RESUMEN
The capacity of Candida spp. to form biofilms allows them to attach either to living or inert surfaces, promoting their persistence in hospital environments. In a previous study, we reported strain-to-strain variations in Candida spp. biofilm development, suggesting that some genotypes may be greater biofilm formers than others. In this study, we hypothesize that isolates pertaining to clusters may be found more frequently in the environment due to their ability to form biofilms compared to singleton genotypes. Two hundred and thirty-nine Candida spp. isolates (78 clusters) from candidemia patients admitted to 16 hospitals located in different cities and countries-and the same number of singleton genotypes used as controls-were tested in terms of biofilm formation using the crystal violet and the XTT reduction assays. Candida albicans clusters showed higher biofilm formation in comparison to singleton genotypes (P < .01). The biofilms formed by intra-hospital C. albicans clusters showed higher metabolic activity (P < .05). Furthermore, marked variability was found among species and type of cluster. We observed that the higher the number of isolates, the higher the variability of biofilm production by isolates within the cluster, suggesting that the production of biofilm by isolates of the same genotype is quite diverse and does not depend on the type of cluster studied. In conclusion, candidemia Candida spp. clusters-particularly in the case of C. albicans-show significantly more biomass production and metabolic activity than singleton genotypes.
Asunto(s)
Biopelículas/crecimiento & desarrollo , Candida albicans/crecimiento & desarrollo , Candida albicans/genética , Candida parapsilosis/crecimiento & desarrollo , Candida parapsilosis/genética , Candida tropicalis/crecimiento & desarrollo , Candida tropicalis/genética , Brasil , Dinamarca , Variación Genética , Genotipo , Humanos , Italia , EspañaRESUMEN
BACKGROUND: Streptococcus tigurinus was recently described as a new streptococcal species within the viridans group streptococci (VGS). The objectives of the present work were to analyse the clinical and microbiological characteristics of S. tigurinus isolated from patients with bacteraemias, to determine the prevalence of S. tigurinus among VGS endocarditis in Spain, and to compare the clinical characteristics and outcomes of endocarditis caused by S. tigurinus and other VGS. METHODS: Retrospective nationwide study, performed between 2008 and 2016 in 9 Spanish hospitals from 7 different provinces comprising 237 cases of infective endocarditis. Streptococcal isolates were identified by sequencing fragments of their 16S rRNA, sodA and groEL genes. Clinical data of patients with streptococcal endocarditis were prospectively collected according to a pre-established protocol. RESULTS: Patients with endocarditis represented 7/9 (77.8%) and 26/86 (30.2%) of the bacteraemias caused by S. tigurinus and other VGS, respectively (p < 0.001), in two of the hospital participants. Among patients with streptococcal endocarditis, 12 different Streptococcus species were recognized being S. oralis, S. tigurinus and S. mitis the three more common. No relevant statistical differences were observed in the clinical characteristics and outcomes of endocarditis caused by the different VGS species. CONCLUSIONS: In this multicenter study performed in Spain, S. tigurinus showed a higher predilection for the endocardial endothelium as compared to other VGS. However, clinical characteristics and outcomes of endocarditis caused by S. tigurinus did not significantly differ from endocarditis caused by other oral streptococci.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/epidemiología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/epidemiología , Estreptococos Viridans/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/diagnóstico , Bacteriemia/epidemiología , Bacteriemia/microbiología , Endocarditis Bacteriana/microbiología , Monitoreo Epidemiológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , España/epidemiología , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Estreptococos Viridans/clasificación , Estreptococos Viridans/fisiología , Adulto JovenRESUMEN
A 59-year-old Caucasian male presented with progressive dyspnea, arthralgias and fever for three days. A diastolic regurgitation murmur was detected in the aortic area. A transesophageal echocardiograph showed several vegetations and severe aortic regurgitation. Blood cultures yielded Neisseria gonorrhoeae beta-lactamase negative. The patient had not noticed any urogenital discomfort or urethral discharge. The patient successfully underwent surgery for septal abscess debridement. The patient received ceftriaxone 2 g bid for eight weeks and the clinical follow-up was uneventful. The review of the literature revealed a total of the 38 additional cases reported between 1980 and the present. The majority of the patients were young, male and with native valve involvement. There has been a clear tendency for left-sided valve involvement (especially in the aortic valve). All valve cultures were reported negative despite, in most cases, the marked tissue destruction. Polymerase chain reaction was performed in two patients and positive results were shown in both. Cultures of exudates from other locations were negative in most cases. One striking fact is the high proportion of patients who underwent surgery (72 %). Information regarding antibiotic sensitivity was available in 28 cases, with penicillin resistance reported in six patients (21 %) and intermediate sensitivity in four patients (14 %). Resistance to ciprofloxacin was reported in two cases (7 %). A rapid increase and distribution of isolates resistant to third generation cephalosporins have been recently detected. The mortality is high, particularly taking into account that most were young patients who had not presented previous heart disease.
