Evolution of Antimicrobial Susceptibility to Penicillin in Invasive Strains of Streptococcus pneumoniae during 2007-2021 in Madrid, Spain.

The use of pneumococcal conjugate vaccines has affected the epidemiology and distribution of Streptococcus pneumoniae serotypes causing Invasive Pneumococcal Disease (IPD). The aim of this study was to analyze the evolution of the phenotypical profiles of antimicrobial susceptibility to penicillin (PEN) in all IPD strains isolated in Madrid, Spain, during 2007-2021. In total, 7133 invasive clinical isolates were characterized between 2007 and 2021. Levels of PENR and PNSSDR were 2.0% and 24.2%, respectively. In addition, 94.4% of all the PENR belonged to four serotypes, including 11A (33.6%), 19A (30.8%), 14 (20.3%) and 9V (9.8%). All the strains of serotype 11A, which is a non-PCV13 serotype, were detected after the year 2011. Serotypes 6C, 15A, 23B, 24F, 35B, 19F, 16F, 6B, 23F, 24B, 24A, 15F and a limited number of strains of serogroups 16 and 24 (non-typed at serotype level) were associated with PNSSDR (p < 0.05). PNSSDR strains of non-PCV13 serotypes 11A, 24F, 23B, 24B, 23A and 16F were more frequent from 2014 to 2021. The changes in S. pneumoniae serotype distribution associated with the use of conjugate vaccines had caused in our region the emergence of non-PCV13 pneumococcal strains with different PENR or PNSSDR patterns. The emergence of serotype 11A resistant to penicillin as the most important non-PCV13 serotype is a worrisome event with marked relevance from the clinical and epidemiological perspective.

Distribution of Multidrug-Resistant Invasive Serotypes of Streptococcus pneumoniae during the Period 2007-2021 in Madrid, Spain.

After the systematic use of conjugate vaccines, the invasive pneumococcal disease (IPD) was included into the Madrid Notifiable Diseases Surveillance System through an Epidemiological Surveillance Network. Furthermore, Streptococcus pneumoniae was included in the Spanish Plan of Antibiotic Resistance. The aim of this study was to analyse the multidrug-resistant (MDR) phenotype distribution among invasive strains of Streptococcus pneumoniae isolated during 2007-2021 from usually sterile clinical samples in Madrid, Spain. A total number of 7133 invasive pneumococcal isolates were studied during the period from February 2007 to December 2021. Serotyping was characterised using the Pneumotest-Latex and by the Quellung reaction. Antibiotic susceptibility testing to penicillin (PEN), erythromycin (ERY), and levofloxacin (LVX) was performed using the E-test according to the EUCAST guidelines and breakpoints. Combination of non-susceptibility to PEN at standard dosing regimen (PNSSDR), resistance to ERY (ERYR) and to LVX (LVXR) was considered to be multidrug-resistant at standard dosing regimen of penicillin (MRPSDR), whereas the combination of resistance to PEN (PENR), ERYR, and LVXR was considered multidrug-resistant (MDR). The number of MDRPSDR and or MDR strains in the entire population (n = 7133) during the complete period (2007-2021) were 51 (0.7%) and 6 (0.1%), respectively. All MDRPSDR and/or MDR strains belonged to nine serotypes: 19A (n = 13), 15A (n = 12), 9V (n = 12), 14 (n = 7), 24F (n = 3), 15F (n = 1), 19F (n = 1), 6B (n = 1) and 6C (n = 1). Only two serotypes (9V and 19A) were found among MDR strains, and most of them (5/6) belonged to serotype 9V. Only 12.4% of the strains typified as serotype 9V were MDRPSDR and only 5.2% as MDR. The levels of pneumococcal MDRPSDR and/or MDR in this study were low and all six MDR strains were isolated between 2014 and 2018. These results reinforce the importance of monitoring the evolution of non-susceptible serotypes including those with MDR in the coming years, especially after the introduction of new conjugate vaccines of a broader spectrum.

News from the west: the orchid bees from Parque Nacional do Iguaçu, Paraná, Brazil (Hymenoptera, Apidae, Euglossina) / Notícias do oeste: as abelhas-das-orquídeas do Parque Nacional do Iguaçu, Paraná, Brasil (Hymenoptera, Apidae, Euglossina)

Abstract: Orchid bees were surveyed at Parque Nacional do Iguaçu, the largest remnant of Seasonal Semideciduous Forest in Brazil. Seven species were collected, and Eufriesea violacea (Blanchard) was the most common species, followed by Euglossa annectans Dressler. The observed species richness and species composition agree with what is known for the local euglossine faunas in fragments of Seasonal Semideciduous Forest of southern and southeastern Brazil. On the other hand, the abundance of individuals was remarkably low. The occurrence of a severe winter in 2013 and the collection of several males in other fragments suggest that this noteworthy low abundance can be fortuitous.

