Feasibility and outcomes after dose reduction of immunochemotherapy in young adults with Burkitt lymphoma and leukemia: results of the BURKIMAB14 trial.

High dose-intensive or infusional intermediate-dose immunochemotherapy is highly effective treatment for Burkitt lymphoma irrespective of human immunodeficiency virus (HIV) infection. However, toxicities of these regimens are relevant, especially in older adults and elderly patients. The prospective multicenter BURKIMAB14 trial included four to six blocks of immunochemotherapy according to stage (localized: 1 and 2 non-bulky; advanced: 2 bulky, 3, 4) and age, with dose reduction in patients >55 years old. Dose-intensity of chemotherapy was reduced in patients ≤55 years old after achieving complete metabolic response (CMR). Their outcomes were compared with those of similar patients included in the former BURKIMAB08 trial, in which there was no dose reduction. CMR was attained in 86 of 107 (80%) patients (17/19 in localized stages and 69/88 in advanced stages). Patients from the BURKIMAB14 trial ≤55 years old showed similar overall survival (OS), fewer infections and cytopenias than patients from the BURKIMAB08 trial. Patients >55 years old had a significantly higher treatment- related mortality despite dose reduction of chemotherapy. With a median follow-up of 3.61 years the 4-year OS probability was 73% (range, 63-81%). Age (≤55 vs. >55 years) and stage (localized vs. advanced) had prognostic significance. No significant differences in OS were observed in HIV-positive versus HIV-negative patients. The results of BURKIMAB14 are similar to those of other dose-intensive immunochemotherapy trials. Age >55 years and advanced stage, but not HIV infection, were associated with poor survival. Dose reduction of chemotherapy in young adults in CMR is safe and does not impact outcomes (clinicaltrials gov. Identifier: NCT05049473).

[Chryseobacterium spp., a new opportunistic pathogen associated with cystic fibrosis?]. / Chryseobacterium spp., ¿nuevo patógeno oportunista asociado a fibrosis quística?

INTRODUCTION: There is an increase in the isolation of non-fermenting gramnegative bacilli in patients with cystic fibrosis (CF). The present study evaluates the frequency of isolates of Chryseobacterium spp., analyzing its characteristics, resistance patterns and clinical outcome of patients. METHODS: It has been collected all respiratory isolates of Chryseobacterium spp. of patients attended in the CF unit of Hospital de la Princesa for three years (march 2009-march 2012). For phenotypic and genotypic identification and sensitivity study conventional methodology was used. For the assessment of the patients lung function was considered the forced expiratory volume in one second (FEV1) and the results were analyzed with SPSS. RESULTS: There was an increase in the incidence of Chryseobacterium spp. with 17 isolates from 9 patients. Three patients had chronic colonization by this microorganism and one showed significant impairment of lung function. Seven patients showed also colonization with Staphylococcus aureus and 4 of them with Pseudomonas aeruginosa. CONCLUSION: Chryseobacterium spp. should be considered as a new emerging opportunistic pathogen in patients with CF. It is essential the clinical and microbiological monitoring of this group of patients for detection of Chryseobacterium spp. colonization and to prevent the chronic infection. In these circumstances it must assess its possible eradication, though its clinical impact is unknown. Cotrimoxazole being the best treatment option.

Burkholderia cepacia complex infection in an Adult Cystic Fibrosis unit in Madrid.