Asunto(s)
Antibacterianos/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/cirugía , Gonorrea/complicaciones , Neisseria gonorrhoeae/aislamiento & purificación , Recuento de Colonia Microbiana , Farmacorresistencia Bacteriana , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Gonorrea/tratamiento farmacológico , Gonorrea/mortalidad , Gonorrea/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neisseria gonorrhoeae/efectos de los fármacos , Neisseria gonorrhoeae/fisiología , Reacción en Cadena de la Polimerasa , Resultado del TratamientoRESUMEN
The aim of this study was to determine the prevalence and characteristics of non-fluoroquinolone (FQ)-susceptible Streptococcus pyogenes isolates and to study their mechanisms of resistance. We performed a prospective prevalence study with 468 isolates collected from 2005 to 2007 and a retrospective study that was based on the examination of existing data collected from 1999 to 2008. The retrospective study included data for isolates with high-level resistance (HR) to ciprofloxacin (MIC >or= 32 microg/ml) (HR isolates) and isolates with the same emm types as those reported in the literature with low-level resistance (LR) to ciprofloxacin (MICs, 2 to 8 microg/ml) (LR isolates, n = 205). Genetic characterization of the isolates was performed by means of emm typing and multilocus sequence typing. The prevalence of LR ranged from 1.9% in 2005 to 30.8% in 2007. This increase was mainly due to the circulation of an emm6 subtype (emm6.4) that represented 77.1% of the LR isolates in 2007. Notably, another emm6 subtype, also detected in 2007 (emm6.37), showed coresistance to 14- and 15-membered macrolides mediated by the mefA gene. Only three HR isolates were detected (isolates emm68.1/ST247/T3,13,B3264, emm77/ST399/T28, and emm28/ST52/T28), and all were identified in the retrospective study. Overall, the 673 isolates represented 25 emm types. All LR isolates were clustered into two emm types: emm6 (six emm6 subtypes) and emm75. All the 156 emm6 isolates had LR, harbored the Ser79/Ala mutation in the parC gene product, and had the same sequence type (ST), ST382. Most (21/33) of the emm75 isolates had LR, showed the Ser79/Phe plus Asp91/Asn double mutation in the parC gene product, and were ST150. The Asp91/Asn mutation by itself did not confer resistance to FQs.
Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Fluoroquinolonas/farmacología , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/efectos de los fármacos , Adulto , Antibacterianos/uso terapéutico , Niño , Femenino , Fluoroquinolonas/uso terapéutico , Genes Bacterianos , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Mutación/genética , Estudios Prospectivos , España/epidemiología , Infecciones Estreptocócicas/etiología , Streptococcus pyogenes/genéticaRESUMEN
The objectives of this study were to gain further insight on Candida genotype distribution and percentage of clustered isolates between hospitals and to identify potential clusters involving different hospitals and cities. We aim to genotype Candida spp. isolates causing candidemia in patients admitted to 16 hospitals in Spain, Italy, Denmark, and Brazil. Eight hundred and eighty-four isolates (Candida albicans, n = 534; C. parapsilosis, n = 282; and C. tropicalis, n = 68) were genotyped using species-specific microsatellite markers. CDC3, EF3, HIS3, CAI, CAIII, and CAVI were used for C. albicans, Ctrm1, Ctrm10, Ctrm12, Ctrm21, Ctrm24, and Ctrm28 for C. tropicalis, and CP1, CP4a, CP6, and B for C. parapsilosis. Genotypes were classified as singletons (genotype only found once) or clusters (same genotype infecting two or more patients). Clusters were defined as intra-hospital (involving patients admitted to a single hospital), intra-ward (involving patients admitted to the same hospital ward) or widespread (involving patients admitted to different hospitals). The percentage of clusters and the proportion of patients involved in clusters among species, genotypic diversity and distribution of genetic diversity were assessed. Seven hundred and twenty-three genotypes were detected, 78 (11%) being clusters, most of which (57.7%; n = 45/78) were intra-hospital clusters including intra-ward ones (42.2%; n = 19/45). The proportion of clusters was not statistically different between species, but the percentage of patients in clusters varied among hospitals. A number of genotypes (7.2%; 52/723) were widespread (found at different hospitals), comprising 66.7% (52/78) of clusters, and involved patients at hospitals in the same city (n = 21) or in different cities (n = 31). Only one C. parapsilosis cluster was a widespread genotype found in all four countries. Around 11% of C. albicans and C. parapsilosis isolates causing candidemia are clusters that may result from patient-to-patient transmission, widespread genotypes commonly found in unrelated patients, or insufficient microsatellite typing genetic discrimination.
