[Macrolide-resistant Mycoplasma pneumoniae: Do we know the situation in Europe?] / Mycoplasma pneumoniae y resistencias a macrólidos: ¿Conocemos la situación en Europa?

Mycoplasma pneumoniae is a bacterium that lacks a cell wall. It produces infections all It produces infections world-wide, in epidemic outbreaks every 4-7 years, or endemically. Its clinical manifestations occur mostly in the respiratory tract and it is a common cause of atypical pneumonia. The treatment is with macrolides, tetracyclines or fluoroquinolones. Since 2000, an increase in resistance to macrolides has been detected worldwide, being more frequent in Asia. In Europe the frequency of resistance ranges between 1% and 25%, depending on the country. Molecular techniques and serology techniques provides very high sensitivity in diagnostic confirmation, being very useful for detecting and controlling M. pneumoniae outbreaks. The detection of resistance to macrolides requires a sequencing technique.

Infecciones del tracto urinario. Estudio de sensibilidad antimicrobiana en Navarra / Uncomplicated urinary tract infections. Antimicrobial susceptibility study in Navarre

Fundamento: La infección del tracto urinario (ITU) tiene una elevada prevalencia en atención primaria. Con el fin de mejorar el tratamiento empírico se ha estudiado la etiología y el perfil de resistencia antibiótica de las bacterias más frecuentes productoras de ITU comunitaria en Navarra. Material y métodos: Estudio retrospectivo (2014-2016) en el que se incluyeron los microorganismos aislados con recuento significativo en muestras de orina de pacientes con ITU. Se analizó la etiología global y en función de la edad y sexo. El estudio de sensibilidad se realizó con los aislamientos del 2016. Resultados: Escherichia coli fue el microorganismo más aislado tanto en el conjunto de la población (60,8%) como en cada uno de los grupos analizados según edad y sexo. Su sensibilidad fue: nitrofurantoína 97,4%, fosfomicina 96,5%, amoxicilinaácido clavulánico 83,8%, trimetoprim-sulfametoxazol 68,3%, quinolonas 63,4% y amoxicilina 41,9%. Los datos de sensibilidad ponderada muestran que la sensibilidad a fosfomicina fue 83,4% en varones <15 años, 89,4% en mujeres <15 años y 81,9% en mujeres entre 15-65 años, y a nitrofurantorina 86,7% en mujeres <15 años y 82,2% en mujeres entre 15-65 años. Conclusiones: E. coli continua siendo el microorganismo más frecuente en ITU de origen comunitario con sensibilidad a fosfomicina y nitrofurantoína superior al 95%. El tratamiento empírico de ITU en nuestro medio debería excluir amoxicilina, amoxicilina-ácido clavulánico, trimetoprim-ulfametoxazol y quinolonas. Fosfomicina puede emplearse de forma empírica en el tratamiento de cistitis no complicada en varones menores de 15 años y en mujeres menores de 65 años y nitrofurantoína en mujeres menores de 65 años

Background: Urinary tract infection (UTI) is a high prevalence infection at the community level. In order to improve the adequacy of the empirical therapy, we evaluated the etiology and the resistance pattern of the main uropathogens responsible for community acquired UTI in Navarre. Methods: Retrospective study (2014-2016) in which we included microorganisms recovered with significant counts from samples of patients with community-acquired UTI. The global etiology and etiology according to age and sex was analyzed. Antimicrobial resistance was studied with urotopathogens isolated in 2016. Results: Escherichia coli was the most frequently isolated microorganism both in the population (60.8%) and in each of the groups analyzed according to age and sex. The sensitivity of E. coli was: nitrofurantoin 97.4%, fosfomycin 96.5% amoxicillin-clavulanic acid 83.8%, trimethoprim-sulfamethoxazole 68.3%, quinolones 63.4% and amoxicillin 41.9%. Pooled sensitivity shows that the sensitivity to fosfomycin was 83.4% in men <15 years, 89.4% in women <15 years and 81.9% in women between 15-65 years; and to nitrofurantoin was 86.7% in women <15 years and 82.2% in women between 15-65 years. Conclusions: E. coli continues to be the most frequent microorganism in community-acquired UTI with a rate of sensitivity to fosfomycin and nitrofurantoin above 95%. The empirical treatment of UTI in our environment should not include amoxicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole or quinolones. Fosfomycin may be empirically used in the treatment of uncomplicated cystitis in men younger than 15 years and in women under 65 years, and nitrofurantoin may be used empirically in women under 65 years

[Uncomplicated urinary tract infections. Antimicrobial susceptibility study in Navarre]. / Infecciones del tracto urinario. Estudio de sensibilidad antimicrobiana en Navarra.

