Activity of propyl-propane-thiosulfinate and propyl-propane-thiosulfonate against carbapenem-resistant Gram-negative bacteria.

Organosulfur compounds derived from plants of the Allium genus, such as propyl-propane-thiosulfinate (PTS) and propyl-propane-thiosulfonate (PTSO), have been proposed as an alternative in antibiotic resistance. The aim of this study was to compare the activity of these substances with other antibiotics against clinical isolates of carbapenem-resistant (CAR-R) and carbapenem-susceptible (CAR-S) Gram-negative bacteria. A total of 126 clinical isolates of CAR-R and 155 CAR-S bacteria were selected, including Enterobacterales, A. baumannii and P. aeruginosa. The antibiotic susceptibility of all isolates was assessed using the microdilution and Kirby-Bauer methods for PTS, PTSO, amoxicillin/clavulanate, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, imipenem, ciprofloxacin, and amikacin. Both PTS and PTSO demonstrated in vitro bactericidal activity against CAR-R Enterobacteriaceae and A. baumannii, with no significant difference in activity compared to their response against CAR-S isolates. However, both compounds were less active against P. aeruginosa than against any of the other bacteria, regardless of their resistance to carbapenems. In all cases, the minimum inhibitory concentration values of PTSO were significantly lower than those of PTS. These findings offer valuable information about the potential antibacterial use of these substances, particularly against infections that currently have limited therapeutic options.

Características sociodemográficas y factores de riesgo asociados a las bacteriurias significativas en un área de salud del sudeste español / Sociodemographic characteristics and risk factors associated to significative bacteriuria in a Spanish health area

Objetivo. Determinar las características epidemiológicasde las bacteriurias significativas (BS) y su relación con factoressociodemográficos, así como analizar los factores de riesgo enpacientes hospitalizados.Material y métodos. Estudio descriptivo transversal realizado sobre el conjunto de registros obtenidos a partir del procesamiento de todas las muestras de urocultivos recibidas en ellaboratorio de Microbiología del Hospital Universitario Virgende las Nieves (Granada, España) entre enero de 2016 y diciembre de 2020, diferenciando entre población infantil y adulta.Como variables dependientes se analizaron la presencia de BS,las variables independientes fueron la edad en años, sexo, añoy mes de la muestra, tipo de muestra, procedencia de la muestra y número de aislamientos. En los urocultivos obtenidos depacientes ingresados se evaluó la presencia de factores de riesgo asociados a partir del Conjunto Mínimo Básico de Datos.Resultados. Se analizaron 68.587 registros válidos (un96,3% del total). El 40,8% (IC95%: 40,4%-41,2%) de los urocultivos en adultos y el 33,8% (IC95%: 32,9%-34,7%) en niños fueron positivos. La incidencia en adultos descendió de18,2 casos/1.000 habitantes en el año 2016 a 14,6 casos/1.000habitantes en 2020. Para estos mismos años, la incidencia enmenores disminuyó de 21,1 a 8,4 casos/1.000 habitantes, respectivamente. Los urocultivos positivos fueron más frecuentesen niños del ámbito urbano frente al ámbito rural (OR=1,37;p<0,01), sin significación en adultos. En adultos hospitalizados,por cada año de edad transcurrido, el riesgo de BS aumentó un2%, (OR=1,02), fue un 36% mayor en mujeres (OR=1,36), un18% superior en obesos (OR=1,18) y un 17% más frecuente en pacientes con enfermedad renal (OR=1,17), todas ellas deforma significativa (p<0,01). No se observó relación entre BS ydiagnóstico de COVID-19. (AU)

Objective. To determine the epidemiological characteristics of significative bacteriuria (SB) and their relationship withsociodemographic factors and to analyze risk factors in inpatients.Material and methods. Cross-sectional descriptive studycarried out on urine culture samples received between 2016-2020 in the Microbiology laboratory, differentiating betweenminors and adults. The dependent variable was the presenceof SB and the independent variables were age, sex, year, typeof sample and source of the sample. In urine cultures of inpatients, risk factors were evaluated from the Minimum BasicData Set.Results. A total of 68,587 valid records (96.3% of thetotal) were analyzed. 40.8% (95% CI: 40.4%-41.2%) of urinecultures in adults and 33.8% (95% CI: 32.9%-34.7%) in children were positive, with an incidence that ranged in adultsbetween 18.2 cases/1,000 inhabitants in 2016 and 14.6 cases/1,000 inhabitants in 2020 and 21.1 and 8.4 cases/1,000 inhabitants respectively in minors. Positive urine cultures were more frequent in children from urban areas compared to ruralareas (OR=1.37; p<0.01). In hospitalized adults, for each yearof age the risk of SB increased by 2%, it was 36% higher inwomen, 18% higher in obese patients and 17% more frequentin patients with kidney disease, (p<0.01). No relationship wasobserved between SB and diagnosis of COVID-19. (AU)

Toxoplasma gondii Seropositivity Interacts with Catechol-O-methyltransferase Val105/158Met Variation Increasing the Risk of Schizophrenia.