INTRODUCTION: Burkholderia cepacia complex have emerged as significant pathogens in cystic fibrosis (CF) patients due to the risk of cepacia syndrome and the innate multi-resistance of the microorganisms to antibiotics. The aim of this study was to describe the antimicrobial susceptibility profiles, the genotypes and subtypes of BCC, and the clinical evolution of CF patients with BCC. METHODS: The lung function and Brasfield and Shwachman score were assessed in 12 patients. BCC were identified and susceptibility was studied by MicroScan (Siemens). Species and genospecies of BCC were confirmed by molecular methods in a Reference Centre (Majadahonda). RESULTS: BCC were identified in 12 of 70 patients (17.1%) over a ten year period. The mean age to colonization by BCC was 24.4 years (SD: 7.71). B. cenocepacia was isolated in 4 patients (33.3%), B. contaminans was isolated in 3 patients (25%), both B. vietnamiensis and B. stabilis were isolated in 2 patients (16.7%), and B. cepacia, B. multivorans and B. late were isolated in one patient (8.3%). Among the B. cenocepacia, subtype IIIa was identified in two strains, and subtype IIIb was identified in the other two strains. There was susceptibility to meropenem in 90% of BCC, 80% to cotrimoxazole, 60% to minocycline, 50% to ceftazidime, and 40% to levofloxacin. CONCLUSIONS: B. cenocepacia was the most prevalent species among the BCC isolated in CF adult patients, and subtypes IIIa and IIIb were identified in the 50% of the strains. Meropenem and cotrimoxazole showed the best activity.

Comparison of three statistical methods for establishing tentative wild-type population and epidemiological cutoff values for echinocandins, amphotericin B, flucytosine, and six Candida species as determined by the colorimetric Sensititre YeastOne method.

The Sensititre YeastOne (SYO) method is a widely used method to determine the susceptibility of Candida spp. to antifungal agents. CLSI clinical breakpoints (CBP) have been reported for antifungals, but not using this method. In the absence of CBP, epidemiological cutoff values (ECVs) are useful to separate wild-type (WT) isolates (those without mechanisms of resistance) from non-WT isolates (those that can harbor some resistance mechanisms), which is the goal of any susceptibility test. The ECVs for five agents, obtained using the MIC distributions determined by the SYO test, were calculated and contrasted with those for three statistical methods and the MIC(50) and modal MIC, both plus 2-fold dilutions. The median ECVs (in mg/liter) (% of isolates inhibited by MICs equal to or less than the ECV; number of isolates tested) of the five methods for anidulafungin, micafungin, caspofungin, amphotericin B, and flucytosine, respectively, were as follows: 0.25 (98.5%; 656), 0.06 (95.1%; 659), 0.25 (98.7%; 747), 2 (100%; 923), and 1 (98.5%; 915) for Candida albicans; 8 (100%; 352), 4 (99.2%; 392), 2 (99.2%; 480), 1 (99.8%; 603), and 0.5 (97.9%; 635) for C. parapsilosis; 1 (99.2%; 123), 0.12 (99.2%; 121), 0.25 (99.2%; 138), 2 (100%; 171), and 0.5 (97.2%; 175) for C. tropicalis; 0.12 (96.6%; 174), 0.06 (96%; 176), 0.25 (98.4%; 188), 2 (100%; 209), and 0.25 (97.6%; 208) for C. glabrata; 0.25 (97%; 33), 0.5 (93.9%; 33), 1 (91.9%; 37), 4 (100%; 51), and 32 (100%; 53) for C. krusei; and 4 (100%; 33), 2 (100%; 33), 2 (100%; 54), 1 (100%; 90), and 0.25 (93.4%; 91) for C. orthopsilosis. The three statistical methods gave similar ECVs (within one dilution) and included ≥ 95% of isolates. These tentative ECVs would be useful for monitoring the emergence of isolates with reduced susceptibility by use of the SYO method.

[Fungal sinus infection by Schizophyllum commune: Report of two clinical cases]. / Infección fúngica sinusal por Schizophyllum commune: a propósito de dos casos clínicos.

BACKGROUND: Schizophyllum commune is a basidiomycete fungus which is widely distributed in nature. Its role as responsible for disease in humans is not well known, partly due to its difficult identification. The incorporation of mass spectrometry techniques (MALDI-TOF) and molecular biology to the laboratories has allowed the description of a greater number of cases. CASE REPORT: In this paper, we present two cases in which S. commune was identified as the causative agent of disease: in the first case an immunocompetent patient suffered from chronic rhinosinusitis, and in the second one a sphenoid sinus infection was diagnosed in an immunocompromised patient. In both cases, S. commune was isolated. Its identification was possible by means of MALDI-TOF and this was confirmed in both patients by amplification and sequencing of the ITS region. CONCLUSIONS: In conclusion, S. commune should be considered a potential causative agent of fungal disease. Currently, MALDI-TOF and sequencing techniques are necessary for its identification.

