Characterizing carbapenemase-producing Escherichia coli isolates from Spain: high genetic heterogeneity and wide geographical spread.

Introduction: Carbapenemase-Producing Escherichia coli (CP-Eco) isolates, though less prevalent than other CP-Enterobacterales, have the capacity to rapidly disseminate antibiotic resistance genes (ARGs) and cause serious difficult-to-treat infections. The aim of this study is phenotypically and genotypically characterizing CP-Eco isolates collected from Spain to better understand their resistance mechanisms and population structure. Methods: Ninety representative isolates received from 2015 to 2020 from 25 provinces and 59 hospitals Spanish hospitals were included. Antibiotic susceptibility was determined according to EUCAST guidelines and whole-genome sequencing was performed. Antibiotic resistance and virulence-associated genes, phylogeny and population structure, and carbapenemase genes-carrying plasmids were analyzed. Results and discussion: The 90 CP-Eco isolates were highly polyclonal, where the most prevalent was ST131, detected in 14 (15.6%) of the isolates. The carbapenemase genes detected were bla OXA-48 (45.6%), bla VIM-1 (23.3%), bla NDM-1 (7.8%), bla KPC-3 (6.7%), and bla NDM-5 (6.7%). Forty (44.4%) were resistant to 6 or more antibiotic groups and the most active antibiotics were colistin (98.9%), plazomicin (92.2%) and cefiderocol (92.2%). Four of the seven cefiderocol-resistant isolates belonged to ST167 and six harbored bla NDM. Five of the plazomicin-resistant isolates harbored rmt. IncL plasmids were the most frequent (45.7%) and eight of these harbored bla VIM-1. bla OXA-48 was found in IncF plasmids in eight isolates. Metallo-ß-lactamases were more frequent in isolates with resistance to six or more antibiotic groups, with their genes often present on the same plasmid/integron. ST131 isolates were associated with sat and pap virulence genes. This study highlights the genetic versatility of CP-Eco and its potential to disseminate ARGs and cause community and nosocomial infections.

First Report of an Extensively Drug-Resistant ST23 Klebsiella pneumoniae of Capsular Serotype K1 Co-Producing CTX-M-15, OXA-48 and ArmA in Spain.

An extensively drug-resistant (XDR) Klebsiella pneumoniae isolate MS3802 from a tracheostomy exudate was whole-genome sequenced using MiSeq and Oxford Nanopore MinION platforms in order to identify the antimicrobial resistance and virulence determinates and their genomic context. Isolate MS3802 belonged to the clone ST23 and presented a capsular serotype K1, associated with hypervirulent K. pneumoniae (hvKp) isolates. The isolate harboured a chromosomally encoded blaCTX-M-15 gene and contained a large IncHI1B hybrid virulence/resistance plasmid carrying another copy of the blaCTX-M-15 and the virulence factors iucABCD-iutA, iroBCDN, rmpA and rmpA2. The carbapenemase gene blaOXA-48 was found in a Tn1999-like transposon and the 16S rRNA methylase armA gen located in the vicinity of other antibiotic-resistant genes on an IncM2 plasmid. This study represents, to the best of our knowledge, the first description of a blaCTX-M-15-, blaOXA-48- and armA-harbouring K. pneumoniae of ST23 and capsular serotype K1 in Spain. Our report emphasizes the importance of implementing new surveillance strategies to monitor the risk of emergence and spread of such XDR and hypervirulent K. pneumoniae isolates.

Análisis de la demanda de detección de SARS-CoV-2 en un área de salud de España / Analysis of the demand for detection of SARS-CoV-2 in a health area of Spain