Schizophrenia is a heterogeneous and severe psychotic disorder. Epidemiological findings have suggested that the exposure to infectious agents such as Toxoplasma gondii (T. gondii) is associated with an increased risk for schizophrenia. On the other hand, there is evidence involving the catechol-O-methyltransferase (COMT) Val105/158Met polymorphism in the aetiology of schizophrenia since it alters the dopamine metabolism. A case−control study of 141 patients and 142 controls was conducted to analyse the polymorphism, the prevalence of anti-T. gondii IgG, and their interaction on the risk for schizophrenia. IgG were detected by ELISA, and genotyping was performed with TaqMan Real-Time PCR. Although no association was found between any COMT genotype and schizophrenia, we found a significant association between T. gondii seropositivity and the disorder (χ2 = 11.71; p-value < 0.001). Furthermore, the risk for schizophrenia conferred by T. gondii was modified by the COMT genotype, with those who had been exposed to the infection showing a different risk compared to that of nonexposed ones depending on the COMT genotype (χ2 for the interaction = 7.28, p-value = 0.007). This study provides evidence that the COMT genotype modifies the risk for schizophrenia conferred by T. gondii infection, with it being higher in those individuals with the Met/Met phenotype, intermediate in heterozygous, and lower in those with the Val/Val phenotype.

Antimicrobial Activity of the Circular Bacteriocin AS-48 against Clinical Multidrug-Resistant Staphylococcus aureus.

The treatment and hospital-spread-control of methicillin-resistant Staphylococcus aureus (MRSA) is an important challenge since these bacteria are involved in a considerable number of nosocomial infections that are difficult to treat and produce prolonged hospitalization, thus also increasing the risk of death. In fact, MRSA strains are frequently resistant to all ß-lactam antibiotics, and co-resistances with other drugs such as macrolides, aminoglycosides, and lincosamides are usually reported, limiting the therapeutical options. To this must be added that the ability of these bacteria to form biofilms on hospital surfaces and devices confer high antibiotic resistance and favors horizontal gene transfer of genetic-resistant mobile elements, the spreading of infections, and relapses. Here, we genotypically and phenotypically characterized 100 clinically isolated S. aureus for their resistance to 18 antibiotics (33% of them were OXA resistant MRSA) and ability to form biofilms. From them, we selected 48 strains on the basis on genotype group, antimicrobial-resistance profile, and existing OXA resistance to be assayed against bacteriocin AS-48. The results showed that AS-48 was active against all strains, regardless of their clinical source, genotype, antimicrobial resistance profile, or biofilm formation capacity, and this activity was enhanced in the presence of the antimicrobial peptide lysozyme. Finally, we explored the effect of AS-48 on formed S. aureus biofilms, observing a reduction in S. aureus S-33 viability. Changes in the matrix structure of the biofilms as well as in the cell division process were observed with scanning electron microscopy in both S-33 and S-48 S. aureus strains.

[Etiology of urinary tract infections in our health area and susceptibility profile of the most common uropathogens.] / Etiología de las infecciones urinarias en nuestra área sanitaria y perfil de sensibilidad de los uropatógenos más frecuentes.

BACKGROUND AND OBJECTIVE: Adequate empirical treatment should be established for treatment urinary tract infections, considering the prevalence of the most frequent microorganisms in each geographic area and their susceptibility to different antibiotics. The objective of the study is to analyze the epidemiology of UTIs in our Health Area as well as to understand the antibiotic susceptibility of the most prevalent isolated microorganisms to guide empirical treatment. The objective was to establish a reasoned system for recommending ITU empirical therapy, based on the microorganisms causing episodes assisted in a Regional Hospital, knowing their antibiotic susceptibility. PATIENTS AND METHODS: A descriptive-retrospective study was carried out based on the results of 12,204 urine cultures of the year 2018. The overall empirical activity of the antibiotics tested was calculated, differentiating between episodes of the community and of in patients, adults and children. RESULTS: Escherichia coli was the most frequently isolated microorganism in all studied groups. The following microorganisms in frequency, in adults, were Enterococcus faecalis, Klebsiella pneumoniae and yeasts (8%). In the group of children these were Enterococcus faecalis and Proteus mirabilis. There was no difference in the activity of antibiotics against Escherichia coli, in adults or in children, of the community or in patients, with sensitivityto fosfomycin and nitrofuranto in greater than 96%; at imipenem and piperacillin-tazobactam greater than 94% and third generation cephalosporins greater than 90%. However, the overall empirical activity, without distinction by microorganism, was for fosfomycin 77.96-80.60% in adults and 92.73-94.50% in children; to prevent 77.70-78.74% in adults and 92.36-91.28% in children; for piperacillin-tazobactam of 77.57-80.03% in adults and 89.09-94.04% in children; and for cefotaxime of 53.28-54.76% in adults and 68.73-74.77% in children. CONCLUSIONS: Fosfomycin, piperacillin-tazobactam or imipenem were the best option for empirical treatment without covering all episodes in adults. Each Center must establish a reasoned profile of empirical treatment of the infection, which should also take into account risk factors for a microorganism and clinical severity.

