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Two episodes of bacteremia of cutaneous origin in a female patient were caused by two unrelated Streptococcus canis isolates within 1-year interval between the two infection episodes. The most likelihood transmission route in both episodes was a dog pet that habitually licked patient´s legs. Isolates were characterised by antimicrobial susceptibility test and whole genome sequencing. They belonged to sequence type (ST) 40 and 43, respectively. The ST40 isolate harboured antimicrobial resistance genes aadE, ermB and tetO, displaying resistance to erythromycin, clindamycin and tetracyclines, while ST43 isolate did not presented any known antimicrobial resistance determinant and was susceptible to all antibiotics tested. S. canis infections are rare in human; however, attention is needed for patients at risk with companion animals.
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Zoonosis Bacterianas , Infecciones Estreptocócicas , Streptococcus , Animales , Perros , Femenino , Humanos , Antibacterianos/farmacología , Farmacorresistencia Bacteriana/genética , Pruebas de Sensibilidad Microbiana , Infecciones Estreptocócicas/veterinaria , Infecciones Estreptocócicas/microbiología , Zoonosis Bacterianas/diagnósticoRESUMEN
We described a case of a 65-year-old man with a brain abscess caused by Porphyromonas gingivalis and Eubacterium nodatum. The patient presented right central facial nerve palsy, mutism and right hemiparesis at the examination. The patient underwent a left frontal craniotomy with evacuation of the brain abscess. Specimens were collected for microbiological analysis and intravenous treatment was started with levetiracetam, dexamethasone, meropenem (1 g/8 h) and linezolid (600 mg/12 h). After identification of anaerobic bacteria the antibiotic treatment was changed to piperacillin/tazobactam (4 g/0,5 g/8 h), fulfilling 8 weeks of antibiotic with good clinical and radiological evolution.
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Absceso Encefálico , Accidente Cerebrovascular , Masculino , Humanos , Anciano , Porphyromonas gingivalis , Eubacterium , Absceso Encefálico/diagnóstico , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/microbiología , Accidente Cerebrovascular/tratamiento farmacológico , Bacterias Anaerobias , Antibacterianos/uso terapéuticoRESUMEN
Bacteoides finegoldii is a Gram-negative, rod-shaped and obligate anaerobic bacteria isolated in human feces during studies of intestinal microbiota. We present a case report in which B. finegoldii was isolated and identified from the blood culture of a 93-year-old patient with abdominal pain. Microbiological identification was performed by MALDI-TOF MS and confirmed later by 16S rRNA sequencing. An abdomino-pelvic CT scan was conducted, showing a mass of neoplastic appearance that infiltrated the sigmoid colon and bladder, probably producing a colo-vesical fistula. Up to now, this is the first report of B. finegoldii causing human infection.
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Bacterias , Bacteroides , Humanos , Anciano de 80 o más Años , ARN Ribosómico 16S/genética , Técnicas de Tipificación Bacteriana , Bacterias/genética , Bacterias Gramnegativas , Espectrometría de Masa por Láser de Matriz Asistida de Ionización DesorciónRESUMEN
Bacteroides pyogenes is a Gram-negative obligate anaerobe, saccharolytic, non-motile, non-pigment-producing and non-spore-forming rod. Reports of human infections caused by B. pyogenes are scarce, with approximately 30 cases documented in scientific literature. The aim of this study was to describe the clinical characteristics of 8 different patients and to study the in vitro antibiotic susceptibility of the strains, as well as to evaluate the in vivo activity of the prescribed treatments. We conducted a descriptive retrospective study by searching all B. pyogenes isolates from January 2010 to March 2023 at the Basurto University Hospital. This included all cases, both in monomicrobial or polymicrobial cultures. Among the eight patients, three experienced severe infections such as bacteremia and osteomyelitis. All the strains were susceptible to amoxicillin/clavulanic acid, piperacillin/tazobactam, imipenem, meropenem, clindamycin, metronidazole and moxifloxacin.