[First report of a case of fungal keratitis due to Curvularia hominis in Spain]. / Queratitis fúngica por Curvularia hominis: primer caso descrito en España.

BACKGROUND: Dematiaceous fungal genus Curvularia is a causal agent of keratitis, onychomycosis, and skin infections. In 2014, using DNA sequencing techniques, five new species, including Curvularia hominis, were described. In this article, a report is presented on the first clinical case of C.hominis infection in Spain. It concerns a corneal ulcer caused by this recently described species. CASE REPORT: A 46 year-old male patient with a corneal ulcer in his left eye went to the Emergency Department. Specimens were obtained from the lesion, and the patient was admitted due to the risk of corneal perforation. The fungal culture of the specimens revealed a filamentous fungus that was identified by microscopic examination as Curvulariaspp. Using mass spectrometry (MALDI-TOF) the isolate was identified as Curvularia lunata. To confirm the identification, the isolate was sent to the National Centre of Microbiology in Spain, where ITS region sequencing was performed, and it was finally identified as C.hominis. The patient received voriconazole and progressed favourably. To repair the corneal damage, the patient received an amniotic membrane transplantation. CONCLUSIONS: C.hominis should be considered a causal agent of keratitis and sequencing techniques are now necessary for species-level identification of Curvularia isolates. This is the first case report in Spain caused by this species.

Serotypes and genotypes of S. pneumoniae isolates from adult invasive disease in Spain: A 5-year prospective surveillance after pediatric PCV13 licensure. The ODIN study.

Serotypes/genotypes causing invasive pneumococcal disease (IPD) in adults are determined by vaccination strategies. The aim of this study was to assess the epidemiology of IPD in adults (≥18 years) after PCV13 introduction for children: serotypes, clonal complexes, antibiotic non-susceptibility and clinical presentations. We performed a prospective, clinical surveillance of hospitalized culture-confirmed IPDs in adults in nine Spanish hospitals (August 2010-June 2015). A total of 1087 culture-confirmed IPD episodes were included, of which 772 (71.0%) had bacteremic pneumonia (401 complicated/371 uncomplicated pneumonia), 122 (11.2%) meningitis, 102 (9.4%) non-focal bacteremia, 34 (3.1%) peritonitis and 57 (5.3%) others. The most common serotypes were: 3 (12.7%), 19A (8.5%), 8 (7.7%), 7F (6.3%), 1 (4.2%), 6C (4.2%), 11A (4.2%), 22F (4.2%) and 14 (4.0%). Vaccine types (PCV13 + 6C) caused 49.8% of IPD episodes, with a significant decrease over the 5-year period, and significant decreases in serotypes 6C and 7F. The most common genotypes were: CC180 (8.4%), CC191 (6.0%), and CC53 (5.0%). Vaccine types caused 53.9% (414/768) pneumonia episodes and 58.9% (235/399) complicated pneumonia, 53.4% IPD in adults <50 years (143/268), and 54.7% IPD in immunocompetent patients (337/616). Overall non-susceptibility was 25.9% to penicillin (1.1% for parenteral criteria), 24.9% to erythromycin and 2.7% to levofloxacin. CONCLUSIONS: Although the percentage of vaccine-types causing IPDs in adults significantly decreased, it remained high. Associations of vaccine types with pneumonia (with complicated pneumonia for specific serotypes), and immunocompetent patients point to the burden of IPD caused by PCV13 serotypes.

Queratitis fúngica por Curvularia hominis: primer caso descrito en España / First report of a case of fungal keratitis due to Curvularia hominis in Spain