ANTECEDENTES Y OBJETIVO: Se debe establecer un tratamiento empírico adecuado que acabe con la mayor parte de las infecciones del tracto urinario (ITU), teniendo en cuenta la prevalencia de los microorganismos más frecuentes en cada área geográfica y la sensibilidad de estos a los distintos antibióticos. El objetivo del estudio es analizar la epidemiología de las ITU en nuestra Área Sanitaria, así como conocer la sensibilidad antibiótica de los microorganismos aislados más prevalentes para orientar el tratamiento empírico. PACIENTES Y MÉTODOS: Se realizó un estudio descriptivo-retrospectivo a partir de los resultados de12.204 urocultivos del año 2018. Se calculó la actividad empírica global de los antibióticos ensayados, diferenciando entre episodios de la comunidad y de pacientes hospitalizados, adultos y niños. RESULTADOS: Escherichia coli fue el microorganismo más frecuentemente aislado en todos los grupos estudiados. Los siguientes microorganismos en frecuencia, en los adultos, fueron Enterococcus faecalis, Klebsiella pneumoniae y levaduras (8%). En el grupo de los niñosestos fueron Enterococcus faecalis y Proteus mirabilis.N o hubo diferencia en la actividad de los antibióticos frente a Escherichia coli, en adultos o en niños, de la comunidad u o hospitalizado, con sensibilidad a fosfomicina y nitrofurantoína superior al 96%; a imipenem y piperacilina-tazobactam superior al 94% y cefalosporinas de tercera generación superior al 90%. Sin embargo,la actividad empírica global, sin distinción por microorganismo, fue para fosfomicina del 77,96-80,60% en adultos y del 92,73-94,50% en niños; para imipenem del 77,70-78,74% en adultos y del 92,36-91,28% en niños; para piperacilina-tazobactam del 77,57-80,03% en adultos y del 89,09-94,04% en niños; y para cefotaxima del 53,28-54,76% en adultos y del 68,73-74,77% en niños. CONCLUSIONES: Fosfomicina, piperacilina-tazobactame imipenem fueron la mejor opción de tratamiento empírica, sin cubrir todos los episodios en los adultos. Cada centro de trabajo debe establecer un perfil razonado de tratamiento empírico de la infección, que además deben tener en cuenta los factores de riesgo para un microorganismo y la gravedad clínica.

Etiología de las infecciones urinarias en nuestra área sanitaria y perfil de sensibilidad de los uropatógenos más frecuentes / Etiology of urinary tract infections in our health area and susceptibility profile of the most common uropathogens

ANTECEDENTES Y OBJETIVO: Se debe establecer un tratamiento empírico adecuado que acabe con la mayor parte de las infecciones del tracto urinario (ITU), teniendo en cuenta la prevalencia de los microorganismos más frecuentes en cada área geográfica y la sensibilidad de estos a los distintos antibióticos. El objetivo del estudio es analizar la epidemiología de las ITU en nuestra Área Sanitaria, así como conocer la sensibilidad antibiótica de los microorganismos aislados más prevalentes para orientar el tratamiento empírico. PACIENTES Y MÉTODOS: Se realizó un estudio descriptivo-retrospectivo a partir de los resultados de12.204 urocultivos del año 2018. Se calculó la actividad empírica global de los antibióticos ensayados, diferenciando entre episodios de la comunidad y de pacientes hospitalizados, adultos y niños. RESULTADOS: Escherichia coli fue el microorganismo más frecuentemente aislado en todos los grupos estudiados. Los siguientes microorganismos en frecuencia, en los adultos, fueron Enterococcus faecalis, Klebsiella pneumoniae y levaduras (8%). En el grupo de los niñosestos fueron Enterococcus faecalis y Proteus mirabilis.N o hubo diferencia en la actividad de los antibióticos frente a Escherichia coli, en adultos o en niños, de la comunidad u o hospitalizado, con sensibilidad a fosfomicina y nitrofurantoína superior al 96%; a imipenem y piperacilina-tazobactam superior al 94% y cefalosporinas de tercera generación superior al 90%. Sin embargo,la actividad empírica global, sin distinción por microorganismo, fue para fosfomicina del 77,96-80,60% en adultos y del 92,73-94,50% en niños; para imipenem del 77,70-78,74% en adultos y del 92,36-91,28% en niños; para piperacilina-tazobactam del 77,57-80,03% en adultos y del 89,09-94,04% en niños; y para cefotaxima del 53,28-54,76% en adultos y del 68,73-74,77% en niños. CONCLUSIONES: Fosfomicina, piperacilina-tazobactame imipenem fueron la mejor opción de tratamiento empírica, sin cubrir todos los episodios en los adultos. Cada centro de trabajo debe establecer un perfil razonado de tratamiento empírico de la infección, que además deben tener en cuenta los factores de riesgo para un microorganismo y la gravedad clínica

BACKGROUND AND OBJECTIVE: Adequate empirical treatment should be established for treatment urinary tract infections, considering the prevalence of the most frequent microorganisms in each geographic area and their susceptibility to different antibiotics. The objective of the study is to analyze the epidemiology of UTIs in our Health Area as well as to understand the antibiotic susceptibility of the most prevalent isolated microorganisms to guide empirical treatment. The objective was to establish a reasoned system for recommending ITU empirical therapy, based on the microorganisms causing episodes assisted in a Regional Hospital, knowing their antibiotic susceptibility. PATIENTS AND METHODS: A descriptive-retrospective study was carried out based on the results of 12,204 urine cultures of the year 2018. The overall empirical activity of the antibiotics tested was calculated, differentiating between episodes of the community and of inpatients, adults and children. RESULTS: Escherichia coli was the most frequently isolated microorganism in all studied groups. The following microorganisms in frequency, in adults, were Enterococcus faecalis, Klebsiella pneumoniae and yeasts (8%). In the group of children these were Enterococcus faecalis and Proteus mirabilis. There was no difference in the activity of antibiotics against Escherichia coli, in adults or in children, of the community or inpatients, with sensitivity to fosfomycin and nitrofurantoin greater than 96%; at imipenem and piperacillin-tazobactam greater than 94% and third generation cephalosporins greater than 90%. However, the overall empirical activity, without distinction by microorganism, was for fosfomycin 77.96-80.60% in adults and 92.73-94.50% in children; to prevent 77.70-78.74% in adults and 92.36-91.28% in children; for piperacillin-tazobactam of 77.57-80.03% in adults and 89.09-94.04% in children; and for cefotaxime of 53.28-54.76% in adults and 68.73-74.77% in children. CONCLUSIONS: Fosfomycin, piperacillin-tazobactam or imipenem were the best option for empirical treatment without covering all episodes in adults. Each Center must establish a reasoned profile of empirical treatment of the infection, which should also take into account risk factors for a microorganism and clinical severity

Effectiveness of Electronic Guidelines (GERH®) to Improve the Clinical Use of Antibiotics in An Intensive Care Unit.

