[Etiology of community-acquired lower urinary infections and antimicrobial resistance of Escherichia coli: a national surveillance study]. / Etiología de la infección urinaria baja adquirida en la comunidad y resistencia de Escherichia coli a los antimicrobianos de primera línea. Estudio nacional multicéntrico.

BACKGROUND AND OBJECTIVES: The increasing rates of resistance exhibited by uropathogens represent a serious problem. The aim of this study was to determine, in Spain, the etiology of community-acquired lower urinary infections and antimicrobial resistance of Escherichia coli isolates. METHODS: Prospective multicenter study conducted between February and June 2006, in 15 microbiology laboratories located in 9 autonomous regions. RESULTS: A total of 3,109 isolates were recovered. E. coli was the most frequent (70.8%), followed by Klebsiella spp (6.8%) Proteus spp (6.6%), and Enterococcus spp (5.5%). The resistant rate of E. coli for phosphomycin was 1.7%, 3.8% nitrofurantoin, 6.9% cefexime, 8.1% amoxicillin-clavulanic, 8.9% cefuroxime, and 23.9% ciprofloxacin. The 5.2% were extended-spectrum beta-lactamase (ESBL)- producing microorganisms. Resistance of E. coli to ciprofloxacin was lower in people younger than 40 years (6.7% vs 33.9% in > 60, p < 0.001), and in some regions (12.5% in Galicia vs 37.3% in Valencia). ESBL-producing E.coli was higher in people older than 60 years (79.1% vs 7% in < 40, p < 0.001), and exhibited geographic variations (18.4% in Valencia, 0.8% in Galicia). The 68.6% of ESBL-producing E.coli were resistant to cotrimoxazole, 72.2% to ciprofloxacin vs 10.6% to nitrofurantoin and 1.9% to phosphomycin. CONCLUSIONS: The increasing rates of resistance and cross-resistance of this study make evident a real problem that strengthens the need for a reevaluation of the empiric treatment of lower urinary infections.

Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit.

BACKGROUND: An outbreak of severe nosocomial Burkholderia cepacia infections in patients admitted to intensive care unit (ICU), including investigation of the reservoir, is described. METHODS: Over a period of 18 days, isolates of Burkholderia cepacia were recovered from different biological samples from five patients who were admitted to a multidisciplinary 18-bed intensive care unit. Isolation of B. cepacia was associated with bacteraemia in three cases, lower respiratory tract infection in one and urinary tract infection in one. Contact isolation measures were instituted; new samples from the index patients and adjacent patients were collected; and samples of antiseptics, eau de Cologne and moisturizing body milk available in treatment carts at that time were collected and cultured. RESULTS: B. cepacia was isolated from three samples of the moisturizing body milk that had been applied to the patients. Three new hermetically closed units, from three different batches, were sent for culture; two of these were positive as well. All strains recovered from environmental and biological samples were identified as belonging to the same clone by pulsed-field gel electrophoresis. The cream was withdrawn from all hospitalization units and no new cases of B. cepacia infection developed. CONCLUSION: Moisturizing body milk is a potential source of infection. In severely ill patients, the presence of bacteria in cosmetic products, even within accepted limits, may lead to severe life-threatening infections.

Caracterización de Escherichia coli de los grupos filogenéticos A y B1 causantes de infección extraintestinal / Characterization of Escherichia coli isolates derived from phylogenetic groups A and B1 causing extraintestinal infection

Introducción. Escherichia coli de los grupos filogenéticos no patógenos A y B1 raramente causan infecciones extraintestinales. El objetivo de este estudio es el de caracterizar 37 E. coli de los grupos filogenéticos A y B1 y compararlos con 37 E. coli del grupo B2 y 31 del grupo D, productores de las mismas infecciones. Métodos. De estos 105 casos de E. coli aislados de orina de pacientes con cistitis y pielonefritis y de sangre de pacientes con sepsis urinaria y de otros orígenes, se estudió el grupo filogenético, 15 genes de virulencia, los antígenos O asociados a infección extraintestinal y la sensibilidad a fluoroquinolonas. Resultados. Los aislados de E. coli de los grupos A/B1 presentaron menos determinantes de virulencia (media de 3,5) que los del grupo B2 (8,6; p < 0,001) y D (5,3; p < 0,001); sin embargo un subgrupo formado por 3 aislados del grupo A y 5 del B1 poseían 5 o más factores. E. coli de los grupos A/B1 se asociaron con frecuencia significativa a resistencia a fluoroquinolonas (74%; p < 0,001), mientras que los del grupo B2 se asociaron a sensibilidad (76%; p 5 0,003). E. coli de los grupos A/B1 se aislaron de forma significativa en pacientes con pielonefritis y sepsis y factores favorecedores de infección, asociación que no se observó en pacientes con cistitis. Conclusión. E. coli de los grupos filogenéticos A y B1, a pesar de que en general presentan un bajo potencial patógeno, se han mostrado capaces de producir infecciones extraintestinales, especialmente en pacientes con factores favorecedores de infección (AU)