Asunto(s)
Candidemia , Antifúngicos , Brasil/epidemiología , Candida/genética , Candidemia/epidemiología , Genotipo , Humanos , Italia/epidemiología , EspañaRESUMEN
OBJECTIVES: To describe trends in fosfomycin resistance in urinary isolates of Escherichia coli producing extended-spectrum beta-lactamases (ESBLs) in relation to fosfomycin consumption and to characterize representative fosfomycin-resistant isolates. METHODS: In 2007-08, an unexpected increase in fosfomycin resistance in ESBL-producing urinary E. coli was observed. Laboratory records were reviewed and a prospective surveillance study was initiated on all urinary tract infections caused by ESBL-producing, fosfomycin-resistant E. coli. bla(ESBL) types, phylogroups, genetic environment and afa/dra operon were determined by PCR and sequencing. Molecular epidemiology was analysed by PFGE and multilocus sequence typing. To elucidate possible mechanisms of fosfomycin resistance, uhpT, glpT, uhpA, ptsI, cyaA and murA genes were analysed. Fosfomycin consumption was determined as recommended by WHO. RESULTS: From 2004 to 2008, fosfomycin consumption increased by 50%, while fosfomycin resistance in ESBL producers increased from 2.2% to 21.7%. Of 26 isolates studied, 24 produced CTX-M-15 and belonged to the O25b-ST131-phylogroup B2 clonal strain. PFGE revealed two clusters. Cluster I included 18 isolates, 16 of them indistinguishable from strains producing CTX-M-15 previously described in Madrid. The five isolates of Cluster II had the IS26 linked to bla(CTX-M-15) and the afa/dra operon. In Cluster I isolates, no mutations in glpT, uhpT, uhpA, ptsI, cyaA and murA were detected. Cluster II isolates showed a 15 bp deletion (A(169)-C(183)) in uhpA. CONCLUSIONS: Fosfomycin resistance in urinary E. coli has increased due to the acquisition of this resistance by a previously circulating CTX-M-15-producing E. coli O25b-ST131-phylogroup B2 strain. This happened during a period when the use of fosfomycin increased by 50%.
Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Infecciones por Escherichia coli/microbiología , Escherichia coli/efectos de los fármacos , Fosfomicina/farmacología , Infecciones Urinarias/microbiología , beta-Lactamasas/biosíntesis , Antibacterianos/uso terapéutico , Técnicas de Tipificación Bacteriana , ADN Bacteriano/genética , Escherichia coli/clasificación , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/epidemiología , Proteínas de Escherichia coli/genética , Fosfomicina/uso terapéutico , Genotipo , Humanos , Reacción en Cadena de la Polimerasa , Prevalencia , Análisis de Secuencia de ADN , Infecciones Urinarias/epidemiologíaAsunto(s)
Fungemia/mortalidad , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Complicaciones Posoperatorias/mortalidad , Rhodotorula/aislamiento & purificación , Adolescente , Adulto , Niño , Femenino , Fungemia/etiología , Fungemia/microbiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/microbiología , Rhodotorula/genética , Adulto JovenRESUMEN
Seventy-four Streptococcus pyogenes isolates showing the macrolide-lincosamide-streptogramin B (MLS(B)) resistance phenotype carrying the ermA gene (72 of which showed the inducible resistance phenotype) were obtained between 1999 and 2004. Seven different sequence types (STs) and emm types were detected: emm22/ST46 (n=33); emm77/ST63 (n=22); emm73/ST331 (n=10); emm94/ST89 (n=6); and one isolate each of emm28/ST52, emm11/ST403 and emm4/ST38. All ST46 isolates were susceptible to tetracycline and almost all reacted against the T12 type (all agglutinated into the T-pattern 3/12/13/B3264). Resistance to tetracycline was observed in all ST63 (tetO+) and ST89 (tetM+) isolates. Most of the ST63 isolates reacted against the T28 type (all agglutinated into the T-pattern 9/13/28). The 74 isolates were grouped into eight pulsed-field gel electrophoresis pulsotypes (one cluster for each emm/ST type, except for emm77/ST63).