The objective of the study was to evaluate the capacity of GERH®-derived local resistance maps (LRMs) to predict antibiotic susceptibility profiles and recommend the appropriate empirical treatment for ICU patients with nosocomial infection. Data gathered between 2007 and 2016 were retrospectively studied to compare susceptibility information from antibiograms of microorganisms isolated in blood cultures, lower respiratory tract samples, and urine samples from all ICU patients meeting clinical criteria for infection with the susceptibility mapped by LRMs for these bacterial species. Susceptibility described by LRMs was concordant with in vitro study results in 73.9% of cases. The LRM-predicted outcome agreed with the antibiogram result in >90% of cases infected with the bacteria for which GERH® offers data on susceptibility to daptomycin, vancomycin, teicoplanin, linezolid, and rifampicin. Full adherence to LRM recommendations would have improved the percentage adequacy of empirical prescriptions by 2.2% for lower respiratory tract infections (p = 0.018), 3.1% for bacteremia (p = 0.07), and 5.3% for urinary tract infections (p = 0.142). LRMs may moderately improve the adequacy of empirical antibiotic therapy, especially for lower respiratory tract infections. LRMs recommend appropriate prescriptions in approximately 50% of cases but are less useful in patients with bacteremia or urinary tract infection.

Characterization of Fosfomycin and Nitrofurantoin Resistance Mechanisms in Escherichia coli Isolated in Clinical Urine Samples.

Fosfomycin and nitrofurantoin are antibiotics of choice to orally treat non-complicated urinary tract infections (UTIs) of community origin because they remain active against bacteria resistant to other antibiotics. However, epidemiologic surveillance studies have detected a reduced susceptibility to these drugs. The objective of this study was to determine possible mechanisms of resistance to these antibiotics in clinical isolates of fosfomycin- and/or nitrofurantoin-resistant UTI-producing Escherichia coli. We amplified and sequenced murA, glpT, uhpT, uhpA, ptsI, cyaA, nfsA, nfsB, and ribE genes, and screened plasmid-borne fosfomycin-resistance genes fosA3, fosA4, fosA5, fosA6, and fosC2 and nitrofurantoin-resistance genes oqxA and oqxB by polymerase chain reaction. Among 29 isolates studied, 22 were resistant to fosfomycin due to deletion of uhpT and/or uhpA genes, and 2 also possessed the fosA3 gene. Some modifications detected in sequences of NfsA (His11Tyr, Ser33Arg, Gln67Leu, Cys80Arg, Gly126Arg, Gly154Glu, Arg203Cys), NfsB (Gln44His, Phe84Ser, Arg107Cys, Gly192Ser, Arg207His), and RibE (Pro55His), and the production of truncated NfsA (Gln67 and Gln147) and NfsB (Glu54), were associated with nitrofurantoin resistance in 15/29 isolates; however, the presence of oqxAB plasmid genes was not detected in any isolate. Resistance to fosfomycin was associated with the absence of transporter UhpT expression and/or the presence of antibiotic-modifying enzymes encoded by fosA3 plasmid-mediated gene. Resistance to nitrofurantoin was associated with modifications of NfsA, NfsB, and RibE proteins. The emergence and spread of these resistance mechanisms, including transferable resistance, could compromise the future usefulness of fosfomycin and nitrofurantoin against UTIs. Furthermore, knowledge of the genetic mechanisms underlying resistance may lead to rapid DNA-based testing for resistance.

Antibacterial and Antifungal Activity of Propyl-Propane-Thiosulfinate and Propyl-Propane-Thiosulfonate, Two Organosulfur Compounds from Allium cepa: In Vitro Antimicrobial Effect via the Gas Phase.

Propyl-propane thiosulfinate (PTS) and propyl-propane thiosulfonate (PTSO) are two volatile compounds derived from Allium cepa with a widely documented antimicrobial activity. The aim of this study was to evaluate their anti-candidiasis activity and the ability of its gaseous phase to inhibit bacterial and yeast growth in vitro. The minimum inhibitory concentration of various antifungal products (including PTS and PTSO) was determined versus 203 clinical isolates of Candida spp. through broth microdilution assay. Additionally, the antimicrobial activity through aerial diffusion of PTS and PTSO was evaluated over the growth of a collection of bacteria and yeasts cultivated in agar plates. All yeasts were susceptible to the antifungals tested, except C. glabrata and C. krusei, that showed azole resistance. PTSO (MIC50 and MIC90 ranged from 4 to 16 mg/L and 8 to 32 mg/L, respectively) was significantly more active against yeasts than PTS (MIC50 and MIC90 ranged from 16 to 64 mg/L and 32 to 64 mg/L). Values were higher than those obtained for antifungal drugs. Gaseous phases of PTS and PTSO generated growth inhibition zones whose diameters were directly related to the substances concentration and inversely related to the microbial inoculum. The quantification of PTS and PTSO levels reached in the growth media through aerial diffusion displayed a concentration gradient from the central zone to the periphery. Only P. aeruginosa ATCC 27853 showed resistance, while yeasts (C. albicans ATCC 200955 and C. krusei ATCC 6258) presented the higher susceptibility to both compounds. These results suggest that PTS and PTSO display antibacterial and anti-candidiasis activity in vitro through aerial diffusion, having potential use in human therapy.

