Outbreak of multiresistant OXA-24- and OXA-51-producing Acinetobacter baumannii in an internal medicine ward.

Here we describe the clinical, microbiological, epidemiological, and molecular characterization of an outbreak of multidrug-resistant Acinetobacter baumannii (MRAB) involving 5 patients admitted to the internal medicine ward of our hospital. Over a 6-week period, 5 MRAB isolates were recovered from 5 patients, including 1 with fatal meningitis, 3 with skin and soft tissue infections, and 1 with respiratory colonization. One sample obtained during environmental monitoring in the ward was A. baumannii-positive. According to the pulsed-field gel electrophoresis typing results, the strains isolated from all patients and the environmental sample belonged to a single clone, identified as ST79 by multilocus sequence typing. The blaOXA-24 and blaOXA-51 carbapenemases were detected in all isolates. Four patients died, but only the death of the meningitis patient was probably related to the A. baumannii infection. The infection source was probably the hands of the healthcare workers because the outbreak strain was isolated from the surface of a serum container. The results of the present study revealed the importance of strict adherence to control measures by all healthcare workers because the consequences of noncompliance can be very serious.

Skin and soft tissue infections caused by Staphylococcus lugdunensis: report of 20 cases.

Staphylococcus lugdunensis is an unusually virulent coagulase-negative Staphylococcus (CoNS). The aim of the present study was to investigate the clinical and microbiological characteristics of 20 cases of skin and soft tissue infections (SSTIs) due to S. lugdunensis that occurred in our area. The frequency of SSTIs due to this organism was 0.42%. The infection was secondary to trauma, surgery or skin disease in 15 patients (75%). Abscesses (7 cases), surgical wound infections (6 cases) and cellulitis (3 cases) were the most common clinical presentations. Breast, abdomen and lower limbs were the most frequent locations. Twelve infections were community-acquired (60%) and S. lugdunensis was the only pathogen isolated from 15 of the 20 specimens (75%). All patients were cured after therapy with antibiotics, associated or not with surgical drainage. The duration of antibiotic treatment ranged from 5 to 21 days. All isolates were susceptible to most of the antibiotics tested including oxacillin. In conclusion, S. lugdunensis is a CoNS that should be considered a potential pathogen when isolated from SSTIs, especially in patients with skin diseases or after trauma or surgery. S. lugdunensis can be underrated if microbiology laboratories do not routinely identify CoNS to the species level in these infections.

Fulminant necrotizing fasciitis due to Vibrio parahaemolyticus.

Necrotizing soft-tissue infection due to Vibrio parahaemolyticus is unusual. We report a case of necrotizing fasciitis due to V. parahaemolyticus in a 92-year-old woman with a history of chronic renal failure, diabetes mellitus and malnutrition. Clinical evolution was fulminant and the patient died 6 h after admission. A review of all cases previously reported showed that the infection occurred in patients with underlying diseases through ingestion of raw oysters or inoculation via traumatic injury in marine environments. The mortality rate of all reviewed cases was 42.8 %. In conclusion, V. parahaemolyticus should be considered a possible causative agent of necrotizing fasciitis, especially in patients with underlying disease. Early diagnosis and prompt aggressive debridement associated with antibiotic therapy are essential in order to save the patient's life, because clinical evolution can be fulminant and mortality rates are high.

Surgical site infection due to Aeromonas species: report of nine cases and literature review.

Gastrointestinal and wound infections are the most common clinical presentation of Aeromonas. Surgical site infections (SSIs) due to this microorganism are rare. We studied the clinical and microbiological characteristics of 9 cases that appeared at 2 Spanish hospitals and reviewed 15 cases available in the literature. All patients (including our cases) had gastrointestinal or biliary diseases. 21 patients (91.3%) developed SSIs after abdominal or pelvic surgery. The mean duration from surgery to the onset of wound infection was 2.2 d in our 9 patients. The infection was polymicrobial in 17 patients (77.2%) and 19 cases were nosocomial (95%). Clinical outcome of all cases was uniformly good after treatment except for 2 patients. Two patients were cured only with surgical drainage. In conclusion, SSIs due to Aeromonas species have a probable endogenous source after abdominal or pelvic surgery and the onset is rapid in most cases. Clinical outcome is good after antibiotic treatment but surgical drainage without antibiotic therapy can be sufficient to clear the infection in some cases.

Urinary tract infection due to Achromobacter xylosoxidans: report of 9 cases.

