ABSTRACT
We report the epidemiological impact of carbapenemase-producing Enterobacteriaceae (CPE) in Spain in 2012. Of the 237 carbapenemases detected, 163 were from the OXA-48 group, 60 were from VIM-1, 8 were from KPC-2, 5 were from IMP, and 1 was from NDM-1. Interhospital spread of carbapenemase-producing Klebsiella pneumoniae was due to a limited number of multilocus sequence types (MLST) and carbapenemase types, including ST15-VIM-1, ST11-OXA-48, ST405-OXA-48, ST101-KPC-2, and ST11-VIM-1. The number of CPE cases in Spain has increased sharply in recent years, due mainly to the emergence of OXA-48.
Subject(s)
Bacterial Proteins/metabolism , Enterobacteriaceae/enzymology , beta-Lactamases/metabolism , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/genetics , Enterobacteriaceae/drug effects , Enterobacteriaceae/genetics , Humans , Microbial Sensitivity Tests , Multilocus Sequence Typing , Spain , beta-Lactamases/geneticsABSTRACT
OBJECTIVES: There is scarce information on the clinical relevance and antifungal susceptibility of Candida bracarensis, Candida nivariensis, Candida orthopsilosis and Candida metapsilosis. The objective of this study was to assess the prevalence and in vitro antifungal susceptibility of these cryptic species among 173 blood isolates previously identified as Candida glabrata or Candida parapsilosis at the Hospital of Cruces (Barakaldo, Spain). The survey was extended to 518 clinical isolates from the culture collection of the Universidad del País Vasco-Euskal Herriko Unibertsitatea (UPV-EHU; Bilbao, Spain). METHODS: In vitro susceptibilities to 5-fluorocytosine, amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, micafungin, posaconazole and voriconazole were tested. RESULTS: All isolates of C. glabrata were identified as C. glabrata sensu stricto. Inside the C. parapsilosis complex, 2.4% of isolates from the Hospital of Cruces and 5.8% from the UPV-EHU were C. metapsilosis or C. orthopsilosis. Of 457 isolates, 435 (95.19%) were C. parapsilosis sensu stricto, 11 (2.41%) C. metapsilosis and 11 (2.41%) C. orthopsilosis. Only seven blood isolates were C. metapsilosis (0.44%) or C. orthopsilosis (1.09%). These cryptic species were also isolated from other relevant clinical specimens. Four C. parapsilosis sensu stricto (5.6%) were susceptible dose-dependent, and one was resistant to both fluconazole and voriconazole (1.4%). Moreover, 19 isolates of C. parapsilosis sensu stricto (26.4%) were intermediately susceptible to itraconazole and higher concentrations of echinocandins were needed to inhibit this species. Most C. orthopsilosis and C. metapsilosis were susceptible to all antifungal agents tested, but one otic isolate of C. metapsilosis was resistant to fluconazole and 5-fluorocytosine. CONCLUSIONS: C. metapsilosis and C. orthopsilosis are associated with human disease and show a different antifungal susceptibility profile compared with C. parapsilosis sensu stricto.
Subject(s)
Antifungal Agents/pharmacology , Blood/microbiology , Candida/drug effects , Candida/isolation & purification , Candidemia/microbiology , Drug Resistance, Multiple, Fungal , Candida/classification , Candida glabrata/drug effects , Candida glabrata/isolation & purification , Candidemia/drug therapy , Candidemia/epidemiology , Hospitals , Humans , Microbial Sensitivity Tests , Spain/epidemiologyABSTRACT
Nail fungal infections are considered one of the major dermatological problems due to their high rate of therapeutic failure, management and treatment difficulties. Long-term treatments, inadequate therapies, mycological misdiagnosis and follow-up, secondary alterations of the nail, and resistant microorganisms, are some of the causes of these complications. Although the discovery of new antifungal agents has provided some effective molecules, none of the current available drugs are totally effective. It is important to continue researching in this field to provide new antifungal agents and combined therapies.
Subject(s)
Antifungal Agents/therapeutic use , Onychomycosis/drug therapy , Administration, Oral , Administration, Topical , Antifungal Agents/administration & dosage , Drug Therapy, Combination , HumansABSTRACT
The in vitro antifungal activity of terbinafine against 521 clinical isolates of seven species of dermatophytes, including four onychomycosis-causative species, as well as five Scopulariopsis brevicaulis isolates was determined by a modified Clinical and Laboratory Standards Institute microdilution method. Results showed a high antifungal activity of terbinafine against all dermatophyte isolates (geometric minimal inhibitory concentration (MIC)=0.026 microg/mL; concentration inhibiting 50% of mycological growth (MIC50)=0.03 microg/mL; and concentration inhibiting 90% of mycological growth (MIC90)=0.06 microg/mL). The geometric mean MICs against onychomycosis-causative dermatophyte species was lower (0.024 microg/mL) than the global MIC. However, the in vitro activity of terbinafine against S. brevicaulis was considerably lower (geometric mean MIC=1.38 microg/mL) in comparison with dermatophytes. The antifungal activity of itraconazole was lower than that of terbinafine against these fungi. These data confirm the high in vitro antifungal activity of terbinafine against dermatophytes, under standardised conditions.