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Antibacterianos , Bacterias Anaerobias , Humanos , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Centros de Atención Terciaria , España/epidemiología , Estudios Retrospectivos , Pruebas de Sensibilidad MicrobianaRESUMEN
The genus Fusobacterium contains currently 13 species presenting as non-sporing, obligate anaerobic, Gram-negative fusiform rods. Fusobacterium ulcerans was discovered in 1988 causing tropical ulcers. We present the case of a patient with diverticulitis complicated with bacteremia. Both aerobic bottles were positive at 20 and 24 h, while one anaerobic bottle was positive at 36 h. Escherichia coli and Fusobacterium ulcerans were identified from subcultures by MALDI-TOF MS with a score of 2.02 and 2.35, respectively. The 16S rRNA gene was sequenced in order to confirm the identification of F. ulcerans with a 100% homology to the reference strain. The patient was treated with 4 g/0,5 g of IV piperacillin/tazobactam and later with 1 g/0,2 g of amoxicillin/clavulanic during 7 days with good clinical evolution.
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Bacteriemia , Traslocación Bacteriana , Humanos , ARN Ribosómico 16S/genética , Fusobacterium/genética , Bacteriemia/microbiología , Bacterias Gramnegativas , Espectrometría de Masa por Láser de Matriz Asistida de Ionización DesorciónRESUMEN
From the very beginning of the SARS-CoV-2 pandemic, one of the very few common opinions was that to control the expansion of the virus as many as the possible test had to be done. Antigen tests, being affordable and easy and fast to use, represented a great opportunity to expand the testing capacities of many healthcare systems. However, in 2021 with the appearance of the new SARS-CoV-2 variants, variant tracking strategies had to be implemented, which often included needing a second test to determine the variant of the patients diagnosed with antigen tests or not taking these samples into consideration at all. Therefore, we proposed recovering the positive antigen test devices to include them in our routine variant tracking strategy. The recovered positive antigen test devices obtained from 1st April 2021 to 15the January 2022 were analysed following the variant tracking protocol in force. The results obtained were compared to the positive samples detected by RT-PCR which were processed for variant tracking during the same period. 21,304 samples were processed, 6297 from the recovered positive antigen devices and 15,007 from the standard nasopharyngeal swabs. Only 773 (3.63%) samples were no conclusive, 104 (1.65%) from the recovered antigen devices and 669 (4.46%) from the RT-PCR positive group. This difference was statistically significant (p < 0.01). Taking this into account the proposed method is suitable and very recommendable, as it is an important measure to have a better and immediate picture of the circulating variants in every community.
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COVID-19 , SARS-CoV-2 , COVID-19/diagnóstico , Humanos , Pandemias , SARS-CoV-2/genética , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: The objective of this study was to compare the numeric cut-off index (COI) of automated antigen tests with the cycle-threshold (Ct) value. MATERIALS AND METHODS: COI values of all samples processed with the Elecsys® SARS-CoV-2 Antigen (Roche, Switzerland) from January to February 2022 were retrieved and the positive were compared to RdRP Cts of Allplex Variants I (Seegene, Korea). COI between 0.6 and 1 were considered indeterminate and overproved by RT-PCR. RESULTS: From 13,937 samples 7944(57%) were positive and 189(1.35%) indeterminate. There was a strong correlation between Cts and COI values at the positive samples, but that was not the case for indeterminates. CONCLUSIONS: COI values of the positive samples (COI >1) are comparable to Ct values and may therefore be used as proxy viral loads, however this is not the case for indeterminate samples.