Antecedentes: Curvularia es un género fúngico dematiáceo responsable de queratitis, onicomicosis e infecciones de piel. En 2014, gracias a la secuenciación, se describieron cinco nuevas especies dentro del género, entre ellas Curvularia hominis. En este trabajo se describe el primer caso clínico de infección por C.hominis en España. Se trata de un caso de úlcera corneal producida por esta especie recientemente descubierta. Caso clínico: Un varón de 46 años acudió a urgencias por presentar una úlcera corneal en el ojo izquierdo. Se le tomó muestra de la lesión e ingresó en el hospital por riesgo de perforación corneal. El cultivo de la muestra reveló un hongo filamentoso cuyo examen microscópico permitió identificar como Curvulariaspp. Mediante espectrometría de masas MALDI-TOF el hongo fue identificado como Curvularia lunata. Para confirmar la identificación se envió el aislamiento al Centro Nacional de Microbiología de España, donde se llevó a cabo la secuenciación de la región ITS y finalmente se identificó como C.hominis. El paciente fue tratado con voriconazol y evolucionó favorablemente. Para la recuperación de la córnea dañada fue sometido a un trasplante de membrana amniótica. Conclusiones: C.hominis debe ser considerado un agente causal de queratitis y en la actualidad las técnicas de secuenciación son necesarias para su identificación. Este caso clínico constituye el primero descrito en España producido por esta especie

Background: Dematiaceous fungal genus Curvularia is a causal agent of keratitis, onychomycosis, and skin infections. In 2014, using DNA sequencing techniques, five new species, including Curvularia hominis, were described. In this article, a report is presented on the first clinical case of C.hominis infection in Spain. It concerns a corneal ulcer caused by this recently described species. Case report: A 46 year-old male patient with a corneal ulcer in his left eye went to the Emergency Department. Specimens were obtained from the lesion, and the patient was admitted due to the risk of corneal perforation. The fungal culture of the specimens revealed a filamentous fungus that was identified by microscopic examination as Curvulariaspp. Using mass spectrometry (MALDI-TOF) the isolate was identified as Curvularia lunata. To confirm the identification, the isolate was sent to the National Centre of Microbiology in Spain, where ITS region sequencing was performed, and it was finally identified as C.hominis. The patient received voriconazole and progressed favourably. To repair the corneal damage, the patient received an amniotic membrane transplantation. Conclusions: C.hominis should be considered a causal agent of keratitis and sequencing techniques are now necessary for species-level identification of Curvularia isolates. This is the first case report in Spain caused by this species

Breakthrough pulmonary Aspergillus fumigatus infection with multiple triazole resistance in a Spanish patient with chronic myeloid leukemia.

BACKGROUND: An allogeneic hematopoietic cell transplantation (allo-HCT) patient presented with chronic pulmonary aspergillosis associated to pulmonary graft versus host disease (GVHD) and was treated for a long time with several antifungal agents that were administered as prophylaxis, combination therapies, and maintenance treatment. The patient suffered from a breakthrough invasive pulmonary aspergillosis due to Aspergillus fumigatus after long-term antifungal therapy. MATERIAL AND METHODS: Several isolates were analyzed. First isolates were susceptible in vitro to all azole agents. However, after prolonged treatment with itraconazole and voriconazole a multiple azole resistant A. fumigatus isolate was cultured from bronchoalveolar lavage (BAL) when the patient was suffering from an invasive infection, and cavitary lesions were observed. RESULTS: Analysis of the resistant mechanisms operating in the last strain led us to report the first isolation in Spain of an azole resistant A. fumigatus strain harboring the L98H mutation in combination with the tandem repeat (TR) alteration in CYP51A gene (TR-L98H). Long-term azole therapy may increase the risk of resistance selecting strains exhibiting reduced susceptibility to these compounds. However, since the isolates were genetically different the suggestion that could be made is that the resistance was not induced during the prolonged azole therapy but the patient might simply have acquired this resistant isolate from the environment, selected by the therapy. CONCLUSIONS: These findings suggest that in all long-term treatments with antifungal agents, especially with azoles, repeated sampling and regular susceptibility testing of strains isolated is necessary as resistant isolates could be selected.