INTRODUCCIÓN: Desde el descubrimiento del virus SARSCoV-2 la técnica de reacción en cadena de la polimerasa (RT-PCR) se ha convertido en el método fundamental para el diagnóstico de la enfermedad en su fase aguda. El objetivo es describir la serie basada en la demanda de determinaciones de RT-PCR recibidas en un Servicio de Microbiología en un hospital de tercer nivel de referencia durante tres meses desde el inicio de la epidemia por SARS-CoV-2. MATERIAL Y MÉTODOS: Se realizó un análisis retrospectivo del total de las RT-PCR solicitadas en el servicio de microbiología analizado desde el 25 de febrero de 2020 al 26 de mayo de 2020 (90 días). Se agruparon por semanas epidemiológicas y servicio peticionario. Se realizó un análisis descriptivo por edad, género y número de solicitudes por paciente. Se consideró significativo un nivel de confianza del 95% (p < 0.05). RESULTADOS: Se recibieron un total de 27.106 de solicitudes que correspondían a 22.037 pacientes. Edad mediana 53,7 (RIC 40,9-71,7) años, mujeres: 61,3%. Proporción de pacientes con alguna RT-PCR positiva: 14%. Del total de peticiones de RT-PCR fueron positivas 3.710. La rentabilidad máxima fue la semana epidemiológica 13, con un 39,0%. El servicio peticionario que más RT-PCR ha solicitado de forma global ha sido atención primaria con 15.953 solicitudes. Pacientes con 3 o más RT-PCR: 565, de ellos, 19 pacientes presentaron un resultado positivo tras haber sido negativos. CONCLUSIONES: Las solicitudes han ido aumentando en función de la evolución de la epidemia. La RT-PCR posee un elevado rendimiento diagnóstico en las fases de mayor contagiosidad y/o transmisibilidad del virus

INTRODUCTION: Since the discovery of the SARS-CoV-2 virus, the polymerase chain reaction technique (RT-PCR) has become the fundamental method for diagnosing the disease in its acute phase. The objective is to describe the demand-based series of RT-PCR determinations received at a Microbiology Service at a third-level reference hospital for a health area for three months spanning from the onset of the epidemic by SARS-CoV-2. METHODS: A retrospective analysis of the total of the RT-PCR requested in the Microbiology Service analyzed from 02/25/2020 to 05/26/2020 (90 days) has been carried out. They have been grouped by epidemiological weeks and by the petitioner service. A descriptive analysis was carried out by age, gender and number of requests for each patient. In the tests carried out, a confidence level of 95% (p <0.05) was considered significant. RESULTS: A total of 27,106 requests was received corresponding to 22,037 patients. Median age 53.7 (RIC 40.9-71.7) years, women: 61.3%. Proportion of patients with any positive RT-PCR: 14%. Of the total requests for RT-PCR, positive 3,710. Week 13 had the highest diagnosis performance (39.0%). The primary care has been the service thar has made the most requests (15,953). Patients with 3 or more RT-PCR: 565, of them, 19 patients had a positive result after previously having a negative one. CONCLUSIONS: Requests have been increasing depending on the evolution of the epidemic. The RT-PCR has a high diagnostic performance in the phases of highest contagiousness and / or transmissibility of the virus

Carbapenemase-producing Pseudomonas aeruginosa in Spain: interregional dissemination of the high-risk clones ST175 and ST244 carrying blaVIM-2, blaVIM-1, blaIMP-8, blaVIM-20 and blaKPC-2.

Carbapenemase-producing (CP) Pseudomonas aeruginosa is rare compared with mutation-driven carbapenem-resistance, but this situation may be changing. A collection of CP P. aeruginosa isolates was characterized in this study. In 2016, 232 unduplicated carbapenem-resistant P. aeruginosa isolates, of which 71 (30.6%) carried carbapenemase genes, were submitted to the Spanish antibiotic reference laboratory and were further analysed by whole-genome sequencing (WGS). Of the 71 CP P. aeruginosa, 39 (54.9%) carried blaVIM-2, 14 (19.7%) blaVIM-1, 8 (11.3%) blaIMP-8, 6 (8.5%) blaVIM-20, 2 (2.8%) blaVIM-2 plus blaKPC-2, one (1.4%) blaIMP-13 and one (1.4%) blaVIM-1 plus blaIMP-18. Four sequence types (ST175, ST244, ST815 and ST155) encompassed 83.1% of the 71 CP P. aeruginosa; ST175 was detected in hospitals from seven provinces. Using core genome multilocus sequence typing (cgMLST), four clusters were detected: Cluster 1 included nine ST815/VIM-2 isolates; Cluster 2 included five ST175/VIM-2 isolates; Cluster 3 included seven ST244 isolates (five VIM-2 and two VIM-2 plus KPC-2); and Cluster 4 included 11 ST175 isolates (seven VIM-2 and four IMP-8). The average number of acquired resistance genes was significantly higher in the blaVIM-1-carying isolates (7.1 ± 0.94) than in the blaVIM-2-carrying isolates (4.5 ± 0.20). CP P. aeruginosa isolates are spreading in Spain, mainly due to the dissemination of high-risk clones such as ST175 and ST244 producing VIM and IMP carbapenemases. Emergence of CP P. aeruginosa is a cause of clinical and epidemiological concern.