In Vitro Antibacterial Activity of Propyl-Propane-Thiosulfinate and Propyl-Propane-Thiosulfonate Derived from Allium spp. against Gram-Negative and Gram-Positive Multidrug-Resistant Bacteria Isolated from Human Samples.

BACKGROUND: The aim of this study was to compare the in vitro antibacterial activity of two compounds derived from Alliaceae, PTS (propyl-propane-thiosulfinate), and PTSO (propyl-propane-thiosulfonate), with that of other antibiotics commonly used against bacteria isolated from humans. MATERIALS AND METHODS: A total of 212 gram-negative bacilli and 267 gram-positive cocci isolated from human clinical samples and resistant to at least one group of antibiotics were selected. In order to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) to various antibiotics as well as PTS and PTSO, all isolates underwent broth microdilution assay. RESULTS: PTS showed moderate activity against Enterobacteriaceae with MIC50 (and MBC50) and MIC90 (and MBC90) values of 256-512 mg/L, while PTSO showed greater activity with MIC50 and MIC90 values of 64-128 mg/L and MBC50 and MBC90 values of 128-512 mg/L. These data show the bactericidal activity of both compounds and indicate that PTSO was more active than PTS against this group of bacteria. Both compounds showed lower activity against P. aeruginosa (MIC50 = 1024 mg/L, MIC90 = 2048 mg/L, MBC50 = 2048 mg/L, and MBC90 = 2048 mg/L, for PTS; MIC50 = 512 mg/L, MIC90 = 1024 mg/L, MBC50 = 512 mg/L, and MBC90 = 2048 mg/L, for PTSO) compared to those obtained in others nonfermenting gram-negative bacilli (MIC50 = 128 mg/L, MIC90 = 512 mg/L, MBC50 = 128 mg/L, and MBC90 = 512 mg/L, for PTS; MIC50 = 64 mg/L, MIC90 = 256 mg/L, MBC50 = 64 mg/L, and MBC90 = 256 mg/L, for PTSO) and also indicate the bactericidal activity of both compounds against these groups of bacteria. Finally, the activity against S. aureus, E. faecalis, and S. agalactiae was higher than that observed against enterobacteria, especially in the case of PTSO (MIC50 = 8 mg/L, MIC90 = 8 mg/L, MBC50 = 32 mg/L, and MBC90 = 64 mg/L, in S. aureus; MIC50 = 4 mg/L, MIC90 = 8 mg/L, MBC50 = 8 mg/L, and MBC90 = 16 mg/L, in E. faecalis and S. agalactiae). CONCLUSION: PTS and PTSO have a significant broad spectrum antibacterial activity against multiresistant bacteria isolated from human clinical samples. Preliminary results in present work provide basic and useful information for development and potential use of these compounds in the treatment of human infections.

Estudio prospectivo de la incidencia de patógenos genitales oportunistas y estrictos que crecen en medios de cultivo artificiales / Prospective study of the incidence of opportunistic and strict genital pathogens that grow in artificial culture media

Antecedentes y objetivo: Las infecciones genitourinarias exudativas o purulentas son un motivo de consulta frecuente en Atención Primaria y especializada. El objetivo de nuestro estudio fue determinar la incidencia de los microorganismos más frecuentemente implicados en el desarrollo de vulvovaginitis, vaginosis, cervicitis, uretritis y balanitis en una población general, atendida en el área sanitaria dependiente de 2hospitales de tercer nivel de la provincia de Granada. Pacientes y métodos: Se analizaron todas las muestras recibidas para diagnóstico microbiológico de infección genital baja entre el 1 de febrero y el 31 de mayo del 2015, siguiendo un protocolo de trabajo normalizado. La detección de los microorganismos en la muestra se realizó mediante técnicas de cultivo en medios artificiales o de hibridación de ácidos nucleicos (Affirm VPIII). Resultados: Se analizaron 2.017 muestras, obtenidas de 1.722 pacientes distintos (1.626 mujeres y 96 varones). En 772 pacientes (44,8%; 745 mujeres y 27 varones) se detectó la presencia de, al menos, un microorganismo con significación clínica. Entre las mujeres, el microorganismo más frecuente fue Gardnerella vaginalis (G. vaginalis), presente en el 26,7% de las mujeres atendidas, seguido de Candida albicans (20,0%), Trichomonas vaginalis (1,0%) y Ureaplasma urealyticum (0,4%). En el 10,4% de los varones se detectó Neisseria gonorrhoeae y en un 6,3% Haemophilus spp. Conclusiones: En nuestra población, la vaginosis bacteriana por G. vaginalis, la vulvovaginitis por Candida spp., la tricomoniasis, la gonococia y las uretritis por Ureaplasma spp. y Haemophilus spp. fueron, en este orden, las infecciones genitales exudativas más frecuentes

