Widespread dispersion of the resistance element tet(B)::ISCR2 in XDR Acinetobacter baumannii isolates.

Acinetobacter baumannii is a significant nosocomial pathogen often associated with extreme drug resistance (XDR). In Argentina, isolates of A. baumannii resistant to tetracyclines have accounted for more than 40% of drug-resistant isolates in some hospitals. We have previously reported the dispersion of the tet(B) resistance element associated with the ISCR2 transposase in epidemiologically unrelated A. baumannii isolates recovered from 1983 to 2011. This study extends this surveillance to 77 recent (2009-2013) XDR A. baumannii isolates with different levels of minocycline susceptibility. Isolates were examined by a pan-PCR assay, which showed six different amplification patterns, and specific PCRs were used for the confirmation of the the ΔISCR2-tet(B)-tet(R)-ISCR2 element. The tet(B) gene was present in 66 isolates and the ISCR2 element in 68 isolates; the tet(B) gene was associated with ISCR2 in all tet(B)-positive isolates. We conclude that this element is widespread in XDR A. baumannii isolates from Argentina and could be responsible for the emergence of tetracycline resistance in recent years.

Genetic Variability of AdeRS Two-Component System Associated with Tigecycline Resistance in XDR-Acinetobacter baumannii Isolates.

The emergence of tigecycline resistance has increased in the last years. Although tigecycline-resistant Acinetobacter baumannii isolates were described all over the world, few reports regarding the molecular basis of this resistance are available. It has been recognized that the overexpression of AdeABC efflux pump is related to the tigecycline-resistant phenotype. In 37 clinical A. baumannii isolates we first determined the tigecycline-resistant phenotype and then, within a selected group, we analyzed the sequence of the adeRS operon, which is involved in the expression of the AdeABC efflux pump. Nucleotide sequence analysis of adeR and adeS showed the presence of 5 and 16 alleles, respectively. These results expose a high genetic variability in both genes, the adeS gene being more susceptible to genetic variation. The presence of 2 AdeR and 2 AdeS new variants were reported. Two of the new AdeRS variants were present in the intermediate and the resistant tigecycline A. baumannii isolates, suggesting a putative role in the development of the observed phenotype. More studies need to be addressed to determine the role of the genetic variability observed in the adeRS operon.

First case of Streptococcus lutetiensis bacteremia involving a clindamycin-resistant isolate carrying the lnuB gene.

Here, we describe the first case of a Streptococcus lutetiensis isolate harboring the lnuB gene.

Human Brucella canis outbreak linked to infection in dogs.

The zoonotic risk of Brucella canis has been considered fairly high for persons who handle breeding dogs in kennels or are exposed to infected animals. Transmission to humans in other circumstances has been thought to be rare. We describe an uncommon outbreak of brucellosis caused by B. canis which, to the best of our knowledge, is the first reported in the literature. This outbreak involved six persons (three children and three adults), a bitch and three puppies which had close daily contact with the family. The clinical symptoms of the index case led to an erroneous diagnosis and the infection would have gone undiagnosed if culture had not been positive. This report aims to increase awareness of medical personnel of the need to order screening tests for children, immunodeficient persons or pregnant women presenting with fever of unknown origin, unexplained spleen or liver enlargement or other systemic signs. The emerging zoonotic potential of this disease in urban areas and the need to coordinate canine brucellosis surveillance systems should be evaluated.

[Phenotypic and genotypic characterization of imipenem-resistant Pseudomonas aeruginosa isolated in a Buenos Aires hospital]. / Caracterización fenotípica y genotípica de la resistencia a imipenem en Pseudomonas aeruginosa aisladas en un hospital de Buenos Aires.

