Potential clinical use of azithromycin against gastroenteritis-causing pathogens other than Campylobacter.

The activity of azithromycin against enteritis-producing agents other than Campylobacter spp. was studied. The susceptibility to azithromycin, through gradient test, of 88 clinical isolates (51 Salmonella spp., 23 Aeromonas spp., 10 Shigella sonnei and 4 Yersinia enterocolitica) for one year was studied prospectively. The results were compared with the activity of ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin by microdilution. For azithromycin, the minimum inhibitory concentration (MIC) 50 and MIC90 were 4 and 12 mg/l, respectively. Six (6.8%) isolates were simultaneously resistant to ampicillin, trimethoprim- sulfamethoxazole and ciprofloxacin, and 3 (50%) of them presented a MIC >256 mg/l. Azithromycin may be a good empirical therapeutic option for the treatment of bacterial enteritis.

[Presence of Streptococcus bovis in urine samples from patients experiencing symptoms of urinary tract]. / Presencia de Streptococcus bovis en muestras de orina de sujetos con síntomas de infección del aparato urinario.

Given the relevance of proper clinical validation of Streptococcus bovis, we here consider revising its presence in urine samples in order to determine its relative frequency and the pattern of antibiotic susceptibility. The susceptibility to antibiotics of 91 isolates of S. bovis from urine samples was retrospectively reviewed over a period of 4 years (2012-2015). The mean age of patients was 55 years, 81% of whom were women and 37.4% were hospitalized patients suffering from urological diseases (61%). Susceptibility to penicillin, vancomycin and teicoplanin was 97.8%. Due to the fact that S. bovis can be infrequent in urine isolates and given its presence in patients suffering from urological diseases, further pathogenic studies, showing the true ability of this group of bacteria to produce disease, are required.

[Isolated yeast species in urine samples in a Spanish regional hospital]. / Especies de levaduras aisladas en muestras de orina en un hospital regional de España.

Candiduria detection in hospitalized or immunocompromised patients is of great clinical significance. The aim of our study was to describe the isolation frequency of significant species of yeasts in urine samples processed in our hospital during the period 2010- 2013, and to analyze their susceptibility to commonly used antifungal agents. Species identification was performed by seeding on a chromogenic medium, the filamentation test and automated systems (ASM Vitek and MALDI Biotyper), while susceptibility was determined using the ASM Vitek system. Of the 632 yeast isolates in urine, 371 were Candida albicans species and 261 non-C. albicans Candida spp. The species with the highest number of resistant isolates were Candida glabrata and Candida krusei. Based on the results obtained, we believe that species identification and the susceptibility study should be current practice in the laboratories when species other than C. albicans are isolated.

[Etiology of urinary tract infections in our health area and susceptibility profile of the most common uropathogens.] / Etiología de las infecciones urinarias en nuestra área sanitaria y perfil de sensibilidad de los uropatógenos más frecuentes.

BACKGROUND AND OBJECTIVE: Adequate empirical treatment should be established for treatment urinary tract infections, considering the prevalence of the most frequent microorganisms in each geographic area and their susceptibility to different antibiotics. The objective of the study is to analyze the epidemiology of UTIs in our Health Area as well as to understand the antibiotic susceptibility of the most prevalent isolated microorganisms to guide empirical treatment. The objective was to establish a reasoned system for recommending ITU empirical therapy, based on the microorganisms causing episodes assisted in a Regional Hospital, knowing their antibiotic susceptibility. PATIENTS AND METHODS: A descriptive-retrospective study was carried out based on the results of 12,204 urine cultures of the year 2018. The overall empirical activity of the antibiotics tested was calculated, differentiating between episodes of the community and of in patients, adults and children. RESULTS: Escherichia coli was the most frequently isolated microorganism in all studied groups. The following microorganisms in frequency, in adults, were Enterococcus faecalis, Klebsiella pneumoniae and yeasts (8%). In the group of children these were Enterococcus faecalis and Proteus mirabilis. There was no difference in the activity of antibiotics against Escherichia coli, in adults or in children, of the community or in patients, with sensitivityto fosfomycin and nitrofuranto in greater than 96%; at imipenem and piperacillin-tazobactam greater than 94% and third generation cephalosporins greater than 90%. However, the overall empirical activity, without distinction by microorganism, was for fosfomycin 77.96-80.60% in adults and 92.73-94.50% in children; to prevent 77.70-78.74% in adults and 92.36-91.28% in children; for piperacillin-tazobactam of 77.57-80.03% in adults and 89.09-94.04% in children; and for cefotaxime of 53.28-54.76% in adults and 68.73-74.77% in children. CONCLUSIONS: Fosfomycin, piperacillin-tazobactam or imipenem were the best option for empirical treatment without covering all episodes in adults. Each Center must establish a reasoned profile of empirical treatment of the infection, which should also take into account risk factors for a microorganism and clinical severity.

