Ultra-fast direct method for identifying microorganisms from BACTEC lytic/10 anaerobic/F flasks.

Background: Fast diagnosis of bloodstream infections remains the most important challenge for clinical microbiologists. The introduction of the mass-spectrometry represents a breakthrough, although several methods are already commonly used for the direct identification from positive blood cultures we present a faster method (ultra fast) for Lytic anaerobic flasks. Methods: We compare the ultra-fast (UF) method with the extensively employed differential centrifugation method (DC) and both to routine identification after 18-24 h of incubation. UF and DC method correlation rates to the gold standard were calculated, and statistical significance was proved with the Z test. Results: UF performed better overall than DC, with this difference being statistically significant. This tendency was observed in every subanalysis.

Characteristics of genital herpes in Bilbao (Northern Spain): 12-year retrospective study / Características del herpes genital en Bilbao (Norte de España): estudio retrospectivo de 12 años

Introducción: El virus herpes simple tipo 2 (VHS-2) es la causa más frecuente de herpes genital (HG), pero la infección genital por el virus herpes simple tipo 1 (VHS-1) está en aumento. El objetivo del estudio fue analizar las características epidemiológicas de pacientes con HG. Métodos: Estudio retrospectivo desde enero del 2004 hasta diciembre del 2015 de pacientes con HG atendidos en 2 consultas de enfermedades de transmisión sexual (ETS) en la Organización Sanitaria Integrada Bilbao-Basurto, en el norte de España. Se revisaron y analizaron los datos de interés de los pacientes. Resultados: Mil tres pacientes (524 hombres y 479 mujeres) fueron incluidos. El 74% tenía infección por VHS-2. El VHS-1 aumentó durante el periodo estudiado, significativamente en hombres (28% en 2004-2007 vs. 50% en 2012-2015). El VHS-1 fue mayor en mujeres en comparación con hombres (56% vs. 44%). La infección primaria fue más frecuente en los infectados con VHS-1 comparado con VHS-2 (79% vs. 21%). En pacientes con VHS-1, la infección primaria fue superior en hombres (86%) y en menores de 30 años. El 63% de las infecciones por VHS-2 fueron recurrencias. En el análisis multivariante, la edad, el origen extranjero, la recurrencia, el contacto previo con HG de la pareja sexual, la infección previa por Neisseria gonorrhoeae y la prostitución se asociaron con mayor riesgo de infección por VHS-2. Conclusiones:El VHS-2 fue la causa principal del HG, pero la proporción de VHS-1 aumentó. El antecedente de ETS y las conductas sexuales de riesgo fueron predominantes en los pacientes con HG por VHS-2.(AU)

Background: Herpes simplex virus type 2 (HSV-2) is the most common cause of genital herpes (GH), but genital infection by herpes simplex virus type 1 (HSV-1) is increasing. The aim of this study was to analyze and compare epidemiological characteristics of patients with GH. Methods:Retrospective study conducted from January 2004 to December 2015 in patients with GH attended at two Sexually Transmitted Diseases (STDs) medical consultation of Bilbao-Basurto Integrated Health Organisation in Northern Spain. Patient's medical history was reviewed and data of interest was analyzed. Results: One thousand three patients (524 male and 479 female) were reviewed. HSV-2 was detected in 74%. The proportion of HSV-1 increased during the study period, significantly in men (28% in 2004–2007 vs. 50% in 2012–2015). More female than male had HSV-1 infection (56% vs. 44%). The proportion of primary infection was higher among HSV-1 compared to HSV-2 (79% vs. 21%). Among the patients with HSV-1, primary infection was higher among men (86%) and in younger than 30 years. Recurrent GH was higher among HSV-2 infections (63%). In a multivariate model older age, geographic origin outside Spain, recurrent infection, prior contact with a partner's genital herpetic lesions, previous N. gonorrhoeae infection and prostitution were significantly associated with HSV-2 infection. Conclusions: HSV-2 was the most common causative agent of GH, but the proportion of HSV-1 increased. Overall, antecedent of STD and sexual risk behaviors were more frequent in patients with genital HSV-2 infection.(AU)

Characteristics of genital herpes in Bilbao (Northern Spain): 12-year retrospective study.

