Tuberculosis in Spain: An opinion paper / Tuberculosis en España: Un documento de opinión

This document is the result of the deliberations of the Committee on Emerging Pathogens and COVID-19 of the Il lustrious Official College of Physicians of Madrid (ICOMEM) regarding the current situation of tuberculosis, particularly in Spain. We have reviewed aspects such as the evolution of its incidence, the populations currently most exposed and the health care circuits for the care of these patients in Spain. We have also discussed latent tuberculosis, the reality of extrapul monary disease in the XXI century and the means available in daily practice for the diagnosis of both latent and active forms. The contribution of molecular biology, which has changed the perspective of this disease, was another topic of discussion. The paper tries to put into perspective both the classical drugs and their resistance figures and the availability and indications of the new ones. In addition, the reality of direct observa tion in the administration of antituberculosis drugs has been discussed. All this revolution is making it possible to shorten the treatment time for tuberculosis, a subject that has also been reviewed. If everything is done well, the risk of relapse of tuberculosis is small but it exists. On the other hand, many special situations have been discussed in this paper, such as tuberculosis in pediatric age and tuberculosis as a cause for concern in surgery and intensive care. The status of the BCG vaccine and its present indications as well as the future of new vaccines to achieve the old dream of eradicating this disease have been discussed. Finally, the ethical and medicolegal impli cations of this disease are not a minor issue and our situation in this regard has been reviewed (AU)

El presente documento es el resultado de las deliberacio nes del Comité sobre Patógenos Emergentes y COVID-19 del Ilustre Colegio Oficial de Médicos de Madrid (ICOMEM) en re lación a la situación actual de la tuberculosis, particularmente en España. Hemos revisado aspectos tales como la evolución de su incidencia, las poblaciones actualmente más expuestas y los circuitos sanitarios para la atención a estos pacientes en España. Se ha discutido también la tuberculosis latente, la rea lidad de la enfermedad extrapulmonar en el siglo XXI y los me dios de que en la práctica diaria se dispone para el diagnóstico tanto de las formas latentes como de las activas. La aportación de la biología molecular que ha cambiado la perspectiva de es ta enfermedad ha constituido otro de los temas de debate. El documento trata de poner en perspectiva tanto los fármacos clásicos y sus cifras de resistencia como la disponibilidad e in dicaciones de los nuevos. Junto a esto, se ha discutido la rea lidad de la observación directa en la administración de fárma cos antituberculosos. Toda esta revolución está posibilitando el acortamiento del tiempo de tratamiento de la tuberculosis tema que ha sido igualmente revisado. Si todo se hace bien, el riesgo de recaída de la tuberculosis es pequeño pero existen te. Por otra parte, muchas situaciones especiales han merecido discusión en este documento como por ejemplo la tuberculosis en edad pediátrica y la tuberculosis como causa de preocupa ción en cirugía y cuidados intensivos. Se ha discutido tanto la situación de la vacuna BCG y sus indicaciones presentes, co mo el futuro de nuevas vacunas que permitan alcanzar el viejo sueño de erradicar esta enfermedad. Finalmente, las implica ciones éticas y medicolegales que esta enfermedad plantea no son un tema menor y se ha revisado nuestra situación en este particular (AU)

The microbiology of sepsis is more than the application of new technologies in diagnosis

Adequate and rapid microbiological diagnosis of sepsis is essential for correct treatment, having a direct impact on patient prognosis. Clinical Microbiology Services must adapt fast circuits that allow prioritizing and individualizing the diagnosis of these patients. The measures adopted should not be based solely on the incorporation of new technologies but, to a large extent, on ensuring accurately collection and processing of samples, avoiding unnecessary losses of time in processing and ensuring that the information derived from this process adequately reaches the prescribing physician. (AU)

Diagnóstico microbiológico de la infección por SARS-CoV-2 durante la pandemia en Navarra / Microbiological diagnosis of SARS-CoV-2 infection during the pandemic in Navarra

