Weighting the impact of virulence on the outcome of Pseudomonas aeruginosa bloodstream infections.

OBJECTIVES: We assessed the association between the lethality of Pseudomonas aeruginosa in a Caenorhabditis elegans model and outcomes of P. aeruginosa bloodstream infections. METHODS: A total of 593 P. aeruginosa bloodstream isolates recovered from a prospective Spanish multicentre study were analysed. Clinical variables, susceptibility profiles and Type III Secretion System (TTSS) genotypes (exoU/exoS genes) were available from previous studies. A C. elegans virulence score (CEVS) was used, classifying the isolates into high (CEVS 4-5), intermediate (CEVS 3) and low (CEVS 1-2) virulence. The main outcome analysed was 30-day mortality. RESULTS: Up to 75% (446/593) of the isolates showed a high-virulence phenotype, and 17% (101/593) a low-virulence one. No association between virulence phenotype and the main outcome variable (30-day mortality) was found (29/101 (28.7%) versus 127/446 (28.5%), p 1). However, an inverse association between C. elegans virulence and multidrug-resistant and extensively drug-resistant profiles was documented (OR 0.655 (95% CI 0.571-0.751) and OR 0.523 (95% CI 0.436-0.627), p <0.001, respectively), whereas the exoU genotype was significantly more frequent among isolates showing high virulence (10/101 (9.9%) versus 112/446 (25.1%), p <0.001). Moreover, although significance was not reached, strains showing a high-virulence phenotype tended to be associated with community-acquired infections (1/101 (1%) versus 25/446 (5.6%), p 0.065), whereas low-virulence phenotypes tended to be associated with a higher illness severity (such as higher median Pitt score: 2 (1-4) versus 1 (0-3), p 0.036, or initial multiorgan dysfunction: 17/101 (16.8%) versus 41/446 (9.2%), p 0.024), with some underlying conditions (such as chronic renal failure 24/101 (23.8%) versus 59/446 (13.2%), p 0.013), and with the respiratory source of infections (17/101 (16.8%) versus 45/446 (10.1%), p 0.058). CONCLUSIONS: Our results indicate that the P. aeruginosa virulence phenotype in a C. elegans model correlates with virulence genotype (TTSS) and resistance profile, but it is a poor prognostic marker of mortality in bloodstream infections.

Predictive factors for mortality in patients with methicillin-resistant Staphylococcus aureus bloodstream infection: impact on outcome of host, microorganism and therapy.

Mortality related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) remains high, despite changes in the epidemiology. To analyze the current predictive factors for mortality we conducted a prospective study in a large cohort of patients with MRSA-BSI from 21 Spanish hospitals. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed, including susceptibility to antibiotics and molecular characterization. Vancomycin MICs (V-MIC) were tested by the E-test and microdilution methods. Time until death was the dependent variable in a Cox regression analysis. Overall, 579 episodes were included. Acquisition was nosocomial in 59% and vascular catheter was the most frequent source (38%). A dominant PFGE genotype was found in 368 (67%) isolates, which belonged to Clonal Complex (CC)5 and carried SCCmecIV and agr2. Microdilution V-MIC50 and V-MIC90 were 0.7 and 1.0 mg/L, respectively. Initial therapy was appropriate in 66% of episodes. Overall mortality was observed in 179 (32%) episodes. The Cox-regression analysis identified age >70 years (HR 1.88), previous fatal disease (HR 2.16), Pitt score >1 (HR 3.45), high-risk source (HR 1.85) and inappropriate initial treatment (HR 1.39) as independent predictive factors for mortality. CC5 and CC22 (HR 0.52 and 0.45) were associated with significantly lower mortality rates than CC8. V-MIC ≥1.5 did not have a significant impact on mortality, regardless of the method used to assess it.

[Investigation of antimicrobial resistance to Enterococcus faecium]. / Investigación de las resistencias a antimicrobianos en Enterococcus faecium.

We performed a antibiotic resistance study on Enterococcus faecium isolated from intrahospitalary and extrahospitalary samples between 2004 and 2010. Three different samples were studied; urine, blood and wound swabs, considering a strain per patient. We included in the study a global amount of 637 E. faecium isolares. We employed semiautomatic system WIDER I for identification and sensitivity testing. We considered susceptibility and resistance criteria recommended by MENSURA group. We found a susceptibility rate of 48.05% to betalactams, 100% to linezolid, and 99.46% to vancomycin. The resistance to aminoglycosides ranged between 41.41 and 73.55%. We obtained 6 isolates resistant to vancomycin one of them from an extrahospitalary strain and five from intrahospitalary strains. It seems that vancomycin resistance should be controlled.