From 129 P. aeruginosa isolated at a health care centre located in Buenos Aires (Hospital "Eva Perón"), 14% produced IMP-13. Although 18 isolates were metallo-beta-lactamases (MBL) producers, only those isolates that displayed altered outer membrane protein profiles correlated with the resistant category according to CLSI or even Subcomisión de Antimicrobianos, SADEBAC, AAM. Phenotypic screening of metallo-beta-lactamases proved to be appropriate for detecting MBL producing isolates. IMP-13 producing isolates corresponded to at least five different clonal types, which not only suggests the dissemination of the resistant strain but also of the resistant marker.

First report of Comamonas kerstersii causing urinary tract infection.

The association of Comamonas kerstersii with peritonitis resulting from perforated appendix and its isolation from a psoas abscess and pelvic peritonitis have previously been described by us. We present the first case of C. kerstersii urinary tract infection, broadening the spectrum of infections caused by this species.

First case of bacteraemia due to Acinetobacter schindleri harbouring blaNDM-1 in an immunocompromised patient.

Clinically significant NDM-1-producing Acinetobacter schindleri has not yet been described in the literature. We report the first case of bacteraemia due to an A. schindleri strain harbouring blaNDM-1 recovered from an immunocompromised patient. Our report reinforces the fact that NDM-1 can easily be acquired by Acinetobacter species.

Whole-genome analysis and description of an outbreak due to carbapenem-resistant Ochrobactrum anthropi causing pseudo-bacteraemias.

Ochrobactrum anthropi, a rare human pathogen, has been isolated predominantly from patients with catheter-related bacteraemia and rarely from other infections. In 2016, six cases of pseudo-bacteraemia caused by carbapenem-resistant O. anthropi isolates were recovered from an Argentinian hospital. The resistant phenotype exposed by the isolates caught our attention and led to an extensive epidemiologic investigation. Here we describe the characterization of a carbapenem-resistant O. anthropi outbreak whose probable cause was by contaminated collection tubes. The genome analysis of one strain revealed the presence of various resistant determinants. Among them, a metal-dependent hydrolase of the ß-lactamase superfamily I, phnP, was found. Lately the recovery of unusual multidrug-resistant pathogens in the clinical setting has increased, thus emphasizing the need to implement standardized infection control practice and epidemiologic investigation to identify the real cause of hospital outbreaks.

[Community-acquired methicillin-resistant Staphylococcus aureus infections in a hospital for acute diseases]. / Infecciones adquiridas en la comunidad por Staphylococcus aureus resistente a meticilina en un hospital de agudos.

Community-acquired methicillin-resistant Staphylococcus aureus infections in a hospital for acute diseases. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent pathogens associated with nosocomial infections. However, most recently, MRSA has arisen as an emerging community pathogen, causing serious infections, mainly among young patients. We herein describe 33 cases of infections caused by community-acquired MRSA (C-MRSA), diagnosed between May 2005 and June 2006, at "Eva Perón" Hospital. The isolations were retrospectively studied. Methicillin resistance was confirmed by means of the detection of the mecA gene, and the genes for two virulence factors (Panton-Valentine Leucocidin -PVL- and gamma-haemolysin) as well as the cassette mec type were screened by PCR. All the patients were previously healthy. Four patients under 12, presented bacteremia, one had serious pneumonia, and the three remaining patients had osteoarticular infections; all the patients over 12, had skin and soft tissue infections without systemic damage. The C-MRSA strains harboured cassette mec type IV, and the PVL and gamma-haemolysin genes. They were methicillin-resistant, with no other associated resistances. It is important to consider the presence of these community- acquired strains in order to develop strategies for their correct treatment.

Unusual presentations of Comamonas kerstersii infection.

The association of Comamonas kerstersii with peritonitis resulting from the presence of perforated appendix has previously been described by our research team. In the present study, we describe the isolation of this microorganism from two forms of unusual presentations of C. kerstersii infection not previously described in the literature: localized intra-abdominal infection (psoas abscess) and pelvic peritonitis.

[Evaluation of API Coryne System, version 2.0, for diphteroid gram-positive rods identification with clinical relevance]. / Evaluación del sistema API coryne, versión 2.0, para la identificación de bacilos gram-positivos difteroides de importancia clínica.