El diagnóstico microbiológico es esencial en el conocimiento y manejo de las enfermedadesinfecciosas, tanto en los procesos habituales de la práctica clínica como en la aparición denuevos microorganismos, como en los próximos que puedan aparecer con el cambio climáticoy la nueva situación de los vectores que transmiten enfermedades en nuestro medio. El 11 de marzo 2020 la Organización Mundial de la Salud declaró la alerta por pandemiamundial por SARS-CoV-2 que se descubrió y se aisló por primera vez en Wuhan, China, en unbrote de neumonía de etiología desconocida vinculada a un mercado. Es una infección quetiene un origen zoonótico, se transmitió de un huésped animal a uno humano. Actualmente nose conoce de forma clara de dónde proviene el SARS-CoV-2. A principios de enero de 2020, científicos chinos anunciaron que habían aislado y secuenciadocompletamente el virus y lo publicaron; esto permitió disponer de técnicas de PCR para realizar eldiagnóstico de la infección por SARS Cov2 en todo el mundo. El objetivo de este trabajo es revisarel papel llevado a cabo desde el Servicio de Microbiología Clínica del Hospital Universitario deNavarra en la pandemia de COVID-19 y, en concreto, en nuestra comunidad, Navarra. Más de dos años después y, sin dejar de lado el profundo impacto sanitario, familiar y socialque ha tenido, debemos quedarnos con lo positivo del aprendizaje profesional y personaladquirido para aplicarlo en nuestro día a día, así como para las futuras pandemias que vengan.(AU)

Utilidad del panel de PCR multiplex en el diagnóstico microbiológico temprano y adecuación antimicrobiana en pacientes críticos con neumonía / Usefulness of the multiplex PCR panel in the early microbiological diagnosis and antimicrobial suitability in critical patients with pneumonia / Utilidade do painel de PCR multiplex no diagnóstico microbiológico precoce e adequação antimicrobiana em pacientes críticos com pneumonia

Resumen: Introducción: el inicio temprano de la antibioticoterapia adecuada en infecciones graves se asocia con reducción de la mortalidad. La identificación precoz del microorganismo es fundamental para realizar un tratamiento dirigido y disminuir la terapéutica inicial inapropiada. Objetivo: valorar la utilidad de una técnica de biología molecular por amplificación de ácidos nucleicos mediante reacción en cadena de polimerasa en tiempo real para diagnóstico microbiológico temprano y adecuación de la antibioticoterapia en pacientes con neumonías graves. Metodología: estudio retrospectivo observacional llevado a cabo en la unidad de cuidados intensivos del Hospital Maciel. Se analizaron muestras respiratorias de pacientes con diagnóstico o sospecha de neumonía. Se compararon los resultados microbiológicos obtenidos por técnicas convencionales y por biología molecular multiplex (panel neumonía). Resultados: se incluyeron 53 muestras obtenidas de 51 pacientes. El multiplex detectó al menos un microorganismo en 38 (71,7%) muestras frente a 30 (56.6%) desarrollos en cultivos tradicionales. La mayoría de las muestras se obtuvieron bajo antibioticoterapia previa (86.8%). El panel neumonía mostró un porcentaje de concordancia positiva combinado de 100% y un porcentaje de concordancia negativa del 94% para la identificación bacteriana en comparación con los métodos microbiológicos tradicionales. En 27 (51%) casos el resultado del panel de neumonía determinó un cambio en la conducta terapéutica. Conclusiones: la técnica de PCR permite la identificación temprana de microorganismos causantes de neumonía optimizando la terapéutica empírica inicial y racionalizando el uso de antimicrobianos. Un panel negativo aleja el planteo de infección respiratoria a gérmenes habituales y permite considerar diagnósticos diferenciales en cuanto a foco y/o etiología.

