Antimicrobial susceptibility of microorganisms that cause urinary tract infections in pediatric patients / Sensibilidad antimicrobiana de microorganismos causantes de infecciones del tracto urinario en pacientes pediátricos

INTRODUCTION: Cumulative susceptibility reports are a valuable tool for the empirical treatment of urinary tract infections, especially in the current context of increasing resistance rates. Our objective was to analyze the antimicrobial susceptibility of bacterial isolates in urine cultures of pediatric patients during a five-year period. METHODS: Retrospective study of urine cultures from 2011 to 2015. Identification and antimicrobial susceptibility tests were performed using the Vitek-2 system (BioMérieux(R)) and categorized according to EUCAST criteria. Antimicrobial susceptibility data were analyzed by gender and age groups (neonates, 1 month to 5 years, 5-15 years) before being compared with data obtained from patients over the age of 15 years. RESULTS: During the study period, 17164 urine cultures were processed from 7924 patients under 16 years of age. Antimicrobial susceptibility rates in these patients were: ampicillin 36.3%, amoxicillin/clavulanic acid 75.3%, cefuroxime 83.2%, co-trimoxazole 68.9%, ciprofloxacin 85.3%, fosfomycin 85.5%, nitrofurantoin 84.4% and 3rd generation cephalosporins 89-91%. Aminoglycosides (>92%) and carbapenems (95%) maintained the highest susceptibility rates. The prevalence of ESBL-producing isolates was significantly lower in children under the age of 16 years (1.5% vs. 4.1%). In patients under the age of 16 years, Escherichia coli isolates in girls were significantly more sensitive (p < 0.0001) to ampicillin (41% vs. 30%) and amoxicillin/clavulanic acid (82% vs. 72%) than in boys. CONCLUSIONS: The compilation of cumulative susceptibility reports disaggregated by age or gender reveals significant differences. In our setting, cefuroxime may be considered the first-line empirical treatment in pediatric patients

INTRODUCCIÓN: Los informes de sensibilidad acumulada son una herramienta valiosa para guiar el tratamiento empírico de infecciones urinarias, sobre todo en el contexto actual de crecientes tasas de resistencia. Nuestro objetivo es analizar la sensibilidad antimicrobiana de bacterias aisladas de urocultivos de pacientes pediátricos durante un período de 5 años. MÉTODOS: Estudio retrospectivo de los urocultivos del período 2011-2015. La identificación y estudios de sensibilidad se realizaron con el sistema Vitek-2 (BioMérieux(R)) y se interpretaron según los criterios de EUCAST. Se analizaron los datos de sensibilidad antimicrobiana según sexo y tramos de edad (neonatos, 1 mes-5 años, 5-15 años) y se compararon con los datos de mayores de 15 años. RESULTADOS: En el período analizado se procesaron 17.164 urocultivos de 7.924 pacientes menores de 16 años. Los porcentajes de sensibilidad en estos pacientes fueron: ampicilina 36,3%; amoxicilina/clavulánico 75,3%; cefuroxima 83,2%; cotrimoxazol 68,9%; ciprofloxacino 85,3%; fosfomicina 85,5%; nitrofurantoína 84,4%, y cefalosporinas de tercera generación 89-91%. Aminoglucósidos (>92%) y carbapenemas (95%) mantienen las mayores tasas de sensibilidad. La prevalencia de aislamientos productores de BLEE fue significativamente menor en niños menores de 16 años (1,5% vs. 4,1%). En menores de 16 años, los aislamientos de Escherichia coli procedentes de mujeres fueron significativamente (p < 0,0001) más sensibles a ampicilina (41% vs. 30%) y amoxicilina-clavulánico (82% vs. 72%) que en varones. CONCLUSIONES: La elaboración de informes de sensibilidad acumulados desglosados por edad o sexo permite detectar importantes diferencias. En nuestra área, cefuroxima puede considerarse como primera opción de tratamiento empírico en pacientes pediátricos

Plasmid-mediated quinolone resistance.