Background and objective: Purulent or exudative genitourinary infections are a frequent reason for consultation in primary and specialized health care. The objective of this study was to determine the incidence of the microorganisms most commonly involved in the development of bacterial vaginosis, cervicitis, urethritis, vulvovaginitis, and balanitis in a general population attending 2tertiary level hospitals in the province of Granada (Spain). Patients and methods: All the samples received for the microbiological diagnosis of acute lower genital tract infection between February and May 2015 were analysed following a standard protocol. Detection of the microorganisms in the samples was performed by cultivation in artificial media or nucleic acid hybridisation techniques (Affirm VPIII). Results: The analysis included a total of 2,017 samples, obtained from 1,722 different patients (1626 women and 96 men).. The presence of at least one microorganism with clinical significance was detected in 772 patients (44.8%; 745 women and 27 men). Among the women, the most frequent microorganism more found was Gardnerella vaginalis, present in the 26.7%, followed by Candida albicans (20.0%), Trichomonas. vaginalis (1.0%), and Ureaplasma urealyticum (0.4%). Neisseria gonorrhoeae and Haemophilus spp. were detected in 10.4% and 6.3% of samples of male origin, respectively. Conclusions: In the studied population, bacterial vaginosis by G. vaginalis, vulvovaginitis by Candida spp., trichomoniasis, gonorrhea, and urethritis by Ureaplasma spp. and Haemophilus spp., were the most frequent exudative genital infections

Susceptibility of clinical isolates of Campylobacter jejuni and Campylobacter coli to colistin.

Campylobacter spp. are one of the most frequent causes of bacterial diarrhea worldwide. Although severe diarrhea is not highly prevalent, the risk of a fatal outcome is increased when infection is caused by strains resistant to macrolides, fluoroquinolones, and/or tetracyclines. It is therefore necessary to test the susceptibility of these bacteria to other antibiotics such as colistin, which may serve as an alternative therapeutic option in these situations. The E-test was used to investigate the activity of erythromycin and colistin against 30 clinical isolates of Campylobacter spp. The MIC values obtained (range: 0.38-8 mg/liter) were sufficiently low, given the elevated concentrations that colistin sulfate can reach in the intestinal lumen, for this antibiotic to be considered useful to treat severe diarrhea caused by Campylobacter spp. resistant to first-line antibiotics.

Escherichia coli y Klebsiella pneumoniae productores de betalactamasa de espectro extendido en infecciones de vías urinarias: evolución de la resistencia antibiótica y opciones terapéuticas / Extended-spectrum beta-lactamase-producing Escherichia coliand Klebsiella pneumoniae from urinary tract infections: Evolution of antimicrobial resistance and treatment options

Antecedentes y objetivos: Se analiza la presencia, a lo largo de los años en infecciones urinarias, de aislados de Escherichia coli y Klebsiella spp. productores de betalactamasa de espectro extendido (BLEE), y su sensibilidad a antibióticos. Material y método: Se realizó un estudio retrospectivo entre 2012 y 2016. La sensibilidad a ciprofloxacino, tobramicina, cefoxitina, fosfomicina, nitrofurantoína, cotrimoxazol y carbapenémicos se analizó mediante el sistema MicroScan®. Resultados: Se procesaron 95.399 muestras y se aislaron 9.772 E. coli, 1.784 Klebsiella pneumoniae y 248 Klebsiella oxytoca. Las cepas con BLEE fueron más frecuentes en mujeres, aunque disminuyó durante 2015 y 2016 (65,7-67,2%). La prevalencia de K. pneumoniae BLEE aumentó todos los años (28,1% en el 2016). La prevalencia media de E. coli BLEE fue del 10,5%, con escasas oscilaciones. Las mayores resistencias ocurrieron a ciprofloxacino y cotrimoxazol, 89,5 y 94,7% en 2015, respectivamente, y las menores a imipenem. Fosfomicina y nitrofurantoína fueron muy activos sobre E. coli BLEE. Conclusiones: E. coli y K. pneumoniae con BLEE fueron prevalentes y, sobre todo esta última, con una importante resistencia a ciprofloxacino y cotrimoxazol. La sensibilidad a imipenem fue elevada

Background and objectives: A study of the susceptibility to antimicrobials of the extended spectrum beta-lactamase phenotypes (ESBL) in Escherichia coli and Klebsiella spp. was performed to discover the evolution of this type of resistance from urinary tract infections. Material and method: A retrospective study was carried out between 2012 and 2016. Susceptibility to ciprofloxacin, tobramycin, cefoxitin, fosfomycin, nitrofurantoin, co-trimoxazole, and carbapenems was analyzed using MicroScan® system. Results: A total of 95,399 samples were processed and 9,772 E. coli, 1,784 Klebsiella pneumoniae and 248 Klebsiella oxytoca were isolated. ESBL strains were more frequent in women, although they decreased during 2015 and 2016 (65.7-67.2%). The prevalence of K. pneumoniae ESBL increased annually (28.1% in 2016). The average prevalence of E. coli ESBL was 10.5% with few oscillations. Higher resistance occurred to ciprofloxacin and cotrimoxazole, 89.5 and 94.7% in 2015, respectively, and there was lesser resistance to imipenem. Fosfomycin and nitrofurantoin were very active on E. coli ESBL. Conclusions: ESBL producing E. coli and K. pneumoniae were prevalent, especially the latter, with a significant resistance to ciprofloxacin and cotrimoxazole. Susceptibility to imipenem was high

Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae from urinary tract infections: Evolution of antimicrobial resistance and treatment options. / Escherichia coli y Klebsiella pneumoniae productores de betalactamasa de espectro extendido en infecciones de vías urinarias: evolución de la resistencia antibiótica y opciones terapéuticas.