[Evaluation of the variability in the susceptibility of Acinetobacter baumannii to tigecycline in the same medium with two methods of quantitative diffusion different commercial]. / Evaluación de la variabilidad en la sensibilidad de Acinetobacter baumannii a tigeciclina en un mismo medio de cultivo con dos métodos de difusión cuantitativos comerciales diferentes.

INTRODUCTION: Tigecycline may be a therapeutic alternative for the control of multidrug-resistant Acinetobacter baumannii, although there is no consensus on the cutoffs or susceptibility to the variability of the minimum inhibitory concentration (MIC) according to the culture medium and strips for the antibiogram against this microorganism by quantitative diffusion method. Therefore, the objective was to verify this variability and propose epsilometer test strip that more closely resemble to the standard method. MATERIAL AND METHODS: 38 strains of A. baumannii were selected and evaluated their susceptibility to tigecycline with two different commercial strips (E-TEST and Liofilchem). MICs were compared with those obtained by the standard technique of microdilution broth. RESULTS: MICs obtained by the Liofilchem strip were more similar to standard method than those obtained by E-TEST strips. CONCLUSION: In the two studied strips, higher MICs to those obtained by the standard method were observed leading to false-positive tigecicline resistance in many cases. However, the Liofilchem strip showed the results more closely resemble to the standard method.

Hidatidosis hepática: revisión de tres casos / Hepatic hydatidosis: A review of three cases

La hidatidosis es una parasitosis zoonótica causada por cestodos del género Echinococcus. La única que tiene relevancia clínica en España es la E. granulosus. En la mayoría de los casos se trata de quistes hidatídicos abdominales cuya localización más frecuente es el hígado. La forma de presentación más habitual es el descubrimiento accidental. El diagnóstico se realiza fundamentalmente mediante ecografía, tomografía axial computarizada y resonancia magnética. Presentamos tres casos clínicos de hidatidosis hepática, dos de ellos diagnosticados de manera casual y uno, en una paciente con un síndrome febril. En todos los casos se realizó tratamiento quirúrgico, y únicamente en el último se realizó tratamiento médico con albendazol. La hidatidosis hepática sigue siendo un problema de salud importante en España. Los programas de control no han resultado totalmente eficaces para modificar la distribución global de la enfermedad hidatídica (AU)

Hydatidosis is a zoonotic parasitic infection caused by the cestode Echinococcus. The only clinically relevant one in Spain is E. granulosus. In most of the cases, these are abdominal hydatic cysts, whose most frequent location is in the liver. The most common presentation is discovered causally. The diagnosis is basically made by means of an ultrasound, computed tomography and magnetic resonance imaging. We present three cases of hepatic hydatidosis, two of which were diagnosed casually and one in a patient with febrile syndrome. Surgical treatment was performed in all the cases and only the latter received medical treatment with albendazole. Hepatic hydatidosis continues to be an important health problem in Spain. The control programs have not been effective to modify the global distribution of the hydatid disease (AU)

[Streptococcus pneumoniae: antibiotic resistance and serotypes in a two-year period]. / Streptococcus pneumoniae: resistencia antibiótica y serotipos en un periodo de dos años.

Streptococcus pneumoniae is the main etiologic agent in community-acquired pneumonia, meningitis in adults and acute medium otitis in children. Our aim was to study antimicrobial susceptibility and serotypes of Streptococcus pneumoniae strains isolated in our medium. We evaluated 83 strains in a period of two years: 41% of the strains were invasive, and 47% of the strains were resistant to penicillin, 42.1% to erythromycin, 16.8% to cefotaxime, 34.9% to tetracycline and 16.8% to chloranphenicol. All studied strains were susceptible to vancomycin. We found 28 different serotypes. The most frequently found serotypes were 19, 6, 9, 23, 3, 15, and NT. The S. pneumoniae strains which showed the highest penicillin resistance belong to serotype 19. Multiresistant strains belong to serotypes 19, 6, 23 and NT.

[Microorganisms isolated from outpatient urine samples and antimicrobial susceptibility over a 12-year period]. / Microorganismos aislados de muestras de orina procedentes de la comunidad y patron de sensibilidad en un periodo de 12 anos.