ANTECEDENTES Y OBJETIVO: Se debe establecer un tratamiento empírico adecuado que acabe con la mayor parte de las infecciones del tracto urinario (ITU), teniendo en cuenta la prevalencia de los microorganismos más frecuentes en cada área geográfica y la sensibilidad de estos a los distintos antibióticos. El objetivo del estudio es analizar la epidemiología de las ITU en nuestra Área Sanitaria, así como conocer la sensibilidad antibiótica de los microorganismos aislados más prevalentes para orientar el tratamiento empírico. PACIENTES Y MÉTODOS: Se realizó un estudio descriptivo-retrospectivo a partir de los resultados de12.204 urocultivos del año 2018. Se calculó la actividad empírica global de los antibióticos ensayados, diferenciando entre episodios de la comunidad y de pacientes hospitalizados, adultos y niños. RESULTADOS: Escherichia coli fue el microorganismo más frecuentemente aislado en todos los grupos estudiados. Los siguientes microorganismos en frecuencia, en los adultos, fueron Enterococcus faecalis, Klebsiella pneumoniae y levaduras (8%). En el grupo de los niñosestos fueron Enterococcus faecalis y Proteus mirabilis.N o hubo diferencia en la actividad de los antibióticos frente a Escherichia coli, en adultos o en niños, de la comunidad u o hospitalizado, con sensibilidad a fosfomicina y nitrofurantoína superior al 96%; a imipenem y piperacilina-tazobactam superior al 94% y cefalosporinas de tercera generación superior al 90%. Sin embargo,la actividad empírica global, sin distinción por microorganismo, fue para fosfomicina del 77,96-80,60% en adultos y del 92,73-94,50% en niños; para imipenem del 77,70-78,74% en adultos y del 92,36-91,28% en niños; para piperacilina-tazobactam del 77,57-80,03% en adultos y del 89,09-94,04% en niños; y para cefotaxima del 53,28-54,76% en adultos y del 68,73-74,77% en niños. CONCLUSIONES: Fosfomicina, piperacilina-tazobactame imipenem fueron la mejor opción de tratamiento empírica, sin cubrir todos los episodios en los adultos. Cada centro de trabajo debe establecer un perfil razonado de tratamiento empírico de la infección, que además deben tener en cuenta los factores de riesgo para un microorganismo y la gravedad clínica.

Susceptibility evolution to antibiotics of Enterobacter cloacae, Morganella morganii, Klebsiella aerogenes and Citrobacter freundii involved in urinary tract infections: an 11-year epidemiological surveillance study. / Evolución de la sensibilidad a los antibióticos de Enterobacter cloacae, Morganella morganii, Klebsiella aerogenes y Citrobacter freundii causantes de infecciones del tracto urinario: un estudio de vigilancia epidemiológica de 11 años.