Resumo: Abelhas-das-orquídeas foram amostradas no Parque Nacional do Iguaçu, o maior fragmento de Floresta Estacional Semidecidual do Brasil. Sete espécies foram coletadas e Eufriesea violacea (Blanchard) foi a espécie mais comum, seguida por Euglossa annectans Dressler. A riqueza e composição de espécies observadas concordam com o que se conhece para as faunas locais de abelhas euglossinas em fragmentos de Floresta Estacional Semidecidual. Por outro lado, a abundância de indivíduos foi notavelmente baixa. A ocorrência de um inverno severo em 2013 e a coleta de muitos machos em outros fragmentos sugerem que tal baixa abundância pode ser fortuita.

Estudio poblacional de seroprevalencia de anticuerpos frente al virus de la hepatitis A en la Comunidad de Madrid, 2008-2009 / Population study of seroprevalence of antibodies against hepatitis A virus in the Community of Madrid, 2008-2009

INTRODUCCIÓN: Las encuestas de seroprevalencia permiten conocer el nivel de endemicidad del virus de la hepatitis A (VHA). El objetivo de este estudio es estimar la seroprevalencia (SP) de anticuerpos frente al VHA por grupos de edad y compararlos con los obtenidos en las anteriores encuestas. METODOLOGÍA: Estudio observacional de tipo transversal. La población diana está constituida por los residentes de 2-60 años de edad de la Comunidad de Madrid. Se ha realizado un muestreo por conglomerados bietápico, con estratificación de las unidades de primera etapa. Tras la firma del consentimiento informado, a cada participante se le extrajo una muestra de suero para el estudio y se recogieron datos sociodemográficos mediante un cuestionario. RESULTADOS: La SP de anticuerpos frente a hepatitis A es de 46,8% (IC95%: 44,6-49,0). La SP aumenta con la edad. Es mayor en la población procedente de países de mayor endemicidad y en la población con menor nivel de estudios y clase social más baja. Con relación a la encuesta anterior se observa un incremento de la SP en los menores de 30 años y un descenso a partir de esa edad. Si se considera sólo la población autóctona y procedente de países de muy baja endemicidad, el incremento es estadísticamente significativo en el grupo de 2-5 años. CONCLUSIONES: Nuestra región presenta un nivel de endemicidad muy bajo por lo que, siguiendo las recomendaciones de la OMS, la vacunación debe ser dirigida a grupos específicos de riesgo

INTRODUCTION: Seroprevalence surveys enable the level of endemicity of hepatitis A (HAV) to be assessed. The aim of this study was to estimate the seroprevalence (SP) antibody against HAV by age group, and compare it with those obtained in previous surveys. METHODS: Observational cross-sectional study. The target population consists of residents from 2 to 60 years old in the Community of Madrid. Two-stage cluster sampling was performed with stratification of first stage units. After signing the informed consent, a serum sample was extracted from each participant and sociodemographic data were collected by a questionnaire. RESULTS: SP antibodies to hepatitis A is 46.8% (95% CI 44.6 to 49.0). The SP increases with age. It is higher in the population from more endemic countries and people with less education and lower social class. In relation to the previous survey, SP increased in the population under 30 years old, and a decline after that age is observed. If only the autochthonous population and from countries with very low endemicity is observed, the increase is statistically significant in the 2-5 years age group. CONCLUSIONS: Our region has a very low level of endemicity thus, following the recommendations of WHO, vaccination should be targeted at specific risk groups

[Population study of seroprevalence of antibodies against hepatitis A virus in the Community of Madrid, 2008-2009]. / Estudio poblacional de seroprevalencia de anticuerpos frente al virus de la hepatitis A en la Comunidad de Madrid, 2008-2009.

INTRODUCTION: Seroprevalence surveys enable the level of endemicity of hepatitis A (HAV) to be assessed. The aim of this study was to estimate the seroprevalence (SP) antibody against HAV by age group, and compare it with those obtained in previous surveys. METHODS: Observational cross-sectional study. The target population consists of residents from 2 to 60 years old in the Community of Madrid. Two-stage cluster sampling was performed with stratification of first stage units. After signing the informed consent, a serum sample was extracted from each participant and sociodemographic data were collected by a questionnaire. RESULTS: SP antibodies to hepatitis A is 46.8% (95% CI 44.6 to 49.0). The SP increases with age. It is higher in the population from more endemic countries and people with less education and lower social class. In relation to the previous survey, SP increased in the population under 30 years old, and a decline after that age is observed. If only the autochthonous population and from countries with very low endemicity is observed, the increase is statistically significant in the 2-5 years age group. CONCLUSIONS: Our region has a very low level of endemicity thus, following the recommendations of WHO, vaccination should be targeted at specific risk groups.