Episodios de salmonelosis no tifoidea en pacientes adultos del Área Valladolid Oeste en 2017: evaluación de la idoneidad de la petición del cultivo microbiológico y del tratamiento pautado / Episodes of nontyphoidal salmonellosis in adult patients of the Valladolid West Area in 2017: evaluation of the suitability of the microbiological culture request and the prescribed treatment

INTRODUCCIÓN: Las salmonelosis gastroenteríticas suponen aún la segunda causa diagnosticada de diarrea infecciosa en nuestro medio, la mayoría de estos cuadros clínicos son leves y autolimitados y por eso el uso de antibióticos está circunscrito a pocos supuestos. El objetivo del trabajo fue describir los episodios de diarrea por Salmonella enterica subsp. enterica, valorando la idoneidad de la petición y del uso de antibióticos de acuerdo a los criterios que figuran en la metodología. MATERIAL Y MÉTODOS: Se realizó un estudio observacional descriptivo retrospectivo recabando datos de la historia clínica. RESULTADOS: Se incluyeron 122 episodios. El motivo guía de consulta fue la diarrea, que generó una mayor demanda en los Servicios de Urgencia Hospitalaria (42,6%). Se aislaron sobre todo el serotipo Enteritidis (53,3%) y Typhimurium (40,2%). La adecuación de la petición del coprocultivo fue alta, 90,2%. Se prescribió antibiótico en el 64,6% (79) de los episodios, la mayoría en pacientes menores de 65 años (58 episodios), con una media de edad de 48,43 años. Los episodios se trataron principalmente con ciprofloxacino y azitromicina, en 57 y 14 episodios respectivamente. La duración media de la antibioterapia fue de 6 días. Existió un adecuado uso de los antibióticos en un 49,1%. Cuando el origen de la petición fue el Servicio de Urgencias hospitalario resultó inadecuado en el 63,5% (33) de ellos. Fue inadecuado en un 60,0% (39) de episodios cuando se aisló Salmonella serotipo Enteriditis. En casi la mitad, el 48,85% (42) de los 58 episodios en que se prescribió antibiótico entre los menores de 65 años (86), no estaba indicado. CONCLUSIONES: Se deberían implementar acciones formativas enfocadas a optimizar el manejo de antibióticos en esta entidad así como promover contribuciones que describan esta realidad

INTRODUCTION: Gastroenteritic salmonellosis is still the second cause diagnosed of infectious diarrhea, most of these clinical pictures are mild and self-limited and therefore the use of antibiotics is limited to few cases. The aim of the study was to describe the episodes of diarrhea caused by Salmonella enterica subsp. enterica, assessing the suitability of the request and the use of antibiotics according to the criteria included in the methodology. MATERIAL AND METHODS: A retrospective, descriptive, observational study was conducted, collecting data from the clinical history. RESULTS: A total of 122 episodes were included. The reason for consultation was diarrhea, which generated a greater demand in the Hospital Emergency Services (42.6%). The most frequent serotypes isolated were Enteritidis (53.3%), and Typhimurium (40.2%). The adequate request of the stool was 90.2%. Antibiotic was prescribed in 64.6% (79) of the episodes, most patients under 65 years (58 episodes), the average age was 48.43 years. They were treated mainly with ciprofloxacin and azithromycin, in 57 and 14 episodes, respectively. The average duration of antibiotic treatment was 6 days. There was an adequate use of antibiotics in 49.1% of episodes. When the origin of the request was the Hospital Emergency Service, it was inadequate in 63.5% (33) of them. It was inadequate in 60.0% (39) of episodes when ser. Enteritidis was isolated. Almost half, 48.85% (42) of the 58 episodes in which antibiotics were prescribed among those under 65 (86), were treated without being indicated. CONCLUSIONS: Training actions should be implemented focused on optimizing the management of antibiotics in this entity

