Fungemia diseminada por Saprochaete clavata / Disseminated fungemia by Saprochaete clavata

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Colonoscopia y endocarditis: una relación comprometida / Colonoscopy and endocarditis: a compromised relationship

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Evaluación del sistema automatizado UF-1000i® en el diagnósticode infección urinaria / Evaluation of the Sysmex UF-1000i® automated system for the diagnosis of urinary tract infection

Objetivos: Evaluar el sistema Sysmex UF-1000i®como cribado de orina en el diagnóstico de infecciones del tracto urinario y las células epiteliales (CE) como predicción de contaminación en mujeres en edadfértil. Métodos: Se procesaron 1.730 orinas; referencia el cultivo en placa. Resultados: Para un punto de corte de 50 bacterias/ l, sensibilidad: 91,3%, especiflcidad: 73,1%, VPN:93,2%. Para una especiflcidad del 90% para las CE, sensibilidad: 31,0%, VPP: 67,0%, VPN: 66,0%.Conclusión: El sistema evaluado es eflcaz y rápido. Las CE pueden predecir la contaminación (AU)

Objective: To evaluate the Sysmex UF-1000i®system as a urine screening method for the diagnosis of urinary tract infection, and epithelial cells as a predictive value of contamination in woman of childbearing age. Methods: A total of 1730 urine samples were processed using a urine culture as a reference. Results: With 50 bacteria/ l as a cut-off point, the results were: sensitivity 91.3%, speciflcity 73.1%, negative predictive value 96.2%. For a speciflcity of 90% for epithelial cells, the results were: sensitivity 31.0%,positive predictive value 67.0%, negative predictive value 66.0%.Conclusion: The evaluated system is fast and effective. Epithelial cells could be used to predict contamination (AU)

[Evaluation of the Sysmex UF-1000i automated system for the diagnosis of urinary tract infection]. / Evaluación del sistema automatizado UF-1000i en el diagnóstico de infección urinaria.

OBJECTIVE: To evaluate the Sysmex UF-1000i system as a urine screening method for the diagnosis of urinary tract infection, and epithelial cells as a predictive value of contamination in woman of childbearing age. METHODS: A total of 1730 urine samples were processed using a urine culture as a reference. RESULTS: With 50 bacteria/µl as a cut-off point, the results were: sensitivity 91.3%, specificity 73.1%, negative predictive value 96.2%. For a specificity of 90% for epithelial cells, the results were: sensitivity 31.0%, positive predictive value 67.0%, negative predictive value 66.0%. CONCLUSION: The evaluated system is fast and effective. Epithelial cells could be used to predict contamination.

Artritis séptica por Scedosporium apiospermum de lenta instauración tras infiltración periarticular / Slow onset septic arthritis by Scedosporium apiospermum after periarticular infiltration

Antecedentes. Las artritis fúngicas de origen hematógeno suelen afectar preferentemente a pacientes con afectación de la inmunidad celular o a usuarios de drogas por vía intravenosa. En el paciente inmunocompetente suele producirse por la inoculación del microorganismo mediante un mecanismo invasor. La experiencia del tratamiento con azoles en estos pacientes es muy escasa. Caso clínico. Presentamos un caso clínico de artritis por Scedosporium apiospermum caracterizado por su lenta instauración, falta de respuesta a posaconazol y caspofungina, y resolución final mediante desbridamiento y tratamiento con voriconazol. Conclusiones. La administración de voriconazol junto al desbridamiento quirúrgico constituye un tratamiento eficaz en la artritis por S. apiospermum(AU)

Background. Fungal arthritis is usually of haematogenous origin, and mainly affects patients with impaired cellular immunity or users of intravenous drugs. The infection in immunocompetent patients is generally caused by direct inoculation of the microorganism through an invasive device. The experience of azole therapy in these patients is limited. Case report. We report a case of arthritis caused by Scedosporium apiospermum characterized by its slow onset, lack of response to posaconazole and caspofungin, and its successful resolution after surgical debridement and treatment with voriconazole. Conclusions. Treatment with voriconazole and surgical debridement is an effective therapy for arthritis due to S. apiospermum(AU)

[Slow onset septic arthritis by Scedosporium apiospermum after periarticular infiltration]. / Artritis séptica por Scedosporium apiospermum de lenta instauración tras infiltración periarticular.

BACKGROUND: Fungal arthritis is usually of haematogenous origin, and mainly affects patients with impaired cellular immunity or users of intravenous drugs. The infection in immunocompetent patients is generally caused by direct inoculation of the microorganism through an invasive device. The experience of azole therapy in these patients is limited. CASE REPORT: We report a case of arthritis caused by Scedosporium apiospermum characterized by its slow onset, lack of response to posaconazole and caspofungin, and its successful resolution after surgical debridement and treatment with voriconazole. CONCLUSIONS: Treatment with voriconazole and surgical debridement is an effective therapy for arthritis due to S. apiospermum.

[What are we learning about Staphylococcus saprophyticus?]. / Qué estamos aprendiendo de Staphylococcus saprophyticus?