Dermatomycosis due to Neoscytalidium spp / Dermatomicosis por Neoscytalidium spp

No disponible

Infección fúngica sinusal por Schizophyllum commune: a propósito de dos casos clínicos / Fungal sinus infection by Schizophyllum commune: report of two clinical cases

ANTECEDENTES: Schizophyllum commune es un hongo basidiomiceto ampliamente distribuido en la naturaleza. Su papel como responsable de enfermedad en el ser humano ha sido poco conocido, en parte debido a su difícil identificación. La incorporación a los laboratorios de técnicas de espectrometría de masas (MALDI-TOF) y biología molecular ha permitido la descripción de un mayor número de casos. CASO CLÍNICO: En este trabajo presentamos dos casos en los que se identificó S. commune como agente causal de enfermedad: un caso de rinosinusitis crónica en un paciente inmunocompetente y otro caso de infección del seno esfenoidal en un paciente inmunocomprometido. En ambos casos se aisló S. commune. Su identificación fue posible gracias al MALDI-TOF y esta se confirmó en ambos pacientes mediante la amplificación y secuenciación de la región ITS. CONCLUSIONES: Concluimos que S. commune debe ser considerado un posible agente causal de enfermedad micótica. Actualmente, las técnicas de MALDI-TOF y secuenciación son necesarias para su identificación

BACKGROUND: Schizophyllum commune is a basidiomycete fungus which is widely distributed in nature. Its role as responsible for disease in humans is not well known, partly due to its difficult identification. The incorporation of mass spectrometry techniques (MALDI-TOF) and molecular biology to the laboratories has allowed the description of a greater number of cases. CASE REPORT: In this paper, we present two cases in which S. commune was identified as the causative agent of disease: in the first case an immunocompetent patient suffered from chronic rhinosinusitis, and in the second one a sphenoid sinus infection was diagnosed in an immunocompromised patient. In both cases, S. commune was isolated. Its identification was possible by means of MALDI-TOF and this was confirmed in both patients by amplification and sequencing of the ITS region. CONCLUSIONS: In conclusion, S. commune should be considered a potential causative agent of fungal disease. Currently, MALDI-TOF and sequencing techniques are necessary for its identification

Chryseobacterium spp., ¿nuevo patógeno oportunista asociado a fibrosis quística? / Chryseobacterium spp., a new opportunistic pathogen associated with cystic fibrosis?

INTRODUCCIÓN: En los últimos años se ha incrementado el aislamiento de bacilos gramnegativos no fermentadores en los pacientes con fibrosis quística (FQ). En el presente trabajo se registra la frecuencia de aislamientos de Chryseobacterium spp., analizándose sus características, patrones de resistencia y evolución clínica de los pacientes con FQ de nuestra unidad. MÉTODOS: Se recogieron todos los aislamientos respiratorios de Chryseobacterium spp. de los pacientes atendidos en la unidad de FQ del Hospital de la Princesa durante 3años (marzo 2009-marzo 2012). Para su identificación fenotípica y genotípica y para el estudio de sensibilidad se empleó metodología convencional. Para la valoración de la función pulmonar de los pacientes se tuvo en cuenta el volumen espirado forzado en el primer segundo (FEV1) y los resultados se analizaron con el paquete estadístico SPSS. RESULTADOS: Se constató un aumento en la incidencia de Chryseobacterium spp., obteniéndose 17 aislamientos pertenecientes a 9 pacientes. Tres enfermos presentaron colonización crónica por este microorganismo y uno de ellos mostró un deterioro significativo de la función pulmonar. En 7 de los pacientes existió co-colonización con Staphylococcus aureus, y con Pseudomonas aeruginosa en 4 de ellos. CONCLUSIÓN: Chryseobacterium spp. debe ser considerado como un nuevo patógeno oportunista emergente en pacientes con FQ. Es imprescindible una vigilancia microbiológica y clínica de este grupo de pacientes para detectar la colonización por Chryseobacterium spp. y poder evitar la infección crónica. En estas circunstancias, y aunque se desconoce su implicación clínica, se debe valorar su posible erradicación, siendo el cotrimoxazol la mejor opción terapéutica