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COVID-19 , Humanos , COVID-19/diagnóstico , SARS-CoV-2/genética , Reacción en Cadena de la Polimerasa , Pruebas Inmunológicas , República de Corea , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: We describe a rare case of a disseminated Nocardia farcinica infection associated with hip osteomyelitis. METHODS: A 91-year-old female patient was admitted with oedema of her right leg, fever of 38 °C and data consistent with ruptured Baker's cyst. A disseminated Nocardia farcinica infection including bloodstream infection, pneumonia and multiple abscesses along both lower limbs was observed. RESULTS: After a four-week course of 320 mg/1600 mg/12 h of intravenous trimethoprim/sulfamethoxazole and multiple chirurgic drainages the patient was discharged with oral trimethoprim/sulfamethoxazole. Nevertheless, the patient expired done month after being discharged from the hospital. CONCLUSIONS: The implementation of a combination of intravenous antibiotics and drainages resulted in an initial improvement in the patient's condition. However, despite these interventions, the patient ultimately passed away probably due to natural causes.
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Bacteriemia , Nocardiosis , Osteomielitis , Femenino , Humanos , Anciano , Anciano de 80 o más Años , Hueso Púbico , Nocardiosis/complicaciones , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Osteomielitis/tratamiento farmacológico , Osteomielitis/complicacionesRESUMEN
BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are a public health problem, worsened by frequent reinfections, whose incidence rate is not known in Spain. The objective of this study is to estimate in patients diagnosed with NG, CT or mixed infection (NG and CT): (1) the incidence of reinfections by the same microorganism, (2) the total incidence of Sexually Transmitted Infections (STI), both by the same microorganism and by infections other than the initial one, and (3) to identify predictors of reinfection. METHODS: Observational prospective case series involving 986 patients with CT and/or NG at specialized STI clinics in Biscay (Spain) between 2016 and 2019. RESULTS: The six month cumulative incidence of reinfection by the same microorganism was 17.24% (CI95%: 14.9-19.7) and 24.65% (CI95%: 21.9-27.4) for any STI (reinfection or other). Being an immigrant (OR=1.8; CI95%: 1.3-2.6), men who have sex with men (OR=1.8; CI95%: 1.3-2.6), number of sexual partners (OR=4.3; CI95%: 2.7-6.8 for more than 5 partners), having a new partner (OR=1.7; CI95%: 1.08-2.6), not always using a condom (OR=1.4; CI95%: 1.02-1.9) and consumption of alcohol prior to sex (OR=3.8; CI95%: 1.5-9.5) were associated with reinfection by any STI. CONCLUSION: These characteristics allow doctors to identify patients in whom to prioritize short-term rescreening for repeated infections with any STIs after initial treatment for NG or CT.
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Infecciones por Chlamydia , Gonorrea , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual , Masculino , Humanos , Gonorrea/epidemiología , Gonorrea/prevención & control , Chlamydia trachomatis , Incidencia , Reinfección , Homosexualidad Masculina , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/epidemiología , Enfermedades de Transmisión Sexual/epidemiologíaRESUMEN
Capnocytophaga canis is still a rare cause of infection. We present a case of an immunocompetent patient admited in the hospital with functional impotence, pain and erythema in his left leg after suffering two scratches from his cat 48 h ago. After obtaining blood and wound cultures, broad-spectrum antimicrobial therapy with intravenous amoxicillin clavulanate was initiated. After 1 day and with a clear improvement of the symptoms the patient was discharged from the hospital with cellulitis and transient bacteremia as diagnosis and completing 1 week of antimicrobial therapy orally. After 80 and 92 h of incubation, both anaerobic flasks were positive. In the Gram-stain Gram-negative rod-shaped bacteria could be observed. Despite subculturing in brucella blood agar, tripticase soy agar with 5â% of sheep blood and chocolate agar, in both anaerobic and microaerophilic conditions, the strain could not be recovered. However, these Gram-negative rods could be identified as C. canis by 16S rRNA sequencing, Capsular typing was performed to study the strain, but none of the studied capsule-types tested positive. C. canis is still a rare cause of human infection, but it must be considered in the differential diagnosis of infections related to bites, scratches and licks from dogs or cats.