Urinary tract infection (UTI) due to Achromobacter xylosoxidans is rare. The aims were to know the frequency and clinical characteristics of this infection in our area. We performed a retrospective analysis of 9 patients with UTI caused by this organism diagnosed over a period of 13 y. The mean age was 63.1 y. All patients had underlying diseases or urological abnormalities. The most frequent underlying diseases were solid or hematological malignancies (3 cases). Seven patients (77.7%) had urological abnormalities. Eight patients had symptoms of cystitis and 1 remained asymptomatic. Seven patients had community acquired UTIs. Clinical outcome was favourable in 5 patients after antibiotic treatment and recurrence occurred in 3 patients who had urological abnormalities. All isolates were susceptible to imipenem and piperacillin-tazobactam, 88.8% were susceptible to ceftazidime and 77.7% were susceptible to trimethoprim-sulfamethoxazole. High frequencies of resistance to ampicillin (100%), amoxicillin/clavulanic acid (78%), cefuroxime (100%), cefotaxime (67%), norfloxacin (89%), ciprofloxacin (78%), nitrofurantoin (89%) and gentamicin (67%) were observed. UTI due to A. xylosoxidans was predominantly observed in elderly patients with predisposing factors, especially urological abnormalities, malignancies and immunosuppression. Treatment can be difficult due to the high level of antibiotic resistance. Trimethoprim-sulfamethoxazole may be useful for treatment, particularly in outpatients with community acquired infections.

Prosthetic hip infection due to Brucella melitensis: case report and literature review.

Prosthetic joint infection (PJI) due to Brucella spp. is extremely rare. We report the case of a prosthetic hip infection due to Brucella melitensis in a 51-year-old male patient. The initial presentation was a gluteal abscess. There was radiographic evidence of implant loosening. The patient was cured after prolonged treatment with streptomycin, rifampicin, and doxycycline, followed by 2-stage exchange of the prosthesis. Brucella spp. should be considered in the differential diagnosis of PJI in countries where brucellosis is endemic. The review of all cases previously reported shows that a conservative approach using antibiotics alone can be followed in patients without signs of implant loosening. In contrast, prolonged antibiotic treatment and prosthetic joint revision should be considered in patients with evidence of implant loosening.

Infección extraintestinal por Aeromonas spp: revisión de 38 casos / Extraintestinal infection due to Aeromonas spp: review of 38 cases

Introducción. Aeromonas spp. es una causa habitual de gastroenteritis pero ocasionalmente puede producir infecciones extraintestinales. El objetivo de este estudio es conocer las características clínicas y microbiológicas de las infecciones extraintestinales producidas por este microorganismo en nuestro medio. Pacientes y métodos. Se revisaron retrospectivamente las historias clínicas de los enfermos con infecciones extraintestinales por Aeromonas spp., diagnosticadas en el Hospital Universitario de Guadalajara entre enero de 1990 y diciembre de 2005. La identificación microbiológica y la susceptibilidad antimicrobiana de las cepas aisladas se realizaron mediante el sistema automático MicroScan WalkAway-40 (DadeBerhing). Resultados. Se diagnosticaron 38 casos: 18 infecciones abdominales, 11 de piel y partes blandas, 3 del tracto urinario, 3 del aparato respiratorio y 3 bacteriemias sin foco primario. La especie más frecuente fue A. hydrophila (16 casos). El 76,3% de los enfermos presentaron patologías de base predisponentes, siendo las de naturaleza neoplásica las más frecuentes (34,2%), seguida de diabetes mellitus (21%). El 50% de las infecciones fueron polimicrobianas y el 21% de origen nosocomial. La mortalidad global fue del 16,2%. Los antibióticos con mayor porcentaje de sensibilidad fueron gentamicina, amikacina, cefotaxima y ciprofloxacino. Conclusiones. Aeromonas spp. debe ser tenida en cuenta en infecciones del sistema biliar, infecciones de heridas quirúrgicas abdominales y celulitis postraumáticas. La infección extraintestinal con frecuencia es polimicrobiana, suele aparecer en enfermos con patologías de base y en general el pronóstico es bueno. Los antibióticos más activos in vitro fueron gentamicina, amikacina, cefotaxima y ciprofloxacino (AU)

