Recuperación de Chlamydia trachomatis y otros patógenos en la orina de varones con piuria estéril atendidos en urgencias / Recovery of Chlamydia trachomatis and other pathogens in urine from men with sterile pyuria attended in an emergency department

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Low antimicrobial resistance rates of Mycobacterium tuberculosis complex between 2000 and 2015 in Gipuzkoa, northern Spain / Baja tasa de resistencia antibiótica de Mycobacterium tuberculosis complex en Gipuzkoa, norte de España, entre 2000 y 2015

OBJECTIVE: Although the incidence of tuberculosis (TB) has declined, TB drug resistance remains a major problem. The TB rate in Gipuzkoa (northern Spain) is higher than the European average. The objective of this study was to determine the antimicrobial susceptibility of 1855 Mycobacterium tuberculosis complex isolates (94.5% of confirmed cases between 2000 and 2015). METHODS: Susceptibility testing was performed using the agar proportion method and a commercial broth system (MGIT 960). In isoniazid- or rifampicin-resistant strains, we studied genetic determinants of drug resistance and genotype (MIRU-VNTR). RESULTS: The annual mean incidence of TB was 24.5 cases per 100,000 population on average, and tended to decrease. The multidrug-resistant TB rate was 0.5% (9/1855), and no extensively drug-resistant TB strains were detected. Rates of resistance to isoniazid and rifampicin were 3.9% (range, 3.4-4.3%) and 0.6% (range, 0.4-1.4%), respectively. TB resistance was more common among foreign-born individuals and those who had received previous TB treatment. Genotyping of 102 resistant strains showed predominance of the Euro-American lineage, although 4/9 multidrug-resistant strains had Eastern lineages (2 East African-Indian, and 2 East Asian (Beijing)). CONCLUSIONS: In Gipuzkoa, with a moderate incidence of TB, resistance was very low, mostly being detected among individuals who were born abroad or who had a history of TB treatment

OBJETIVO: Aunque la incidencia de tuberculosis (TB) está descendiendo, la resistencia a fármacos antituberculosos continúa siendo un grave problema. Gipuzkoa, norte de España, tiene una tasa de TB superior a la media europea. El objetivo de este trabajo fue estudiar la sensibilidad a los antibióticos de 1.855 aislamientos de Mycobacterium tuberculosis complex (94,5% de los casos confirmados entre 2000 y 2015). MÉTODOS: El estudio de susceptibilidad se realizó mediante el método de las proporciones en agar, y mediante dilución en caldo (sistema MGIT 960). En las cepas resistentes a isoniacida o rifampicina se analizaron determinantes genéticos de resistencia y el genotipo (MIRU-VNTR). RESULTADOS: La incidencia media anual de TB fue de 24,5 casos por 100.000 habitantes, con una tendencia decreciente. La tasa de multirresistencia fue del 0,5% (9/1.855), y no se detectaron cepas con resistencia extrema. Las tasas de resistencia a isoniacida y rifampicina fueron del 3,9% (rango: 3,4-4,3%) y 0,6% (rango: 0,4-1,4%), respectivamente. La TB resistente fue más frecuente entre las personas nacidas en el extranjero y entre los que recibieron tratamiento antituberculoso previo. El genotipado de 102 cepas resistentes mostró predominio del linaje Euro-Americano, aunque 4/9 cepas multirresistentes pertenecieron a linajes orientales (2 East African-Indian, y 2 East Asian (Beijing)). CONCLUSIONES: En Gipuzkoa, con una incidencia moderada de TB, la resistencia fue muy baja, y asociada especialmente a personas nacidas en el extranjero o que recibieron tratamiento antituberculoso previo

Tratamiento antibiótico dirigido en infecciones por Mycoplasma genitalium: análisis de mutaciones asociadas con resistencia a macrólidos y fluoroquinolonas / Guided antibiotic therapy for Mycoplasma genitalium infections: Analysis of mutations associated with resistance to macrolides and fluoroquinolones

INTRODUCCIÓN: El objetivo de este trabajo fue analizar la susceptibilidad de Mycoplasma genitalium a macrólidos y fluoroquinolonas mediante técnicas moleculares. MÉTODOS: La susceptibilidad a macrólidos se analizó (Gipuzkoa, 2014-2017) mediante PCR en tiempo real con sondas (gen 23S ARNr) y a fluoroquinolonas mediante secuenciación tras PCR convencionales (genes parC/gyrA). RESULTADOS: Se detectaron mutaciones asociadas con resistencia a macrólidos en 43/263 (16,3%) casos y con posible resistencia a fluoroquinolonas en 21/267 (7,9%). La resistencia a macrólidos fue más frecuente tras tratamiento previo con azitromicina (76,5 vs. 7,4%; p < 0,001) y con la pauta única de 1 g (31,3 vs. 7% pauta ampliada, p < 0,001). Se detectaron 5/245 (2%) casos con mutaciones de posible resistencia para ambos antibióticos. CONCLUSIONES: La técnica empleada para el estudio de la susceptibilidad de Mycoplasma genitalium a la azitromicina permitió una respuesta rápida con un tratamiento antibiótico dirigido. Moxifloxacino puede ser una buena alternativa en casos con resistencia a macrólidos

INTRODUCTION: The objective of this study was to analyse the susceptibility of Mycoplasma genitalium to macrolides and fluoroquinolones using molecular techniques. METHODS: Susceptibility to macrolides was tested (Gipuzkoa, 2014-2017) by a rapid probe-based real-time polymerase chain reaction assay (23S rRNA gene) and to fluoroquinolones by sequencing the parC and gyrA genes. RESULTS: Mutations associated with macrolide resistance were detected in 43/263 (16.3%) cases and potential fluoroquinolone resistance in 21/267 (7.9%). Macrolide resistance was more frequent in patients previously treated with azithromycin (76.5% vs 7.4%, P < .001) as well as in those treated with a single 1g dose (31.3%) vs the extended regimen (7%, P < .001). There were 5/245 (2%) cases with mutations probably associated with resistance to both antibiotics. CONCLUSIONS: The technique used for testing Mycoplasma genitalium susceptibility to azithromycin allowed the rapid implementation of resistance-guided antibiotic therapy. Moxifloxacin could be a good option in cases of macrolide resistance

Molecular characterization of Staphylococcus aureus carrying the panton-valentine leucocidin genes in northern Spain.

OBJECTIVES: To study the prevalence of the Panton-Valentine leucocidin (PVL) gene in methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) Staphylococcus aureus obtained in Gipuzkoa, northeastern area of the Basque Country, north-central Spain, and perform the molecular characterization of PVL-positive isolates. METHODS: Molecular studies comprised: PVL gene detection by PCR, staphylococcal chromosome cassette mec (SCCmec) typing, spa sequencing, multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), and detection of the arginine catabolic mobile element (ACME). RESULTS: Between 1978 and 2006, only two (0.3%) of the 686 MRSA isolates studied were positive for the PVL gene. This percentage increased between 2007 and 2009, when the PVL gene was detected in 30 of the 679 MRSA (4.4%) and in nine of the 1227 MSSA (0.7%) isolates. The 41 PVL-positive isolates characterized had eight different sequence types (STs). Twenty-three MRSA PVL-positive isolates were ST8, spa type t008, seven of which were ACME positive, erythromycin-resistant and showed the PFGE pattern (90-100% similarity) of the USA300 clone. ST8 was also the most prevalent ST among the nine MSSA PVL-positive isolates. CONCLUSION: The current epidemiology of PVL-positive MRSA in our region more closely resembles that of the USA rather than that of other European countries, being USA300 or USA300-like isolates the most prevalent ones.