The ability of the API Coryne system, version 2.0, to identify 178 strains of gram-positive rods was evaluated. Seventy eight isolates belonged to genus Corynebacterium and one hundred to related genera, all strains were isolated from clinical samples at the Laboratory of Bacteriology, Hospital de Clínicas José de San Martin (UBA) between 1995 and 2004. The isolates were identified according to von Graevenitz and Funke's scheme. One hundred and sixty two out of 178 strains (91%) were correctly identified at genus and species level (IC95 = 85.6-94.6), in 44 of them (24.7%) additional tests were needed to final identification. Sixteen strains (9%) were not correctly identified (IC95 = 5.4-14.4); none of the 178 strains remained unidentified. The API Coryne system, version 2.0, is useful to identify the majority of Cory-nebacterium species with clinical relevance: Corynebacterium jeikeium, Corynebacterium urealyticum, Corynebacterium striatum, Corynebacterium pseudodiphtheriticum, Corynebacterium amycolatum and related species such as Arcanobacterium haemolyticum, Dermabacter hominis, Listeria monocytogenes, among others. Nevertheless for yellow-pigmented diphteroid gram-positive rods (Aureobacterium spp., Leifsonia aquatica, Microbacterium spp. and Cellulomonas spp.) and for acid fast gram-positive rods (Rhodococcus, Gordonia, Tsukamurella and Nocardia) the identification usefulness the system is limited.

['In vitro' activity of different antimicrobial agents on Gram-negative nonfermentative bacilli, excluding Pseudomonas aeruginosa and Acinetobacter spp]. / Actividad "in vitro" de diferentes antibacterianos sobre bacilos gram-negativos no fermentadores, excluidos Pseudomonas aeruginosa y Acinetobacter spp.

Gram-negative nonfermentative bacilli (NFB) are widely spread in the environment. Besides of difficulties for identification, they often have a marked multiresistance to antimicrobial agents, including those active against Pseudomonas aeruginosa. The objective of this study was to evaluate the 'in vitro' activity of different antimicrobial agents on 177 gram-negative nonfermentative bacilli isolates (excluding Pseudomonas aeruginosa and Acinetobacter spp.) isolated from clinical specimens. Minimum inhibitory concentrations (MIC) were determined according to the Mueller Hinton agar dilution method against the following antibacterial agents: ampicillin, piperacillin, piperacillin-tazobactam, sulbactam, cefoperazone, cefoperazone-sulbactam, ceftazidime, cefepime, aztreonam, imipenem, meropenem, colistin, gentamicin, amikacin, trimethoprim-sulfamethoxazole, chloramphenicol, erythromycin, rifampin, norfloxacin, ciprofloxacin and minocycline. Seven isolates: Sphingobacterium multivorum (2), Sphingobacteriumspiritivorum (1), Empedobacterbrevis (1), Weeksella virosa (1), Bergeyella zoohelcum (1) and Oligella urethralis (1), were tested for amoxicillin-clavulanic acid and ampicillin-sulbactam susceptibility, and susceptibility to cefoperazone or sulbactam was not determined. Multiresistance was generally found in Stenotrophomonas maltophilia, Burkholderia cepacia, Chryseobacterium spp., Myroides spp., Achromobacter xylosoxidans, and Ochrobactrum anthropi isolates. On the other hand, Pseudomonas stutzeri, Shewanella putrefaciens-algae, Sphingomonas paucimobilis, and Pseudomonas oryzihabitans, Bergeyella zoohelcum, Weeksella virosa and Oligella urethralis were widely susceptible to the antibacterial agents tested. As a result of the wide variation in antimicrobial susceptibility shown by different species, a test on susceptibility to different antibacterial agents is essential in order to select an adequate therapy. The marked multiresistance evidenced by some species, prompts the need to develop new antimicrobial agents active against this group of bacteria and to search for synergistic combinations.

