Infectious etiology of diarrheas studied in a third-level hospital during a five-year period.

INTRODUCTION AND OBJECTIVE: Infectious diarrheas are highly frequent and responsible for a major consumption of resources. This study identified the main diarrhea-causing microorganisms in a health area of Granada (Spain) and determined changes in the epidemiologic pattern over a five-year period. MATERIAL AND METHOD: A retrospective study was conducted based on results obtained in the Microbiology Laboratory of Hospital Universitario Virgen de las Nieves (Granada, Spain). RESULTS: Out of the 25,113 stool microbiological and/or parasitological studies ordered, 2,292 microorganisms were identified in 2,152 samples from 1,892 patients. There was a predominance of bacterial diarrheas (50.1 %), mainly caused by Campylobacter spp. (22.2 %), whose frequency increased significantly during the last two years, and by Salmonella spp. (16.4 %), whose frequency remained stable during the whole study period. We highlight the high frequency of Rotavirus (33.5 %), although a significant decrease was observed during the last two years. Salmonella spp. was more frequently detected during the summer and autumn, Campylobacter spp. during the spring, and Rotavirus during the winter. Viral processes were predominant (53.3 %) in pediatric patients, mainly Rotavirus in under 2-yr-olds, whereas bacterial processes predominated in older children and adults. Diarrhea began at community level in 84.2 % of patients, requiring hospitalization in 25.8 % of cases, and diarrhea was nosocomial in the remaining 15.8 %. CONCLUSIONS: During the study period, there was a significant increase in the frequency of diarrhea caused by Campylobacter spp., a significant reduction in the frequency of diarrhea due to Rotavirus, and no change in the frequency of diarrhea due to Salmonella spp., all of which showing a marked seasonal distribution.

Etiología infecciosa de las diarreas estudiadas en un hospital de tercer nivel durante un periodo de cinco años / Infectious etiology of diarrheas studied in a third-level hospital during a five-year period

INTRODUCCIÓN Y OBJETIVO: las diarreas infecciosas son muy frecuentes y generan un importante consumo de recursos. Se determinaron los principales microorganismos productores de diarrea en un área sanitaria de Granada y la evolución del patrón epidemiológico durante cinco años. MATERIAL Y MÉTODO: se realizó un estudio retrospectivo a partir de los resultados obtenidos durante cinco años en el Laboratorio de Microbiología del Hospital Virgen de las Nieves. RESULTADOS: de 25.113 solicitudes de estudio microbiológico y/o parasitológico en heces, se identificaron 2.292 microorganismos, en 2.152 muestras de 1.892 pacientes. Predominaron las diarreas bacterianas (50,1 %), sobre todo por Campylobacter spp. (22,2 %), cuya frecuencia aumentó significativamente en los dos últimos años, y Salmonella spp. (16,4 %), que se mantuvo a lo largo del periodo. Destacó la elevada frecuencia de Rotavirus (33,5 %), aunque disminuyó significativamente en los dos últimos años. Salmonella spp. se detectó más frecuentemente en verano y otoño, Campylobacter spp. en primavera y Rotavirus en invierno. En los pacientes pediátricos predominaron los procesos víricos (53,3 %), destacando Rotavirus en menores de 2 años, mientras que, en niños mayores y adultos, lo hicieron los procesos de origen bacteriano. En el 84,2 % de los pacientes la diarrea se inició a nivel comunitario, siendo necesario el ingreso del 25,8 %, y en el 15,8 % la diarrea fue nosocomial. CONCLUSIONES: durante el periodo analizado se produjo un incremento significativo de la frecuencia de diarreas por Campylobacter spp., y una disminución, también significativa de Rotavirus, manteniéndose la frecuencia de diarreas por Salmonella spp., todas ellas con una marcada distribución estacional

INTRODUCTION AND OBJECTIVE: Infectious diarrheas are highly frequent and responsible for a major consumption of resources. This study identified the main diarrhea-causing microorganisms in a health area of Granada (Spain) and determined changes in the epidemiologic pattern over a five-year period. MATERIAL AND METHOD: A retrospective study was conducted based on results obtained in the Microbiology Laboratory of Hospital Universitario Virgen de las Nieves (Granada, Spain). RESULTS: Out of the 25,113 stool microbiological and/ or parasitological studies ordered, 2,292 microorganisms were identified in 2,152 samples from 1,892 patients. There was a predominance of bacterial diarrheas (50.1 %), mainly caused by Campylobacter spp. (22.2 %), whose frequency increased significantly during the last two years, and by Salmonella spp. (16.4 %), whose frequency remained stable during the whole study period. We highlight the high frequency of Rotavirus (33.5 %), although a significant decrease was observed during the last two years. Salmonella spp. was more frequently detected during the summer and autumn, Campylobacter spp. during the spring, and Rotavirus during the winter. Viral processes were predominant (53.3 %) in pediatric patients, mainly Rotavirus in under 2-yr-olds, whereas bacterial processes predominated in older children and adults. Diarrhea began at community level in 84.2 % of patients, requiring hospitalization in 25.8 % of cases, and diarrhea was nosocomial in the remaining 15.8 %. CONCLUSIONS: During the study period, there was a significant increase in the frequency of diarrhea caused by Campylobacter spp., a significant reduction in the frequency of diarrhea due to Rotavirus, and no change in the frequency of diarrhea due to Salmonella spp., all of which showing a marked seasonal distribution

Evolution of the resistance to antibiotics of bacteria involved in urinary tract infections: a 7-year surveillance study.