BACKGROUND: Herpes simplex virus type 2 (HSV-2) is the most common cause of genital herpes (GH), but genital infection by herpes simplex virus type 1 (HSV-1) is increasing. The aim of this study was to analyze and compare epidemiological characteristics of patients with GH. METHODS: Retrospective study conducted from January 2004 to December 2015 in patients with GH attended at two Sexually Transmitted Diseases (STDs) medical consultation of Bilbao-Basurto Integrated Health Organisation in Northern Spain. Patient's medical history was reviewed and data of interest was analyzed. RESULTS: One thousand three patients (524 male and 479 female) were reviewed. HSV-2 was detected in 74%. The proportion of HSV-1 increased during the study period, significantly in men (28% in 2004-2007 vs. 50% in 2012-2015). More female than male had HSV-1 infection (56% vs. 44%). The proportion of primary infection was higher among HSV-1 compared to HSV-2 (79% vs. 21%). Among the patients with HSV-1, primary infection was higher among men (86%) and in younger than 30 years. Recurrent GH was higher among HSV-2 infections (63%). In a multivariate model older age, geographic origin outside Spain, recurrent infection, prior contact with a partner's genital herpetic lesions, previous N. gonorrhoeae infection and prostitution were significantly associated with HSV-2 infection. CONCLUSIONS: HSV-2 was the most common causative agent of GH, but the proportion of HSV-1 increased. Overall, antecedent of STD and sexual risk behaviors were more frequent in patients with genital HSV-2 infection.

Epidemiological surveillance study of gonococcal infection in Northern Spain / Estudio de vigilancia epidemiológica de la infección gonocócica en el Norte de España

BACKGROUND: Treatment of gonorrhoea is threatened by antimicrobial resistance, and decreased susceptibility to recommended therapies is emerging. Thus, gonococcal infection (GI) is becoming a public health problem. The objectives of the present study were to monitor the antimicrobial sensitivity in Neisseria gonorrhoeae (NG) during 2011-2015 and to study their genogroups. METHODS: Antimicrobial susceptibility was studied by disc diffusion, in addition to the agar dilution method for cefixime and ceftriaxone and the Etest(R) for azithromycin. Genotyping was performed by the NG multi-antigen sequence typing (NG-MAST) method. Genogroups of closely related sequence types (STs) were defined. RESULTS: All the strains were susceptible to cefixime, ceftriaxone and gentamicin and 1.8% of the strains were resistant to azithromycin. A total of 531 STs and 6 genotypes (Gs) were identified during 2012-2015 period. G2992 was the largest and was associated with resistance to azithromycin, and with men who have sex with men (MSM), alongside G2400. G1407 and G2400 strains were related to high minimum inhibitory concentration (MICs) to cefixime and G1407 also to ceftriaxone. For the first time, G1861 and G2018 were described and associated with ciprofloxacin resistance and G2018 also with high MICs to ceftriaxone. CONCLUSION: Molecular typing is a useful tool to predict antimicrobial resistance. These results show the need to develop novel antimicrobials or to design new antimicrobial therapies based on drugs that show their efficacy against GI. This also highlights the importance of developing sexually transmitted infection (STI) surveillance in homosexual populations

INTRODUCCIÓN: el tratamiento de la gonorrea está amenazado por la resistencia antimicrobiana, y la disminución de la sensibilidad a las terapias recomendadas está emergiendo. Por ello la infección gonocócica (IG) se está convirtiendo en un problema de salud pública. MÉTODOS: la sensibilidad antimicrobiana se estudió por el método de difusión en disco, cefixima y ceftriaxona fueron testados por el método de dilución en agar y azitromicina por Etest. El genotipado se realizó por el método NG multi-antigen sequence typing (NG-MAST). Se definieron genogrupos con secuenciotipos (STs) relacionados. RESULTADOS: todas las cepas fueron sensibles a cefixima, ceftriaxona y gentamicina y el 1,8% resistentes a azitromicina. Se identificaron 531 STs y 6 genotipos (Gs) durante el período 2012-2015. El G2992 fue el más grande y se relacionó con resistencia a azitromicina, y con hombres que tienen sexo con hombres (HSH) junto con el G2400. Las cepas pertenecientes a los G1407 y G2400 se relacionaron con altas concentraciones mínimas inhibitorias (CMIs) a cefixima y el G1407 también a ceftriaxona. Se describe por primera vez la presencia del G1861 y G2018 y su relación con la resistencia a ciprofloxacino y la relación del G2018 con alta CMI a ceftriaxona. CONCLUSIÓN: El tipado molecular es una herramienta útil para predecir la resistencia antimicrobiana. Estos resultados muestran la necesidad de desarrollar nuevos antimicrobianos o nuevas terapias basadas en fármacos que demuestren su eficacia contra la IG. También muestra la importancia del desarrollo de la vigilancia de las infecciones de transmisión sexual (ITS) en la población homosexual

Epidemiological surveillance study of gonococcal infection in Northern Spain.