[Diagnosis and treatment of Helicobacter pylori infection. Its relationship with gastrointestinal ulcer and antimicrobial resistance]. / Diagnóstico y tratamiento de la infección por Helicobacter pylori. Su relación con la úlcera gastrointestinal y la resistencia a los antimicrobianos.

Reliable data regarding the efficacy of different schemes of triple therapy for the eradication of Helicobacter pylori in our country, are not available. Patients with Helicobacter pylori infection and non-ulcer dyspepsia or active peptic ulcer disease were randomized in three different groups for therapy with, omeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1000 mg, twice daily for one week (OCA 1, 40 patients) and the same treatment but for two weeks in a second group (OCA 2, 40 patients). The third group received omeprazole 20 mg, clarithromycin 500 mg and metronidazole 500 mg twice daily during one week (OCM, 40 patients). The primary efficacy end point was the eradication of Helicobacter pylori as confirmed by negative urea breath test, 4 weeks after the completion of treatment. Of 120 patients enrolled in the study, 113 met the entry criteria. Of them, 103 completed the treatment. When analyzed by intention to treat, after 4 weeks of finishing the treatment, Helicobacter pylori was eradicated in 92.3% of patients in OCA 1, 89.7% in OCA 2, and 82.8% in OCM. There was no significant difference between the three groups, regarding the eradication efficacy. Side effects were observed more frequently in OCA 2 and OCM groups. Primary resistance to amoxicillin and clarithromycin was not demonstrated, while 20% of cultured strains were resistant to metronidazole. In patients with peptic ulcer disease or non-ulcer dysplasia, triple therapy with omeprazole and two antibiotics is highly effective in the eradication of Helicobacter pylori. One week of OCA therapy is as effective as two weeks of OCA or one week of OCM, with less side effects.

[Evaluation of API 20 NE (version 6.0) in rare Gram-negative non-glucose-fermenting bacilli]. / Evaluación de API 20 NE (versión 6.0) en bacilos gram-negativos no fermentadores de glucosa infrecuentes.

The ability of the API 20 NE method (6.0 version, bio-Mérieux, Marcy L'Etoile, France) to identify 188 strains of gram negative nonfermentative bacilli (NFB) was evaluated (Fenazinic pigment producing Pseudomonas aeruginosa and Acinetobacter spp. were excluded). These were isolated from patients treated at the Hospital de Clínicas José de San Martín of the University of Buenos Aires during the period 1996-2001. Strains were identified according to the Schreckenberger P testing method. Out of 188 NFB strains, 175 (93.09%) were correctly identified by the API 20 NE method at the genus and species level (IC95 = 88.47-96.27) while 61 (32.45%) required additional testing for correct identification. Thirteen strains (6.91%; IC95 3.73-11.53) could not be correctly identified and none of them were classified as "non identified". The API 20 NE method is a practical, easy to handle, fast and useful system for the identification of NFB since conventional manual methods take longer and require many biochemical, enzymatic and physiological tests which are sometimes not available depending on the size and capability of the laboratory. Although it is easy to handle, the API 20 NE identification system must be interpreted by an expert microbiologist who must compare the results obtained by this system with the information provided by the distinctive cultures and mobility patterns of these organisms.

[Activity of 14 antimicrobials against Eikenella corrodens]. / Actividad de catorce antimicrobianos sobre Eikenella corrodens.