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Invasive infections caused by Capnocytophaga canimorsus , a Gram-negative rod found in the oral cavity of healthy dogs and cats, are rare but they are increasing worldwide. We report a case of septic arthritis in a native knee joint due to this micro-organism. A 57-year-old man, with a well-controlled chronic HIV infection, attended the Emergency Department because of left knee pain and shivering without measured fever. A knee arthrocentesis and a computed tomography scan were performed, revealing septic arthritis with collections in the left leg posterior musculature. He was admitted to the Infectious Diseases Department for antibiotic treatment. Initial synovial fluid was inoculated in blood culture bottles, and the anaerobic one was positive after 63 h. Gram stain revealed fusiform Gram-negative rods, identified as C. canimorsus by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) directly from the bottle. Identification was confirmed by 16S rRNA sequencing and serotyping was performed by PCR, with serovar A as the outcome. Due to an unfavourable clinical course, the patient required two surgical cleanings and after appropriate antibiotic treatment he was discharged 2 months later.
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BACKGROUND: Chlamydia trachomatis (CT) infections are a public health problem because of its high incidence and consequences on reproductive health. Our aim is to describe the socio-demographic, behavioral and clinical characteristics of patients with CT infection in order to adapt preventive interventions for the highest risk groups. METHODS: Prospective case series of all patients diagnosed with CT between September 2016 and January 2019 in the reference STI clinics of Osakidetza (Basque Health Service) in Bizkaia (Spain). RESULTS: 847 patients (88.2%) agreed to participate: 41% women, 33.8% heterosexual men and 25% men who has sex with men (MSM); 33% were immigrants and 26% were under the age of 25 (33% of the women). Only 20% systematically used condoms. 36% had previously had STI and 28% had simultaneously another STI. 55% of the infections were asymptomatic (70% among women). In MSM, the rectum was affected in 69.5% of cases, the urethra in 31.4%, and the pharynx in 14.5%. The cervix was affected in 86.5% of the women, the rectum in 17.6%, and the pharynx in 13.8%. A contact study was only carried out in 58% of cases. The reinfection rate at 4 weeks was 17% among those with criteria to perform a test of cure. CONCLUSION: Our results justify implement opportunistic screening in women under the age of 25 and young immigrants of both sexes, by taking genital and extragenital samples, as well as developing appropriate guidelines for the notification and follow-up of contacts.
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Infecciones por Chlamydia , Minorías Sexuales y de Género , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Femenino , Homosexualidad Masculina , Humanos , Masculino , Conducta SexualRESUMEN
BACKGROUND: Chlamydia trachomatis (CT) infections are a public health problem because of its high incidence and consequences on reproductive health. Our aim is to describe the socio-demographic, behavioral and clinical characteristics of patients with CT infection in order to adapt preventive interventions for the highest risk groups. METHODS: Prospective case series of all patients diagnosed with CT between September 2016 and January 2019 in the reference STI clinics of Osakidetza (Basque Health Service) in Bizkaia (Spain) RESULTS: 847 patients (88.2%) agreed to participate: 41% women, 33.8% heterosexual men and 25% men who has sex with men (MSM); 33% were immigrants and 26% were under the age of 25 (33% of the women). Only 20% systematically used condoms. 36% had previously had STI and 28% had simultaneously another STI. 55% of the infections were asymptomatic (70% among women). In MSM, the rectum was affected in 69.5% of cases, the urethra in 31.4%, and the pharynx in 14.5%. The cervix was affected in 86.5% of the women, the rectum in 17.6%, and the pharynx in 13.8%. A contact study was only carried out in 58% of cases. The reinfection rate at 4 weeks was 17% among those with criteria to perform a test of cure. CONCLUSION: Our results justify implement opportunistic screening in women under the age of 25 and young immigrants of both sexes, by taking genital and extragenital samples, as well as developing appropriate guidelines for the notification and follow-up of contacts.