Summary: Introduction: the early initiation of the adequate antibiotic therapy in severe infections is associated to a reduction in mortality. Early identification of the microorganism is essential to define directed therapy and decrease the initial inadequate treatment. Objective: to assess usefulness of a molecular biology technique by nucleic acid amplification through a polymerase chain reaction in real time for an early microbiological diagnosis and correction of the antibiotic therapy in patients with severe pneumonias. Method: retrospective, observational study conducted in the intensive care unit of Maciel Hospital. The respiratory samples of patients with a diagnosis of pneumonia or suspicious to have pneumonia were analyzed. The microbiological results obtained were compared using conventional techniques and multiplex molecular biology (pneumonia panel). Results: 53 samples obtained from 51 patients were included in the study. Multiplex detected at least one microorganism in 38 (71.7%) samples compared to 30 (56.6%) in traditional cultures. Most samples were obtained under the previous antibiotic therapy (86.8%). The pneumonia panel showed a combined positive agreement percentage of 100% and a negative agreement of 94% for the identification of bacteria when compared to the traditional microbiological methods. In 27 cases (51%) the pneumonia panel results determined changing the therapeutic behavior. Conclusions: the PCR technique allows for the early identification of microorganisms causing pneumonia, thus optimizing initial empirical therapy and rationalizing the use of antibiotics. A negative panel reduces the suspicion of a respiratory infection caused by the usual germs and enables considering differential diagnosis in terms of etiology or cause.

Resumo: Introdução: o início precoce da antibioticoterapia adequada em infecções graves está associado à redução da mortalidade. A identificação precoce do microrganismo é essencial para realizar o tratamento dirigido e reduzir o uso inicial inadequado de antimicrobianos. Objetivo: avaliar a utilidade de uma técnica de biologia molecular para amplificação de ácidos nucleicos por reação em cadeia da polimerase em tempo real para diagnóstico microbiológico precoce e adequação da antibioticoterapia em pacientes com pneumonia grave. Metodologia: estudo observacional retrospectivo realizado na unidade de terapia intensiva do Hospital Maciel. Amostras respiratórias de pacientes com diagnóstico ou suspeita de pneumonia foram analisadas. Os resultados microbiológicos obtidos por técnicas convencionais e por biologia molecular multiplex (painel de pneumonia) foram comparados. Resultados: foram incluídas 53 amostras obtidas de 51 pacientes. O multiplex detectou pelo menos um microrganismo em 38 (71,7%) amostras em comparação com 30 (56,6%) usando culturas tradicionais. A maioria das amostras foi obtida com antibioticoterapia prévia (86,8%). O painel de pneumonia mostrou uma concordância percentual positiva combinada de 100% e uma concordância percentual negativa de 94% para identificação bacteriana em comparação com métodos microbiológicos tradicionais. Em 27 (51%) casos, o resultado do painel de pneumonia determinou mudança no comportamento terapêutico. Conclusões: a técnica de PCR permite a identificação precoce de microrganismos causadores de pneumonia, otimizando a terapia empírica inicial e racionalizando o uso de antimicrobianos. Um painel negativo afasta a suspeita de infecção respiratória pelos germes usuais e permite considerar diagnósticos diferenciais em termos de foco e/ou etiologia.

Procesamiento de muestras osteoarticulares para diagnóstico microbiológico: resultados de una encuesta multicéntrica nacional / Processing of osteoarticular samples for microbiological diagnosis: Results of a national multi-center survey

Introducción: Nuestro objetivo fue evaluar la variabilidad en el procesamiento de muestras osteoarticulares para el diagnóstico microbiológico entre distintos centros nacionales. Métodos: Se diseñó una encuesta online con 13 preguntas y se difundió a través de la SEIMC a los servicios de microbiología de los distintos centros. Resultados: Obtuvimos 72 respuestas. En más de la mitad de los centros, de tercer nivel, se reciben al menos 5 muestras. Aproximadamente la mitad de los centros agitan con vórtex las muestras de hueso/implante, utilizándose la sonicación sobre todo en centros de tercer nivel. Se realizan cultivos para bacterias aerobias y anaerobias durante 6-10 días de incubación, pero con diferencias en los medios de cultivo líquidos. El diagnóstico molecular se realiza en menos del 50% de los centros, siendo la PCR universal (ARNr 16S) la técnica más empleada. Conclusiones: Existe heterogeneidad fundamentalmente en el empleo de sonicación, los medios líquidos de cultivo o el diagnóstico molecular, probablemente en relación directa con los recursos y capacidades de cada centro.(AU)