BACKGROUND: We conducted a retrospective analysis on the identification and antibiogram of all bacteria isolated from urine samples with microbiological confirmation of urinary tract infection (UTI) in a Spanish reference hospital over a 7-year period. METHODS: A retrospective analysis was performed of the identification and antibiogram data. RESULTS: A total of 31,758 uropathogens were isolated. Escherichia coli accounted for the majority (55.2%) of these, followed by Enterococcus faecalis (18.0%) and Klebsiella spp (10.3%). The highest E coli susceptibility rates were to imipenem (93.0%-99.8%), amikacin (97.3%-99.5%), nitrofurantoin (96.7%-98.9%), and fosfomycin (95.3%-100%), and the lowest were to cefuroxime (67.8%-86.4%), ciprofloxacin (61.2%-69.8%), and co-trimoxazole (55.0%-65.5%). We highlight the overall high activity of imipenem, piperacillin-tazobactam, nitrofurantoin, and fosfomycin on isolates versus the low activity of fluoroquinolones, co-trimoxazole, or cephalosporins. The activity of amoxicillin-clavulanic acid and fosfomycin decreased significantly over the 7-year study period. CONCLUSIONS: Imipenem and piperacillin-tazobactam appear to be good options for the empiric treatment of UTI acquired in hospital or requiring hospitalization, whereas nitrofurantoin and fosfomycin can be first-choice antibiotics for the treatment of uncomplicated community-acquired cystitis. However, surveillance studies are required to detect resistance to these antibiotics, given that an increase in uropathogen resistance rates may contraindicate its future use in empiric UTI therapy.

[Use of MPO chromogenic culture medium for routine processing of urine cultures]. / Utilidad del medio cromogénico MPO en el procesamiento habitual del urocultivo.

BACKGROUND: The chromogenic culture medium, MPO, was compared to culture on CLED (cystein, lactose, electrolyte-deficient) agar for the detection, enumeration and identification of urinary tract pathogens. METHODS: A total of 1,080 clinical urine specimens were assessed. All samples were inoculated in MPO and CLED using the calibrated loop method. RESULTS: Among 145 positive urine samples, 171 strains of bacteria were isolated (111 Escherichia coli, 26 Enterococcus spp., 12 Proteus spp., 10 Enterobacteriaceae from the Klebsiella-Enterobacter-Serratia group, 5 Pseudomonas aeruginosa, 4 Streptococcus agalactiae, 3 Staphylococcus spp. and 4 Candida albicans. For all samples, enumeration of microorganisms was comparable with the two media studied. Identification was also similar, except for 6 cases in which Enterococcus spp. were only detected with the chromogenic medium. CONCLUSIONS: Overall urine culture results with MPO chromogenic medium were similar to those obtained with CLED, making it a feasible alternative to the standard medium. Moreover, use of a chromogenic technique implies a significant reduction in workload, since additional tests to identify the microorganisms isolated are not needed in most cases.

Utilidad del medio cromogénico MPO en el procesamiento habitual del urocultivo / Use of MPO chromogenic culture medium for routine processing of urine cultures

FUNDAMENTOS. Evaluación del medio cromogénico MPO frente al medio CLED (cisteína, lactosa, deficiente en electrolitos) respecto a su utilidad en la detección, enumeración e identificación de patógenos del tracto urinario. MÉTODOS. Se han estudiado 1.080 muestras de orina a las que se les efectuó urocultivo en MPO y CLED empleando el método del asa calibrada. RESULTADOS. A partir de 145 muestras de orina positivas se aislaron 171 cepas bacterianas (Escherichia coli, 111; Enterococcus spp., 26; Proteus spp., 12; Enterobacteriaceae del grupo Klebsiella-Enterobacter-Serratia, 10; Pseudomonas aeruginosa, 5; Streptococcus agalactiae, 4; Staphylococcus spp., 3, y Candida albicans, 4. Los resultados de los recuentos y los tipos de microorganismos aislados fueron análogos en ambos medios, aunque en 6 casos la presencia de Enterococcus spp. sólo se detectó en el medio cromogénico. CONCLUSIONES. El medio MPO para la realización del urocultivo ofrece resultados análogos al CLED y su utilización lleva a una importante disminución de la carga de trabajo asociada a la realización de esta técnica. Este ahorro de trabajo se debe a que en la mayoría de los casos es posible obviar la realización de pruebas complementarias para la identificación de los microorganismos aislados a partir de muestras de orina (AU)