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BACKGROUND: Herpes simplex virus type 2 (HSV-2) is the most common cause of genital herpes (GH), but genital infection by herpes simplex virus type 1 (HSV-1) is increasing. The aim of this study was to analyze and compare epidemiological characteristics of patients with GH. METHODS: Retrospective study conducted from January 2004 to December 2015 in patients with GH attended at two Sexually Transmitted Diseases (STDs) medical consultation of Bilbao-Basurto Integrated Health Organisation in Northern Spain. Patient's medical history was reviewed and data of interest was analyzed. RESULTS: One thousand three patients (524 male and 479 female) were reviewed. HSV-2 was detected in 74%. The proportion of HSV-1 increased during the study period, significantly in men (28% in 2004-2007 vs. 50% in 2012-2015). More female than male had HSV-1 infection (56% vs. 44%). The proportion of primary infection was higher among HSV-1 compared to HSV-2 (79% vs. 21%). Among the patients with HSV-1, primary infection was higher among men (86%) and in younger than 30 years. Recurrent GH was higher among HSV-2 infections (63%). In a multivariate model older age, geographic origin outside Spain, recurrent infection, prior contact with a partner's genital herpetic lesions, previous N. gonorrhoeae infection and prostitution were significantly associated with HSV-2 infection. CONCLUSIONS: HSV-2 was the most common causative agent of GH, but the proportion of HSV-1 increased. Overall, antecedent of STD and sexual risk behaviors were more frequent in patients with genital HSV-2 infection.
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Herpes Genital , Herpesvirus Humano 1 , Anciano , Femenino , Herpes Genital/epidemiología , Herpesvirus Humano 2 , Humanos , Masculino , Estudios Retrospectivos , España/epidemiologíaRESUMEN
The objective of this study was the phenotypic and genotypic characterization of a carbapenem resistant Acinetobacter baumannii (CRAB) isolate. The isolate, recovered in Northern Spain in 2019, was identified by MALDI-TOF to the species level. Antimicrobial susceptibility testing was performed using the Phoenix BD NMIC-502 Panel, E-test, and broth microdilution methods. The presence of a metallo-ß-lactamase (MBL) was verified by PCR and immunochromatographic assays. The genetic location of the MBL was confirmed using S1-pulsed-field gel electrophoresis (S1-PFGE) followed by Southern blot hybridization. Whole genome sequencing (WGS) was completed using the Miseq and MinION platforms, followed by core-genome MLST (cgMLST) and seven-locus MLST analysis. The CRAB was assigned ST85 (Pasteur scheme) and ST957 (Oxford scheme) representing international clone (IC) 9 and harbored the intrinsic ß-lactamase OXA-94 with ISAba1 upstream of it, and the MBL bla NDM-6. Hybridization experiments revealed that the bla NDM-6 was encoded on the chromosome. Using WGS the bla NDM-6 environment could be identified arranged in the following order: ISAba14, aphA6, ISAba125, bla NDM-6, ble MBL, trpF, dsbC, cutA, and ISAba14. Downstream, a 10,462 bp duplication was identified, including a second copy of bla NDM-6 in the following genetic composition: ISAba125, bla NDM-6, ble MBL, trpF, dsbC, cutA, and ISAba14. To our knowledge, this is the first description of bla NDM-6 in A. baumannii. The MBL was present in two copies in the chromosome in a new genetic environment associated with IS elements highlighting the contribution of mobile genetic elements in the dissemination of this gene.
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BACKGROUND: Treatment of gonorrhoea is threatened by antimicrobial resistance, and decreased susceptibility to recommended therapies is emerging. Thus, gonococcal infection (GI) is becoming a public health problem. The objectives of the present study were to monitor the antimicrobial sensitivity in Neisseria gonorrhoeae (NG) during 2011-2015 and to study their genogroups. METHODS: Antimicrobial susceptibility was studied by disc diffusion, in addition to the agar dilution method for cefixime and ceftriaxone and the Etest® for azithromycin. Genotyping was performed by the NG multi-antigen sequence typing (NG-MAST) method. Genogroups of closely related sequence types (STs) were defined. RESULTS: All the strains were susceptible to cefixime, ceftriaxone and gentamicin and 1.8% of the strains were resistant to azithromycin. A total of 531 STs and 6 genotypes (Gs) were identified during 2012-2015 period. G2992 was the largest and was associated with resistance to azithromycin, and with men who have sex with men (MSM), alongside G2400. G1407 and G2400 strains were related to high minimum inhibitory concentration (MICs) to cefixime and G1407 also to ceftriaxone. For the first time, G1861 and G2018 were described and associated with ciprofloxacin resistance and G2018 also with high MICs to ceftriaxone. CONCLUSION: Molecular typing is a useful tool to predict antimicrobial resistance. These results show the need to develop novel antimicrobials or to design new antimicrobial therapies based on drugs that show their efficacy against GI. This also highlights the importance of developing sexually transmitted infection (STI) surveillance in homosexual populations.
