Susceptibility of 186 Nocardia sp. isolates to 20 antimicrobial agents.

This study determined the antimicrobial susceptibilities of 186 clinical isolates of Nocardia spp. isolated in Gipuzkoa, northern Spain, between 1998 and 2009. Most isolates were recovered from respiratory samples, Nocardia nova, N. farcinica, N. cyriacigeorgica, N. abscessus, and N. carnea being the species most frequently isolated. Linezolid and amikacin were the only two antimicrobials to which all isolates were susceptible. The majority of N. flavorosea, N. carnea, and N. farcinica isolates were trimethoprim-sulfamethoxazole resistant.

Antimicrobial susceptibilities and serotypes of Streptococcus pneumoniae isolates from elderly patients with pneumonia and acute exacerbation of chronic obstructive pulmonary disease.

In the elderly, Streptococcus pneumoniae is the most common cause of pneumonia and one of the most frequently isolated pathogens in cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study was conducted to compare the pneumococcal isolates obtained during episodes of AECOPD and pneumonia in patients of ≥65 years old and to analyze whether in patients with AECOPD and pneumonia within a short interval, the same isolate caused both episodes. This laboratory-based study was performed between 2005 and 2008. Pneumococcal isolates from episodes of pneumonia (n = 401) and AECOPD (n = 398), matched one-to-one by date of isolation, were characterized. The serotypes and genotypes of other pneumococcal isolates causing pneumonia and AECOPD in the same patient were compared. In patients with pneumonia, COPD as an underlying disease was not associated with more-drug-resistant pneumococci. In contrast, isolates causing AECOPD showed higher rates of resistance than those causing pneumonia. Serotypes 1, 3, and 7F were more frequent in pneumonia. The same pneumococcus was involved in 25.7% (9/35 patients) of patients with two consecutive AECOPD episodes but in only 6.3% (2/32 patients) of COPD patients with pneumonia and exacerbation (Fisher's exact test; P = 0.047). Less invasive serotypes were isolated more often in AECOPD and were more resistant to antimicrobials. The presence of a specific pneumococcal serotype in AECOPD does not predict the etiology of subsequent pneumonia.

Prevalence and clonal characterization of Streptococcus pyogenes clinical isolates with reduced fluoroquinolone susceptibility in Spain.

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.

In vivo development of high-level fluoroquinolone resistance in Streptococcus pneumoniae in chronic obstructive pulmonary disease.

Patients with chronic obstructive pulmonary disease are generally subjected to multiple regimens of antimicrobial treatment. The development of high-level levofloxacin resistance (i.e., a minimum inhibitory concentration >8 mu g/mL) in 8 patients whose previous pneumococcal isolates showed susceptibility is described. Molecular methods were used to characterize the strains and to study the sequential changes in fluoroquinolone targets.

[Dermatophytosis with concurrent lesions in distant locations. Prognostic and therapeutic significance]. / Dermatofitosis con lesiones concurrentes a distancia. Importancia pronóstica y terapéutica.

INTRODUCTION: Recurrence and a lack of treatment response are common in dermatophytosis. In patients with cutaneous and concurrent toenail lesions, often only the former are investigated, which may result in inappropriate treatment due to misdiagnosis. METHODS: Between January 2000 and April 2004, we prospectively studied the presence of dermatophytic fungi in lesions other than those prompting the consultation to further investigate the diagnosis. RESULTS: We prospectively identified 61 patients with dermatophytosis and concurrent lesions caused by the same fungus at sites distant from the primary lesion. Concurrent lesions occurred in 15.9% of culture-confirmed dermatophyte infections. Thirty-six patients (59%) consulted for skin lesions located at sites other than that of the primary lesion in the foot. The most frequently identified species was Trichophyton rubrum (50/61, 82%). CONCLUSIONS: Localization of all the lesions, as well as isolation and identification of the causative fungus, are essential to establish the prognosis and choose the most appropriate antifungal agent, route of administration, and duration of treatment in dermatophytosis.

Fluoroquinolone and macrolide treatment failure in pneumococcal pneumonia and selection of multidrug-resistant isolates.

Streptococcus pneumoniae serotype 3, isolated from a penicillin-allergic patient and initially susceptible to fluoroquinolones, macrolides, lincosamides, quinupristin-dalfopristin, and telithromycin, became resistant to all these drugs during treatment. Mutations in the parC and gyrA and in the 23S rRNA and the ribosomal protein L22 genes were detected in the resistant isolates.

Dermatofitosis con lesiones concurrentes a distancia. Importancia pronóstica y terapéutica / Dermatophytosis with concurrent lesions in distant locations. Prognostic and therapeutic significance

En las dermatofitosis son frecuentes las recaídas y la falta de respuesta al tratamiento. En enfermos que presentaban lesiones en piel y concurrentemente lesiones en las uñas del pie, a menudo sólo se solicitaba el estudio de las primeras. Esta razón nos llevó a evaluar una posible causa de tratamiento inadecuado por falta de un diagnóstico correcto. MÉTODOS. Entre enero de 2000 y abril de 2004 se estudió de forma prospectiva la presencia de hongos dermatofitos en otras lesiones diferentes de la que motivó la consulta. RESULTADOS. Se detectaron 61 casos de dermatofitosis que presentaron de manera simultánea lesiones a distancia de su localización inicial, causadas por el mismo hongo. Estas lesiones concurrentes ocurrieron en el 15,9% de las dermatofitosis confirmadas por cultivo. En 36 casos(59%) el motivo de la consulta fue una lesión en la piel, a distancia de su lesión primaria localizada en los pies. Trichophyton rubrum fue la especie más frecuente(50/61, 82%). CONCLUSIONES. La localización de todas las lesiones y el aislamiento e identificación del hongo causal son fundamentales para establecer un pronóstico y elegir el antifúngico, la vía de administración y la duración más adecuados (AU)

INTRODUCTION. Recurrence and a lack of treatment response are common in dermatophytosis. In patients with cutaneous and concurrent to enail lesions, often only the former are investigated, which may result in inappropriate treatment due to misdiagnosis. METHODS. Between January 2000 and April 2004, we prospectively studied the presence of dermatophytic fungi in lesions other than those prompting the consultation to further investigate the diagnosis. RESULTS. We prospectively identified 61 patients with dermatophytosis and concurrent lesions caused by the same fungus at sites distant from the primary lesion. Concurrent lesions occurred in 15.9% of culture-confirmed dermatophyte infections. Thirty-six patients (59%) consulted for skin lesions located at sites other than that of the primary lesion in the foot. The most frequently identified species was Trichophyton rubrum (50/61, 82%). CONCLUSIONS. Localization of all the lesions, as well as isolation and identification of the causative fungus, are essential to establish the prognosis and choose the most appropriate antifungal agent, route of administration, and duration of treatment in dermatophytosis (AU)