Introduction. Aeromonas spp. typically cause gastroenteritis, but can occasionally produce extraintestinal infections. The aim of this study was to determine the clinical and microbiological characteristics of extraintestinal infections caused by Aeromonas spp. in our area. Patients and methods. The clinical histories of patients with extraintestinal infections by Aeromonas spp. diagnosed in Hospital Universitario de Guadalajara (Guadalajara, Spain) from January 1990 to December 2005 were reviewed. Identification and susceptibility testing of the strains were performed by the MicroScan WalkAway-40 automated method (DadeBerhing). Results. Thirty-eight cases of extraintestinal infections were diagnosed: 18 abdominal infections, 11 skin and soft tissue infections, 3 urinary tract infections, and 3 episodes of bacteremia with no primary focus. The species most frequently found was A. hydrophila (16 cases). Infection occurred most often in patients with underlying diseases (76,3%), including malignancy (34,2%) and diabetes mellitus (21%). Polymicrobial infections were detected in 50% and the etiology was nosocomial in 21%. The mortality rate was 16,2%. Gentamicin, amikacin, cefotaxime and ciprofloxacin had the highest activity against the Aeromonas species isolated. Conclusions. Aeromonas spp. as the causative infectious agent should be kept in mind in patients with infections of the biliary system, surgical wounds in the abdomen and posttraumatic cellulitis. Extraintestinal infection is usually polymicrobial, appears most commonly in patients with underlying diseases, and generally has a good prognosis. The most active antibiotics in vitro were gentamicin, amikacin, cefotaxime and ciprofloxacin (AU)

[Extraintestinal infection due to Aeromonas spp.: review of 38 cases]. / Infección extraintestinal por Aeromonas spp.: revisión de 38 casos.

INTRODUCTION: Aeromonas spp. typically cause gastroenteritis, but can occasionally produce extraintestinal infections. The aim of this study was to determine the clinical and microbiological characteristics of extraintestinal infections caused by Aeromonas spp. in our area. PATIENTS AND METHODS: The clinical histories of patients with extraintestinal infections by Aeromonas spp. diagnosed in Hospital Universitario de Guadalajara (Guadalajara, Spain) from January 1990 to December 2005 were reviewed. Identification and susceptibility testing of the strains were performed by the MicroScan WalkAway-40 automated method (DadeBerhing). RESULTS: Thirty-eight cases of extraintestinal infections were diagnosed: 18 abdominal infections, 11 skin and soft tissue infections, 3 urinary tract infections, and 3 episodes of bacteremia with no primary focus. The species most frequently found was A. hydrophila (16 cases). Infection occurred most often in patients with underlying diseases (76.3%), including malignancy (34.2%) and diabetes mellitus (21%). Polymicrobial infections were detected in 50% and the etiology was nosocomial in 21%. The mortality rate was 16.2%. Gentamicin, amikacin, cefotaxime and ciprofloxacin had the highest activity against the Aeromonas species isolated. CONCLUSIONS: Aeromonas spp. as the causative infectious agent should be kept in mind in patients with infections of the biliary system, surgical wounds in the abdomen and posttraumatic cellulitis. Extraintestinal infection is usually polymicrobial, appears most commonly in patients with underlying diseases, and generally has a good prognosis. The most active antibiotics in vitro were gentamicin, amikacin, cefotaxime and ciprofloxacin.

Cutaneous infection due to Bacillus pumilus: report of 3 cases.

Human infection due to Bacillus pumilus is exceptional. We report 3 cases of cutaneous infection caused by B. pumilus that occurred in 3 shepherds, 2 of whom were members of the same family. The lesions appeared to have a morphology similar to that of cutaneous anthrax lesions. Two patients were cured after treatment with amoxicillin-clavulanate, and the third patient was cured after prolonged treatment with ciprofloxacin. To our knowledge, primary cutaneous infection due to B. pumilus has not been reported. B. pumilus should be considered in patients who develop lesions suggestive of cutaneous anthrax.

Urinary tract infection due to non-typhoidal Salmonella: report of 19 cases.

OBJECTIVES: Urinary tract infection (UTI) caused by non-typhoidal Salmonella (NTS) is rare. The aims were to know the frequency and clinical characteristics of this infection in our area. PATIENTS AND METHODS: We performed a retrospective analysis of patients with bacteriuria due to NTS diagnosed in our hospital from January 1990 to December 2005. RESULTS: Nineteen patients with bacteriuria caused by NTS were diagnosed, representing 0.07% of the UTIs diagnosed in our area over the same period. The mean age was 62.5 years old. Eighteen patients (94.7%) had symptoms of UTI (12, cystitis; 6, pyelonephritis), and 1 remained asymptomatic. Fourteen patients (73.6%) had chronic diseases; diabetes mellitus was present in 8 of them (42.1%) and 7 patients (36.8%) were undergoing immunosuppressor treatment. Eight patients (42.1%) had urologic abnormalities. S. enteritidis was the most common serotype isolated (16 cases). Eleven patients required antibiotic treatment over 2 or more weeks. Four patients had recurrent Salmonella UTIs (22.2%), and in 2 of them recurrence occurred after prolonged treatment during 3.5 and 5 weeks, respectively. CONCLUSIONS: UTI due to NTS was predominantly observed in elderly patients with underlying diseases, especially diabetes mellitus, urologic abnormalities and immunosuppression. Prolonged antibiotic treatment should be considered due to the high frequency of complicating conditions, although the infection can be recurrent despite prolonged treatment.