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Gonorrea , Minorías Sexuales y de Género , Antibacterianos/farmacología , Técnicas de Tipificación Bacteriana , Genotipo , Gonorrea/epidemiología , Gonorrea/microbiología , Homosexualidad Masculina , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae/clasificación , Neisseria gonorrhoeae/efectos de los fármacos , EspañaRESUMEN
Introducción: El urocultivo como gold standard para diagnóstico de infección del tracto urinario (ITU) supone una carga de trabajo considerable en los Servicios de Microbiología Clínica, debido al elevado número de muestras recibidas que finalmente serán negativas. Por ello, utilizar sistemas de cribado que además reduzcan el tiempo de respuesta del diagnóstico de ITU es necesario. El nuevo citómetro de flujo UF-5000 (Sysmex Corporation) es capaz de diferenciar entre bacterias gramnegativas y grampositivas mediante el parámetro BACT-info según el fabricante. El objetivo de nuestro estudio fue evaluar la capacidad de discriminación gram del citómetro UF-5000. Métodos: Estudio prospectivo de 449 orinas recogidas de forma consecutiva, en el período 7/3/2022-27/5/2022, en las que se comparó el flag BACT-info con el urocultivo como método de referencia. Resultados: La sensibilidad obtenida tanto para bacterias gramnegativas como positivas fue superior al 95%. Sin embargo, en el caso de bacterias grampositivas, el índice Kappa moderado (0,49) y el valor predictivo positivo bajo (37,1%) indicó que la correlación entre el flag BACT-info y el urocultivo no era aceptable, por lo que no sería recomendable informarlo al clínico peticionario. Conclusión: El uso del citómetro UF-5000 supone un adelanto en la orientación etiológica de las ITUs causadas por bacterias gramnegativas. Informar la morfología gram en la muestra de orina reduce el tiempo de respuesta en el diagnóstico microbiológico de ITU, lo que tendría un impacto en la disminución y optimización del tratamiento empírico, y, por ende, en la generación de resistencias antimicrobianas. (AU)
Introduction. Urine culture as a gold standard for the diagnosis of urinary tract infection (UTI) involves a considerable workload in Clinical Microbiology Departments, due to the high number of samples received that will ultimately be negative. Therefore, it is necessary to use screening systems that also reduce the turnaround time for UTI diagnosis. The new flow cytometer UF-5000 (Sysmex Corporation) is able to differentiate between Gram-negative and Gram-positive bacteria using the BACT-info parameter according to manufacturer. The aim of our study was to evaluate the gram discrimination ability of the UF-5000 cytometer. Methods. A prospective study with 449 urine samples collected consecutively was conducted, in the period 7/3/2022- 27/5/2022, in which the BACT-info flag was compared with urine culture as the reference method. Results. The sensitivity obtained for both Gram-negative and Gram-positive bacteria was above 95%. However, for Gram-positive bacteria, the moderate Kappa index (0.49) and the low positive predictive value (37.1%) indicated that the correlation between BACT-info flag and urine culture was not acceptable and should not be reported to the requesting clinician. Conclusion. Implementation of the third generation UF5000 cytometer represents a significant advance in the aetiological orientation of UTIs caused by Gram-negative bacteria. Reporting the Gram morphology in the urine samples reduces the response time in the microbiological diagnosis of UTI, which would have an impact on the reduction and optimisation of empirical treatment, and thus on the generation of antimicrobial resistance. (AU)