Surveillance of listeriosis in Navarre, Spain, 1995-2005--epidemiological patterns and characterisation of clinical and food isolates.

We monitored the incidence of human listeriosis in Navarre, a region in north of Spain between 1995 and 2005, and carried out the characterisation of Listeria monocytogenes isolates obtained from clinical samples and ready-to-eat products (sliced cooked meat, smoked salmon and liver pate). The active surveillance requesting hospitals to notify all listeriosis cases (n=40) yielded higher incidence rates (average annual rate 0.65/100,000 inhabitants, range 0.18-1.18/100,000 inhabitants) than expected. Pregnant women were the largest group affected (n=13, 32.5% of the cases), with a peak in incidence during the last three years of the study period. From the 40 human cases we obtained 33 Listeria isolates. Serological and molecular characterisation by PFGE identified 20 different pulsotypes, which on three occasions enabled us to link sporadic cases into clusters. Although we could not identify the incriminated food product we found two clinical pulsotypes among smoked salmon and cooked meat isolates. Surveillance of listeriosis in Spain should be improved and coordinated with other European Union Member States in order to better estimate the burden of disease and to prevent foodborne outbreaks.

[In vitro activity of ertapenem against clinical bacterial isolates in 69 Spanish medical centers (E-test study)]. / Actividad in vitro de ertapenem frente a cepas bacterianas clínicas aisladas en 69 centros médicos españoles (Estudio E-test).

This study was conducted to assess the in vitro activity of ertapenem against clinical bacterial isolates from patients with community-acquired intra-abdominal and lower tract respiratory infections in Spain in 2003. As the study was conducted before the marketing of ertapenem, it was also useful to define a baseline susceptibility pattern for ertapenem in each of the participating hospitals for later surveillance studies. Each partipating site identified a variable number of aerobic and facultative bacteria isolated from patients with community-acquired intra-abdominal infection or pneumonia using standard procedures. E-test strips were used for determining the minimum inhibitory concentration (MIC) of ertapenem, while for other antimicrobials either quantitative dilution techniques or qualitative diffusion procedures were used according to each microbiology laboratory's routine practice. MIC breakpoints for categorization of susceptibility provided by the CLSI were used for interpreting MIC values. A total of 2,901 recent clinical isolates from patients with community-acquired intra-abdominal infection or pneumonia hospitalized in 69 Spanish medical centers were tested. These isolates included 2,039 Gram-negative bacteria (1,646 Enterobacteriaceae, 216 Haemophilus, 123 non-fermenting Gram-negative bacteria [NFGNB] and 54 others) and 862 Gram-positive bacteria (556 pneumococci, 159 staphylococci, 96 streptococci other than S. pneumoniae, 44 enterococci and 7 others). Ertapenem was very active in vitro against Enterobacteriaceae (99.8% susceptible), Haemophilus (96.3% susceptible), pneumococci (99.6% susceptible, of which 31% were penicillin non-susceptible strains), streptococci other than S. pneumoniae (99.0% susceptible) and methicillin-susceptible staphylococci (94.8% susceptible). For other Gram-positive and Gram-negative pathogens for which ertapenem susceptible breakpoints have not been defined, MIC(90) values were 0.38 and 0.064 mg/l, respectively. As expected, ertapenem had minimal activity in vitro against NFGNB, enterococci and methicillin-resistant staphylococci (MIC(90) of >32 mg/l for all three). Ertapenem was highly active in vitro against most bacteria isolated from patients with community-acquired intra-abdominal and lower respiratory tract infections.

[Microbiology of tuberculosis]. / Microbiología de la tuberculosis.

For a century, the diagnosis of tuberculosis, based on bacilloscopy and the isolation and identification of Mycobacterium tuberculosis in cultures, has been slow and not very sensitive. This has made it necessary on occasions to initiate treatment with tuberculostatics in an empirical way. The routine incorporation of liquid mediums and molecular genetic techniques in the final decade of the XX century brought an important advance by clearly increasing the sensitivity, precision and rapidity of diagnosis. The present blossoming of molecular techniques is making possible a better understanding of the disease's epidemiology, the factors of virulence and the mechanisms of resistance, which in the near future will give rise to new strategies of prevention and for treating the disease.

[Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)]. / Evolución en las características epidemiológicas de la tuberculosis en Navarra (1994-2003).