Introduction. Escherichia coli isolates from the non-pathogenic phylogenetic groups A and B1 rarely cause extraintestinal infections. The aim of this study was to analyze 37 E. coli isolates pertaining to phylogenetic groups A and B1 and compare them with 37 E. coli isolates from group B2 and 31 from group D, which caused the same infections. Methods. Among 105 E. coli isolated from the urine of patients with cystitis and pyelonephritis and from the blood of patients with urinary-source and other-source bacteriemia, the E. coli phylogenetic groups, 15 virulence-associated genes, 7 O-antigens and fluoroquinolone resistance were analyzed. Results. E. coli from groups A and B1 showed fewer virulence determinants (median 3.5) than E. coli from group B2 (8.6, P < .001) or D (5.3, P < .001); however, a subgroup containing 3 isolates from group A and 5 from B1 harbored 5 o more factors. E. coli from groups A/B1 were associated with resistance to fluoroquinolones (74%, P < .001), whereas E. coli from group B2 were associated with susceptibility to this antibiotic (76%, P 5 .003). E. coli from groups A/B1 were isolated significantly more frequently in patients with pyelonephritis or sepsis and local or general factors favoring infection, association not observed in patients with cystitis. Conclusions. Even though most of the E. coli isolates from phylogenetic groups A and B1 presented a low virulence potential, they were able to cause extraintestinal infections, particularly in compromised patients (AU)

[Characterization of Escherichia coli isolates derived from phylogenetic groups A and B1 causing extraintestinal infection]. / Caracterización de Escherichia coli de los grupos filogenéticos A y B1 causantes de infección extraintestinal.

INTRODUCTION: Escherichia coli isolates from the non-pathogenic phylogenetic groups A and B1 rarely cause extraintestinal infections. The aim of this study was to analyze 37 E. coli isolates pertaining to phylogenetic groups A and B1 and compare them with 37 E. coli isolates from group B2 and 31 from group D, which caused the same infections. METHODS: Among 105 E. coli isolated from the urine of patients with cystitis and pyelonephritis and from the blood of patients with urinary-source and other-source bacteriemia, the E. coli phylogenetic groups, 15 virulence-associated genes, 7 O-antigens and fluoroquinolone resistance were analyzed. RESULTS: E. coli from groups A and B1 showed fewer virulence determinants (median 3.5) than E. coli from group B2 (8.6, P < 0.01) or D (5.3, P < .001); however, a subgroup containing 3 isolates from group A and 5 from B1 harbored 5 or more factors. E. coli from groups A/B1 were associated with resistance to fluoroquinolones (74%, P < .001), whereas E. coli from group B2 were associated with susceptibility to this antibiotic (76%, P = .003). E. coli from groups A/B1 were isolated significantly more frequently in patients with pyelonephritis or sepsis and local or general factors favoring infection, association not observed in patients with cystitis. CONCLUSIONS: Even though most of the E. coli isolates from phylogenetic groups A and B1 presented a low virulence potential, they were able to cause extraintestinal infections, particularly in compromised patients.

Comparative study of Escherichia coli virulence determinants in strains causing urinary tract bacteremia versus strains causing pyelonephritis and other sources of bacteremia.

To assess the role of phylogenetic background and putative virulence factors (VFs) in Escherichia coli causing urinary bacteremia, 50 strains isolated from this condition were compared with 50 strains isolated from pyelonephritis and 50 from other sources of bacteremia. papA and papGII were significantly more prevalent in urinary bacteremia and pyelonephritis (78%, 66% and 70%, 58%) than in other-source bacteremia (48% and 24%), whereas sfa/focDE and cnf1 were more prevalent in urinary-source bacteremia (56% and 44%) than in pyelonephritis and other-source bacteremia (28%, 42% and 20%, 28%). Group B2 was the most frequent in all conditions (63% of isolates) and exhibited the greatest concentration of VFs. Urinary tract bacteremia, pyelonephritis, and other-source bacteremia isolates presented similar virulence scores (7.8, 7.0, and 6.6); however, there were striking differences among the phylogenetic groups (8.7 in group B2 versus 3.4 in group A; P < .001). Group A and B1 strains almost exclusively infected compromised hosts.