BACKGROUND AND OBJECTIVES: A study of the susceptibility to antimicrobials of the extended spectrum beta-lactamase phenotypes (ESBL) in Escherichia coli and Klebsiella spp. was performed to discover the evolution of this type of resistance from urinary tract infections. MATERIAL AND METHOD: A retrospective study was carried out between 2012 and 2016. Susceptibility to ciprofloxacin, tobramycin, cefoxitin, fosfomycin, nitrofurantoin, co-trimoxazole, and carbapenems was analyzed using MicroScan® system. RESULTS: A total of 95,399 samples were processed and 9,772 E. coli, 1,784 Klebsiella pneumoniae and 248 Klebsiella oxytoca were isolated. ESBL strains were more frequent in women, although they decreased during 2015 and 2016 (65.7-67.2%). The prevalence of K. pneumoniae ESBL increased annually (28.1% in 2016). The average prevalence of E. coli ESBL was 10.5% with few oscillations. Higher resistance occurred to ciprofloxacin and cotrimoxazole, 89.5 and 94.7% in 2015, respectively, and there was lesser resistance to imipenem. Fosfomycin and nitrofurantoin were very active on E. coli ESBL. CONCLUSIONS: ESBL producing E. coli and K. pneumoniae were prevalent, especially the latter, with a significant resistance to ciprofloxacin and cotrimoxazole. Susceptibility to imipenem was high.

Prevalence and genetic diversity of Trichomonas vaginalis in the general population of Granada and co-infections with Gardnerella vaginalis and Candida species.

PURPOSE: Purulent or exudative genitourinary infections are a frequent cause of consultation in primary and specialized healthcare. The objectives of this study were: to determine the prevalence of Trichomonas vaginalis and co-infections with Candida spp. and Gardnerella vaginalis in vaginal secretion; and to use multilocus sequence typing (MLST) to analyse the genetic diversity of T. vaginalis strains. METHODOLOGY: The samples were submitted for analysis (n=5230) to a third-level hospital in Granada (Southern Spain) between 2011 and 2014; eight T. vaginalis strains isolated during 2015 were randomly selected for MLST analysis. Culture and nucleic acid hybridization techniques were used to detect microorganisms in the samples. RESULTS: The prevalence of T. vaginalis was 2.4 % between 2011 and 2014, being higher during the first few months of both 2011 and 2012. Among samples positive for T. vaginalis, co-infection with G. vaginalis was detected in 29 samples and co-infection with Candida spp. in 6, while co-infection with all three pathogens was observed in 3 samples. The only statistically significant between-year difference in co-infection rates was observed for T. vaginalis with G. vaginalis due to an elevated rate in 2011. MLST analysis results demonstrated a high genetic variability among strains circulating in our setting. CONCLUSION: These findings emphasize the need for the routine application of diagnostic procedures to avoid the spread of this sexually transmitted infection.

Valoración de la adherencia al tratamiento antibiótico en Atención Primaria mediante la determinación de niveles del fármaco utilizando una técnica de cromatografía líquida / Assessment of adherence to antibiotic treatment in Primary Care by determining levels of the drug using a liquid chromatography technique

Introducción. La falta de adherencia a los tratamientos antibióticos es una cuestión de especial interés, que tiene importantes implicaciones clínicas, pues se asocia a fallo terapéutico y al aumento de las resistencias bacterianas, ocasionando un alto coste sanitario. El objetivo de nuestro trabajo fue valorar, en pacientes ambulatorios, el grado de adherencia a los tratamientos antibióticos prescritos, a través de la detección de éstos en sangre, orina o esputo. Material y métodos. Se determinaron las concentraciones de los antibióticos prescritos en 39 pacientes (34 con sospecha clínica de infección del tracto urinario y 5 de infección de vías respiratorias bajas) atendidos en consultas de Atención Primaria del Distrito Sanitario de Almería (España), mediante una técnica de cromatografía líquida acoplada a espectrometría de masas en tándem. Resultados. El 48,7% de los pacientes no cumplió de manera correcta con el tratamiento indicado, debido a la omisión completa o parcial en la toma de los antibióticos prescritos. Esta falta de adherencia fue independiente de la edad y sexo de los pacientes, del número de dosis diarias del antibiótico y de que estuvieran, o no, recibiendo otra medicación. Conclusiones. Consideramos que técnicas analíticas precisas, como la cromatografía líquida, pueden ser útiles para detectar los tratamientos inadecuados o incompletos, así como el grado de adherencia de los pacientes ambulatorios, y, de esta forma, poder establecer medidas adecuadas que incidan en el control del cumplimiento terapéutico (AU)

Introduction. The lack of adherence to antibiotic treatments is a matter of special interest, which has important clinical implications, as it is associated with therapeutic failure and increased bacterial resistance causing a high sanitary cost. The objective of our study was to assess the degree of adherence to prescribed antibiotic treatment in outpatients through the detection of these in blood, urine or sputum. Material and methods. Concentrations of antibiotics prescribed in 39 patients (34 with clinical suspicion of urinary tract infection and 5 with clinical suspicion of low respiratory tract infection) treated in Primary Care consultations of the Sanitary District of Almería (Spain) were determined by ultrahigh performance liquid chromatography coupled to tandem mass spectrometry. Results. A 48.7% of the patients did not comply correctly with the indicated treatment due to the complete or partial omission in taking the prescribed antibiotics. This lack of adherence was independent of the age and sex of the patients, the number of daily doses of the antibiotic, and whether or not they were receiving another medication. Conclusions. Precise analytical techniques such as liquid chromatography can be useful to detect inadequate or incomplete treatments as well as the degree of adherence of outpatients. Thus, adequate measures could be established that affect the control of therapeutic compliance (AU)

Etiological and Resistance Profile of Bacteria Involved in Urinary Tract Infections in Young Children.