The first plasmid-mediated gene involved in quinolone resistance (qnrA1) was reported in 1998. It codes for a pentapeptide-repeat protein that protects type II topoisomerases from quinolones. Additional related plasmid-mediated genes (qnrB, qnrS and qnrC) and chromosomal homologs of them have also been discovered. Two other plasmid-mediated resistance mechanisms were later reported: modification of quinolones with a piperazinyl substituent by the acetyltransferase Aac(6)-Ib-cr and active efflux by QepA, a pump related to the major facilitator superfamily transporters. These genes have a wide geographical distribution (essentially in enterobacteria), although their real prevalence is only partially known because of the difficulty of phenotypic detection of this type of resistance. Although these mechanism cause low-level resistance, they favor and complement the selection of additional mechanisms of resistance.

Outbreak of invasive group A streptococcal disease among children attending a day-care center.

BACKGROUND: Most cases of invasive group A streptococcal (GAS) disease arise sporadically in the community, but outbreaks of severe invasive GAS infections have been reported in closed environments, such as military populations, family communities and hospitals. An outbreak of invasive GAS disease involving 3 cases of streptococcal toxic shock syndrome (TSS), one with a fatal course, occurred among children attending a day-care center located in Cantabria, Northern Spain. OBJECTIVE: To determine the characteristics of GAS isolates obtained from the outbreak environment. METHODS: GAS isolates obtained from children attending the same day-care facility, staff members, and family contacts were assayed for emm typing, pulse-field gel electrophoresis (PFGE), and toxin-gene content. One isolate obtained from the fatal case was also characterized by multilocus sequence typing. Antimicrobial susceptibility testing was done. Strains from patients unrelated to the outbreak were included for comparison. RESULTS: All GAS isolates from children attending the day-care center, including those from streptococcal TSS cases, shared the same emm type 4, genomic pattern by PFGE (A) and toxin-gene profile. Neither the emm type nor the PFGE pattern or toxin gene profile of the outbreak-associated strains were encountered among GAS isolated from household or staff contacts. CONCLUSIONS: A clone of GAS belonging to emm type 4 and characterized by a specific PFGE pattern and toxin-gene profile was responsible for a community outbreak of streptococcal TSS disease in a child day-care center in Spain. This is the first day-care outbreak reported in our country.

Cultivos de vigilancia epidemiológica de bacterias resistentes a los antimicrobianos de interés nosocomial / Epidemiological surveillance cultures in antimicrobial-resistant bacteria causing nosocomial infection

Los cultivos de vigilancia epidemiológica y la tipificación molecular han sido importantes aportaciones de la Microbiología Clínica al control de la infección nosocomial. En este documento se ofrece información sobre recogida, transporte, conservación y procesamiento de muestras para cultivos de vigilancia, criterios para la interpretación de los resultados y la emisión de los mismos en relación con las bacterias de mayor interés en infección nosocomial. Se incluyen Staphylococcus aureus resistente a meticilina (SARM), Enterococcus spp. resistentes a glucopéptidos, enterobacterias productoras de betalactamasas de espectro extendido (BLEE), Acinetobacter baumannii multirresistente y Pseudomonas aeruginosa resistente a carbapenems. Esta información pretende aportar una aproximación general al problema, a partir de la cual el laboratorio desarrolle directrices propias, en función de las necesidades acordadas con el equipo multidisciplinar de control de infección nosocomial (AU)

Implementation of surveillance culture programs and molecular typing are important contributions of Clinical Microbiology to the control of nosocomial infections. This document provides information on collection, transport, preservation, and processing of samples for surveillance culture, as well as the criteria for interpreting and reporting the results of relevant etiologic agents in nosocomial infection. This includes methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant Enterococcus spp., enterobacteria producing extended-spectrum b -lactamases (ESBLs), multiresistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa. Details on the available methods for rapid diagnosis are also presented. The information in this document attempts to provide a general approach to the problem and may be considered a starting point for laboratories that are developing their own guidelines, according to needs defined by the multidisciplinary nosocomial infection control team (AU)

Neumonía por Ralstonia pickettii en un paciente adulto inmunocompetente / Ralstonia pickettii pneumonia in an inmunocompetent adult

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