BACKGROUND: Treatment of gonorrhoea is threatened by antimicrobial resistance, and decreased susceptibility to recommended therapies is emerging. Thus, gonococcal infection (GI) is becoming a public health problem. The objectives of the present study were to monitor the antimicrobial sensitivity in Neisseria gonorrhoeae (NG) during 2011-2015 and to study their genogroups. METHODS: Antimicrobial susceptibility was studied by disc diffusion, in addition to the agar dilution method for cefixime and ceftriaxone and the Etest® for azithromycin. Genotyping was performed by the NG multi-antigen sequence typing (NG-MAST) method. Genogroups of closely related sequence types (STs) were defined. RESULTS: All the strains were susceptible to cefixime, ceftriaxone and gentamicin and 1.8% of the strains were resistant to azithromycin. A total of 531 STs and 6 genotypes (Gs) were identified during 2012-2015 period. G2992 was the largest and was associated with resistance to azithromycin, and with men who have sex with men (MSM), alongside G2400. G1407 and G2400 strains were related to high minimum inhibitory concentration (MICs) to cefixime and G1407 also to ceftriaxone. For the first time, G1861 and G2018 were described and associated with ciprofloxacin resistance and G2018 also with high MICs to ceftriaxone. CONCLUSION: Molecular typing is a useful tool to predict antimicrobial resistance. These results show the need to develop novel antimicrobials or to design new antimicrobial therapies based on drugs that show their efficacy against GI. This also highlights the importance of developing sexually transmitted infection (STI) surveillance in homosexual populations.

Chlamydia trachomatis re-infection in Spain: A STI clinic-based cohort study / Reinfección por Chlamydia trachomatis en España: un estudio de cohorte en una Unidad de ITS

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is the most frequently reported sexually transmitted infection (STI) in developed countries, but there is a lack data on its incidence and population dynamics in Spain. The objectives of this study were to estimate the incidence of C. trachomatis in patients seeking medical attention in an STI clinic with a defined population catchment area, to identify factors associated with this infection, and to explore differences between factors associated with new infections and re-infections. METHODS: A retrospective study was conducted on a cohort of patients from a STI clinic who underwent chlamydia testing at least twice between 2007 and 2015. RESULTS: Of the 2633 patients who met study selection criteria, 795 (30.2%) tested positive for C. trachomatis at baseline (baseline Chlamydia). The overall incidence was 7.97/100 person-years (95% CI: 7.2-8.8): 5.9/100 person-years (95% CI: 5.2-6.7) among patients testing negative for C. trachomatis at baseline, and 18.3 person-years (95% CI: 15.6-21.5) among those testing positive at baseline. In multivariate analysis, the factors independently associated with overall incidence were a history of infection with C. trachomatis in the previous 6 months (hazard ratio=3.6; 95% CI: 2.3-5.4), younger age (HR <20 vs ≥35 years=5.5; 95% CI: 3.2-9.5), male sex, 2 or more sexual partners in the previous month and year, and inconsistent condom use. CONCLUSIONS: Guidelines should be established for C. trachomatis in Spain, including recommendations on the need for follow-up and re-testing, independently of age. Though data concerning the optimal timing of re-testing are inconclusive, our findings support the establishment of a 3-6 month interval

INTRODUCCIÓN: Chlamydia trachomatis es la infección de transmisión sexual (ITS) más frecuentemente notificada en los países desarrollados, pero en España carecemos de información sobre su incidencia y su dinámica poblacional. Nuestros objetivos han sido estimar la incidencia de C.trachomatis en los pacientes de una clínica de ITS con una población de referencia definida, identificar factores asociados con ella y evaluar diferencias entre los factores asociados con las nuevas infecciones y las reinfecciones. MÉTODOS: Cohorte retrospectiva de pacientes de una Unidad de ITS con pruebas diagnósticas para Chlamydia en más de una ocasión entre 2007 y 2015. RESULTADOS: De los 2.633 pacientes que cumplieron los criterios de inclusión en el estudio, 795 (30,2%) tuvieron un resultado positivo de C.trachomatis en el episodio basal (Chlamydia basal). La incidencia global fue de 7,97/100 años-persona (IC 95%: 7,2-8,8): 5,9/100 años-persona (IC 95%: 5,2-6,7) entre los pacientes con chlamydia basal negativa y 18,3 años-persona (IC 95%: 15,6-21,5) entre aquellos con chlamydia basal positiva. En los análisis multivariantes, los factores asociados independientemente con la incidencia global fueron haber padecido otra infección por C.trachomatis en los últimos 6meses (hazard ratio [HR] = 3,6; IC95%: 2,3-5,4), menor edad (HR < 20 vs ≥ 35 = 5,5; IC95%: 3,2-9,5), ser hombre, 2 o más parejas en el último mes o en el último año y la utilización inconsistente del preservativo. CONCLUSIÓN: Son necesarias guías de práctica clínica para C.trachomatis en España que incluyan recomendaciones sobre la necesidad de seguimiento y re-cribado, independientemente de la edad. El periodo óptimo para repetir las pruebas no está establecido, nuestros resultados apoyan la implantación de un intervalo de 3-6 meses