Subject(s)
Antifungal Agents/pharmacology , Arthrodermataceae/drug effects , Naphthalenes/pharmacology , Onychomycosis/microbiology , Culture Media , Itraconazole/pharmacology , Microbial Sensitivity Tests , TerbinafineABSTRACT
OBJECTIVES: The in vitro antifungal activity of posaconazole was compared with that of fluconazole and amphotericin B. MATERIALS AND METHODS: A microdilution method (M27-A2) was used with 331 clinical yeast isolates. RESULTS: The geometric mean MICs of posaconazole, fluconazole and amphotericin B were 0.16, 0.91 and 0.15 mg/L, respectively. Posaconazole was markedly more active than fluconazole and was active against 9/11 fluconazole-resistant Candida albicans, and five Candida glabrata had an MIC of posaconazole of 16 mg/L. CONCLUSIONS: These data indicate that posaconazole is a potentially effective antifungal agent for the treatment of mycoses caused by yeasts.
Subject(s)
Amphotericin B/pharmacology , Antifungal Agents/pharmacology , Candida/drug effects , Candidiasis, Oral/microbiology , Triazoles/pharmacology , Fluconazole/pharmacology , Humans , Microbial Sensitivity TestsABSTRACT
OBJECTIVE: To evaluate the role of pH in the seroagglutination test (SAT)and Rose Bengal (RB) test, and to determine the influence of pH on the agglutinating activity of IgM, IgG and IgA antibodies. MATERIALS AND METHODS: The SAT was performed at pH 7.2 or pH 5.0 in standard microtiter-type polystyrene plates using Ring Test antigen or the Brucella suspension (BRUCAPT) provided in the Brucellacapt kits. Specific antibodies against native hapten were determined by radial immunodiffusion. Additionally, IgG, IgA and IgM fractions were separated from 8 sera by absorption chromatography and their agglutinating capacity was studied at pH 7.2 and 5.0. RESULTS: We studied 72 sera from patients with clinical brucellosis taken at the time of hospitalization, 16 from persons in contact with infected animals, and 16 from healthy donors. SAT results at pH 5.0 correlated with those obtained with the Rose Bengal test. Four Rose Bengal-positive sera were found to be SAT-negative at pH 7.2 and SAT-positive at pH 5.0. SAT performed at pH 5.0 with BRUCAPT antigen yielded higher titers than tests performed at pH 7.2 or 5.0 with Ring Test antigen (p < 0.001), with highest titers in IDR-positive sera. Among the 8 IgG fractions, all but one agglutinated at pH 7.2, and in 4, IgG titers showed significant increases at pH 5.0. Three IgA fractions were SAT-negative at pH 7.2 and SAT-positive at pH 5.0; the other 5 agglutinated at both pH conditions and were DTT-sensitive. All IgA fractions but one were positive by Rose Bengal. Agglutinating activity of the IgM fraction was not affected by pH. CONCLUSION: The SAT performed with the buffer and antigen suspension included in the Brucellacapt kit (pH 5.0) is highly useful for detecting agglutinating and non-agglutinating antibodies at pH 7.2.
Subject(s)
Agglutination Tests/methods , Antibodies, Bacterial/immunology , Brucella melitensis/immunology , Brucellosis/diagnosis , Hydrogen-Ion Concentration , Antigen-Antibody Reactions , Antigens, Bacterial/immunology , Bacteremia/diagnosis , Bacteremia/immunology , Bacteremia/microbiology , Brucellosis/immunology , Brucellosis/microbiology , Chemical Fractionation , Coloring Agents/chemistry , Counterimmunoelectrophoresis , Dithiothreitol/pharmacology , Humans , Immunodiffusion , Immunoglobulin A/immunology , Immunoglobulin G/immunology , Immunoglobulin M/immunology , Lipopolysaccharides/immunology , Reagent Kits, Diagnostic , Reagent Strips , Rose Bengal/chemistryABSTRACT
We compared the in vitro antifungal activity of amphotericin B lipid complex (ABLC) with that of itraconazole (ITZ) against 535 yeast strains and 173 opportunistic filamentous fungi by using a microdilution method (National Committee for Clinical Laboratory Standards M27-A and M38-P). The overall geometric mean MIC was 0.13 microg/ml and 0.177 microg/ml for ITZ and ABLC, respectively, and the MIC(50) was 0.125 microg/ml for both agents against yeast isolates. ITZ had a similar or slightly superior efficacy compared to ABLC when tested against Candida albicans, Candida parapsilosis, Cryptococcus neoformans, Candida krusei, Candida glabrata and Candida tropicalis. Effectiveness against C. glabrata was lower for ITZ (MIC(90) 2 microg/ml, and for ABLC, 0.5 microg/ml). For Aspergillus fumigatus, activity of ITZ was superior in comparison with ABLC (MIC(90) 1 and 16 microg/ml, respectively); MIC(90) for Aspergillus niger was 4 and 2 microg/ml for ABLC and ITZ, respectively. Scedosporium spp. showed a low susceptibility to both ABLC and ITZ. In conclusion, ABLC and ITZ are useful alternatives for the treatment of severe fungal infections. The selection of an antifungal agent should be made considering the toxicological and pharmacological properties and cost/benefit relationship and be supported by the susceptibility of the isolate.