Introduction. Our aim was to evaluate the variability in the processing of osteoarticular samples for microbiological diagnosis between different national centers. Methods: An online survey with 13 questions was designed and it was sent through SEIMC to the Microbiology Departments of the different centers. Results: We obtained 72 answers. In more than half of the tertiary-care centers, at least 5 samples are received. Approximately half of the centers vortex bones/implant samples. Sonication is used mostly in tertiary-care centers. Cultures for aerobic and anaerobic bacteria are performed during 6-10 days of incubation but with differences in liquid culture media. Molecular diagnosis is performed in less than 50% of the centers. Universal PCR (16S rRNA) is the most widely used technique. Conclusion: We found heterogeneity especially in the use of sonication, liquid culture media or molecular diagnosis, probably in direct relation to the resources and capacities of each center.(AU)

Does ascitic fluid filtration improve the microbiological diagnosis of spontaneous bacterial peritonitis? An experimental laboratory study / A filtração do líquido ascítico melhora o diagnóstico microbiológico da peritonite bacteriana espontânea? Um estudo experimental laboratorial

Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method (AU)

Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado (AU)

Processing of osteoarticular samples for microbiological diagnosis: Results of a national multi-center survey.

INTRODUCTION: Our aim was to evaluate the variability in the processing of osteoarticular samples for microbiological diagnosis between different national centers. METHODS: An online survey with 13 questions was designed and it was sent through SEIMC to the Microbiology Departments of the different centers. RESULTS: We obtained 72 answers. In more than half of the tertiary-care centers, at least 5 samples are received. Approximately half of the centers vortex bones/implant samples. Sonication is used mostly in tertiary-care centers. Cultures for aerobic and anaerobic bacteria are performed during 6-10 days of incubation but with differences in liquid culture media. Molecular diagnosis is performed in less than 50% of the centers. Universal PCR (16S rRNA) is the most widely used technique. CONCLUSION: We found heterogeneity especially in the use of sonication, liquid culture media or molecular diagnosis, probably in direct relation to the resources and capacities of each center.

Does ascitic fluid filtration improve the microbiological diagnosis of spontaneous bacterial peritonitis? An experimental laboratory study / A filtração do líquido ascítico melhora o diagnóstico microbiológico da peritonite bacteriana espontânea? Um estudo experimental laboratoria

ABSTRAC: Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method. (AU)

RESUMO:Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado. (AU)

Processing of osteoarticular samples for microbiological diagnosis: Results of a national multi-center survey. / Procesamiento de muestras osteoarticulares para diagnóstico microbiológico: resultados de una encuesta multicéntrica nacional.

INTRODUCTION: Our aim was to evaluate the variability in the processing of osteoarticular samples for microbiological diagnosis between different national centers. METHODS: An online survey with 13 questions was designed and it was sent through SEIMC to the Microbiology Departments of the different centers. RESULTS: We obtained 72 answers. In more than half of the tertiary-care centers, at least 5 samples are received. Approximately half of the centers vortex bones/implant samples. Sonication is used mostly in tertiary-care centers. Cultures for aerobic and anaerobic bacteria are performed during 6-10 days of incubation but with differences in liquid culture media. Molecular diagnosis is performed in less than 50% of the centers. Universal PCR (16S rRNA) is the most widely used technique. CONCLUSION: We found heterogeneity especially in the use of sonication, liquid culture media or molecular diagnosis, probably in direct relation to the resources and capacities of each center.

Estudio colaborativo sobre la utilidad del panel Meningitis/Encephalitis FilmArray (Biofire) en el diagnóstico de pacientes con sospecha de meningitis o encefalitis / Collaborative study on the usefulness of the Meningitis/Encephalitis FilmArray (Biofire) panel in the diagnosis of patients with suspected meningitis or encephalitis / Estudo colaborativo sobre a utilidade do painel Meningitis/Encephalitis FilmArray (Biofire) no diagnóstico de pacientes com suspeita de meningite ou encefalite