Chlamydia trachomatis re-infection in Spain: A STI clinic-based cohort study.

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is the most frequently reported sexually transmitted infection (STI) in developed countries, but there is a lack data on its incidence and population dynamics in Spain. The objectives of this study were to estimate the incidence of C. trachomatis in patients seeking medical attention in an STI clinic with a defined population catchment area, to identify factors associated with this infection, and to explore differences between factors associated with new infections and re-infections. METHODS: A retrospective study was conducted on a cohort of patients from a STI clinic who underwent chlamydia testing at least twice between 2007 and 2015. RESULTS: Of the 2633 patients who met study selection criteria, 795 (30.2%) tested positive for C. trachomatis at baseline (baseline Chlamydia). The overall incidence was 7.97/100 person-years (95% CI: 7.2-8.8): 5.9/100 person-years (95% CI: 5.2-6.7) among patients testing negative for C. trachomatis at baseline, and 18.3 person-years (95% CI: 15.6-21.5) among those testing positive at baseline. In multivariate analysis, the factors independently associated with overall incidence were a history of infection with C. trachomatis in the previous 6 months (hazard ratio=3.6; 95% CI: 2.3-5.4), younger age (HR <20 vs ≥35 years=5.5; 95% CI: 3.2-9.5), male sex, 2 or more sexual partners in the previous month and year, and inconsistent condom use. CONCLUSIONS: Guidelines should be established for C. trachomatis in Spain, including recommendations on the need for follow-up and re-testing, independently of age. Though data concerning the optimal timing of re-testing are inconclusive, our findings support the establishment of a 3-6 month interval.

Recommendations for the treatment of invasive fungal infection caused by filamentous fungi in the hematological patient

El tratamiento antifúngico del paciente hematológico ha alcanzado una gran complejidad con la llegada de nuevos antifúngicos y pruebas diagnósticas que han dado lugar a diferentes estrategias terapéuticas. La utilización del tratamiento más adecuado en cada caso es fundamental en infecciones con tanta mortalidad. La disponibilidad de recomendaciones como éstas, realizadas con la mejor evidencia por un amplio panel de 48 expertos, en las que se intenta responder a cuándo está indicado tratar y con qué hacerlo considerando diferentes aspectos del paciente (riesgo de infección fúngica, manifestaciones clínicas, galactomanano, TC de tórax y profilaxis realizada), puede ayudar a los clínicos a mejorar los resultados(AU)

Antifungal treatment in the hematological patient has reached a high complexity with the advent of new antifungals and diagnostic tests, which have resulted in different therapeutic strategies. The use of the most appropriate treatment in each case is essential in infections with such a high mortality. The availability of recommendations as those here reported based on the best evidence and developed by a large panel of 48 specialists aimed to answer when is indicated to treat and which agents should be used, considering different aspects of the patient (risk of fungal infection, clinical manifestations, galactomanann test, chest CT scan and previous prophylaxis) may help clinicians to improve the results(AU)

Documento de consenso de las sociedades científicas españolas. Vacunas profilácticas frente al VPH / No disponible

No disponible

[An analysis of 182 enterococcal bloodstream infections: epidemiology, microbiology, and outcome]. / Análisis de 182 episodios de bacteriemia por enterococo: estudio de la epidemiología, microbiología y evolución clínica.