INTRODUCTION: The objective of this study was to analyse the susceptibility to antibiotic of Citrobacter freundii, Klebsiella aerogenes, Enterobacter cloacae, Serratia marcescens, Providencia stuartii and Morganella morganii (CESPM group), detected in urine cultures. METHODS: Between 2006 and 2016 we analyzed CESPM group Enterobacteria isolated from urine cultures from both primary health-care centers and Hospital Virgen de las Nieves (Granada). We studied the susceptibility to aminoglycosides, fosfomycin, nitrofurantoin, quinolones, piperacillin/tazobactam, cefepime, imipenem and trimethoprim/sulfamethoxazole following CLSI interpretation criteria. RESULTS: A total of 736 isolates were studied: 30.57% E. cloacae, 23.50% M. morganii, 20.38% K. aerogenes, 10.32% C. freundii, 8.83% S. marcescens and 6.38% P. stuartii. A significant decrease in the antibiotic susceptibility was observed. Gentamicin, ciprofloxacin, imipenem and cefepime showed susceptibility over 80%. CONCLUSIONS: E. cloacae, M. morganii and K. aerogenes were the most common isolates. Cefepime and imipenem are still a good empiric therapeutic alternative given its activity in vitro.

High clinical impact of rapid susceptibility testing on CHROMID ESBL® medium directly from swabs.

BACKGROUND: Antibiotic resistance is a serious public health challenge exacerbated by the widespread use of ß-lactam and glycopeptide antibiotics. The identification of resistances is crucial, and CHROMID ESBL medium has been developed to detect enterobacteria with extended-spectrum ß-lactamases (ESBL). The objective of this study was to evaluate the potential of this medium to detect other types of resistant bacteria. METHODS: Vancomycin, cefoxitin, imipenem, and cefepime disks were used to measure growth on CHROMID ESBL medium of ß-lactam-resistant Gram-negative (83 with ESBL, 57 with carbapenemases, 35 with AmpC and 3 Stenotrophomonas maltophilia) and Gram-positive [37 vancomycin-susceptible (vancoS) microorganisms and 21 vancomycin-resistant (vancoR) Enterococcus faecium] clinical isolates (retrospective study) and colonization by the aforementioned bacteria (prospective study), using 649 rectal swabs, 314 pharyngeal swabs, and 44 swabs from other localizations. RESULTS: Retrospective study: species grown on the medium exhibited different colors. Growth on the medium was observed for: all ESBL enterobacteria, which were susceptible to imipenem and cefoxitin; 95% of isolates with carbapenemases, mostly resistant to imipenem; 80% of those with AmpC; 86% of vancoR E. faecium isolates; and 42% of vancoS E. faecalis isolates, with large growth inhibition halos around the vancomycin disk. Prospective study: vancoR E. faecium, ESBL Klebsiella, Pseudomonas with carbapenemases, A. baumannii (mostly from rectal swabs), S. maltophilia, Achromobacter xylosoxidans, and Burkholderia cenocepacia (mostly from pharyngeal swabs) were isolated from the 246 positive samples. CONCLUSIONS: CHROMID ESBL medium permitted the differential growth of Gram-negative bacteria, many with ESBL and carbapenemases. ESBL enterobacteria were susceptible to imipenem, carbapenemase-producing microorganisms grew around the imipenem disk, and vancoR E. faecium was isolated on the medium. Results of the prospective study demonstrate the potential clinical relevance of this medium. S. maltophilia was more frequently detected with pharyngeal swabs and ESBL Klebsiella, A. baumannii, and Pseudomonas with rectal swabs.

[Chronic bacterial prostatitis. Clinical and microbiological study of 332 cases]. / Prostatitis crónica bacteriana. Estudio clínico y microbiológico de 332 casos.

BACKGROUND AND OBJECTIVE: Chronic bacterial prostatitis (CBP) is characterized by long-lasting symptoms, frequently associated with psychosomatic disorders. The objective of the study was to study PCB in our environment clinically and microbiologically. METHODS: Between January 2013 and December 2014 761 patients with suspected CBP were studied. Of these patients 332 (43.6%) underwent a complete microbiological study and the major clinical signs and symptoms were collected. RESULTS: Eighteen point four percent of patients were diagnosed microbiologically with CBP, Enterococcus faecalis being the main aetiologic agent (37.7%), followed by Escherichia coli (22.2%). Ninety-six point seven percent of the CBP had positive semen cultures, while only 22.9% had positive urine post-semen cultures. Data of sensitivity, specificity, positive predictive value and negative predictive value of semen were 96.7%, 95.9%, 84.3% and 99.3%, respectively and urine post-semen 22.9%, 99.3%, 87.5% and 85.1%, respectively. Testicular perineum pain (44.3%), ejaculatory discomfort (27.9%) and haemospermia (26.2%) were highlighted as the patients' main clinical manifestations. CONCLUSIONS: Fractionated culture for the microbiological diagnosis of CBP could be simplified by the culture of urine pre-semen and semen, without the need for the culture of urine post-semen. The main aetiologic agent of CBP in our media was Enterococcus faecalis, followed by Escherichia coli.