Asunto(s)
Proteínas Bacterianas/genética , Farmacorresistencia Bacteriana/genética , Metiltransferasas/genética , Streptococcus pyogenes/genética , Antibacterianos/farmacología , Proteínas Portadoras/genética , Electroforesis en Gel de Campo Pulsado , Eritromicina/farmacología , Humanos , Pruebas de Sensibilidad Microbiana , Filogenia , España , Streptococcus pyogenes/clasificación , Streptococcus pyogenes/efectos de los fármacos , Resistencia a la TetraciclinaRESUMEN
BACKGROUND: The aim of this study was to report the emergence of linezolid-resistant coagulase-negative staphylococci (CoNS) in an intensive care unit. METHODS: An observational study was conducted in critically ill patients with colonization or infection by linezolid-resistant CoNS between January 2010 and December 2014. We analyzed the epidemiological and clinical features, and the mechanism of resistance to linezolid. We also evaluated the association between the incidence of linezolid-resistant CoNS strains and the consumption of linezolid in the study period. RESULTS: During the study period 49 patients had a linezolid-resistant CoNS strain isolated from clinical samples (blood in 42 cases, urine in 6, peritoneal fluid in 1). Molecular study showed a combination of mechanisms of resistance. Most patients were critically ill (APACHE II score = 21.9 ± 8.3) and nearly all had undergone surgery and invasive procedures, and had prior exposure to antibiotics. Linezolid-resistant CoNS were considered to be contaminants in 42 patients and associated with infection in 7 patients, comprising bacteremia and septic shock in most of them. They were successfully treated with glycopeptides or daptomycin. A modest significant correlation was observed between the decrease in linezolid consumption and the lower incidence of resistant isolates. CONCLUSIONS: Linezolid-resistant CoNS had emerged in critically ill patients with severe underlying diseases and prior antibiotic exposure. Most isolates represented colonization; however, linezolid-resistant CoNS can produce serious infections in critically ill patients. Glycopeptides and daptomycin seem to provide useful alternatives for therapy of these infections. A relationship was found between linezolid consumption and the incidence of linezolid-resistant CoNS strains.
Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana/genética , Unidades de Cuidados Intensivos/estadística & datos numéricos , Linezolid/farmacología , Infecciones Estafilocócicas/microbiología , Staphylococcus/efectos de los fármacos , Anciano , Bacteriemia/epidemiología , Bacteriemia/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Estafilocócicas/epidemiología , Staphylococcus/genética , Staphylococcus/aislamiento & purificaciónRESUMEN
BACKGROUND: The inappropriate use of antifungals is an important health problem related to increasing adverse effects, unnecessary cost and promotion of resistant and emerging fungal infections. Despite its relevance, many health institutions assign few resources to improve prescribing practices. AIMS: To evaluate the efficiency of an antifungal stewardship programme (ASP) centered on restricted antifungal agents. METHODS: The main activity during the eight-month study was to perform a programmed review of restricted antifungals (lipid formulations of amphotericin B, echinocandins and voriconazole) prescribed in hospitalized patients. In the case of amendable antifungal treatment, a recommendation was included in the electronic medical record. RESULTS: A total of 280 antifungal prescriptions for 262 patients were revised during the study period. The indications were prophylactic in 85 cases (30.4%), pre-emptive in 10 cases (3.5%), empiric in 122 cases (43.6%), and directed in 63 cases (22.5%). A total of 70 prescriptions (25%) in 61 patients were considered to be amendable. In most of these cases, treatment could have been reduced considering the patient's clinical improvement and microbiological results. The most common advice was antifungals change (70%), antifungal withdrawal (21%), removal of one antifungal drug in cases of combined therapy (7%), and switching to oral route (1%). Proposed recommendations were addressed in 28 cases (40%). There was no significant difference in adherence with respect to the type of recommendation (p=0.554). There was a 42% lower use of antifungals during the period of the study compared to that observed during a similar previous period. Mortality among patients who were treated according to the recommendations of the ASP was 17% and in whom treatment was not modified it was 30% (p=0.393). CONCLUSIONS: ASPs centered on hospitalized patients may be an efficient strategy to ameliorate antifungal use in hospitals.