INTRODUCTION: There is an increase in the isolation of non-fermenting gramnegative bacilli in patients with cystic fibrosis (CF). The present study evaluates the frequency of isolates of Chryseobacterium spp., analyzing its characteristics, resistance patterns and clinical outcome of patients. METHODS: It has been collected all respiratory isolates of Chryseobacterium spp. of patients attended in the CF unit of Hospital de la Princesa for three years (march 2009-march 2012). For phenotypic and genotypic identification and sensitivity study conventional methodology was used. For the assessment of the patients lung function was considered the forced expiratory volume in one second (FEV1) and the results were analyzed with SPSS. RESULTS: There was an increase in the incidence of Chryseobacterium spp. with 17 isolates from 9 patients. Three patients had chronic colonization by this microorganism and one showed significant impairment of lung function. Seven patients showed also colonization with Staphylococcus aureus and 4 of them with Pseudomonas aeruginosa. CONCLUSION: Chryseobacterium spp. should be considered as a new emerging opportunistic pathogen in patients with CF. It is essential the clinical and microbiological monitoring of this group of patients for detection of Chryseobacterium spp. colonization and to prevent the chronic infection. In these circumstances it must assess its possible eradication, though its clinical impact is unknown. Cotrimoxazole being the best treatment option

[Methicillin-resistant Staphylococcus aureus in patients with cystic fibrosis]. / Staphylococcus aureus resistente a meticilina en pacientes adultos con fibrosis quística.

OBJECTIVE: To determine the prevalence of chronic colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis, describe antibiotic sensitivity of the strains, and compare the patients' clinical characteristics with those of patients infected with methicillin-sensitive S. aureus (MSSA). PATIENTS AND METHODS: Patients with chronic S. aureus colonization were selected from a total of 50 patients with cystic fibrosis. Sputum samples were cultured according to standard microbiological procedures. Patients were considered to have chronic bronchial colonization if the same microorganism was isolated in 3 consecutive sputum samples, separated by an interval of at least 1 month. The following variables were compared between patients with MSSA (17) and MRSA (8): sex, body mass index, presence of pancreatic insufficiency, bacterial colonization, pulmonary function, Brasfield radiological score, Shwachman clinical score, and number of respiratory exacerbations in the previous year. RESULTS: The prevalence of infection by MRSA was 16%. All the MRSA strains were sensitive to vancomycin, teicoplanin, and linezolid. Patients with MRSA were older and had a larger number of respiratory exacerbations than patients with MSSA. CONCLUSIONS: There is a high percentage of colonization by MRSA in adult cystic fibrosis patients. Although the pathogenic role of this microorganism remains unclear, patients with MRSA had more frequent exacerbations and poorer lung function. Thus, infection control is important and patients should be adequately monitored.

Infección pulmonar recurrente por Aspergillus fumigatus con resistencia a múltiples triazoles en un paciente español con leucemia mieloide crónica / Breakthrough pulmonary Aspergillus fumigatus infection with multiple triazole resistance in a Spanish patient with chronic myeloid leukemia

Antecedentes. Un paciente sometido a un trasplante alogénico de progenitores hematopoyéticos se presentó con aspergilosis pulmonar crónica, asociada a enfermedad pulmonar injerto contra huésped, y fue tratado durante un período prolongado con diversos antimicóticos administrados como profilaxis, tratamiento de combinación y tratamiento de mantenimiento. El paciente experimentó una aspergilosis pulmonar invasiva recurrente debida a Aspergillus fumigatus tras el tratamiento antimicótico prolongado. Material y métodos. Se analizarán diversos aislamientos. Los primeros aislamientos eran sensibles in vitro a todos los azoles. No obstante, tras tratamiento prolongado con itraconazol y voriconazol, a partir de líquido de lavado broncopulmonar (LBA) cuando el paciente experimentó una infección invasiva, se cultivó un aislamiento de A. fumigatus resistente a múltiples azólicos y se observaron lesiones cavitarias. Resultados. El análisis de los mecanismos de resistencia que actuaron en la última cepa nos condujo a publicar un artículo sobre el primer aislamiento en España de una cepa de A. fumigatus resistente a un azol que albergaba la mutación L98H en combinación con una alteración de repeticiones en tándem (RT) en el gen CYP51A (TR-L98H). El tratamiento prolongado con un azol puede aumentar la selección de cepas con una disminución de la sensibilidad a estos fármacos. Sin embargo, en este caso, puesto que los aislamientos eran genéticamente diferentes, se sugirió que la resistencia no estuvo inducida durante el tratamiento prolongado con azólicos sino que el paciente adquirió este aislamiento resistente del entorno y fue seleccionado por el tratamiento. Conclusiones. Los hallazgos del presente estudio sugieren que en todos los tratamientos crónicos con antimicóticos, en particular con azólicos, puede ser necesaria la obtención de muestras repetidas, al igual que la realización de exámenes a intervalos regulares de la sensibilidad de las cepas aisladas, ya que pueden seleccionarse aislamientos resistentes(AU)

