: opción terapéutica / Susceptibility to azithromycin in non-typhoid Salmonella: A therapeutic option

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Vigilancia activa de cepas de Salmonella entericano tifoidea con fenotipo no clásico de resistencia a quinolonas (2014-2019) / Active surveillance of nontyphoidal Salmonella enterica strains with nonclassical quinolone resistance phenotype (2014-2019)

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[Invasive Streptococcus pyogenes infections (2011-2018): EMM-type and clinical presentation]. / Infecciones invasoras por Streptococcus pyogenes (2011-2018): serotipos y presentación clínica.

INTRODUCTION: Streptococcus pyogenes (S. pyogenes) is an important human pathogen that is responsible for a broad range of infections, from uncomplicated to more severe and invasive diseases with high morbidity/mortality. The M protein (emm type) is a critical virulence factor. Several studies have shown an increased incidence of invasive S. pyogenes disease. This was associated with an increase in the prevalence of M1 and M3 types, well-recognised virulent M types. The aim of the present study was to confirm the resurgence of invasive S. pyogenes disease during 2011-2018 and to identify the relationship between specific M types with disease presentation. MATERIAL AND METHODS: Isolates were confirmed using standard techniques: colony morphology, ß-haemolysis, biochemical tests, and agglutination with specific antisera (DiaMondiaL Strep Kit, DiaMondiaL, Langenhagen, Germany). The antibiotic sensitivity was performed using microdilution (Vitek®2 Compact, bioMeriéux, Inc., Durham, NC). Molecular analysis included the determination of the emm gene and superantigen profile. RESULTS: A total of 29 invasive isolates were collected (2011-2018) from blood (16), pleural fluid (9), synovial fluid (3), and cerebrospinal fluid (1). One strain per year was isolated between 2011 and 2013, with 2, 5, 4, 6, and 9 strains being isolated between 2014 and 2018, respectively. The most frequent clinical presentations were bacteraemia and pneumonia (10 and 9 cases). The predominant types were M1 (11 isolates) and M3 (3 isolates). A correlation was found between M1 and M3 types, and pneumonia (6/7 cases) and deep soft tissue infections (3/3 cases). CONCLUSIONS: An increased incidence of invasive S. pyogenes disease was observed during the study period, with M1 and M3 types being those most commonly isolated and associated with pneumonia and deep soft tissue infections.

Vigilancia de multirresistentes: Enterococcus spp. resistente a vancomicina / Surveillance of multiresistance: vancomycin-resistant Enterococcus spp

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Aislamiento de Hanseniaspora opuntiae de hemocultivos de una paciente inmunodeprimida: un hallazgo infrecuente y de difícil valoración / Isolation of Hanseniaspora opuntiae from blood cultures of an immunosuppressed patient: An infrequent and difficult to assess finding

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Recuperación de episodios de infección por Clostridium difficile tras la aplicación de un documento de consenso / Recovery from episodes of Clostridium difficile infection following the implementation of a consensus document

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Condensación pulmonar versus absceso esplénico por Salmonella / Pulmonary consolidation versus splenic abscess due toSalmonella enterica

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[New methodological advances: algorithm proposal for management of Clostridium difficile infection]. / Nuevos avances metodológicos: propuesta de algoritmo para el manejo de la infección por Clostridium difficile.

INTRODUCTION: Clostridium difficile infection (CDI) is considered the most common cause of health care-associated diarrhea and also is an etiologic agent of community diarrhea. The aim of this study was to assess the potential benefit of a test that detects glutamate dehydrogenase (GDH) antigen and C. difficile toxin A/B, simultaneously, followed by detection of C. difficile toxin B (tcdB) gene by PCR as confirmatory assay on discrepant samples, and to propose an algorithm more efficient. MATERIAL AND METHODS: From June 2012 to January 2013 at Hospital Infantil Universitario Niño Jesús, Madrid, the stool samples were studied for the simultaneous detection of GDH and toxin A/B, and also for detection of toxin A/B alone. When results between GDH and toxin A/B were discordant, a single sample for patient was selected for detection of C. difficile toxin B (tcdB) gene. RESULTS: A total of 116 samples (52 patients) were tested. Four were positive and 75 negative for toxigenic C. difficile (Toxin A/B, alone or combined with GDH). C. difficile was detected in the remaining 37 samples but not toxin A/B, regardless of the method used, except one. Twenty of the 37 specimens were further tested for C. difficile toxin B (tcdB) gene and 7 were positive. DISCUSSION: The simultaneous detection of GDH and toxin A/B combined with PCR recovered undiagnosed cases of CDI. In accordance with our data, we propose a two-step algorithm: detection of GDH and PCR (in samples GDH positive). This algorithm could provide a superior cost-benefit ratio in our population.