Eikenella corrodens is a gram-negative bacillus that colonizes as normal flora of the mouth, the upper respiratory tract and the gastrointestinal tract. The aim of this study was to determine the susceptibility patterns against fourteen antibiotics of 25 E. corrodens strains isolated at our hospital. MICs were determined by the agar dilution technique using Müeller-Hinton agar with sheep blood (5% v/v) to penicillin, ampicillin, ampicillin-sulbactam, cephalotin, cefoxitin, ceftiaxone, colistin, gentamicin, amikacin, erythromycin, rifampin, ciprofloxacin and clindamycin. The most active antibiotics were ciprofloxacin and ceftriaxone (MIC90 = 0.008 and 0.125 microgram/ml, respectively), whereas eritromycin, gentamicin and amikacin showed less activity. Only one strain was beta lactamase positive, and it was inhibited by sulbactam. Erithromycin, gentamicin and amikacin had poor activity (MIC90 = 16.8 and 64 micrograms/ml, respectively), whereas all the strains were uniformly resistant to clindamycin (MIC > or = 32 micrograms/ml). We suggest about the need of periodical surveys of E. corrodens susceptibility patterns, since strains have been found with decreased susceptibility against antibiotics which are currently being used for the treatment of infectious diseases.

[Bacteremia by Brucella canis. Isolation with the Bact-Alert system]. / Bacteriemia por Brucella canis. Aislamiento con el sistema Bact-Alert.

Brucella canis and other species of the genus Brucella can cause human disease. However, this species infrequently cause human disease, including in countries where dogs population is highly infected. A 15 years old male was admitted to the hospital with 15 days history of fever without visible focus. Physical examination revealed pain at liver palpation and axillar, cervical and inguinal lymphoadenomegalies. Abdominal ultrasonography showed spleenomegally, the chest Rx and the trans thoracic echocardiogram were normal. Five blood samples were obtained and cultured in 2 standards bottles (time of positivization 72 - 64.8 hours), and 3 pediatric FAN bottles (time of positivization 74.5; 72 and 67.2 hours) (Bact-Alert system, Biomerieux, Marcy, l'Etolie, France). The microorganism was presuntive identified as B. canis, and then was confirmed in the National Reference Center Instituto ANLIS "Carlos G. Malbran". After 14 days of initiating ceftriaxone treatment the patient was afebrile. When the confirmation of Brucella was made, he was discharged and ambulatory was prescribed with doxycycline and rifampin for 21 days. Bones were not compromised and the outcome was good with complete resolution of his illness.

[Bact-Alert automatized system for blood cultures: 5 vs 7 days of incubation. First Argentine multicentre study]. / Sistema automatizado de hemocultivos Bact-Alert: 5 vs 7 dias de incubación. Primer estudio multicéntrico argentino.

Bact-Alert automatized system for blood cultures: 5 vs 7 days of incubation. First Argentine multicentre study. Between January and December 2001, we analyzed 80,141 blood cultures by the Bact-Alert system (14,960 FAN aerobics, 3,855 FAN anaerobic, 11,114 standards aerobics, 11,367 standards anaerobic, 12,054 pediatrics and 26,791 FAN pediatrics bottles) and 44.235 series from 27.615 patients at eight hospitals of Buenos Aires city, one of La Plata city and three of the Buenos Aires province. A total of 13,657 blood cultures yielded a positive result. Only 181 of them had been detected as positive between the 5th and 7th day of incubation and only 26 (0.19%) had clinical significance (Staphylococcus aureus 3; coagulase negative staphylococci 2; Enterococcus faecalis 1; Streptococcus pneumoniae 2; Campylobacter spp 1; Escherichia coli 1; Enterobacter cloacae 1; Enterobacteraerogenes 1; Citrobacter freundii 1; Klebsiella pneumoniae 1; Proteus mirabilis 1; Serratia marcescens 4; yeasts 7, including one strain of Cryptococcus neoformans). Of the total of contaminants, 38% were isolated by the anaerobic standard (65% were Propionibacterium spp and 29% coagulase negative staphylococci), 31.2% by the FAN aerobic (33.3% difphteroids and 28.9% Bacillus spp), 11.8% by the pediatric, 9% by FAN pediatric, 8.33% by aerobic standard and 1.4% by FAN anaerobic bottle. Our results show that the prolonged incubation of blood cultures for more than 5 days using the Bact-Alert system is unnecessary.