Background. An allogeneic hematopoietic cell transplantation (allo-HCT) patient presented with chronic pulmonary aspergillosis associated to pulmonary graft versus host disease (GVHD) and was treated for a long time with several antifungal agents that were administered as prophylaxis, combination therapies, and maintenance treatment. The patient suffered from a breakthrough invasive pulmonary aspergillosis due to Aspergillus fumigatus after long-term antifungal therapy. Material and methods. Several isolates were analyzed. First isolates were susceptible in vitro to all azole agents. However, after prolonged treatment with itraconazole and voriconazole a multiple azole resistant A. fumigatus isolate was cultured from bronchoalveolar lavage (BAL) when the patient was suffering from an invasive infection, and cavitary lesions were observed. Results. Analysis of the resistant mechanisms operating in the last strain led us to report the first isolation in Spain of an azole resistant A. fumigatus strain harboring the L98H mutation in combination with the tandem repeat (TR) alteration in CYP51A gene (TR-L98H). Long-term azole therapy may increase the risk of resistance selecting strains exhibiting reduced susceptibility to these compounds. However, since the isolates were genetically different the suggestion that could be made is that the resistance was not induced during the prolonged azole therapy but the patient might simply have acquired this resistant isolate from the environment, selected by the therapy. Conclusions. These findings suggest that in all long-term treatments with antifungal agents, especially with azoles, repeated sampling and regular susceptibility testing of strains isolated is necessary as resistant isolates could be selected(AU)

Burkholderia cepacia complex infection in an Adult Cystic Fibrosis unit in Madrid

Introduction: Burkholderia cepacia complex have emerged as significant pathogens in cystic fibrosis (CF) patients due to the risk of cepacia syndrome and the innate multi-resistance of the microorganisms to antibiotics. The aim of this study was to describe the antimicrobial susceptibility profiles, the genotypes and subtypes of BCC, and the clinical evolution of CF patients with BCC. Methods The lung function and Brasfield and Shwachman score were assessed in 12 patients. BCC were identified and susceptibility was studied by MicroScan (Siemens). Species and genospecies of BCC were confirmed by molecular methods in a Reference Centre (Majadahonda).Result sBCC were identified in 12 of 70 patients (17.1%) over a ten year period. The mean age to colonization by BCC was 24.4 years (SD: 7.71). B. cenocepacia was isolated in 4 patients (33.3%), B. contaminans was isolated in 3 patients (25%), both B. vietnamiensis and B. stabilis were isolated in 2 patients (16.7%), and B. cepacia, B. multivorans and B. late were isolated in one patient (8.3%). Among the B. cenocepacia, subtype IIIa was identified in two strains, and subtype IIIb was identified in the other two strains. There was susceptibility to meropenem in 90% of BCC, 80% to cotrimoxazole, 60% to minocycline, 50% to ceftazidime, and 40% to levofloxacin. Conclusions B. cenocepacia was the most prevalent species among the BCC isolated in CF adult patients, and subtypes IIIa and IIIb were identified in the 50% of the strains. Meropenem and cotrimoxazole showed the best activity