Asunto(s)
Farmacorresistencia Fúngica , Hospitales Universitarios/organización & administración , Micosis/tratamiento farmacológico , Centros de Atención Terciaria/organización & administración , Antifúngicos/uso terapéutico , Líquidos Corporales/microbiología , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Farmacorresistencia Fúngica Múltiple , Sustitución de Medicamentos , Quimioterapia Combinada , Adhesión a Directriz , Departamentos de Hospitales/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Auditoría Médica , Micosis/microbiología , Micosis/mortalidad , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , España , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Bacteriemia/diagnóstico , Bacteriemia/etiología , Cupriavidus/aislamiento & purificación , Colitis Ulcerosa/complicaciones , Bacteriemia/microbiología , Inmunosupresores/uso terapéutico , Bacilos y Cocos Aerobios Gramnegativos/aislamiento & purificación , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Imipenem/uso terapéuticoRESUMEN
Objective. To analyse the clinical presentation of candidaemia in elderly patients. Methods. A comparison of clinical presentation of candidaemia cases was carried out in a Spanish tertiary hospital between January 2010 and September 2015. Results. Forty-five cases (32%) corresponded to elderly patients (≥ 75 years) and 95 cases (68%) to non-elderly patients (16-74 years). A higher proportion of elderly patients presented solid tumour (51% versus 32%, p=0.026) and a lower proportion had undergone solid or hematopoietic transplantation (0% versus 28%, p<0.001). Fewer elderly patients (16 patients, 36%) had a central venous line inserted than non-elderly patients (81 patients, 85%, p<0.001). Isolation of Candida parapsilosis was significantly lower among elderly (13.3%) than among non-elderly patients (32%, p=0.015). Fundoscopy was carried out in 20 elderly (44%) and in 64 younger patients (67%, p=0.009). The proportion of patients who underwent echocardiography was similar in both groups (56% vs 66%, respectively; p=0.218). Adequate antifungal treatment within the first 48 hours was administered in16 elderly patients (36%) and 58 younger patients (61%, p=0.005). Catheter removal was carried out in 9 elderly patients (68.1%) and in 40 non-elderly patients (49%, p=0.544). Mortality was higher among elderly patients (55.6%) than non-elderly patients (36.8%; p=0.037). Conclusions. Elderly patients account for a substantial proportion of patients suffering from candidaemia in recent years. The clinical management of these patients was less appropriate than in younger patients with respect to fundus examination and the prescription of appropriate antifungal treatment. Mortality in elderly patients was higher than in younger patients (AU)
Objetivo. Analizar la presentación clínica de candidemia en pacientes ancianos. Métodos. Se realizó una comparación de la presentación clínica de los casos de candidemia en un hospital terciario español entre enero de 2010 y septiembre de 2015. Resultados. Cuarenta y cinco casos (32%) correspondieron a pacientes ancianos (≥ 75 años) y 95 casos (68%) a pacientes no ancianos (16-74 años). Un número menor de pacientes ancianos (16 pacientes, 36%) portaban un catéter central en comparación con los pacientes más jóvenes (81 pacientes, 85%, p <0,001). El aislamiento de Candida parapsilosis fue significativamente menor entre los ancianos (13,3%) que entre los más jóvenes (32%, p = 0,015). Se realizó exploración del fondo de ojo en 20 ancianos (44%) y en 64 pacientes más jóvenes (67%, p = 0,009). La proporción de pacientes que se sometieron a ecocardiografía fue similar (56% vs 66%, respectivamente, p = 0,218). Se administró tratamiento antimicótico adecuado en las primeras 48 horas en 16 pacientes ancianos (36%) y 58 pacientes más jóvenes (61%, p = 0,005). La retirada del catéter central se realizó en 9 pacientes ancianos (68,1%) y en 40 pacientes no ancianos (49%, p = 0,544). La mortalidad fue mayor entre los pacientes ancianos (55,6%) que los no ancianos (36,8%, p = 0,037). Conclusiones. Los pacientes ancianos representan una proporción sustancial de pacientes que padecen candidemia. El manejo clínico de estos pacientes fue menos apropiado que en pacientes más jóvenes. La mortalidad en pacientes ancianos fue mayor que en pacientes más jóvenes (AU)
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Candidemia/diagnóstico , Candidemia/tratamiento farmacológico , Candida , Candida/aislamiento & purificación , Antifúngicos/uso terapéutico , Candidemia/prevención & control , Cateterismo Venoso Central/tendencias , Cateterismo Venoso CentralRESUMEN