BACKGROUND: Urinary tract infection (UTI) is a high prevalence infection at the community level. In order to improve the adequacy of the empirical therapy, we evaluated the etiology and the resistance pattern of the main uropathogens responsible for community acquired UTI in Navarre. METHODS: Retrospective study (2014-2016) in which we included microorganisms recovered with significant counts from samples of patients with community-acquired UTI. The global etiology and etiology according to age and sex was analyzed. Antimicrobial resistance was studied with urotopathogens isolated in 2016. RESULTS: Escherichia coli was the most frequently isolated microorganism both in the population (60.8%) and in each of the groups analyzed according to age and sex. The sensitivity of E. coli was: nitrofurantoin 97.4%, fosfomycin 96.5% amoxicillin-clavulanic acid 83.8%, trimethoprim-sulfamethoxazole 68.3%, quinolones 63.4% and amoxicillin 41.9%. Pooled sensitivity shows that the sensitivity to fosfomycin was 83.4% in men <15 years, 89.4% in women <15 years and 81.9% in women between 15-65 years; and to nitrofurantoin was 86.7% in women <15 years and 82.2% in women between 15-65 years. CONCLUSIONS: E. coli continues to be the most frequent microorganism in community-acquired UTI with a rate of sensitivity to fosfomycin and nitrofurantoin above 95%. The empirical treatment of UTI in our environment should not include amoxicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole or quinolones. Fosfomycin may be empirically used in the treatment of uncomplicated cystitis in men younger than 15 years and in women under 65 years, and nitrofurantoin may be used empirically in women under 65 years.

[Comparison of clinical features and diagnosis between the A and B subgroups of respiratory syncytial virus.] / Comparación de las características clínicas y diagnósticas de los subgrupos A y B del virus respiratorio sincitial.

BACKGROUND: Lower respiratory tract infection by respiratory syncytial virus (RSV) is the most frequent cause of admission in children under 2 years old. The RSV subgroups A and B may circulate simultaneously. We aimed to determine whether clinical differences exist between RSV subgroups A and B. Additionally, we tested the sensitivity of the rapid antigen detection test (RADT) based on immunochromatography in diagnosing subgroups A and B, taking the polymerase chain reaction assay (RT-PCR) as reference. METHODS: A retrospective observational study was performed in a tertiary hospital from October 2013 to March 2014. Clinical records and analytical variables of all children under 5 admitted with lower respiratory tract infection and RT-PCR positive for RSV in nasal lavage were consulted. Previously, the RADT for RSV had been performed from the same sample. RESULTS: A total of 198 children under 5 were diagnosed with RSV by RT-PCR: 55 (28%) were RSV-A, 132 (67%) RSV-B and 11 (5%) were positive for both subgroups. No differences were observed between subgroups in medical history, symptoms, radiological and analytical findings, and severity. The sensitivity of RADT for RSV was 52%, higher for RSV-A (69%) than for RSV-B (44%, p=0.001). CONCLUSIONS: The two RSV subgroups were indistinguishable in symptoms and prognosis. The sensitivity of RADT compared to RT-PCR was low and limits its usefulness for clinical decision-making. Key words. Respiratory syncytial virus. RSV subgroups. Rapid antigen detection test. Reverse transcription polymerase chain reaction.

Enfermedad de Chagas neonatal de transmisión vertical en países no endémicos. El uso de la PCR en el diagnóstico: ventajas sobre técnicas convencionales / Congenital transmission of Chagas disease in non-endemic countries. The use of PCR for diagnosis: advantages over conventional techniques

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[Bacteremia by Corynebacterium striatum and neutrocytic ascites. Presentation of a case and review of the literature]. / Bacteriemia por Corynebacterium striatum y ascitis neutrocítica. Presentación de un caso y revisión de la literatura.

Corynebacterium striatum is a Gram-positive pleomorphic bacillus that has been regarded as a saprophyte of mucous membranes and skin. There are certain difficulties in identifying the Corynebacteria species in the laboratory and it is often necessary to resort to techniques which are not available in all laboratories. Over recent years, C. striatum has shown itself to be a potential pathogen generally in weakened or immunodepressed individuals, in relation with intravenous catheters and in intensive care units. We report a case of bacteremia by C. striatum and neutrocytic ascites probably related to that microorganism, and, in view of the rarity of this isolement, we have reviewed the cases published on this subject.

[Bacteremia: a Spanish multicenter study with 5000 cases. The Hospital Infection Study Group (GEIH)]. / Bacteriemia: estudio multicéntrico español con 5.000 casos. Grupo de Estudio de Infección Hospitalaia (GEIH).

INTRODUCTION: Bacteremia is one of the most common nosocomial infections and is still a severe condition that frequently represents a life-threatening problem for the patient. MATERIAL AND METHODS: SEPSIS DATA is a software programme developed by the SEIMC (Spanish Society of Infectious Diseases and Clinical Microbiology) nosocomial infection study group, and it has been designed to collect under common criteria bacteremia cases from Spanish hospitals. In this study, we analyse the results from the first 5,000 cases prospectively collected from 34 hospitals with the following distribution by number of beds: 8 hospitals with less than 200, 15 between 200 and 499.6 between 500 and 999 and 5 with more than 1,000 beds. RESULTS: Male patients (60%), older than 61 years (52%) are the predominant group. Bacteremia acquisition was extra-hospital in 58% of the cases. Most frequent underlying disease was neoplasm (22%) and 9% of the patients had HIV infection. Most frequent bacteremia sources were urinary tract (19.6%), primary (16%) and respiratory tract (15%). Most commonly isolated micro-organisms were E. coli (23%). S. aureus (13%), coagulase-negative Staphylococci (12%) and S. pneumoniae (8%). Microorganisms average time to grow in laboratory was 1.95 days. Origin focus of bacteremia was reported in 30% of the cases. Antibiotic therapy used was active against pathogen isolate in 96% of the cases. Adequate treatment was started empirically from the first day in 76% of the cases. Third generation cephalosporines were the antibiotic group most used (28%). Among the observed complications, 7.68% of the episodes occurred with shock and 2.68% with septic metastasis. Crude mortality until the end of episode was 16.64%.