Acute meningitis due to Brucella spp.

Brucella spp. should be considered in the differential diagnosis of acute meningitis of children living in areas where brucellosis is endemic.

Trichophyton violaceum: un patógeno emergente / Trichophyton violaceum: an emergent pathogen

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Prevalencia de hepatitis a en la provincia de guadalajara. ¿Es España un país de baja endemia? / The prevalence of hepatitis A in the Guadalajara province. Is Spain a country with low endemia?

FUNDAMENTO. España junto con los países de Europa del sur era considerada zona de endemia de grado intermedio. Este hecho tiene consecuencias de cara a los viajeros que visitan estas zonas y a la estrategia de vacunación. Se plantea realizar un estudio de prevalencia para conocer la situación de la infección en la provincia de Guadalajara. MÉTODOS. Se seleccionaron 284 muestras de suero de pacientes que fueron clasificadas por edad, sexo y lugar de residencia (mayor o menor de 10.000 habitantes). En ellos se estudió la presencia de anticuerpos frente al virus de la hepatitis A mediante enzimoinmunoensayo de micropartículas (MEIA) (Abbott). RESULTADOS. Se observó un aumento de prevalencia con la edad de forma que existe una población de baja prevalencia ( 5 por ciento) entre los 0-29 años junto con otra de alta prevalencia (>80 por ciento) en los adultos entre 30 y 74 años. No se observaron diferencias en función del sexo. En el análisis estratificado por edad se observaron diferencias entre los grupos de procedencia rural y urbana. CONCLUSIONES. La baja prevalencia de hepatitis A encontrada en la población más joven, al igual que en otros estudios nacionales, junto con el descenso de la incidencia nos incluye dentro de los países de baja endemia. Este hecho tiene consecuencias en cuanto a los viajeros que visiten nuestro país y de cara a una estrategia vacunal debido al aumento de adultos susceptibles a la infección (AU)

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Hallazgo parasitológico en una niña saharaui / Parasitologic finding in a saharan girl

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Meningitis por Salmonella sp. en el adulto. Presentación de un caso y revisión de la bibliografía española / Salmonella sp. in the adult. Case report and review of the spanish bibliography

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Fiebre y mucositis oral en enfermo inmunodeprimido / Subacute endocarditis due to Actinobacillus actinomycetemcomitans

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Infección urinaria por salmonella no typhi / Urinary infection by Salmonella non thypi

Fundamento: Conocer la frecuencia y las características clínicas de la infección urinaria por Salmonella no typhi en nuestro medio. Pacientes y métodos: Se revisaron retrospectivamente las historias clínicas de los pacientes con bacteriuria por Salmonella no typhi diagnosticados en el Hospital General de Guadalajara entre enero de 1990 y julio de 1999. Resultados: Durante los casi 10 años revisados 9 pacientes fueron diagnosticados de bacteriuria por Salmonella no typhi, lo que representa el 0,056 por ciento de las infecciones urinarias diagnosticadas en nuestro hospital durante dicho período de tiempo. Todos los enfermos presentaron enfermedad de base subyacente y cinco estuvieron sometidos a tratamiento inmunosupresor. Cuatro pacientes presentaron afecciones urológicas. El serogrupo más frecuente fue Salmonella enteritidis (7 casos). Todos los episodios fueron sintomáticos. En 4 enfermos se aisló el mismo microorganismo en las heces. La evolución fue favorable en 5 de los 9 casos. Se produjo recurrencia en 2 pacientes y bacteriemia secundaria en uno. Seis enfermos requirieron tratamiento antibiótico durante dos o más semanas. La duración media del tratamiento fue de 2,5 semanas. Conclusiones: La infección urinaria por Salmonella no typhi ocurre predominantemente en pacientes con inmunosupresión o afecciones urológicas. Recomendamos realizar tratamiento antibiótico prolongado por su tórpida evolución. (AU)