This study aimed to determine the prevalence of microorganisms isolated from urine samples from outpatients and the resistance of the pathogens isolated to antimicrobial agents used in the province of Cordoba, Spain, which has a Health Area of approximately 776,000 inhabitants. It was a retrospective descriptive study covering a 12-year period (1992-2003). All samples were sent from primary care to the microbiology laboratory. The laboratory techniques and criteria for evaluation were the same in all cases. Escherichia coli was the most frequently isolated of the Gram-negative bacteria (64%), while Enterococcus faecalis was the most frequently isolated of the Gram-positive bacteria (6.9%). A decrease in susceptibility of the isolates to the most empirically used antimicrobial drugs was observed.

Streptococcus pneumoniae: resistencia antibiótica y serotipos en un periodo de dos años / Streptococcus pneumoniae: Antibiotic resistance and serotypes in a two-year period

Streptococcus pneumoniae es el principal agente etiológico en la neumonía extrahospitalaria, la meningitis en adultos y la otitis media agudaen los niños. Nuestro objetivo ha sido determinar la resistencia antibiótica y los serotipos de las cepas de S. pneumoniae aisladas en nuestromedio. Se evaluaron un total de 83 cepas en un periodo de dos años. El 41% correspondieron a muestras procedentes de infeccionesinvasoras. El 47% de las cepas fueron resistentes a la penicilina, el 42,1% a la eritromicina, el 16,8% a la cefotaxima, el 34,9% a la tetraciclinay el 16,8% al cloranfenicol. Todas las cepas estudiadas fueron sensibles a la vancomicina. Se encontraron 28 serotipos diferentes. Losserotipos 19, 6, 9, 23, 3, 15 y NT fueron los más frecuentes. Las cepas de S. pneumoniae que presentan mayor porcentaje de resistencia ala penicilina pertenecen al serotipo 19. Las cepas multirresistentes pertenecen a los serotipos 19, 6, 23 y NT

Streptococcus pneumoniae is the main etiologic agent in community-acquired pneumonia, meningitis in adults and acute medium otitis inchildren. Our aim was to study antimicrobial susceptibility and serotypes of Streptococcus pneumoniae strains isolated in our medium. Weevaluated 83 strains in a period of two years: 41% of the strains were invasive, and 47% of the strains were resistant to penicillin, 42.1% toerythromycin, 16.8% to cefotaxime, 34.9% to tetracycline and 16.8% to chloranphenicol. All studied strains were susceptible to vancomycin.We found 28 different serotypes. The most frequently found serotypes were 19, 6, 9, 23, 3, 15, and NT. The S. pneumoniae strains whichshowed the highest penicillin resistance belong to serotype 19. Multiresistant strains belong to serotypes 19, 6, 23 and NT

Microorganismos aislados de muestras de orina procedentes de la comunidad y patrón de sensibilidad en un periodo de 12 años / Microorganisms isolated from outpatient urine samples and antimicrobial susceptibility over a 12-year period

El objetivo de este estudio fue conocer la prevalencia de los microorganismos aislados de muestras de orina procedentes de la comunidaden la provincia de Córdoba (un área sanitaria de 776.000 habitantes aproximadamente), y además determinar las tasas de resistencia a losdiferentes antimicrobianos empleados en Atención Primaria. Se trata de un estudio descriptivo retrospectivo que abarca un periodo de 12años (1992-2003). Todas las muestras fueron remitidas desde los Centros de Salud al Laboratorio de Microbiología del Hospital UniversitarioReina Sofía. Todos los procedimientos analíticos se realizaron siguiendo el proceder habitual del laboratorio. Escherichia coli fue el microorganismoque se aisló con mayor frecuencia entre los gramnegativos, con una media en los doce años del 64%, y Enterococcus faecalis fueel que se aisló con mayor frecuencia entre los grampositivos, con una media del 6,9% del total de microorganismos. Observamos una disminuciónen la sensibilidad de los aislamientos a los antimicrobianos de mayor uso empírico

This study aimed to determine the prevalence of microorganisms isolated from urine samples from outpatients and the resistance of thepathogens isolated to antimicrobial agents used in the province of Córdoba, Spain, which has a Health Area of approximately 776,000 inhabitants.It was a retrospective descriptive study covering a 12-year period (1992-2003). All samples were sent from primary care to themicrobiology laboratory. The laboratory techniques and criteria for evaluation were the same in all cases. Escherichia coli was the most frequentlyisolated of the Gram-negative bacteria (64%), while Enterococcus faecalis was the most frequently isolated of the Gram-positivebacteria (6.9%). A decrease in susceptibility of the isolates to the most empirically used antimicrobial drugs was observed

Artritis séptica por Neisseria meningitidis / Septic arthritis caused by Neisseria meningitidis

No disponible

Artritis gonocócica en un paciente VIH positivo / Gonococcal arthritis in an HIV positive patient

No disponible

Meningoencefalitis por Salmonella virchow de evolución no satisfactoria / Meningoencephalitis due to Salmonella virchow with unsatisfactory outcome

No disponible

[Efficacy of fecal detection of Helicobacter pylori with the HpSA technique in patients with upper digestive hemorrhage]. / Eficacia de la determinación fecal de Helicobacter pylori mediante la técnica HpSA en enfermos con hemorragia digestiva alta.