Background. The objective of this study was to identify the bacteria most frequently responsible for urinary tract infection (UTI) in the population of under-2-year-olds in our geographic area and to evaluate the activity of antibiotics widely used for UTI treatment during a 4-year study period. Materials and Methods. A retrospective analysis was conducted of data on the identification and susceptibility of microorganisms isolated in urine samples from children under 2 years of age. Results. A total of 1,045 uropathogens were isolated. Escherichia coli accounted for the majority (60.3%) of these, followed by Enterococcus faecalis (22.4%) and Klebsiella spp. (6.5%). The highest E. coli susceptibility rates (>90%) were to piperacillin-tazobactam, cefuroxime, cefotaxime, ceftazidime, imipenem, gentamicin, nitrofurantoin, and fosfomycin, and the lowest were to amoxicillin-clavulanic acid and cotrimoxazole. Among all bacteria isolated, we highlight the overall high activity of piperacillin-tazobactam, imipenem, nitrofurantoin, and fosfomycin against both community and hospital isolates and the reduced activity of amoxicillin-clavulanic acid, cephalosporins, gentamicin, and cotrimoxazole. There was no significant change in the total activity of any of the studied antibiotics over the 4-year study period. Conclusion. Empiric treatment with amoxicillin-clavulanic acid, cotrimoxazole, cephalosporins, and gentamicin may be inadequate due to their limited activity against uropathogens in our setting.

Multilocus Sequence Typing analysis of human Campylobacter coli in Granada (Spain) / Tipificación mediante secuencias multilocus de cepas humanas de Campylobacter coli en Granada (España)

Introduction. Different subtypes of Campylobacter spp. have been associated with diarrhoea and a Multilocus Sequence Typing (MLST) method has been performed for subtyping. In the present work, MLST was used to analyse the genetic diversity of eight strains of Campylobacter coli. Material and methods. Nineteen genetic markers were amplified for MLST analysis: AnsB, DmsA, ggt, Cj1585c, CJJ81176-1367/1371, Tlp7, cj1321-cj1326, fucP, cj0178, cj0755/cfrA, ceuE, pldA, cstII, cstIII. After comparing the obtained sequences with the Campylobacter MLST database, the allele numbers, sequence types (STs) and clonal complexes (CCs) were assigned. Results. The 8 C. coli isolates yielded 4 different STs belonging to 2 CCs. Seven isolates belong to ST-828 clonal complex and only one isolate belong to ST-21. Two samples came from the same patient, but were isolated in two different periods of time. Conclusions. MLST can be useful for taxonomic characterization of C. coli isolates (AU)

Introducción. Diferentes subtipos de Campylobacter spp. se han asociado con diarrea y la técnica de tipado mediante análisis de secuencias de múltiples locus (MLST) se ha empleado para la tipificación genética. En el presente trabajo, la técnica MLST se utilizó para analizar la diversidad genética de ocho cepas de Campylobacter coli. Material y métodos. 19 marcadores genéticos fueron amplificados mediante el análisis MLST: AnsB, DmsA, ggt, Cj1585c, CJJ81176-1367/1371, Tlp7, cj1321-cj1326, fucP, cj0178, cj0755/cfrA, ceuE, pldA, cstII, cstIII. Después de comparar las secuencias obtenidas con la base de datos MLST para Campylobacter, se asignaron el número de los alelos, los secuenciotipos (STs) y los complejos clonales (CCs). Resultados. Las 8 cepas de C. coli aisladas mostraron 4 STs diferentes pertenecientes a 2 CCs. Siete aislamientos pertenecieron al complejo clonal ST-828 y sólo un aislado perteneció al ST-21. Dos aislados pertenecieron al mismo paciente, pero fueron obtenidos en diferentes periodos de tiempo. Conclusiones. La técnica MLST puede ser útil para la caracterización taxonómica de aislados de C. coli (AU)

Presencia de Streptococcus bovis en muestras de orina de sujetos con síntomas de infección del aparato urinario / Presence of Streptococcus bovis in urine samples from patients experiencing symptoms of urinary tract

Dada la importancia de la correcta validación clínica de los aislamientos de Streptococcus bovis, nos planteamos la revisión de su presencia en muestras de orina con el objetivo de conocer su frecuencia relativa y su patrón de sensibilidad antibiótica. Se revisó retrospectivamente la sensibilidad a los antibióticos de 91 aislados de S. bovis recuperados de muestras de orina durante un período de 4 años (2012-2015). La media de la edad de los pacientes fue de 55 años y en su mayoría fueron mujeres (81%). El 37,4% eran pacientes hospitalizados con enfermedades urológicas (61%). La sensibilidad a penicilina, vancomicina y teicoplanina fue del 97,8%. Aunque S. bovis puede ser poco común en los aislamientos de orina, su presencia en sujetos con enfermedades de base justifica la realización de estudios de patogenicidad que demuestren la verdadera capacidad de producir enfermedad de este grupo de bacterias.

Given the relevance of proper clinical validation of Streptococcus bovis, we here consider revising its presence in urine samples in order to determine its relative frequency and the pattern of antibiotic susceptibility. The susceptibility to antibiotics of 91 isolates of S. bovis from urine samples was retrospectively reviewed over a period of 4 years (2012-2015). The mean age of patients was 55 years, 81% of whom were women and 37.4% were hospitalized patients suffering from urological diseases (61%). Susceptibility to penicillin, vancomycin and teicoplanin was 97.8%. Due to the fact that S. bovis can be infrequent in urine isolates and given its presence in patients suffering from urological diseases, further pathogenic studies, showing the true ability of this group of bacteria to produce disease, are required.