Introduction: Burkholderia cepacia complex have emerged as significant pathogens in cystic fibrosis (CF)patients due to the risk of cepacia syndrome and the innate multi-resistance of the microorganisms to antibiotics. The aim of this study was to describe the antimicrobial susceptibility profiles, the genotypes and subtypes of BCC, and the clinical evolution of CF patients with BCC. Methods: The lung function and Brasfield and Shwachman score were assessed in 12 patients.BCC were identified and susceptibility was studied by MicroScan (Siemens). Species and genospecies of BCC were confirmed by molecular methods in a Reference Centre (Majadahonda).Results: BCC were identified in 12 of 70 patients (17.1%) over a ten year period. The mean age to colonization by BCC was 24.4 years (SD: 7.71). B. cenocepacia was isolated in 4 patients (33.3%), B. contaminans was isolated in 3 patients (25%), both B. vietnamiensis and B. stabilis were isolated in 2 patients (16.7%), and B. cepacia, B. multivorans and B. late were isolated in one patient (8.3%). Among the B. cenocepacia, subtype IIIa was identified in two strains, and subtype IIIb was identified in the other two strains. There was susceptibility to meropenem in 90% of BCC, 80% to cotrimoxazole, 60% to minocycline, 50% to ceftazidime, and 40% to levofloxacin. Conclusions: B. cenocepacia was the most prevalent species among the BCC isolated in CF adult patients, and subtypes IIIa and IIIb were identified in the 50% of the strains. Meropenem and cotrimoxazole showed the best activity

Staphylococcus aureus resistente a meticilina en pacientes adultos con fibrosis quística / Methicillin-resistant Staphylococcus aureus in patients with cystic fibrosis

Objetivo: valorar la prevalencia de colonización crónica por Staphylococcus aureus resistente a meticilina (SARM) en pacientes con fibrosis quística, describir la sensibilidad antibiótica de las cepas, así como comparar las características clínicas con los pacientes con S. aureus sensible a meticilina (SASM). Pacientes y métodos: de un total de 50 pacientes con FQ se seleccionó a los colonizados crónicamente por S. aureus. Las muestras de esputo se cultivaron según los procedimientos microbiológicos habituales, se consideró colonización bronquial crónica el aislamiento de un mismo microorganismo en más de 3 muestras respiratorias consecutivas con un intervalo mínimo de 1 mes entre ellas. Se compararon las siguientes variables entre los pacientes con SASM (n=17) y aquellos con SARM (n=8): sexo, índice de masa corporal, insuficiencia pancreática, colonización bacteriana, función pulmonar, puntuaciones radiológicas de Brasfield y clínica de Shwachman y número de exacerbaciones respiratorias en el año previo. Resultados: la prevalencia de infección por SARM fue del 16%. El 100% de las cepas SARM fueron sensibles a vancomicina, teicoplanina y linezolid. Los enfermos con SARM tenían más edad, peor estado clínico y mayor número de exacerbaciones respiratorias que los pacientes con SASM. Conclusiones: hay un alto porcentaje de colonización por SARM en los pacientes adultos con fibrosis quística. Aunque el papel patogénico de esta bacteria está aún por determinar, parece que los pacientes con SARM tienen un peor estado clínico y presentan muchas exacerbaciones, por lo que la instauración de medidas de control y vigilancia es importante (AU)

Objective: To determine the prevalence of chronic colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis, describe antibiotic sensitivity of the strains, and compare the patients¿ clinical characteristics with those of patients infected with methicillin-sensitive S. aureus (MSSA). Patients and methods: Patients with chronic S. aureus colonization were selected from a total of 50 patients with cystic fibrosis. Sputum samples were cultured according to standard microbiological procedures. Patients were considered to have chronic bronchial colonization if the same microorganism was isolated in 3 consecutive sputum samples, separated by an interval of at least 1 month. The following variables were compared between patients with MSSA (17) and MRSA (8): sex, body mass index, presence of pancreatic insufficiency, bacterial colonization, pulmonary function, Brasfield radiological score, Shwachman clinical score, and number of respiratory exacerbations in the previous year. Results: The prevalence of infection by MRSA was 16%. All the MRSA strains were sensitive to vancomycin, teicoplanin, and linezolid. Patients with MRSA were older and had a larger number of respiratory exacerbations than patients with MSSA. Conclusions: There is a high percentage of colonization by MRSA in adult cystic fibrosis patients. Although the pathogenic role of this microorganism remains unclear, patients with MRSA had more frequent exacerbations and poorer lung function. Thus, infection control is important and patients should be adequately monitored (AU)

¿Qué debemos saber sobre aspergillus? / What should we know abaut Aspergillus?

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