Resumen El tratamiento inicial para pacientes con sospecha de meningitis bacteriana aguda depende de una evaluación diagnóstica rápida y una terapia antimicrobiana adecuada. El panel de Meningitis/Encephalitis FilmArray (ME) (BioFire Diagnostics, Salt Lake City, EE.UU.) utiliza análisis de PCR múltiple e incluye 14 microorganismos; los resultados se obtienen directamente del LCR en 1 h. Los objetivos de este estudio fueron: a) determinar el rendimiento del ME y b) establecer el impacto del resultado obtenido en el tratamiento antimicrobiano de pacientes con meningoencefalitis. Se incluyeron 112 pacientes y 26 episodios de meningitis. Del total de resultados positivos con el panel para bacterias y hongos, 4/13 no se aislaron de cultivos y correspondieron a pacientes con tratamiento antimicrobiano. De los 26 episodios, los resultados condujeron a cambios terapéuticos en 21 casos. El ME es una herramienta rápida y útil para adecuar un tratamiento antimicrobiano en pacientes con meningoencefalitis.

Abstract The initial treatment for patients with suspected acute bacterial meningitis depends on a rapid diagnostic evaluation and adequate antimicrobial therapy. The Meningitis/Encephalitis FilmArray panel (ME) (BioFire Diagnostics, Salt Lake City, USA) uses multiplex PCR analysis and includes 14 microorganisms; the results are obtained directly from the CSF in 1 h. The objectives of this study were: a) to determine the performance of ME and b) to establish the impact of the result obtained on the antimicrobial treatment of patients with meningoencephalitis. A number of 112 patients and 26 episodes of meningitis were included. Of the total positive results for bacteria and fungi with the panel, 4/13 were not isolated from cultures and corresponded to patients with antimicrobial treatment. Of the 26 episodes, the results led to therapeutic changes in 21 cases. ME is a quick and useful tool to adapt antimicrobial treatment in patients with meningoencephalitis.

Resumo O tratamento inicial para pacientes com suspeita de meningite bacteriana aguda depende de uma avaliação diagnóstica rápida e terapia antimicrobiana adequada. O painel de Meningitis/Encephalitis FilmArray (ME) (BioFire Diagnostics, Salt Lake City, EUA) usa análise PCR multiplex e inclui 14 microrganismos; os resultados são obtidos diretamente do LCR em 1 h. Os objetivos deste estudo foram: a) determinar o desempenho do ME e b) estabelecer o impacto do resultado obtido no tratamento antimicrobiano de pacientes com meningoencefalite. 112 pacientes e 26 episódios de meningite foram incluídos. Do total de resultados positivos com o painel para bactérias e fungos, 4/13 não foram isolados das culturas e corresponderam a pacientes em tratamento antimicrobiano. Dos 26 episódios, os resultados levaram a alterações terapêuticas em 21 casos. ME é uma ferramenta rápida e útil para adaptar o tratamento antimicrobiano em pacientes com meningoencefalite.

Fundamentals and implementation of Microbiological Diagnostic Stewardship Programs. / Fundamentos e implementación de Programas de Optimización de Diagnóstico Microbiológico.

Microbiological diagnostic stewardship programs promote coordinated measures aimed at optimizing the use of diagnostic techniques, thus favouring the adoption of adequate and cost-effective therapeutic, clinical and preventive decisions. The implementation of microbiological diagnostic stewardship relies upon the creation of multidisciplinary committees led by clinical microbiologists for the design of diagnostic algorithms, the adequacy of the laboratory computer system to monitor the relevance of the requested diagnostic tests, the implementation of a quality control system, the design and performance of studies of cost-effectiveness, the training of the petitioner and the technical and nursing staff and the continuous evaluation of the program. The incorporation of microbiological diagnostic stewardship in routine care reports tangible benefits for the patient while strengthening the pivotal role of the clinical microbiologist in the management of infectious diseases.