Background. The inappropriate use of antifungals is an important health problem related to increasing adverse effects, unnecessary cost and promotion of resistant and emerging fungal infections. Despite its relevance, many health institutions assign few resources to improve prescribing practices. Aims. To evaluate the efficiency of an antifungal stewardship programme (ASP) centered on restricted antifungal agents. Methods. The main activity during the eight-month study was to perform a programmed review of restricted antifungals (lipid formulations of amphotericin B, echinocandins and voriconazole) prescribed in hospitalized patients. In the case of amendable antifungal treatment, a recommendation was included in the electronic medical record. Results. A total of 280 antifungal prescriptions for 262 patients were revised during the study period. The indications were prophylactic in 85 cases (30.4%), pre-emptive in 10 cases (3.5%), empiric in 122 cases (43.6%), and directed in 63 cases (22.5%). A total of 70 prescriptions (25%) in 61 patients were considered to be amendable. In most of these cases, treatment could have been reduced considering the patient's clinical improvement and microbiological results. The most common advice was antifungals change (70%), antifungal withdrawal (21%), removal of one antifungal drug in cases of combined therapy (7%), and switching to oral route (1%). Proposed recommendations were addressed in 28 cases (40%). There was no significant difference in adherence with respect to the type of recommendation (p = 0.554). There was a 42% lower use of antifungals during the period of the study compared to that observed during a similar previous period. Mortality among patients who were treated according to the recommendations of the ASP was 17% and in whom treatment was not modified it was 30% (p = 0.393). Conclusions. ASPs centered on hospitalized patients may be an efficient strategy to ameliorate antifungal use in hospitals (AU)
Antecedentes. El uso inadecuado de los antifúngicos es un problema de salud relevante que puede incrementar los efectos adversos y generar costes innecesarios, además de favorecer la aparición de resistencias y de infecciones micóticas emergentes. A pesar de su importancia, muchas instituciones sanitarias destinan escasos recursos para mejorar las prácticas de prescripción. Objetivos. Evaluar la eficiencia de un programa de asesoramiento sobre antifúngicos basado en la prescripción de agentes antifúngicos restringidos. Métodos. La principal actividad durante el estudio de ocho meses de duración fue la realización de una revisión programada de antifúngicos restringidos, prescritos en los pacientes hospitalizados (formulaciones lipídicas de anfotericina B, equinocandinas y voriconazol). En el caso del tratamiento antifúngico modificable, se procedió a anotar una recomendación en la historia clínica electrónica. Resultados. Se revisó un total de 280 prescripciones de antifúngicos en 262 pacientes durante el período de estudio. Las indicaciones fueron de tipo profiláctico en 85 casos (30,4%), anticipado en 10 (3,5%), empírico en 122 (43,6%) y dirigido en 63 (22,5%). Se consideraron modificables un total de 70 prescripciones (25%) en 61 pacientes. En la mayoría de estos casos, el tratamiento podía reducirse teniendo en cuenta la mejoría clínica y los resultados microbiológicos del paciente. La indicación más frecuentemente realizada fue el cambio de antifúngico (70%), seguido por la retirada de dicho fármaco (21%), la eliminación de uno de los fármacos antifúngicos en casos de tratamiento combinado (7%) y, finalmente, la sustitución del tratamiento por la administración oral (1%). Las recomendaciones propuestas se aceptaron en 28 casos (40%). No se produjo una diferencia significativa en la adherencia con respecto al tipo de recomendación (p = 0,554). Durante el período de estudio se evidenció un descenso en el uso de antifúngicos del 42%, en comparación con el uso observado en un período previo similar. La mortalidad de los pacientes que fueron tratados de acuerdo con las recomendaciones fue del 17%, y del 30% en aquellos en los que no se modificó el tratamiento (p = 0,393). Conclusiones. El programa de asesoramiento sobre los antifúngicos prescritos en pacientes hospitalizados puede resultar una estrategia eficaz para mejorar el uso de estos fármacos (AU)
Asunto(s)
Humanos , Micosis/tratamiento farmacológico , Antifúngicos/uso terapéutico , Equinocandinas/uso terapéutico , Anfotericina B/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Fluconazol/uso terapéutico , Prescripción Inadecuada/estadística & datos numéricos , Costos de los Medicamentos/estadística & datos numéricosRESUMEN
Cephalosporins resistance is increasing in Escherichia coli in Spain. We characterize infections by E. coli with reduced susceptibility to third-generation cephalosporins (3GCs) with the AmpC phenotype. Between January 2004 and March 2007, 121 E. coli isolates with the AmpC phenotype were collected (4.8% of all the 2538 E. coli isolates with reduced susceptibility to 3GCs). These isolates were further characterized by clinical and molecular analysis. Plasmid-encoded ampC genes were detected in 46 (38%) isolates (43 CMY-2); 75 isolates (62%) had modifications in the chromosomal ampC promoter region (c-AmpC). CMY-2 producers belonged primarily to the more virulent phylogroup D (48.4%), whereas most isolates of c-AmpC belonged to phylogroup A (56.4%). Bacteremia and infections in children were more frequently produced by CMY-2 producers. CMY-2-producing phylogroup D E. coli belonged to 8 multilocus sequence typing types. Three CMY-2 producers belonged to O25b/ST131/B2 clone. Infections caused by E. coli with the AmpC phenotype may be spreading primarily because of CMY-2-producing phylogroup D isolates, although this enzyme was also detected in the O25b/ST131/B2 clone.