AIM: To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. METHODS: The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. RESULTS: The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. CONCLUSION: There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population.

Evaluation of the MB/BacT system compared with Middlebrook 7H11 and Lowenstein-Jensen media for detection and recovery of mycobacteria from clinical specimens.

MB/BacT vials (an automated system), Middlebrook 7H11 agar plates with the microcolony method for growth detection, and conventional Lowenstein-Jensen egg-based medium were assessed for their rates of recovery, time to detection and ease in aiding the identification of mycobacterial isolates. Of the 2101 consecutive, non-selected specimens for tuberculosis analysed in the laboratory, 158 (7.5%) yielded growth of 159 mycobacteria on at least one of the three media, comprising 111 Mycobacterium tuberculosis and 48 non-tuberculous mycobacteria. Of the 111 specimens positive for M. tuberculosis, 100 isolates were recovered from MB/BacT vials, 99 from M7H11 agar plates, and 86 from Lowenstein-Jensen tubes. The combination of MB/BacT and M7H11 recovered 110 isolates of M. tuberculosis, 107 from M7H11 and Lowenstein-Jensen, and 105 from MB/BacT plus Lowenstein-Jensen. The average time to detection of M. tuberculosis was 11 days with M7H11 using the microcolony method, 16 days with MB/BacT, and 19.5 days with the conventional Lowenstein-Jensen method. The MB/BacT vials recovered greater numbers of non-tuberculous mycobacteria than either of the other two media, but these were considered mostly to be saprophytes. It was concluded that a combination of media was better than a single medium. None of the media combinations showed statistical differences. Use of M7H11 with the microcolony method, which shortens the detection time for mycobacteria and facilitates the detection of mixed cultures, together with the Lowenstein-Jensen tube, was a useful combination.

[Acute fever due to rats]. / Fiebre aguda por mordedura de rata.

The bite of a rat can transmit diverse micro-organisms; however, the development of health measures and the improved conditions of habitability of homes have meant that the infectious diseases transmitted by the aggressions of these animals are infrequent in industrialised countries. In occasional circumstances this type of aggression can still take place, especially in depressed areas on the periphery of big cities and in uninhabited premises, this being a possibility that it is advisable to bear in mind. The case is presented of fever due to a rat bite in a patient who was attacked while cleaning an industrial premise. The evolution of the clinical picture was typical, with Streptobacillus moniliformis isolated as the causal agent, and the picture was controlled with doxicycline without complications arising.

[Antibiotic sensitivity and treatment recommendations for Streptococcus pneumoniae]. / Sensibilidad antibiótica y recomendaciones de tratamiento para Streptococcus pneumoniae.

The aims of present paper were to determine the susceptibility of the strains to the most usual antibiotics in clinical practice and to review the current recommendations to guide the most appropriate treatment. During the period october 2000 to september 2002, the patient's data (age and sex), source of the sample, diagnosis and antibiotic susceptibility were collected on Streptococcus pneumoniae isolates from microbiology laboratories in the Navarra region (555.829 inhabitants). Four hundred and sixty five isolates were identified (166 from invasive infections). Generally, isolates from ear swabs were the most resistant to the antimicrobials tested, while those from blood culture were the most susceptible. Of the Streptococcus pneumoniae tested, 43% were resistant to penicillin, 6.1% to amoxicillin and 6.6% to cefotaxime. Of the 36.3% of Streptococcus pneumoniae isolates that were resistant to erythromycin, 85.45% exhibited the MLSB phenotype while the remaining 14.55% presented with the M phenotype. Multiple-resistance was detected in 32.3% of the strains. The antibiotic resistance rates to beta-lactams (specially penicillin, amoxicillin and cefotaxime/ceftrixone) in Streptococcus pneumoniae don't prevent its clinical use for the most of Streptococcus pneumoniae isolated in our area, except for pneumococcal meningitis.

[Acute sinusitis, bacteremia and meningitis caused by group F beta-hemolytic Streptococcus]. / Sinusitis, bacteriemia y meningitis aguda por Streptococcus betahemolítico del grupo F.

A 32-year old man without immunodepression developed sinusitis followed by acute pyogenic meningitis and beta-hemolytic Streptococcus group F bacteremia. Amplicillin treatment produced a favorable outcome with sequela of righ neurosensorial deafness. Beta-hemolytic Streptococcus group F meningitis, sinusitis and bacteremia is a rare association.