Infección en la lesión por quemadura / Infection by burn injury

RESUMEN Fundamento: La infección de la lesión por quemadura constituye una de las principales causas de morbilidad y mortalidad en el paciente quemado, y una de las complicaciones más temibles en estos pacientes, por lo que el diagnóstico microbiológico de la infección representa un paso importante para el tratamiento oportuno de los mismos. Objetivo: Determinar mediante el estudio microbiológico cualitativo y cuantitativo de la lesión por quemadura el diagnóstico de infección en los pacientes quemados. Metodología: Se realizó un estudio descriptivo, transversal para determinar mediante el estudio microbiológico de la lesión por quemadura la presencia de infección en los pacientes quemados ingresados en el servicio de Caumatología del Hospital Universitario Manuel Ascunce Domenech de la provincia de Camagüey. Se estudiaron 34 enfermos por quemaduras en quienes se evaluaron el estado nutricional de los pacientes al ingreso, la reanimación prehospitalaria, la positividad del cultivo cuantitativo y cualitativo y los gérmenes más comunes aislados. Resultados: En 8 de los pacientes clasificados como bajo peso, sus lesiones estaban colonizadas por microorganismos. Del 79.42 % de los pacientes que tuvieron una reanimación adecuada, se encontró cultivos cualitativos positivos en 12 de ellos. En el 44.12 % de los pacientes lesionados se encontró la presencia de gérmenes con una cuantificación mayor de 105 bacterias por gramo de tejido. La Pseudomonas aeruginosa se aisló en el 38.23 % de los pacientes estudiados. Conclusiones: El estudio bacteriológico cuantitativo constituye un elemento importante en el diagnóstico de la infección en la herida por quemaduras. La Pseudomonas aeruginosa es uno de los gérmenes principales que colonizan e infectan estas lesiones.

ABSTRACT Background: Infection by burn injury is one of the main causes of morbidity and mortality in burn patients, and one of the most dreadful complications in these patients, so the microbiological diagnosis of infection represents an important step at the timely treatment. Objective: To determine through qualitative microbiological study and quantitative analysis of the burn injury the diagnosis of infection in burn patients. Methodology: A descriptive, cross-sectional study was carried out to determine through the microbiological study of the burn injury the presence of infection in burn inpatients from the Caumatology service at Manuel Ascunce Domenech University Hospital in Camagüey. 34 burn patients were studied, their nutritional status upon admission, pre-hospital resuscitation, positivity of the quantitative and qualitative crops and the most common isolated germs were also evaluated. Results: In 8 of the underweight classified patients, their injuries were colonized by microorganisms. In 12 of the 79.42 % of patients who had an appropriate resuscitation, qualitative crops were found positive. In 44.12 % of injured patients found the presence of germs with a quantification greater than 105 bacteria per gram of tissue. Pseudomonas aeruginosa was isolated in the 38.23 % of the studied patients. Conclusions: The quantitative bacteriological study constitutes an important element in the diagnosis of infection in the burn wound. The Pseudomonas aeruginosa is one of the main germs that colonize and infect these lesions.

First national survey of the diagnosis of Helicobacter pylori infection in Clinical Microbiology Laboratories in Spain. / Primera encuesta nacional sobre el diagnóstico de la infección por Helicobacter pylori en los laboratorios de microbiología clínica en España.

INTRODUCTION: The aim of this study was to know, through a national survey, the methods and techniques used for the diagnosis of Helicobacter pylori (Hp) in the different Clinical Microbiology Services/Laboratories in Spain, as well as antibiotic resistance data. METHODS: The survey requested information about the diagnostic methods performed for Hp detection in Clinical Microbiology laboratories, including serology, stool antigen, culture from gastric biopsies, and PCR. In addition, the performance of antibiotic susceptibility was collected. Data on the number of samples processed in 2016, positivity of each technique and resistance data were requested. The survey was sent by email (October-December 2017) to the heads of 198 Clinical Microbiology Laboratories in Spain. RESULTS: Overall, 51 centers from 29 regions answered the survey and 48/51 provided Hp microbiological diagnostic testing. Concerning the microbiological methods used to diagnose Hp infection, the culture of gastric biopsies was the most frequent (37/48), followed by stool antigen detection (35/48), serology (19/48) and biopsy PCR (5/48). Regarding antibiotic resistance, high resistance rates were observed, especially in metronidazole and clarithromycin (over 33%). CONCLUSION: Culture of gastric biopsies was the most frequent method for detection of Hp, but the immunochromatographic stool antigen test was the one with which the largest number of samples were analyzed. Nowadays, in Spain, it concerns the problem of increased antibiotic resistance to 'first-line' antibiotics.

