Proyecto URISCAM: Evaluación multicéntrica del citómetro UF-Series en el despistaje de infecciones urinarias / URISCAM project: multicenter evaluation of the UF-Series cytometer in the urinary tract infections screening

Introducción. El urocultivo, prueba de referencia para confirmar la existencia de Infección del tracto urinario (ITU), es la solicitud más demandada a Microbiología. Nuestro objetivo fue determinar la rentabilidad diagnóstica del citómetro UF-Series como método de cribado en la detección de ITU. Material y métodos. Se analizaron las orinas remitidas a los seis laboratorios de Microbiología participantes en un periodo de 5 días laborables. Se recogieron variables demográficas y de origen de la muestra, tipo de muestra (orina de media micción, sondaje, nefrostomía), recogida con/sin ácido bórico, lectura del citómetro (leucocituria, bacteriuria, morfología bacteriana y células epiteliales) y resultado del urocultivo. Para determinar la capacidad predictiva del citómetro se representaron las curvas ROC. Resultados. Se procesaron 2.468 muestras de pacientes con edad media de 53 años (ratio mujeres:hombres 2:1). El urocultivo detectó un 23% de orinas positivas. Las variables predictoras de ITU fueron: lectura morfológica de bacilos, bacteriuria ≥ 21 bacterias/μL, edad ≥ 65 años, procedencia de las muestras recogidas en urgencias y hospitalización, y presencia de conservante. Con el punto de corte de 21 bacterias, obtuvimos una sensibilidad del 93,3% y un VPN del 94,5%, lo que permitiría dejar de sembrar el 28,9% de las orinas recibidas con 1,6% de falsos negativos. Conclusiones. Consideramos que el UF-Series es una herramienta válida y precisa para la detección de ITU, por lo que podría utilizarse como cribado previo al urocultivo en la práctica clínica, reduciendo el número de orinas a sembrar en aproximadamente un 30% con una tasa baja de falsos negativos (AU)

Introduction. Urine culture, the gold standard to confirm the presence of urinary tract infection (UTI), is the most requested assay in the microbiology department. Our objective was to determine the diagnostic yield of the UF-Series cytometer as a screening method for UTI. Material and methods. All the urine samples sent to the six Microbiology Laboratories participating in a period of 5 working days were analyzed. We collected demographic variables, apart from those variables related to urine samples: source and sample type (midstream, catheterized or nephrostomy urines), collection with/without boric acid, cytometer parameters (leukocyturia, bacteriuria, bacteria morphology and epithelial cells) and urine culture results. ROC curves were plotted to determine predictive capacity of the cytometer. Results. A sample of 2,468 patients with average age of 53 years were processed (ratio women:men 2:1). Urine culture detected 23% of positive urine samples. The predictor variables of UTI were: morphology of bacilli, bacteriuria ≥21 bacteria/μL, age ≥65 years, samples collected in the emergency service and hospitalization and preserving conditions. With 21 bacteria/ μL as a cut-off point, we obtained a sensitivity of 93.3% and 94.5% negative predictive value, then reducing the samples to be cultured by 28.9% with 1.6% false negatives. Conclusions. We consider that the UF-Series is a valid and accurate tool for the detection of UTI. Therefore, it could be used as screening method in the clinical practice prior to the urine culture, reducing culture requirement by approximately 30%, with a low false negative rate (AU)

The spread of KPC-producing Enterobacteriaceae in Spain: WGS analysis of the emerging high-risk clones of Klebsiella pneumoniae ST11/KPC-2, ST101/KPC-2 and ST512/KPC-3.