Nuevos avances metodológicos: propuesta de algoritmo para el manejo de la infección por Clostridium difficile / New methodological advances: algorithm proposal for management of Clostridium difficile infection

Introducción. La infección por Clostridium difficile (ICD) es la causa más frecuente de diarrea asociada a los cuidados sanitarios y también se reconoce un papel etiológico en la diarrea de adquisición comunitaria. El objetivo de este trabajo fue evaluar si la detección simultánea de GDH y toxinas A/B de C. difficile, seguida de PCR como test confirmatorio supuso una mejora frente a la detección única de toxinas A/B, y plantear un algoritmo más eficiente. Material y métodos. Entre Junio 2012 y Enero 2013, en el Hospital Infantil Universitario Niño Jesús, Madrid, se estudiaron muestras de heces para la detección simultánea de GDH y toxinas A/B, y también para la detección única de toxinas A/B. Cuando los resultados entre GDH y toxinas A/B fueron discordantes, se seleccionó una única muestra por paciente para la detección de toxina B (tcdB) de C. difficile por PCR. Resultados. Se estudiaron 116 muestras de 52 pacientes. Por ambos tests, 4 muestras fueron positivas y 75 negativas para la detección de C. difficile toxigénico. En las 37 muestras restantes se detectó C. difficile pero no producción de toxinas independientemente del método utilizado, salvo en un caso. De estas muestras se seleccionaron 20 para detección de toxina B (tcdB) por PCR, siendo 7 positivas. Discusión. La detección simultánea de GDH y toxinas A/B seguida de PCR supuso la recuperación de casos de ICD. La detección de GDH y PCR (en muestras GDH positivas) es la combinación que ofrecería una superior relación coste/efectividad en la población atendida (AU)

Introduction. Clostridium difficile infection (CDI) is considered the most common cause of health care-associated diarrhea and also is an etiologic agent of community diarrhea. The aim of this study was to assess the potential benefit of a test that detects glutamate dehydrogenase (GDH) antigen and C. difficile toxin A/B, simultaneously, followed by detection of C. difficile toxin B (tcdB) gene by PCR as confirmatory assay on discrepant samples, and to propose an algorithm more efficient. Material and Methods. From June 2012 to January 2013 at Hospital Infantil Universitario Niño Jesús, Madrid, the stool samples were studied for the simultaneous detection of GDH and toxin A/B, and also for detection of toxin A/B alone. When results between GDH and toxin A/B were discordant, a single sample for patient was selected for detection of C. difficile toxin B (tcdB) gene. Results. A total of 116 samples (52 patients) were tested. Four were positive and 75 negative for toxigenic C. difficile (Toxin A/B, alone or combined with GDH). C. difficile was detected in the remaining 37 samples but not toxin A/B, regardless of the method used, except one. Twenty of the 37 specimens were further tested for C. difficile toxin B (tcdB) gene and 7 were positive. Discussion. The simultaneous detection of GDH and toxin A/B combined with PCR recovered undiagnosed cases of CDI. In accordance with our data, we propose a two-step algorithm: detection of GDH and PCR (in samples GDH positive). This algorithm could provide a superior cost-benefit ratio in our population (AU)

[Salmonella enterica with nonclassical quinolone resistance phenotype in pediatric patients]. / Salmonella enterica con fenotipo no clásico de resistencia a quinolonas en pacientes pediátricos.