Diagnosis of soil-transmitted helminth infections. An unsolved problemin the omics era. / Diagnóstico de las infecciones por geohelmintos. Un problema sin resolver en la era de las ómicas.

Infections caused by Strongyloides stercoralis and other soil-transmitted worms such as hookworms (Necator americanus and Ancylostoma duodenale) represent a major problem worldwide, especially in developing areas. They are difficult to suspect clinically since they produce non-specific and often overlapping signs and symptoms. Likewise, their long prepatent periods hamper the detection of parasitic structures. Microscopic diagnosis is still the most commonly used tool in healthcare laboratories but it is still far from being the ideal technique to detect these infections due to its low sensitivity. In addition, these nematodes have strong morphologic similarities and consequently microbiological diagnosis remains a challenge. Serology has made progress in the diagnosis of S. stercoralis infection but this option is not yet available for hookworms. Molecular biology techniques have been shown to slightly increase this lack of sensitivity, but as with other parasitic infections, they are not currently available for use in clinical microbiology laboratories. Supplement information: This article is part of a supplement entitled «SEIMC External Quality Control Programme. Year 2016¼, which is sponsored by Roche, Vircell Microbiologists, Abbott Molecular and Francisco Soria Melguizo, S.A. © 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosasy Microbiología Clínica. All rights reserved.

Herida abscesificada debido a Trueperella bernardiae / Abscessed wound resulting from Trueperella Bernardiae

Trueperella bernardiae es un microorganismo grampositivo facultativo anaerobio que forma parte de la microbiota normal de la piel y de la orofaringe, que recientemente ha sido reasignado l género Trueperella. Este patógeno ha sido descrito en muy pocos casos como causante de infección en los seres humanos, debido a su aspecto corineforme y su presencia en cultivos mixtos, y a las dificultades diagnósticas

Cervicitis: Etiology, diagnosis and treatment. / Cervicitis: etiología, diagnóstico y tratamiento.

Cervicitis is the inflammation of the cervix. It is usually caused by an infectious agent, usually sexually transmitted. Cervicitis is frequently asymptomatic and silent infection can cause complications of the upper genital tract. The symptoms are usually nonspecific, the most significant being an increase in vaginal discharge and/or intermenstrual bleeding. For its diagnosis, there are commercial systems based on molecular techniques that include almost all of the known pathogens associated with cervicitis, although cultures should not be abandoned due to the need to conduct studies of susceptibility to antibiotics. It is recommended to initiate an empirical antibiotic therapy that covers C.trachomatis and N.gonorrhoeae in the case of women at high risk of infection by these pathogens, especially if the follow-up is not assured or adequate diagnostic tests are not available. In women with low risk of sexually transmitted infection, antibiotic therapy should be adjusted to the results of the microbiological results.

Microbiological diagnosis of bacteraemia and fungaemia: Blood cultures and molecular methods. / Diagnóstico microbiológico de la bacteriemia y la fungemia: hemocultivos y métodos moleculares.

OBJETIVE: In this review we try to update the new procedures applicable in the microbiological diagnosis of bacteriemia and fungemias. METHOD: Review of scientific literature. RESULTS AND CONCLUSIONS: After defining the process and indicating its fundamental principles, the main biomarkers used in clinical practice are reviewed. Subsequently, the particularities of the pre-analytical phase (collection and transport of samples) are highlighted and the steps to follow for the microbiological identification by classical methods are detailed, based on the culture of the blood samples. In the following section, we review the diagnostic methods not culture based, including those that detect the presence of the genome of the microorganism and those based on the study of proteome by mass spectrometry. The last section describes the procedures more frecuently used for the study of antibiotic susceptibility, both by phenotypic and genotypic methods.