[M. tuberculosis complex drug resistance in Navarre: differences between the local and immigrant populations]. / Resistencias de M. tuberculosis complex en Navarra: diferencias entre población autóctona e inmigrante (2000-2007).

BACKGROUND: Tuberculosis is an important public health problem, whose epidemiology in our country has changed in recent years due to the increase in the immigrant population. The aim of this article is to evaluate the frequency of resistance to the four principal antitubercular drugs in both the local and immigrant populations. METHODS: A study was made of the antibiograms of 457 isolations of Mycobacterium tuberculosis carried out in the Hospital of Navarre in 2000-2007. The antibiograms were processed using the BACTEC460TB system. RESULTS: Twenty six point three percent of the strains corresponded to immigrants, with a significant increase occurring over the period. The frequencies of resistances to the different antitubercular drugs in the local and immigrant populations respectively were: to at least one 5.6% vs 20.8% (p <0.001); to isoniazid 4.5% vs 14.2% (p <0.001); to streptomycin 2.4% vs 12.6% (p <0.001); to rifampicin 0.9% vs 5% (p <0.05); to ethambutol 0.3% vs 2.5% (p <0.05); and multiresistance 0.3% vs 2.5% (p <0.05). CONCLUSION: There are significant differences between local and immigrant populations in the pattern of resistances of the strains isolated. The immigrant population, due to the high frequency with which resistance is shown to isoniazid, must be treated initially with a pattern of four drugs until the result of the biogram is available.

Changing epidemiology of invasive pneumococcal disease following increased coverage with the heptavalent conjugate vaccine in Navarre, Spain.

The present study evaluated changes in the incidence of invasive pneumococcal disease (IPD) and the pattern of serotypes isolated in Navarre, Spain, after the introduction and increased coverage of the heptavalent pneumococcal conjugate vaccine (PCV7). All cases with isolation of pneumococcus from normally sterile bodily fluids were included. The incidence of IPD in children and adults was compared for the periods 2001-2002 and 2006-2007. By the end of 2002, only 11% of children aged <5 years had received any dose of PCV7, whereas, beginning in 2007, the proportion exceeded 50%. Among the cases of IPD aged <5 years, the percentage of those vaccinated increased from 7% during 2001-2002 to 53% during 2006-2007 (p <0.001). The incidence of IPD from PCV7-serotypes decreased by 85% in children <5 years (p <0.001), by 45% in the population aged 5-64 years (p 0.10) and by 68% in those >or=65 years (p 0.004). By contrast, the incidence of IPD from non-PCV7 serotypes increased by 40% overall (p 0.006). The incidence of IPD from all serotypes did not change significantly in children <5 years (from 83 to 72 per 100 000) or in the total population (from 15.8 to 16.3 per 100 000). The percentage of cases as a result of serotypes 7 and 19A increased significantly in both children and adults. No significant changes were seen in the clinical forms of IPD. The pattern of serotypes causing IPD has changed, in both children and adults, following the increased coverage of PCV7, although the incidence has been reduced only slightly.

A large Legionnaires' disease outbreak in Pamplona, Spain: early detection, rapid control and no case fatality.

An outbreak of Legionnaire's disease was detected in Pamplona, Spain, on 1 June 2006. Patients with pneumonia were tested to detect Legionella pneumophila antigen in urine (Binax Now; Binax Inc., Scarborough, ME, USA), and all 146 confirmed cases were interviewed. The outbreak was related to district 2 (22 012 inhabitants), where 45% of the cases lived and 50% had visited; 5% lived in neighbouring districts. The highest incidence was found in the resident population of district 2 (3/1000 inhabitants), section 2 (14/1000). All 31 cooling towers of district 2 were analysed. L. pneumophila antigen (Binax Now) was detected in four towers, which were closed on 2 June. Only the strain isolated in a tower situated in section 2 of district 2 matched all five clinical isolates, as assessed by mAb and two genotyping methods, AFLP and PFGE. Eight days after closing the towers, new cases ceased appearing. Early detection and rapid coordinated medical and environmental actions permitted immediate control of the outbreak and probably contributed to the null case fatality.

[Evaluation of the treatment with oral ciprofloxacin: experience with 24 patients]. / Evaluación del tratamiento oral con ciprofloxacina: experiencia en 24 pacientes.