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Proteínas Bacterianas/biosíntesis , Técnicas de Tipificación Bacteriana , Dermatoglifia del ADN , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Escherichia coli/clasificación , Escherichia coli/enzimología , beta-Lactamasas/biosíntesis , Adulto , Anciano , Anciano de 80 o más Años , Proteínas Bacterianas/clasificación , Proteínas Bacterianas/genética , Análisis por Conglomerados , Escherichia coli/aislamiento & purificación , Femenino , Genotipo , Humanos , Masculino , Pruebas de Sensibilidad Microbiana/métodos , Persona de Mediana Edad , Epidemiología Molecular , Prevalencia , España/epidemiología , beta-Lactamasas/clasificación , beta-Lactamasas/genéticaRESUMEN
The aim of this study was to describe the genetic characteristics of Streptococcus pyogenes showing the MLSB phenotype of macrolide resistance from 1999 to 2005 in Spain and to highlight the substantial increase in these isolates in the last few years. The antimicrobial susceptibilities of 17,232 group A streptococci isolated from Madrid and Gipuzkoa from 1999 to 2005 were studied. The presence of the resistance genes ermA, ermB, mef, tetM, and tetO and the presence of the intTn and xis genes of the Tn916-Tn1545 transposon family were studied in a sample of 739 MLSB-resistant isolates. The epidemiological relationships among these isolates were analyzed by emm typing, T typing, and multilocus sequence typing. Erythromycin resistance was found in 21.3% of the isolates analyzed (annual variation of 14.3% to 28.9%). Until 2003, most erythromycin-resistant isolates showed the M phenotype, but in 2004 and 2005, about 50% of isolates showed the MLSB phenotype. Among the MLSB-resistant isolates studied, 16 clones were identified. The most prevalent clone was a strange emm11/T11/ST403 clone with a null yqiL allele. All but one of the 463 emm11/T11/ST403 isolates carried the ermB, tetM, intTn, and xis genes. The second most prevalent MLSB-resistant clone was emm28/T28/ST52, which comprised two subclones: one bacitracin-resistant, tetracycline-susceptible subclone carrying the ermB gene (n=115) and another bacitracin-susceptible, tetracycline-resistant subclone carrying the ermB and tetM genes (n=33). The rapid diffusion of these two clones, and especially of emm11/T11/ST403, caused the large increase in MLSB-resistant S. pyogenes isolates in Spain, suggesting a potential ability for international dissemination.
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Farmacorresistencia Bacteriana Múltiple/genética , Macrólidos/farmacología , Infecciones Estreptocócicas/epidemiología , Streptococcus pyogenes/efectos de los fármacos , Streptococcus pyogenes/genética , Genotipo , Humanos , Pruebas de Sensibilidad Microbiana , Fenotipo , España/epidemiología , Infecciones Estreptocócicas/microbiologíaAsunto(s)
Fungemia/microbiología , Rhodotorula , Anciano de 80 o más Años , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Espasmo Bronquial/complicaciones , Infecciones Relacionadas con Catéteres/complicaciones , Infecciones Relacionadas con Catéteres/microbiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Farmacorresistencia Fúngica , Quimioterapia Combinada , Femenino , Fungemia/tratamiento farmacológico , Humanos , Hipertensión/complicaciones , Leucemia Linfocítica Crónica de Células B/complicaciones , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/complicacionesRESUMEN
A total of 151 Escherichia coli strains resistant to cefotaxime and ceftazidime were isolated during a prospective surveillance study. These strains were characterized by clinical, microbiological, and molecular analyses and were distributed into four clusters of 103, 11, 6, and 5 isolates, along with 25 unrelated strains. The principal cluster was isolated from urine, wound, blood, and other samples in three hospitals, eight nursing homes, and a community healthcare center. This cluster was associated with both nosocomial (65%) and community-acquired (35%) infections. Most strains were resistant to ciprofloxacin, gentamicin, tobramycin, cefepime, amoxicillin-clavulanic acid, and trimethoprim-sulfamethoxazole but were susceptible to imipenem. All isolates from the four clusters expressed the extended-spectrum beta-lactamase (ESBL) CTX-M-15. This enzyme was also present in 8 (30.8%) of the 26 unrelated isolates. The other ESBLs, CTX-M-14 and CTX-M-32, were detected in five and seven cases, respectively, but they were detected in individual E. coli isolates only. In three clusters, blaCTX-M-15 alleles were linked to an ISEcp1-like element, while in eight strains of cluster II an IS26 element preceded the blaCTX-M-15 allele. An additional pool of resistance genes included tetA, drfA14 or dfrA17, sul1 or sul2, aac(6')Ib, and aac(3)IIb. All except one of the 27 isolates tested for genetic virulence markers harbored the same three virulence genes: iutA and fyuA (siderophores), and traT (serum survival factor). Epidemic or occasional isolates of cefotaxime- and ceftazidime-resistant E. coli can spread between distinct health facilities including hospitals, community health centers, and long-term care centers.