INTRODUCTION: Enterococcal bloodstream infections have acquired considerable importance in recent years, mainly because of the increasing number of cases that occur during hospital admission. METHODS: Retrospective study of the clinical records of patients diagnosed with enterococcal bacteremia and hospitalized over a 12-year period (January 1994-April 2006), analyzing epidemiological, clinical and microbiological characteristics, outcome and prognostic factors. RESULTS: A total of 182 episodes of bacteremia were recorded; 68% of them were nosocomial infections, accounting for 5% of the in-hospital bacteremia episodes in this period. The most frequent sources of infection were urinary tract (29%), cardiovascular (25%), intra-abdominal (21%) and primary bacteremia (12%). Associated comorbid conditions were present in 85% of patients, mainly neoplasms (33%). Enterococcus faecalis was responsible for 70% of cases, E. faecium 22%, and other species of enterococci 8%. Twenty percent were polymicrobial bacteremia. Antibiotic resistance was documented in 23% of the strains: 14% ampicillin, 8% gentamicin, 3% ampicillin and gentamicin, and 0.5% vancomycin. Overall mortality was 31%. Polymicrobial bacteremia and comorbidity were associated with a poor prognosis. CONCLUSION: In our hospital, Enterococcus is the fifth most frequent cause of nosocomial bacteremia. E. faecium is characterized by a high incidence (more than 50% of cases) of ampicillin resistance.

Análisis de 182 episodios de bacteriemia por enterococo: estudio de la epidemiología, microbiología y evolución clínica / An analysis of 182 enterococcal bloodstream infections: epidemiology, microbiology, and outcome

Introducción. La bacteriemia por Enterococcus ha adquirido un papel relevante en los últimos años, principalmente debido al aumento del número de casos intrahospitalarios. Métodos. Estudio retrospectivo de historias clínicas de los pacientes diagnosticados de bacteriemia por enterococo e ingresados en el hospital durante un período de 12 años (enero 1994-abril 2006), analizando sus características epidemiológicas, clínicas y microbiológicas, así como la evolución y los factores pronósticos de la enfermedad. Resultados. Se registraron 182 episodios de bacteriemia, el 68% de los cuales fueron de origen nosocomial, lo que representó el 5% de las bacteriemias intrahospitalarias durante ese período. Las localizaciones más frecuentes de la infección fueron la urinaria (29%), la cardiovascular (25%), la intraabdominal (21%) y la bacteriemia primaria (12%). El 85% de los pacientes presentaron comorbilidad asociada, especialmente enfermedades neoplásicas (33%). El Enterococcus faecalis fue el responsable del 70% de los casos; E. faecium, del 22%, y otras especies de enterococo, del 8%. El 20% de las bacteriemias eran polimicrobianas. Se encontraron un 23% de cepas con resistencia a antibióticos: 14% a ampicilina, 8% a gentamicina, 3% a ampicilina y gentamicina y 0,5% a vancomicina. La mortalidad global de la serie fue del 31%. La presencia de comorbilidad y la bacteriemia polimicrobiana fueron factores de mal pronóstico. Conclusión. En nuestro hospital, el enterococo constituye el quinto patógeno más frecuente de bacteriemia intrahospitalaria, y destaca la elevada incidencia de E. faecium, resistente a ampicilina en más de la mitad de los casos (AU)

Introduction. Enterococcal bloodstream infections have acquired considerable importance in recent years, mainly because of the increasing number of cases that occur during hospital admission. Methods. Retrospective study of the clinical records of patients diagnosed with enterococcal bacteremia and hospitalized over a 12-year period (January 1994-April 2006), analyzing epidemiological, clinical and microbiological characteristics, outcome and prognostic factors. Results. A total of 182 episodes of bacteremia were recorded; 68% of them were nosocomial infections, accounting for 5% of the in-hospital bacteremia episodes in this period. The most frequent sources of infection were urinary tract (29%), cardiovascular (25%), intra-abdominal (21%) and primary bacteremia (12%). Associated comorbid conditions were present in 85% of patients, mainly neoplasms (33%). Enterococcus faecalis was responsible for 70% of cases, E. faecium 22%, and other species of enterococci 8%. Twenty percent were polymicrobial bacteremia. Antibiotic resistance was documented in 23% of the strains: 14% ampicillin, 8% gentamicin, 3% ampicillin and gentamicin, and 0.5% vancomycin. Overall mortality was 31%. Polymicrobial bacteremia and comorbidity were associated with a poor prognosis. Conclusion. In our hospital, Enterococcus is the fifth most frequent cause of nosocomial bacteremia. E. faecium is characterized by a high incidence (more than 50% of cases) of ampicillin resistance (AU)