Diagnóstico microbiológico. Su importancia en las infecciones quirúrgicas / The microbiological diagnosis. Its importance in surgical infections

Introducción: Se ha calculado una prevalencia total de infección de la herida quirúrgica del 5 al 10 por ciento. Objetivo: Resumir los principales elementos que definen el diagnóstico microbiológico y su importancia en las infecciones quirúrgicas, así como analizar aquellos factores que favorecen la proliferación microbiana en las heridas quirúrgicas. Planteamiento: En la actualidad la infección del sitio quirúrgico constituye la tercera infección nosocomial más habitual y la más importante entre los pacientes operados. El acercamiento a este tema se justifica plenamente si se toma en consideración la diversidad de intervenciones quirúrgicas que se realizan actualmente. Conclusiones: El diagnóstico microbiológico resulta fundamental, tanto para definir la fase de la infección como para identificar el microorganismo que afecta el resultado de la operación, ya que contribuye a establecer la sensibilidad a los antibióticos y a la elección adecuada del tratamiento(AU)

Introduction: Total prevalence of surgical site infection is calculated to from 5 to 10 percent of surgical interventions. Objective: To summarize the main elements defining the microbiological diagnosis and its importance in surgical infections, and analyze those factors that favor microbial proliferation in surgical wounds. Development: At present, surgical site infection is the third most recurrent nosocomial infection and the most important among operated patients. The approach to this topic is fully justified if the diversity of surgical interventions currently performed is taken into account. Conclusions: The microbiological diagnosis is fundamental both to define the infection phase and to identify the microorganism affecting the result of the surgical intervention, because it contributes to knowing the sensitivity to antibiotics and to select the treatment appropriately(AU)

La espectrometría de masas MALDI-TOF en el laboratorio de microbiología clínica / MALDI-TOF mass spectrometry in clinical microbiology laboratories

Los métodos fenotípicos empleados para la identificación de microorganismos dependen de procesos metabólicos que requieren de tiempos de incubación mínimos para alcanzar resultados confiables. La espectrometría de masas MALDI-TOF (desorción/ionización láser asistida por una matriz con detección de masas por tiempo de vuelo) se ha instaurado como una metodología relevante para la identificación de microorganismos mediante el análisis de proteínas, a través de la creación de un espectro de masas específico de género y especie. En esta revisión, se presenta MALDI-TOF MS como una tecnología precisa para la identificación de bacterias, levaduras, mohos, en incluso de virus ,que además, permite la reducción del tiempo para obtener un resultado de identificación, que puede impactar los costos de atención y duración de la estancia hospitalaria. La identificación de microorganismos directamente de muestras biológicas y la detección de mecanismos de resistencia a antimicrobianos, prometen un mayor impacto clínico y epidemiológico con el desarrollo e implementación de esta tecnología en los laboratorios de microbiología clínica.

Phenotypic methods used for the identification of microorganisms depend on metabolic processes that require minimum incubation times to achieve reliable results. For this reason, MALDI-TOF MS (Matrix Assisted Laser Desorption/Ionization Mass Spectrometry) has been established as a relevant methodology for the identification of microorganisms using analysis of proteins, through the creation of a mass spectrum specific for genus and species. In the present review, MALDI TOF MS is presented as an accurate technology for identifying bacteria, yeasts, molds and viruses; Its use allows reduction of the time to obtain an identification result, which may impact the costs of care and length of hospital stay. The identification of microorganisms directly from biological samples and the detection of mechanisms of antimicrobial resistance, promise an additional clinical and epidemiological impact with the development and implementation of this technology in clinical microbiology laboratories.

Microbiological diagnosis of biofilm-related infections. / Diagnóstico microbiológico de las infecciones relacionadas con la formación de biopelículas.

Biofilm-related infections represent a serious health problem, accounting for 65- 80% of all infections. The infections are generally chronic and characterized by the persistence of the microorganism, due to the increased resistance of biofilms to both the immune system and antimicrobials. Biofilms can be located to almost every human body tissue and on exogenous devices such as catheters, pacemakers, prosthetic material, implants, urinary catheters, etc. Traditional antimicrobial susceptibility studies in clinical microbiology laboratories have lied on the study of planktonic form of microorganisms. However, this approach might lead to miss the biofilm characteristics and to a treatment failure. Microbiological diagnosis and antimicrobial susceptibility studies of biofilm-related infections are complex and, nowadays, represent a challenge that clinicians and microbiologists have to address as a team in the absence of consensus or standardized protocols.