INTRODUCTION: Staphylococcus saprophyticus is frequent cause of urinary tract infection in women; hence, it is important to know the epidemiology and antibiotic susceptibility of this microorganism. METHOD: A retrospective longitudinal study was performed in urine specimens from outpatients in our health area cultured in the Microbiology Laboratory of C.E. Argüelles (Madrid, Spain) over a 10-year period (1997-2006). RESULTS: Among 35,136 urine cultures with a significant count, we identified 331 S. saprophyticus (0.9%); 324 in women and 7 in men. Mean age of the infected patients was 32.7 years. A total of 83.9% of the strains were in women aged 15 to 44 years (37 women in this group were pregnant) and the largest numbers of isolates were found during the months of June and November. All S. saprophyticus strains were susceptible to vancomycin, rifampin, gentamicin and amoxicillin-clavulanic acid. Of note, there was a high percentage of resistance to erythromycin (37.7%) (96% consistent with the MSB phenotype) which has significantly increased since 1997 (P < 0.05); 1.5% were also resistant to clindamycin. Only 0.9% were resistant to fluorquinolones. Resistance to chloramphenicol, trimethoprim/sulfamethoxazole, and penicillin was 3.9%, 6%, and 55.6%, respectively. Based on the 2006 CLSI guidelines, 45% of S. saprophyticus isolates were considered oxacillin-resistant. CONCLUSION: These results suggest the following: First, S. saprophyticus should be considered among agents causing urinary tract infection in women 15 to 44 years old, including pregnant women, particularly during spring and autumn. Second, cotrimoxazole may be an excellent option for treating cystitis in patients without risk factors. Third, almost half of S. saprophyticus strains were considered oxacillin-resistant, thereby denying the benefit of treatment with oral beta-lactams in urinary tract infections. This is especially important in pregnant women, who should avoid trimethoprim/sulfamethoxazole and quinolones (FDA Group C), as well as fosfomycin, with in vitro resistance.

¿Qué estamos aprendiendo de Staphylococcus saprophyticus? / What are we learning about Staphylococcus saprophyticus?

INTRODUCCIÓN. Staphylococcus saprophyticus es una causa frecuente de infección del tracto urinario en mujeres, por lo que es necesario conocer su epidemiología y sensibilidad antibiótica. MÉTODOS. Estudio longitudinal retrospectivo de los urocultivos comunitarios procesados en el Laboratorio de Microbiología del C.E. Argüelles, durante 10 años (1997-2006). RESULTADOS. En 35.136 urocultivos con recuento significativo, se identificaron 331 S. saprophyticus (0,9%); 324 en mujeres y 7 en varones. La edad media de las pacientes infectadas fue 32,7 años. El 83,9% de las cepasse aislaron en mujeres con edades comprendidas entre 15 y 44 años (37 mujeres de este grupo eran gestantes) y en los meses de junio y noviembre se concentraron el mayor número de aislados. Todos los S. saprophyticus fueron sensibles a vancomicina, rifampicina, gentamicina y amoxicilina-ácido clavulánico. Destaca el elevado porcentaje de resistencia a eritromicina (37,7%) (el 96% compatible con fenotipo MSB), que ha ido aumentando desde 1997 de manera significativa (p de tendencia lineal< 0,05). El 1,5% también fue resistente a clindamicina. Únicamente el 0,9% no fue sensible afluorquinolonas. La resistencia a cloranfenicol, cotrimoxazol y penicilina supuso el 3,9, el 6 y el 55,6%, respectivamente. Siguiendo los criterios del Clinical and Laboratory Standards Institute (CLSI) de 2006, el 45% de S. saprophyticus se consideró resistente a oxacilina. CONCLUSIONES. Estos resultados sugieren: primero, debemos pensar en S. saprophyticus ante la infección del tracto urinario (ITU) de mujeres entre 15 y 44 años, incluidas las gestantes, especialmente en primavera y otoño. Segundo, cotrimoxazol puede ser una excelente opción para el tratamiento de estas cistitis en pacientes sin factores de riesgo. Tercero, prácticamente la mitad de S. saprophyticus son considerados resistentes a oxacilina, denegando el beneficio del tratamiento con betalactámicos orales en las ITU. Esta situación es especialmente importante en mujeres gestantes, en las que no se debe emplear cotrimoxazol y quinolonas (grupo C de la Food and Drug Administration [FDA]) y la fosfomicina es resistente in vitro (AU)

INTRODUCTION. Staphylococcus saprophyticus is frequent cause of urinary tract infection in women; hence, it is important to know the epidemiology and antibiotic susceptibility of this microorganism. METHOD. A retrospective longitudinal study was performed in urine specimens from outpatients in our health area cultured in the Microbiology Laboratory of C.E. Argüelles(Madrid, Spain) over a 10-year period (1997-2006). RESULTS. Among 35,136 urine cultures with a significant count, we identified 331 S. saprophyticus (0.9%); 324 in women and 7 in men. Mean age of the infected patients was 32.7 years. A total of 83.9% of the strains were in women aged 15 to 44 years (37 women in this group were pregnant) and the largest numbers of isolates were found during the months of June and November. AllS. saprophyticus strains were susceptible to vancomycin, rifampin, gentamicin and amoxicillin-clavulanic acid. Of note, there was a high percentage of resistance to erythromycin (37.7%) (96% consistent with the MSB phenotype) which has significantly increased since 1997 (P < 0.05); 1.5% were also resistant to clindamycin. Only 0.9% were resistant to fluorquinolones. Resistance tochloramphenicol, trimethoprim/sulfamethoxazole, and penicillin was 3.9%, 6%, and 55.6%, respectively. Based on the 2006 CLSI guidelines, 45% of S. saprophyticus isolates were considered oxacillin-resistant. CONCLUSION. These results suggest the following: First, S. saprophyticus should be considered among agents causing urinary tract infection in women 15 to 44 years old, including pregnant women, particularly during spring and autumn. Second, cotrimoxazole may be an excellent option for treating cystitis in patients without risk factors. Third, almost half of S. saprophyticus strains were considered oxacillin-resistant, there by denying the benefit of treatment with oral beta-lactams in urinary tract infections. This is especially important in pregnant women, who should avoid trimethoprim/sulfamethoxazole and quinolones (FDA Group C), as well as fosfomycin, with in vitro resistance (AU)