Presencia de Streptococcus bovis en muestras de orina de sujetos con síntomas de infección del aparato urinario / Presence of Streptococcus bovis in urine samples from patients experiencing symptoms of urinary tract

Dada la importancia de la correcta validación clínica de los aislamientos de Streptococcus bovis, nos planteamos la revisión de su presencia en muestras de orina con el objetivo de conocer su frecuencia relativa y su patrón de sensibilidad antibiótica. Se revisó retrospectivamente la sensibilidad a los antibióticos de 91 aislados de S. bovis recuperados de muestras de orina durante un período de 4 años (2012-2015). La media de la edad de los pacientes fue de 55 años y en su mayoría fueron mujeres (81%). El 37,4% eran pacientes hospitalizados con enfermedades urológicas (61%). La sensibilidad a penicilina, vancomicina y teicoplanina fue del 97,8%. Aunque S. bovis puede ser poco común en los aislamientos de orina, su presencia en sujetos con enfermedades de base justifica la realización de estudios de patogenicidad que demuestren la verdadera capacidad de producir enfermedad de este grupo de bacterias.

Given the relevance of proper clinical validation of Streptococcus bovis, we here consider revising its presence in urine samples in order to determine its relative frequency and the pattern of antibiotic susceptibility. The susceptibility to antibiotics of 91 isolates of S. bovis from urine samples was retrospectively reviewed over a period of 4 years (2012-2015). The mean age of patients was 55 years, 81% of whom were women and 37.4% were hospitalized patients suffering from urological diseases (61%). Susceptibility to penicillin, vancomycin and teicoplanin was 97.8%. Due to the fact that S. bovis can be infrequent in urine isolates and given its presence in patients suffering from urological diseases, further pathogenic studies, showing the true ability of this group of bacteria to produce disease, are required.

Especies de levaduras aisladas en muestras de orina en un hospital regional de España / Isolated yeast species in urine samples in a Spanish regional hospital

La detección de candiduria en pacientes hospitalizados o inmunodeprimidos tiene una gran relevancia clínica. El objetivo de nuestro trabajo fue describir la frecuencia de aislamiento de diferentes especies significativas de levaduras en las muestras de orina procesadas en nuestro hospital en el periodo 2010-2013 y analizar su sensibilidad a los antifúngicos de uso habitual. La identificación de especies se realizó por siembra en un medio cromogénico, prueba de filamentación y sistemas automatizados (ASM Vitek y MALDI Biotyper), mientras que la sensibilidad a los antifúngicos se determinó con el sistema ASM Vitek. De los 632 aislamientos de levaduras obtenidos, 371 fueron Candida albicans y 261 especies de Candida no C. albicans. Las especies con mayor número de aislados resistentes fueron Candida glabrata y Candida krusei. Basados en nuestros resultados, consideramos que la identificación de la especie y el estudio de la sensibilidad a los antifúngicos deberían ser prácticas habituales por parte de los laboratorios cuando se aíslan especies diferentes a C. albicans

Candiduria detection in hospitalized or immunocompromised patients is of great clinical significance. The aim of our study was to describe the isolation frequency of significant species of yeasts in urine samples processed in our hospital during the period 2010- 2013, and to analyze their susceptibility to commonly used antifungal agents. Species identification was performed by seeding on a chromogenic medium, the filamentation test and automated systems (ASM Vitek and MALDI Biotyper), while susceptibility was determined using the ASM Vitek system. Of the 632 yeast isolates in urine, 371 were Candida albicans species and 261 non-C. albicans Candida spp. The species with the highest number of resistant isolates were Candida glabrata and Candida krusei. Based on the results obtained, we believe that species identification and the susceptibility study should be current practice in the laboratories when species other than C. albicans are isolated