INTRODUCTION: Decreased susceptibility to fluoroquinolones in Salmonella spp. may lead to treatment failures. The use of ciprofloxacin for extraintestinal and serious intestinal Salmonella infections in children is controversial and therefore the clinical relevance of these strains is not significant. Consequently little is know about the quinolone resistance of strains Salmonella of our paediatric population. The objective of this study was to assess the incidence of nonclassical quinolone resistance phenotype in paediatric patients. MATERIAL AND METHODS: Two hundred and sixty eight Salmonella spp. from Hospital Infantil Universitario Niño Jesús of Madrid (2009-2013) were tested against nalidixic acid and ciprofloxacin by microdilution. Moreover, 146 strains (2011-2013) were tested against ciprofloxacin by E-test. Reduced ciprofloxacin susceptibility was defined as a MIC of 0.125-1 mg/L. RESULTS: Of 42 isolates with reduced ciprofloxacin susceptibility, four isolates showing nonclassical quinolone resistance phenotype. Three were confirmed as carrying of plasmid-mediated quinolone resistance-conferring genes qnr. CONCLUSIONS: The percentage of strains with a genotype that confers a nonclassical quinolone resistance phenotype is low in our series. The identification of these isolates is difficult using conventional methods, but its ability of horizontal spread recommends an appropriate identification. Taking into account the low isolation rate of these strains in this study, evaluation of ciprofloxacin MIC on every nalidixic acid susceptible strain would not be cost effective. Alternatively, we propose to evaluate periodically any changing trend.

Salmonella enterica con fenotipo no clásico de resistencia a quinolonas en pacientes pediátricos / Salmonella enterica with nonclassical quinolone resistance phenotype in pediatric patients

Introducción. Una sensibilidad disminuida a fluoroquinolonas en Salmonella spp. puede asociar fracaso terapéutico. El empleo de ciprofloxacino en infecciones extraintestinales e intestinales graves por Salmonella spp. es controvertido en niños y, consecuentemente, la repercusión clínica de estos aislados es poco significativa. Por tanto, se desconoce el estado real de la resistencia a quinolonas en la población pediátrica atendida. El objetivo del estudio fue evaluar la incidencia del fenotipo no clásico de resistencia a quinolonas en pacientes pediátricos. Material y métodos. En el Hospital Infantil Universitario Niño Jesús de Madrid, se estudió la sensibilidad a ácido nalidíxico y ciprofloxacino por microdilución de 268 Salmonella spp. (2009-2013). Además, 146 cepas (2011-2013) fueron estudiadas frente a ciprofloxacino por E-test. Sensibilidad disminuida a ciprofloxacino fue definida como una CMI de 0,125-1 mg/L. Resultados. De 42 aislados con sensibilidad disminuida a ciprofloxacino, 4 mostraron un fenotipo no clásico de resistencia a quinolonas. Tres aislados eran portadores de genes qnr que determinan resistencia a quinolonas mediada por plásmidos. Conclusiones. El porcentaje de cepas con un genotipo que confiere un fenotipo no clásico de resistencia a quinolonas es bajo en nuestra serie. Su identificación es difícil empleando métodos convencionales pero su capacidad de diseminación recomienda una correcta identificación. Considerando la baja tasa de aislamiento de estas cepas en este estudio, la evaluación de la CMI de ciprofloxacino en todo aislado sensible a ácido nalidíxico podría no ser coste-efectiva. Alternativamente, proponemos un seguimiento periódico para detectar cualquier cambio de tendencia (AU)

Introduction. Decreased susceptibility to fluoroquinolones in Salmonella spp. may lead to treatment failures. The use of ciprofloxacin for extraintestinal and serious intestinal Salmonella infections in children is controversial and therefore the clinical relevance of these strains is not significant. Consequently little is know about the quinolone resistance of strains Salmonella of our paediatric population. The objective of this study was to assess the incidence of nonclassical quinolone resistance phenotype in paediatric patients. Material and methods. Two hundred and sixty eight Salmonella spp. from Hospital Infantil Universitario Niño Jesús of Madrid (2009-2013) were tested against nalidixic acid and ciprofloxacin by microdilution. Moreover, 146 strains (2011-2013) were tested against ciprofloxacin by E-test. Reduced ciprofloxacin susceptibility was defined as a MIC of 0.125-1 mg/L. Results. Of 42 isolates with reduced ciprofloxacin susceptibility, four isolates showing nonclassical quinolone resistance phenotype. Three were confirmed as carrying of plasmid-mediated quinolone resistance-conferring genes qnr. Conclusions. The percentage of strains with a genotype that confers a nonclassical quinolone resistance phenotype is low in our series. The identification of these isolates is difficult using conventional methods, but its ability of horizontal spread recommends an appropriate identification. Taking into account the low isolation rate of these strains in this study, evaluation of ciprofloxacin MIC on every nalidixic acid susceptible strain would not be cost effective. Alternatively, we propose to evaluate periodically any changing trend (AU)

Bacteriemia por anaerobios en pacientes pediátricos / Anaerobic bacteraemia in paediatric patients

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