Decreased tuberculosis incidence and declining clustered case rates, Madrid.

To determine effect of recent tuberculosis transmission rates on incidence rates, we conducted 2 prospective population-based molecular epidemiologic studies in Madrid during 1997-1999 (4% immigrants) and 2002-2004 (14.9% immigrants). Case rates decreased in association with declining clustered case rates among Spanish-born persons. New strains were introduced through immigration.

Analysis of changes in recent tuberculosis transmission patterns after a sharp increase in immigration.

We conducted a population-based molecular epidemiological study of tuberculosis (TB) in Madrid, Spain (2002 to 2004), to define transmission patterns and factors associated with clustering. We particularly focused on examining how the increase in TB cases among immigrants in recent years (2.8% in 1997 to 1999 to 36.2% during the current study) was modifying transmission patterns. Mycobacterium tuberculosis isolates obtained from patients living in nine districts of Madrid (1,459,232 inhabitants) were genotyped. The TB case rate among foreign-born people was three to four times that of Spanish-born people, and the median time from arrival to the onset of treatment was 22.4 months. During the study period, 227 (36.3%) patients were grouped in 64 clusters, and 115 (50.7%) of them were in 21 clusters with mixed Spanish-born and foreign-born patients. Three of the 21 mixed clusters accounted for 21.1% of clustered patients. Twenty-two of 38 (57.9%) immigrants in mixed clusters were infected with TB strains that had already been identified in the native population in 1997 to 1999, including the three most prevalent strains. Factors identified as independent predictors of clustering were homelessness (odds ratio [OR], 2.3; 95% confidence interval [95% CI], 1.2 to 4.5; P = 0.011) and to be born in Spain (OR, 1.8; 95% CI, 1.2 to 2.6; P = 0.002). The results indicated that (i) TB transmission was higher in Spanish-born people, associated mainly with homelessness, (ii) that foreign-born people were much less likely to be clustered, suggesting a higher percentage of infection before arriving in Spain, and (iii) that an extensive transmission between Spanish- and foreign-born populations, caused mainly by autochthonous strains, was taking place in Madrid.

Cumplimiento del tratamiento antituberculoso en presos excarcelados en la Comunidad de Madrid / Compliance of antituberculosis therapy among ex-inmates in the Madrid Area

FUNDAMENTOS. La población penitenciaria no constituye un compartimento estanco sin relación con la comunidad, sino que existe entre ambas un flujo de personas y también de problemas de salud. La elevada incidencia de tuberculosis entre los presos supone, por tanto, una prioridad de Salud Pública. MÉTODOS. Se evalúa el resultado del tratamiento antituberculoso en los presos de la Comunidad de Madrid que fueron excarcelados durante 1997, comparándolos con aquellos que permanecieron ese año en prisión con tratamiento. Se incluyeron los enfermos que cumplían la definición de caso de tuberculosis. Se definió la variable evolución como la situación en la que se encontrase el caso un año después de la fecha de inicio de tratamiento. Para determinar la asociación de las variables de estudio con la evolución se calcularon odds ratio (OR) con sus intervalos de confianza al 95 por ciento. Se utilizó la prueba de chi2 para determinar la significación estadística. RESULTADOS. Se observaron diferencias en la evolución entre los dos grupos: el 69,7 por ciento de los casos de prisión habían finalizado el tratamiento, frente al 20,5 por ciento de los excarcelados. Fue necesario prolongar el tratamiento en un 15,2 por ciento de los casos de prisión, frente al 46,2 por ciento de los excarcelados. El único factor predictor asociado con haber completado el tratamiento al año de iniciarlo fue el lugar de realización, de modo que las personas excarceladas tenían casi 13 veces más riesgo de no haberlo finalizado en ese período (OR= 12,94; IC 95 por ciento: 3,38-13,10) que las que permanecieron en prisión. CONCLUSIONES. Es necesario establecer mecanismos para garantizar la curación de las personas con factores relacionados con la no adherencia al tratamiento. El flujo de información entre los profesionales de la sanidad de prisiones y el resto representa el primer paso para el control de la tuberculosis en los pacientes estudiados, y debe ser potenciado y facilitado (AU)