We have evaluated the clinical effectiveness and possible side effects of oral ciprofloxacin therapy in 24 patients (11 females and 13 males). Two episodes from overall 25 infections were excluded of clinical and microbiological evaluation but were assessed regarding possible side effects. In most patients, the clinical condition was stable at the beginning of therapy. Only 3 patients had nonfatal diseases. Seventeen episodes were urinary tract infections (four of them with concomitant bacteremia), four chronic osteomyelitis, and two severe soft tissue infections; 21 episodes were monomicrobial, and two polymicrobial. The isolated organisms were mostly aerobic gram negative bacilli or facultative anaerobes: E. coli (9), Pseudomonas aeruginosa (5), Proteus mirabilis (5), Serratia marcescens (1), Klebsiella pneumoniae (1), Pseudomonas stutzeri (1), and Acinetobacter calcoaceticus (1). There were only two gram positive isolates: Staphylococcus aureus (1) and Staphylococcus epidermidis (1). The overall clinical response rate was 91%. Gastrointestinal tolerance was excellent. Colonization by Candida or Enterococcus developed in 3 cases (13%), and only one of them developed superinfection. Four patients developed several nervous system abnormalities, two increased transaminase activity and one drug exanthema. Ciprofloxacin appears as an effective drug for the monotherapy of several bacterial infections, including severe enterobacteriaceae and Pseudomonas infections.

Resistencias de M. tuberculosis complex en Navarra: diferencias entre población autóctona e inmigrante (2000-2007) / M. tuberculosis complex drug resistance in Navarre: differences between the local and immigrant populations

Fundamento. La tuberculosis es un importante problemade salud pública, cuya epidemiología ha cambiadoen los últimos años en nuestro país debido al aumentode población inmigrante. El objetivo de este trabajo hasido valorar la frecuencia de resistencias a los cuatroantituberculosos principales, tanto en población autóctonacomo inmigrante.Material y métodos. Se han estudiado los antibiogramasde 457 aislamientos de Mycobacterium tuberculosisrealizados en el Hospital de Navarra en el periodo 2000-2007. Los antibiogramas fueron procesados mediante elsistema BACTEC460TB.Resultados. El 26,3% de las cepas correspondieron a inmigrantes,produciéndose a lo largo del periodo un incrementosignificativo. Las frecuencias de resistenciasa los distintos fármacos antituberculosos en poblaciónautóctona e inmigrante, respectivamente fueron: a almenos uno 5,6% vs 20,8% (p <0,001), a isoniacida 4,5%vs 14,2% (p <0,001), a estreptomicina 2,4% vs 12,5% (p<0,001), a rifampicina 0,9% vs 5% (p <0,05), a etambutol0,3% vs 2,5% (p <0,05) y multirresistencia 0,3% vs 2,5%(p <0,05).Conclusión. Existen diferencias significativas entre lapoblación autóctona e inmigrante en el patrón de resistenciasde las cepas aisladas. Esta última, debidoa la alta frecuencia con que presenta resistencia a laisoniacida, debe tratarse inicialmente con una pautade cuatro fármacos hasta disponer del resultado del antibiograma(AU)

Background. Tuberculosis is an important publichealth problem, whose epidemiology in our countryhas changed in recent years due to the increase in theimmigrant population. The aim of this article is to evaluatethe frequency of resistance to the four principalantitubercular drugs in both the local and immigrantpopulations.Methods. A study was made of the antibiograms of 457isolations of Mycobacterium tuberculosis carried out inthe Hospital of Navarre in 2000-2007. The antibiogramswere processed using the BACTEC460TB system.Results. Twenty six point three percent of the strainscorresponded to immigrants, with a significant increaseoccurring over the period. The frequencies of resistancesto the different antitubercular drugs in the local andimmigrant populations respectively were: to at leastone 5.6% vs 20.8% (p <0.001); to isoniazid 4.5% vs 14.2%(p <0.001); to streptomycin 2.4% vs 12.5% (p <0.001);to rifampicin 0.9% vs 5% (p <0.05); to ethambutol 0.3%vs 2.5% (p <0.05); and multiresistance 0.3% vs 2.5% (p<0.05).Conclusion. There are significant differences betweenlocal and immigrant populations in the pattern of resistancesof the strains isolated. The immigrant population,due to the high frequency with which resistanceis shown to isoniazid, must be treated initially with apattern of four drugs until the result of the biogram is available(AU)