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Cefotaxima/farmacología , Ceftazidima/farmacología , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/microbiología , Infecciones por Escherichia coli/microbiología , Escherichia coli/efectos de los fármacos , Resistencia betalactámica , Adolescente , Adulto , Antibacterianos/farmacología , Proteínas de la Membrana Bacteriana Externa/genética , Sangre/microbiología , Análisis por Conglomerados , Infecciones Comunitarias Adquiridas/epidemiología , Infección Hospitalaria/epidemiología , Elementos Transponibles de ADN/genética , Escherichia coli/clasificación , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/epidemiología , Proteínas de Escherichia coli/análisis , Proteínas de Escherichia coli/genética , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Epidemiología Molecular , Receptores de Superficie Celular/genética , España , Orina/microbiología , Virulencia/genética , Heridas y Lesiones/microbiología , beta-Lactamasas/análisis , beta-Lactamasas/genéticaRESUMEN
Ten epidemiologically related Yersinia enterocolitica clinical isolates were studied. Six isolates were nalidixic acid resistant (MIC > 512 microg/ml), with mutations in the quinolone resistance-determining region (QRDR) of the gyrA gene, suggesting clonal dissemination of a nalidixic acid-susceptible Y. enterocolitica strain which has acquired different mutations generating resistance to nalidixic acid.
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Antiinfecciosos/farmacología , Girasa de ADN/genética , Farmacorresistencia Bacteriana/genética , Mutación , Ácido Nalidíxico/farmacología , Yersinia enterocolitica/genética , Secuencia de Bases , Topoisomerasa de ADN IV/genética , Humanos , Pruebas de Sensibilidad Microbiana , Datos de Secuencia Molecular , Análisis de Secuencia de ADN , Yersiniosis/epidemiología , Yersiniosis/microbiología , Yersinia enterocolitica/efectos de los fármacosRESUMEN
INTRODUCTION: Streptococcus agalactiae is a well-recognized pathogen in the obstetric population and is a cause of invasive infection in adults with underlying diseases. Nevertheless, the role of S. agalactiae in urinary tract infections in the adult non-pregnant population treated in outpatient health care centers has been less extensively studied. METHODS: The clinical significance of S. agalactiae isolation in urine samples from health care center patients was studied in five areas of Spain over a period of six months. The study protocol included the collection of personal, epidemiological and clinical data. A total of 85 patients were studied; 79 were women (17 pregnant) and 6 men. RESULTS: Pyuria was found in 72.9% of the cases. A total of 26.4% (n = 18) of non-pregnant women and all the men had some type of chronic underlying disease and 35.3% (n = 24) had urinary disease. Among the pregnant women, 53% had asymptomatic bacteriuria and 35.3% had vaginal and/or urethral colonization. Among the group of men and non-pregnant women, the most frequent entity was non-complicated cystitis, seen in 66.1% (45 of 68) of cases, followed by complicated infection in 19.1% and asymptomatic bacteriuria in 11.8%. Of the 45 patients with non-complicated cystitis, 35 (77.7%) were over 40 years old and 19 (42.2%) were over 60 years old. CONCLUSIONS: Among the population of non-pregnant adults treated in outpatient health care centers, S. agalactiae isolation from urine was found mainly in women over 40 years old and was the cause of non-complicated urinary tract infection in more than half of cases.