BACKGROUND: The rapid urease test is the most commonly used test in the diagnosis of Helicobacter pylori infection in patients with upper gastrointestinal hemorrhage. However, some studies have suggested that results of this test are frequently false negative when blood is present. An effective new enzyme immunoassay for determining H. pylori antigens in stools has recently begun to be used. AIM: To determine the efficacy of the H. pylori stool antigen test (HpSAT) in patients with upper gastrointestinal hemorrhage. PATIENTS AND METHODS: Thirty-two patients with upper gastrointestinal hemorrhage were prospectively studied from November 1998 to April 1999. In all patients the following tests were performed in the first 72 hours after onset of bleeding and 24 hours after hospital admission: upper gastrointestinal endoscopy, biopsy samples for the rapid urease test and histological study, blood samples for serology, stool samples for HpSAT, and the 13C urea breath test. Criteria for infection was a positive result in at least two of the four diagnostic techniques, except in the case of HpSAT. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: Of the 32 patients, 23 (71.8%) were infected. The results of four HpSAT (12.5%) were negative and 28 were positive (87.5%). HpSAT showed high sensitivity (95.6%) but low specificity (33.3%). The PPV and NPV were 78.5% and 75% respectively. Of the 32 HpSAT, 25 (78.1) were performed in melenic stools: 22 were positive and 3 were negative. Seventy-five percent of negative HpSAT and 78.5% of positive HpSAT corresponded to melenic stools. CONCLUSIONS: HpSAT is a rapid, non-invasive technique that does not appear to be influenced by the presence of blood. Consequently, it can be applied in patients with upper gastrointestinal hemorrhage. The rapid urease test showed high sensitivity, specificity and PPV and should remain the first-line test in patients with upper gastrointestinal hemorrhage. HpSAT is appropriate as a second-line technique and is useful when the rapid urease test is negative and infection is strongly suspected, when no samples for the rapid urease test have been taken and when endoscopy cannot be performed. The result obtained in the present study should be confirmed in future studies with larger samples.

[Tobacco consumption among the student population. Related factors]. / Consumo de tabaco entre la población escolar. Factores relacionados.

OBJECTIVE: To know smoking prevalence among schoolchildren and factors related with this habit. METHODS: A cross-sectional study. 548 school-children in their 6th and 8th years of primary studies at schools from an area of Córdoba (Spain) were interviewed. INTERVENTIONS: Autoadministered questionnaire. RESULTS: Tobacco was tried in 22% (CI 95%: 18.7-25.8) school-children. The average age for starting with this habit was 11.6 (SD)(CI 95%: 11.4-11.8). 12.1% smoked regularly and 1.3% smokers every day. The tobacco consumption in children was related with age (OR = 2.96; CI 95%: 1.12-7.82), cough medicines consumption (OR = 3.15; CI 95%: 1.32-7.48), to have a smokers sister (OR = 2.53; CI 95%: 1.06-6.00) and best friend (OR = 4.42; CI 95%: 1.85-10.60) and drinking beer (OR = 3.68; CI 95%: 1.15-11.7). CONCLUSIONS: The prevalence of smoking in our school-children is very close to that reported by others. Among the factors accounted with the tobacco consumption in schoolchildren, highlight the presence of this habit in the eldest sister and the best friend.

[In vitro activity of clofazimine alone and in combination with amikacin, roxithromycin, rifampicin and rifapentine against Mycobacterium avium-intracellulare]. / Actividad in vitro de clofacimina aisladamente y en asociación con amikacina, roxitromicina, rifampicina y rifapentina frente a Mycobacterium avium-intracellulare.

The activity of clofazimine, amikacin, roxithromycin, rifampicin and rifapentine was tested, alone and in association, against Mycobacterium avium intracellulare. Clofazimine, amikacin and rifapentine were shown to be very active. With all established associations, the MIC observed for each drug alone was appreciably reduced.