Streptococcus agalactiae from pregnant women: antibiotic and heavy-metal resistance mechanisms and molecular typing.

We investigated the antibiotic and heavy-metal resistance mechanisms, virulence genes and clonal relationships of macrolide- and/or lincosamide-resistant (M+/-LR) Streptococcus agalactiae (group B Streptococcus, GBS) isolates from pregnant women in La Rioja in Northern Spain, a region with a significant immigrant population. In total 375 GBS isolates were recovered during 2011. About three-quarters of isolates were from European nationals and the remainder distributed among 23 other nationalities. Seventy-five (20%) were classified as M+/-LR strains and 28 (37%) of these were resistant to ⩾3 classes of antibiotics. Capsular serotypes III (29·3%), V (21·3%) and II (12%) were the most frequent. A wide variety of antibiotic resistance genes were detected in M+/-LR strains; notably, 5·3% harboured the lsa(C) gene associated with cross-resistance, and tet(W) was identified in a single strain. We report, for the first time, the detection of cadmium and copper resistance encoded by tcrB + cadA + cadC genes in 20 M+/-LR strains, which raises the possibility of co-selection of antibiotic and heavy-metal resistance disseminated through mobile genetic elements. The M+/-LR strains were highly diverse by DNA macrorestriction profiles (65 patterns) and 16 multilocus sequence types (STs) distributed among six clonal complexes; the most frequent were ST1, ST19, and ST12, and two strains were novel (ST586 and ST601). In conclusion, a wide diversity of genetic lineages of macrolide, lincosamide and heavy-metal- resistant GBS strains was observed in an ethnically diverse maternal population.

Class 1 integrons lacking qacEDelta1 and sul1 genes in Escherichia coli isolates of food, animal and human origins.

OBJECTIVES: To study the frequency and diversity of class 1 integrons lacking the 3'-conserved segment (CS) in intI1-positive Escherichia coli isolates of different origins. METHODS: The presence of intI1 was previously detected in 84 E. coli isolates of food (21 isolates), animal (32) and healthy-human volunteer (31) origins. The qacEDelta1-sul1 genes were analyzed by PCR and those isolates that lacked these genes were included in this work. The genetic structure of class 1 integrons was determined, using the PCR and sequencing primer-walking strategy. Isolates and plasmids were typed. RESULTS: Class 1 integrons lacking the 3'-CS were found in 13 of the 84 intI1-positive E. coli isolates (15.5%) of food, animal, and human origins. All 13 isolates showed unrelated patterns by REP-PCR. The following gene cassette arrangements were identified inside the class 1 integrons of these 13 strains: dfrA1; dfrA5; dfrA12-orfF-aadA2-cmlA1-aadA1-qacH-IS440-sul3; dfrA12-orfF-aadA2-cmlA1-aadA1-IS440-sul3; estX-psp-aadA2-cmlA1-aadA1-qacH-IS440-sul3; and a new arrangement estX-psp-aadA2-cmlA1Delta-IS1294-DeltacmlA1-aadA1-qacH-IS440-sul3 that contain the IS1294 into the cmlA1 gene (included in GenBank, number EU704128). Complete or truncated mef(B) gene was detected upstream of sul3 gene in this type of integrons. Plasmids were identified in four of the studied strains by PCR-replicon-typing, detecting different combinations of IncY, I1, FIC, FII, FIB plasmids. Non-classic integrons were located into plasmids of 100-150 kb in four studied strains. CONCLUSIONS: Occurrence and diversity of class 1 integrons lacking 3'-CS among the studied intI1-positive E. coli isolates of different origins were relatively high. The sul3 gene was detected in most of class 1 integrons lacking 3'-CS.

Patología puerperal / Puerperal pathology

El puerperio es el periodo desde el final del partohasta la aparición de la primera menstruación. Las posiblespatologías acontecidas en este tiempo son la causamás frecuente de mortalidad materna incluso en nuestromedio. La patología de la lactancia incluye el fallo delactancia, grietas en el pezón, ingurgitación mamaria ymastitis puerperal.La infección puerperal es una complicación obstétricafrecuente aunque las pautas de profilaxis han disminuidomucho la incidencia de esta patología.La patología vascular del puerperio incluye cuadrosde gravedad importante, representando una de lasprincipales causas de mortalidad materna. Se incluye latrombosis venosa profunda y el tromboembolismo pulmonarcomo la complicación más grave de la primera.No parece que la patología psiquiátrica sea másfrecuente en el puerperio que en otra época de la vida,pero sí que se describen los cuadros relacionados coneste periodo, como son el “blues”, la depresión puerperaly la psicosis puerperal.Por último, otros cuadros poco frecuentes, peroque pueden constituir una emergencia médica en elpuerperio son el síndrome de Sheehan, la miocardiopatíaperiparto y la tiroiditis postparto(AU)

The puerperium is the period from the end of labourto the appearance of the first menstruation. Thepossible pathologies that can occur in this period oftime are the most frequent cause of maternal mortalityeven in our setting. The pathology of lactation includesfailure of breastfeeding, cracks in the nipple, mammaryingurgitation and puerperal mastitis.Puerperal infection is a frequent obstetric complicationalthough clinical guidelines for prophylaxis haveconsiderably reduced its incidence.The vascular pathology of the puerperium includesclinical features of great seriousness, representing oneof the main causes of maternal mortality. These includedeep vein thrombosis, of which pulmonary thromboembolismis the most serious complication.It does not appear that a psychiatric pathology ismore frequent in the puerperium than in other periodsof life, but the clinical features related to this period aredescribed, such as “blues”, puerperal depression andpuerperal psychosis.Finally, other clinical features which although infrequentcan constitute a medical emergency in the puerperiumare: Sheehan’s syndrome, peripartum cardiomyopathyand postpartum thyroids(AU)

[Puerperal pathology]. / Patología puerperal.

The puerperium is the period from the end of labour to the appearance of the first menstruation. The possible pathologies that can occur in this period of time are the most frequent cause of maternal mortality even in our setting. The pathology of lactation includes failure of breastfeeding, cracks in the nipple, mammary ingurgitation and puerperal mastitis. Puerperal infection is a frequent obstetric complication although clinical guidelines for prophylaxis have considerably reduced its incidence. The vascular pathology of the puerperium includes clinical features of great seriousness, representing one of the main causes of maternal mortality. These include deep vein thrombosis, of which pulmonary thromboembolism is the most serious complication. It does not appear that a psychiatric pathology is more frequent in the puerperium than in other periods of life, but the clinical features related to this period are described, such as "blues", puerperal depression and puerperal psychosis. Finally, other clinical features which although infrequent can constitute a medical emergency in the puerperium are: Sheehan's syndrome, peripartum cardiomyopathy and postpartum thyroids.