Subject(s)
Amphotericin B/pharmacology , Antifungal Agents/pharmacology , Fungi/drug effects , Itraconazole/pharmacology , Opportunistic Infections/microbiology , Phosphatidylcholines/pharmacology , Phosphatidylglycerols/pharmacology , Culture Media , Dose-Response Relationship, Drug , Drug Combinations , Drug Resistance, Fungal , Fungi/isolation & purification , Humans , Microbial Sensitivity Tests/methods , Microbial Sensitivity Tests/standards , Quality Control , Yeasts/drug effects , Yeasts/isolation & purificationABSTRACT
Las infecciones fúngicas en las uñas se consideran como uno de los mayores problemas en dermatología. Entre las principales causas están la alta tasa de fracaso terapéutico, las dificultades en el tratamiento y los largos períodos necesarios, los deficientes diagnósticos y seguimiento micológicos, y las alteraciones secundarias de las uñas. Sin embargo, la aparición de nuevos antifúngicos, las nuevas formulaciones, los tratamientos combinados o los nuevos métodos han supuesto mejoras evidentes. No obstante, es imprescindible continuar la investigación en este campo(AU)
Nail fungal infections are considered one of the major dermatological problems due to their high rate of therapeutic failure, management and treatment difficulties. Long-term treatments, inadequate therapies, mycological misdiagnosis and follow-up, secondary alterations of the nail, and resistant microorganisms, are some of the causes of these complications. Although the discovery of new antifungal agents has provided some effective molecules, none of the current available drugs are totally effective. It is important to continue researching in this field to provide new antifungal agents and combined therapies(AU)
Subject(s)
Humans , Onychomycosis/drug therapy , Antifungal Agents/therapeutic use , Dermatomycoses/drug therapy , Arthrodermataceae , Yeasts , Yeasts/pathogenicity , Triazoles/therapeutic use , Azoles/therapeutic use , Allylamine/therapeutic use , Drug CombinationsABSTRACT
OBJETIVO. Analizar el efecto del pH en la prueba de seroaglutinación (SAT) y rosa de Bengala (RB) y su influencia sobre la capacidad aglutinante de los anticuerpos IgM, IgG e IgA. MATERIAL Y MÉTODOS. La SAT se realizó a pH 7,2 y a 5,0 en placas de microtiter utilizando "Ring test antigen" (RT) y la suspensión de brucelas utilizada en la prueba de Brucellacapt® (BRUCAPT). La presencia de anticuerpos frente al hapteno nativo (HN) se realizó mediante la prueba de inmunodifusión radial (IDR). Además, se estudió la capacidad aglutinante a pH 7,2 y 5,0 de las fracciones IgG, IgA e IgM de 8 sueros obtenidas mediante cromatografía de adsorción. RESULTADOS. Se han empleado 72 sueros de pacientes con brucelosis, 16 de personas en contacto con animales infectados y 16 de donantes sanos. Los resultados de la SAT a pH 5,0 se correlacionaron con los de la prueba de RB. La SAT de cuatro sueros RB positivos fue negativa a pH 7,2 pero positiva a pH 5,0. Los títulos de la SAT a pH 5,0 con el antígeno BRUCAPT fueron superiores a los obtenidos con el RT (p < 0,001) a pH 7,2 o 5,0, siendo los más elevados los correspondientes a los sueros IDR positivos. De las 8 fracciones IgG, siete aglutinaron a pH 7,2 y en cuatro sus títulos aumentaron significativamente a pH 5,0. Tres fracciones IgA fueron SAT negativas a pH 7,2 pero positivas a pH 5,0 y las otras cinco aglutinaron a pH 7,2 y a 5,0, y además, fueron sensibles al ditiotreitol (DTT). El pH no modificó significativamente la actividad aglutinante de las fracciones IgM. CONCLUSIONES. La prueba de SAT realizada con el tampón de dilución y la suspensión antigénica incluidas en los equipos Brucellacapt® es de gran utilidad para la demostración de la presencia de anticuerpos aglutinantes y no aglutinantes a pH 7,2 (AU)