MIC of amoxicillin/clavulanate according to CLSI and EUCAST: discrepancies and clinical impact in patients with bloodstream infections due to Enterobacteriaceae.

Objectives: To compare results of amoxicillin/clavulanate susceptibility testing using CLSI and EUCAST methodologies and to evaluate their impact on outcome in patients with bacteraemia caused by Enterobacteriaceae. Patients and methods: A prospective observational cohort study was conducted in 13 Spanish hospitals. Patients with bacteraemia due to Enterobacteriaceae who received empirical intravenous amoxicillin/clavulanate treatment for at least 48 h were included. MICs were determined following CLSI and EUCAST recommendations. Outcome variables were: failure at the end of treatment with amoxicillin/clavulanate (FEAMC); failure at day 21; and 30 day mortality. Classification and regression tree (CART) analysis and logistic regression were performed. Results: Overall, 264 episodes were included; the urinary tract was the most common source (64.7%) and Escherichia coli the most frequent pathogen (76.5%). Fifty-two isolates (19.7%) showed resistance according to CLSI and 141 (53.4%) according to EUCAST. The kappa index for the concordance between the results of both committees was only 0.24. EUCAST-derived, but not CLSI-derived, MICs were associated with failure when considered as continuous variables. CART analysis suggested a 'resistance' breakpoint of > 8/4 mg/L for CLSI-derived MICs; it predicted FEAMC in adjusted analysis (OR = 1.96; 95% CI: 0.98-3.90). Isolates with EUCAST-derived MICs >16/2 mg/L independently predicted FEAMC (OR = 2.10; 95% CI: 1.05-4.21) and failure at day 21 (OR= 3.01; 95% CI: 0.93-9.67). MICs >32/2 mg/L were only predictive of failure among patients with bacteraemia from urinary or biliary tract sources. Conclusions: CLSI and EUCAST methodologies showed low agreement for determining the MIC of amoxicillin/clavulanate. EUCAST-derived MICs seemed more predictive of failure than CLSI-derived ones. EUCAST-derived MICs >16/2 mg/L were independently associated with therapeutic failure.

Association of microbiological factors with mortality in Escherichia coli bacteraemia presenting with sepsis/septic shock: a prospective cohort study.

OBJECTIVES: This study aimed to determine the association of Escherichia coli microbiological factors with 30-day mortality in patients with bloodstream infection (BSI) presenting with a dysregulated response to infection (i.e. sepsis or septic shock). METHODS: Whole-genome sequencing was performed on 224 E coli isolates of patients with sepsis/septic shock, from 22 Spanish hospitals. Phylogroup, sequence type, virulence, antibiotic resistance, and pathogenicity islands were assessed. A multivariable model for 30-day mortality including clinical and epidemiological variables was built, to which microbiological variables were hierarchically added. The predictive capacity of the models was estimated by the area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI). RESULTS: Mortality at day 30 was 31% (69 patients). The clinical model for mortality included (adjusted OR; 95% CI) age (1.04; 1.02-1.07), Charlson index ≥3 (1.78; 0.95-3.32), urinary BSI source (0.30; 0.16-0.57), and active empirical treatment (0.36; 0.11-1.14) with an AUROC of 0.73 (95% CI, 0.67-0.80). Addition of microbiological factors selected clone ST95 (3.64; 0.94-14.04), eilA gene (2.62; 1.14-6.02), and astA gene (2.39; 0.87-6.59) as associated with mortality, with an AUROC of 0.76 (0.69-0.82). DISCUSSION: Despite having a modest overall contribution, some microbiological factors were associated with increased odds of death and deserve to be studied as potential therapeutic or preventive targets.

[Epidemiology, risk factors and in vitro susceptibility in candidaemia due to non-Candida albicans species]. / Epidemiología, factores de riesgo y sensibilidad in vitro en candidemias por especies diferentes de Candida albicans.

BACKGROUND: Invasive fungal infection (IFI) has increased in recent years due to there being a greater number of risk factors. IFI caused by Candida is the most frequent, and although Candida albicans is the most isolated species, there is currently a decrease of C. albicans and an increase of other species of the genus. AIMS: To analyse the epidemiology, risk factors, and antifungal susceptibility of blood culture isolates of non-C.albicans Candida species in our hospital in the last 12years. METHODS: A retrospective study was conducted on 107 patients with candidaemia admitted to our hospital. Candida isolates susceptibility to fluconazole, itraconazole, voriconazole, amphotericinB, 5-fluorocytosine, caspofungin, micafungin, and anidulafungin was determined by means of a microdilution technique (Sensititre Yeast One; Izasa, Spain). RESULTS: From a total of 109 strains, 59 belonged to non-C. albicans Candida species: 25 Candida parapsilosis complex, 14 Candida glabrata complex, 13 Candida tropicalis, 4 Candida krusei, 1 Candida lipolytica, 1 Candida membranaefaciens, and 1 Candida pulcherrima. The most common risk factor in adults and children was catheter use. It was observed that 8.5% of those non-C.albicans strains were resistant to fluconazole. CONCLUSIONS: The results of this work confirm that it is necessary to know the epidemiology of non-C.albicans Candida species, the in vitro susceptibility of the species involved, and the main risk factors, especially in patients with predisposing conditions.

