ABSTRACT
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Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Salmonella , Azithromycin/pharmacology , Azithromycin/therapeutic useABSTRACT
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Subject(s)
Humans , Salmonella Infections/microbiology , Salmonella enterica/drug effects , Salmonella enterica/isolation & purification , Drug Resistance, Bacterial , Quinolones/pharmacology , Population Surveillance , PhenotypeABSTRACT
INTRODUCCIÓN: Streptococcus pyogenes (S. pyogenes) es un importante patógeno humano responsable de una gran diversidad de infecciones, algunas de las cuales presentan un carácter severo con elevada morbimortalidad asociada. La proteína M es un determinante de virulencia crítico de este microorganismo. Diferentes estudios comunican un incremento de enfermedad invasora por S. pyogenes (EISP) relacionado con un aumento de serotipos M1 y M3, de reconocida virulencia. El objetivo del trabajo es confirmar el incremento observado de las enfermedades invasoras por S. pyogenes durante 2011-2018, y conocer qué serotipos pudieran estar implicados. MATERIAL Y MÉTODOS: La identificación de los aislados se realizó mediante pruebas fenotípicas convencionales: morfología de las colonias, β-hemólisis, pruebas bioquímicas y detección de antígeno A de Lancefield (DiaMondiaL Strep Kit, DiaMondiaL, Langenhagen, Alemania). La sensibilidad antibiótica se determinó mediante microdilución (Vitek®2 Compact, bioMeriéux, Inc., Durham, NC). La caracterización genotípica incluyó el gen emm y el perfil de superantígenos. RESULTADOS: Entre 2011-2018 se recuperaron 29 S. pyogenes invasores de sangre (16), líquido pleural (9), líquido sinovial (3) y líquido cefalorraquídeo (1). Entre 2011 y 2013, se cuantificó una cepa por año. Entre 2014 y 2018 se aislaron 2, 5, 4, 6 y 9 cepas, respectivamente. Las entidades clínicas más frecuentes fueron bacteriemia y neumonía (10 y 9 casos). Los serotipos mayoritarios fueron M1 (11) y M3 (3), asociados predominantemente a neumonía (6/7 casos) e infección profunda de partes blandas (3/3 casos). CONCLUSIONES: Se constata un incremento de las enfermedad invasora por S. pyogenes en el periodo estudiado resultando mayoritarios, conforme a la bibliografía, los serotipos M1 y M3, los cuales se asocian con neumonía e infección profunda de partes blandas
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, β-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
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Antigens, Bacterial/metabolism , Bacterial Outer Membrane Proteins/metabolism , Carrier Proteins/metabolism , Streptococcal Infections/epidemiology , Streptococcal Infections/microbiology , Streptococcus pyogenes/pathogenicity , Virulence Factors/metabolism , Biomarkers/metabolism , Incidence , Retrospective Studies , Severity of Illness Index , Spain/epidemiology , Streptococcal Infections/diagnosis , Streptococcal Infections/pathology , Streptococcus pyogenes/classification , Streptococcus pyogenes/isolation & purification , Streptococcus pyogenes/metabolismABSTRACT
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.
Subject(s)
Antigens, Bacterial/metabolism , Bacterial Outer Membrane Proteins/metabolism , Carrier Proteins/metabolism , Streptococcal Infections/epidemiology , Streptococcal Infections/microbiology , Streptococcus pyogenes/pathogenicity , Virulence Factors/metabolism , Biomarkers/metabolism , Child , Child, Preschool , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Retrospective Studies , Severity of Illness Index , Spain/epidemiology , Streptococcal Infections/diagnosis , Streptococcal Infections/pathology , Streptococcus pyogenes/classification , Streptococcus pyogenes/isolation & purification , Streptococcus pyogenes/metabolismABSTRACT
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Humans , Anti-Bacterial Agents/pharmacology , Gram-Positive Bacterial Infections/epidemiology , Vancomycin-Resistant Enterococci/isolation & purification , Anti-Bacterial Agents/administration & dosage , Drug Resistance, Multiple, Bacterial , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/microbiologyABSTRACT
IntroductionEnterovirus A71 (EV-A71) is an emerging pathogen that causes a wide range of disorders including severe neurological manifestations. In the past 20 years, this virus has been associated with large outbreaks of hand, foot and mouth disease with neurological complications in the Asia-Pacific region, while in Europe mainly sporadic cases have been reported. In spring 2016, however, an EV-A71 outbreak associated with severe neurological cases was reported in Catalonia and spread further to other Spanish regions.AimOur objective was to investigate the epidemiology and clinical characteristics of the outbreak.MethodsWe carried out a retrospective study which included 233 EV-A71-positive samples collected during 2016 from hospitalised patients. We analysed the clinical manifestations associated with EV-A71 infections and performed phylogenetic analyses of the 3'-VP1 and 3Dpol regions from all Spanish strains and a set of EV-A71 from other countries.ResultsMost EV-A71 infections were reported in children (mean age: 2.6 years) and the highest incidence was between May and July 2016 (83%). Most isolates (218/233) were classified as subgenogroup C1 and 217 of them were grouped in one cluster phylogenetically related to a new recombinant variant strain associated with severe neurological diseases in Germany and France in 2015 and 2016. Moreover, we found a clear association of EV-A71-C1 infection with severe neurological disorders, brainstem encephalitis being the most commonly reported.ConclusionAn emerging recombinant variant of EV-A71-C1 was responsible for the large outbreak in 2016 in Spain that was associated with many severe neurological cases.