OBJECTIVES: We analysed the microbiological traits and population structure of KPC-producing Enterobacteriaceae isolates collected in Spain between 2012 and 2014. We also performed a comparative WGS analysis of the three major KPC-producing Klebsiella pneumoniae clones detected. METHODS: Carbapenemase and ESBL genes were sequenced. The Institut Pasteur MLST scheme was used. WGS data were used to construct phylogenetic trees, to identify the determinants of resistance and to de novo assemble the genome of one representative isolate of each of the three major K. pneumoniae clones. RESULTS: Of the 2443 carbapenemase-producing Enterobacteriaceae isolates identified during the study period, 111 (4.5%) produced KPC. Of these, 81 (73.0%) were K. pneumoniae and 13 (11.7%) were Enterobacter cloacae. Three major epidemic clones of K. pneumoniae were identified: ST11/KPC-2, ST101/KPC-2 and ST512/KPC-3. ST11/KPC-2 differed from ST101/KPC-2 and ST512/KPC-3 by 27 819 and 6924 SNPs, respectively. ST101/KPC-2 differed from ST512/KPC-3 by 28 345 SNPs. Nine acquired resistance genes were found in ST11/KPC-2, 11 in ST512/KPC-3 and 13 in ST101/KPC-2. ST101/KPC-2 had the highest number of virulence genes (20). An 11 bp deletion at the end of the mgrB sequence was the cause of colistin resistance in ST512/KPC-3. CONCLUSIONS: KPC-producing Enterobacteriaceae are increasing in Spain. Most KPC-producing K. pneumoniae isolates belonged to only five clones: ST11 and ST512 caused interregional spread, ST101 caused regional spread and ST1961 and ST678 produced independent hospital outbreaks. ST101/KPC-2 had the highest number of resistance and virulence genes. ST101/KPC-2 and ST512/KPC-3 were recently implicated in the spread of KPC in Italy.

Neglected tropical diseases outside the tropics.

BACKGROUND: The neglected tropical diseases (NTDs) cause significant morbidity and mortality worldwide. Due to the growth in international travel and immigration, NTDs may be diagnosed in countries of the western world, but there has been no specific focus in the literature on imported NTDs. METHODS: Retrospective study of a cohort of immigrants and travelers diagnosed with one of the 13 core NTDs at a Tropical Medicine Referral Unit in Spain during the period April 1989-December 2007. Area of origin or travel was recorded and analyzed. RESULTS: There were 6168 patients (2634 immigrants, 3277 travelers and 257 VFR travelers) in the cohort. NTDs occurred more frequently in immigrants, followed by VFR travelers and then by other travelers (p<0.001 for trend). The main NTDs diagnosed in immigrants were onchocerciasis (n = 240, 9.1%) acquired mainly in sub-Saharan Africa, Chagas disease (n = 95, 3.6%) in immigrants from South America, and ascariasis (n = 86, 3.3%) found mainly in immigrants from sub-Saharan Africa. Most frequent NTDs in travelers were: schistosomiasis (n = 43, 1.3%), onchocerciasis (n = 17, 0.5%) and ascariasis (n = 16, 0.5%), and all were mainly acquired in sub-Saharan Africa. The main NTDs diagnosed in VFR travelers were onchocerciasis (n = 14, 5.4%), and schistosomiasis (n = 2, 0.8%). CONCLUSIONS: The concept of imported NTDs is emerging as these infections acquire a more public profile. Specific issues such as the possibility of non-vectorial transmission outside endemic areas and how some eradication programmes in endemic countries may have an impact even in non-tropical western countries are addressed. Recognising NTDs even outside tropical settings would allow specific prevention and control measures to be implemented and may create unique opportunities for research in future.

Imported infectious diseases in mobile populations, Spain.

Migration has contributed to the emergence of certain infectious diseases. To determine which infectious diseases were most common among 2 mobile immigrant groups (sub-Saharan Africans and Latin Americans) in Spain, we analyzed health and demographic characteristics of 2,198 immigrants referred to the Tropical Medicine Unit of Ramon y Cajal Hospital over a 20-year period. The most frequent diagnoses were for latent tuberculosis (716 patients [32.6%]), filariasis (421 [19.2%]), hepatropic virus chronic infection (262 [19.2%]), intestinal parasites (242 [11.0%]), and malaria (212 [9.6%]). Health screening of immigrant populations is needed to ensure early diagnosis and treatment of potentially transmissible infections.