Epidemiología, factores de riesgo y sensibilidad in vitro en candidemias por especies diferentes de Candida albicans / Epidemiology, risk factors and in vitro susceptibility in candidaemia due to non-Candida albicans species

Antecedentes. La infección fúngica invasora ha aumentado en los últimos años por el incremento de los factores de riesgo; la candidemia es la principal manifestación clínica. Candida albicans es la especie más frecuente, aunque actualmente se ha observado un aumento en otras especies del género. Objetivos. Analizar la epidemiología, los factores de riesgo y la sensibilidad antifúngica de los aislamientos en hemocultivos de especies de Candida diferentes de C.albicans en nuestro hospital en los últimos 12años. Métodos. Se estudiaron retrospectivamente las características epidemiológicas de 107 pacientes con candidemia ingresados en nuestro hospital. Se determinó la sensibilidad de las especies de Candida al fluconazol, el itraconazol, el voriconazol, la anfotericinaB, la 5-fluorocitosina, la caspofungina, la micafungina y la anidulafungina mediante el método de microdilución Sensititre Yeast One (Izasa, España). Resultados. De los 109 aislamientos, 59 correspondieron a las siguientes especies de Candida (diferentes de C.albicans): 25 Candida parapsilosis complex, 14 Candida glabrata complex, 13 Candida tropicalis, 4 Candida krusei, una Candida lipolytica, una Candida membranaefaciens y una Candida pulcherrima. El factor de riesgo más frecuente en adultos y niños con candidemias por estas especies fue ser portador de catéter. El 8,5% de estos aislamientos fueron resistentes al fluconazol. Conclusiones. El resultado de nuestro trabajo confirma la necesidad de conocer la epidemiología de las especies de Candida diferentes de C.albicans, su sensibilidad in vitro y los factores de riesgo asociados, especialmente en pacientes con dichos factores (AU)

Background. Invasive fungal infection (IFI) has increased in recent years due to there being a greater number of risk factors. IFI caused by Candida is the most frequent, and although Candida albicans is the most isolated species, there is currently a decrease of C. albicans and an increase of other species of the genus. Aims. To analyse the epidemiology, risk factors, and antifungal susceptibility of blood culture isolates of non-C.albicans Candida species in our hospital in the last 12years. Methods. A retrospective study was conducted on 107 patients with candidaemia admitted to our hospital. Candida isolates susceptibility to fluconazole, itraconazole, voriconazole, amphotericinB, 5-fluorocytosine, caspofungin, micafungin, and anidulafungin was determined by means of a microdilution technique (Sensititre Yeast One; Izasa, Spain). Results. From a total of 109 strains, 59 belonged to non-C. albicans Candida species: 25 Candida parapsilosis complex, 14 Candida glabrata complex, 13 Candida tropicalis, 4 Candida krusei, 1 Candida lipolytica, 1 Candida membranaefaciens, and 1 Candida pulcherrima. The most common risk factor in adults and children was catheter use. It was observed that 8.5% of those non-C.albicans strains were resistant to fluconazole. Conclusions. The results of this work confirm that it is necessary to know the epidemiology of non-C.albicans Candida species, the in vitro susceptibility of the species involved, and the main risk factors, especially in patients with predisposing conditions (AU)

Catheter-associated bacteremia caused by Ochrobactrum anthropi in a patient on parenteral nutrition

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Aspectos microbiológicos de la criptococosis en la era post-TARGA / Microbiological aspects of the cryptococcosis in the post-HAART era

La criptococosis es una micosis que incrementó su incidencia considerablemente con la aparición del sida. Sin embargo, tras la instauración, a finales de los años noventa, del tratamiento antirretroviral de gran actividad (TARGA), esta incidencia ha experimentado una disminución significativa, especialmente en los países desarrollados, aunque no ocurre lo mismo en los países en vías de desarrollo. Con la introducción del TARGA, no sólo se ha visto afectada la tasa de incidencia, sino también las manifestaciones clínicas, que se han presentado en algunos casos de forma anómala, como consecuencia de una recuperación de la inmunidad, describiéndose un nuevo síndrome, el síndrome inflamatorio de reconstitución inmune, así como manifestaciones raras como la linfadenitis y la afectación cutánea. Por otra parte, las pruebas de diagnóstico también han experimentado cambios, y existe un alto porcentaje de casos con cultivos negativos, microscopia negativa y detección tardía del antígeno criptocócico. En cuanto a los patrones de sensibilidad, también se ha observado una recuperación de la sensibilidad en la mayoría de los casos, hecho relacionado, a su vez, con la disminución de casos de criptococosis y con el menor uso de antifúngicos

Cryptococcosis is a mycoses that increased considerably with the AIDS epidemic. However, with the introduction in the late 90's of the highly active antiretroviral therapy (HAART), this incidence has significantly decreased, especially in developed countries, in contrast with that of developing countries. The introduction of HAART not only has affected the incidence rate, but also the clinical presentation as a consequence of the immune recovery of the host, leading to the description of the so called immune reconstitution inflammatory syndrome. In addition, some rare clinical manifestations of cyptococcosis are currently shown, such as lymphadenitis and cutaneous involvement. Besides clinical presentation, diagnostic tests have also changed, with a high percentage of cases with negative cerebrospinal fluid (CSF) and blood cultures, negative direct CSF microscopy, and delayed antigen positive results. Antifungal susceptibility patterns have also changed towards a recuperation of susceptibility, which is related to the decrease in both the incidence of cryptococcosis and less use of antifungal agents