Subject(s)
Disease Outbreaks/statistics & numerical data , Enterovirus A, Human/genetics , Enterovirus A, Human/isolation & purification , Enterovirus Infections/epidemiology , Nervous System Diseases/diagnosis , Nervous System Diseases/virology , RNA, Viral/genetics , Respiratory Tract Infections/virology , Antigens, Viral , Child, Preschool , Enterovirus A, Human/classification , Enterovirus Infections/diagnosis , Enterovirus Infections/virology , Hospitalization , Humans , Infant , Molecular Epidemiology , Nervous System Diseases/cerebrospinal fluid , Nervous System Diseases/epidemiology , Phylogeny , Phylogeography , RNA, Viral/isolation & purification , Respiratory Tract Infections/epidemiology , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction , Sequence Analysis, DNA , Sequence Analysis, RNA , Spain/epidemiologySubject(s)
Anti-Bacterial Agents/pharmacology , Gram-Positive Bacterial Infections/epidemiology , Vancomycin-Resistant Enterococci/isolation & purification , Anti-Bacterial Agents/administration & dosage , Drug Resistance, Multiple, Bacterial , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/microbiology , HumansABSTRACT
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Humans , Male , Female , Abdominal Abscess/complications , Abdominal Abscess/diagnosis , Abdominal Abscess/therapy , Salmonella enteritidis , Salmonella enteritidis/pathogenicity , Spleen , Salmonella enterica/classification , Salmonella entericaSubject(s)
Abscess/diagnostic imaging , Salmonella Infections/diagnostic imaging , Salmonella enterica , Splenic Diseases/diagnostic imaging , Abscess/microbiology , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Cysts/diagnostic imaging , Diagnostic Errors , Humans , Pleural Effusion/diagnostic imaging , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Bacterial/drug therapy , Salmonella Infections/microbiology , Splenic Diseases/microbiology , Typhoid Fever/diagnosisABSTRACT
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.
Subject(s)
Algorithms , Clostridioides difficile/isolation & purification , Enterocolitis, Pseudomembranous/diagnosis , Immunoenzyme Techniques , Polymerase Chain Reaction , Adolescent , Antigens, Bacterial/analysis , Bacterial Proteins/analysis , Bacterial Toxins/analysis , Child , Child, Preschool , Clostridioides difficile/immunology , Cost-Benefit Analysis , Early Diagnosis , Enterocolitis, Pseudomembranous/microbiology , Enterotoxins/analysis , Feces/microbiology , Female , Glutamate Dehydrogenase/analysis , Humans , Immunoenzyme Techniques/economics , Infant , Male , Polymerase Chain Reaction/economicsABSTRACT
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)
Subject(s)
Humans , Clostridioides difficile/pathogenicity , Clostridium Infections/drug therapy , Medication Therapy Management , Feces/microbiology , Bacterial Proteins/isolation & purification , Communicable Disease Control/methodsABSTRACT
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Subject(s)
Humans , Bacteremia/epidemiology , Bacteria, Anaerobic/pathogenicity , Anti-Bacterial Agents/therapeutic use , Ampicillin/therapeutic use , Gentamicins/therapeutic useABSTRACT
INTRODUCTION: Invasive disease as a result Campylobacter spp. is rarely reported. Bloodstream infections have been reported in patients with immune deficiency or other serious underlying conditions. We conducted a prospective study to know the incidence of Campylobacter jejuni bacteremia in pediatric patients and its susceptibility to erythromycin and ciprofloxacin. METHODS: The identification of Campylobacter isolates was based on routine culture methods. Antimicrobial susceptibility was performed using a disk diffusion method. RESULTS: During April 2010-June 2012, at Hospital Niño Jesús of Madrid, Campylobacter spp. was isolated from 171 stool specimens in 154 patients. The median age was 2 years (3 months-21 year). One hundred and one (66%) isolates were identified as C. jejuni. Nine patients with enteritis due C. jejuni (9%) were immunocompromised. Erythromycin resistance was observed in 5% of the isolates. The resistance to ciprofloxacin was 88%. Blood cultures were obtained of 19 patients infected with C. jejuni (19%). Of these, one had C. jejuni bacteremia. During the study period, other episode of C. jejuni bacteremia was detected in one patient different without positive stool culture for C. jejuni (0.34% of all bloodstreams infections). Both patients were immunocompromised. CONCLUSIONS: Campylobacter spp. is an uncommon cause of bloodstream infection in our serie occurring in pediatric patients with immune deficiency as predisposing factor. In our institution, empirical use of fluoroquinolones for Campylobacter infections should not be recommended by the high rate of resistance. Moreover in our study the resistance to erythromycin is low, however is advisable its surveillance.
Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteremia/epidemiology , Bacteremia/microbiology , Campylobacter Infections/epidemiology , Campylobacter Infections/microbiology , Campylobacter jejuni/drug effects , Adolescent , Child , Child, Preschool , Ciprofloxacin/pharmacology , Drug Resistance, Bacterial , Erythromycin/pharmacology , Feces/microbiology , Female , Humans , Immunocompromised Host , Incidence , Infant , Male , Microbial Sensitivity Tests , Spain/epidemiology , Young AdultABSTRACT
Introducción. La infección por Campylobacter spp. raramente se asocia con enfermedad invasora, sucediendo en pacientes con enfermedad subyacente o inmunodeficiencia. Nuestro objetivo es conocer prospectivamente la incidencia de bacteriemia por Campylobacter jejuni así como su sensibilidad a eritromicina y ciprofloxacino en pacientes pediátricos. Métodos. La identificación de las cepas se realizó según métodos convencionales. La sensibilidad a eritromicina y ciprofloxacino se determinó mediante el método de difusión en disco. Resultados. Entre abril 2010 y junio 2012, en el Hospital Niño Jesús de Madrid, Campylobacter spp. fue aislado de 171 heces de 154 pacientes. Mediana de edad de 2 años (rango 3 meses-21 años). Ciento un aislados (66%) fueron identificados como C. jejuni. Nueve pacientes con aislamiento de C. jejuni (9%) eran inmunodeficientes. Cinco cepas de C. jejuni (5%) fueron resistentes a eritromicina y 89 a ciprofloxacino (88%). Se obtuvieron hemocultivos de 19 pacientes con aislamiento de C. jejuni en heces (19%). De éstos, uno tuvo bacteriemia por C. jejuni. En el periodo estudiado se aisló asimismo C. jejuni a partir sólo del hemocultivo en un paciente diferente. Estos dos bacteriemias por C. jejuni constituyen el 0,34% de las contabilizadas durante el periodo estudiado. Ambos pacientes eran inmunocomprometidos. Conclusiones. En nuestra serie, Campylobacter spp. es una causa infrecuente de bacteriemia, sucediendo en pacientes pediátricos con inmunodeficiencia como factor predisponente. En nuestro centro, el uso empírico de fluoroquinolonas para el tratamiento de la campilobacteriosis estaría desaconsejado dada la elevada tasa de resistencia. La resistencia a eritromicina es baja, sin bien es aconsejable su vigilancia(AU)
Introduction. Invasive disease as a result Campylobacter spp. is rarely reported. Bloodstream infections have been reported in patients with immune deficiency or other serious underlying conditions. We conducted a prospective study to know the incidence of Campylobacter jejuni bacteremia in pediatric patients and its susceptibility to erythromycin and ciprofloxacin. Methods. The identification of Campylobacter isolates was based on routine culture methods. Antimicrobial susceptibility was performed using a disk diffusion method. Results. During April 2010-June 2012, at Hospital Niño Jesús of Madrid, Campylobacter spp. was isolated from 171 stool specimens in 154 patients. The median age was 2 years (3 months-21 year). One hundred and one (66%) isolates were identified as C. jejuni. Nine patients with enteritis due C. jejuni (9%) were immunocompromised. Erythromycin resistance was observed in 5% of the isolates. The resistance to ciprofloxacin was 88%. Blood cultures were obtained of 19 patients infected with C. jejuni (19%). Of these, one had C. jejuni bacteremia. During the study period, other episode of C. jejuni bacteremia was detected in one patient different without positive stool culture for C. jejuni (0.34% of all bloodstreams infections). Both patients were immunocompromised. Conclusions. Campylobacter spp. is an uncommon cause of bloodstream infection in our serie occurring in pediatric patients with immune deficiency as predisposing factor. In our institution, empirical use of fluoroquinolones for Campylobacter infections should not be recommended by the high rate of resistance. Moreover in our study the resistance to erythromycin is low, however is advisable its surveillance(AU)