Micosis infrecuentes / Uncommon mycoses

Antecedentes: La posibilidad de infección fúngica debe tenerse presente en heridas extensas que hayan estado en contacto con el suelo o materia orgánica, aun cuando el paciente sea inmunocompetente. Nuestro objetivo al presentar este caso es contribuir al conocimiento epidemiológico y perfil de sensibilidad de hongos filamentosos que son aislados raramente en muestras clínicas y que pueden ocasionar infecciones potencialmente muy graves. Caso clínico: En las heridas de una paciente inmunocompetente víctima de un atropello se aislaron cuatro hongos filamentosos: Lichtheimia corymbifera, Scedosporium boydii, Fusarium solani y Purpureocillium lilacinum. Algunos de ellos fueron aislados simultáneamente de diversas localizaciones. Se realizó un estudio de sensibilidad a la anfotericina B, posaconazol, voriconazol, itraconazol y anidulafungina mediante Etest a los cuatro hongos. El perfil de sensibilidad obtenido no resultó discordante con los datos aportados en la literatura consultada. Conclusiones: La actuación precoz ante infecciones por hongos filamentosos es primordial, tanto en el tratamiento antifúngico como, muy importante, en la realización de cirugía, limpieza y desbridamientos periódicos de los tejidos afectados. Establecer el perfil de sensibilidad de los hongos implicados contribuye al mejor conocimiento de estos patógenos infrecuentes, cuya incidencia aumenta

Background: Fungal infections should be suspected in severe wounds that have been contaminated with organic material or soil, even when the patient is immunocompetent. The aim of this article is to contribute to a better understanding and knowledge of the antifungal sensitivity and epidemiology of some rare pathogens that may trigger severe infections. Case report: Four different moulds were isolated from the wounds of an immunocompetent woman who was involved in a road accident: Lichtheimia corymbifera, Scedosporium boydii, Fusarium solani and Purpureocillium lilacinum. Some of them were isolated from different sites. A profile of in vitro resistance was performed with an Epsilometer (Etest(TM)) using five antifungal agents: voriconazole, posaconazole, itraconazole, anidulafungin an amphotericin B. The results obtained were consistent with those from other cases reported in the literature. Conclusions: Early aggressive surgery, antifungal therapy and, above all, frequent debridement of necrotic tissue, are the tools against filamentous fungi infections. Antifungal sensitivity of any mould involved in an infection has to be determined, in order to a better understanding of these rare pathogens whose incidence is increasing

[Uncommon mycoses]. / Micosis infrecuentes.

BACKGROUND: Fungal infections should be suspected in severe wounds that have been contaminated with organic material or soil, even when the patient is immunocompetent. The aim of this article is to contribute to a better understanding and knowledge of the antifungal sensitivity and epidemiology of some rare pathogens that may trigger severe infections. CASE REPORT: Four different moulds were isolated from the wounds of an immunocompetent woman who was involved in a road accident: Lichtheimia corymbifera, Scedosporium boydii, Fusarium solani and Purpureocillium lilacinum. Some of them were isolated from different sites. A profile of in vitro resistance was performed with an Epsilometer (Etest™) using five antifungal agents: voriconazole, posaconazole, itraconazole, anidulafungin an amphotericin B. The results obtained were consistent with those from other cases reported in the literature. CONCLUSIONS: Early aggressive surgery, antifungal therapy and, above all, frequent debridement of necrotic tissue, are the tools against filamentous fungi infections. Antifungal sensitivity of any mould involved in an infection has to be determined, in order to a better understanding of these rare pathogens whose incidence is increasing.

Brote de Salmonella Typhimurium monofásica asociada al consumo de carne asada de cerdo / Monophasic Salmonella Typhimurium outbreak due to the consumption of roast pork meat

Se describe un brote de gastroenteritis aguda por Salmonella enterica serovar Typhimurium monofásica 4, 5, 12: i:-, en una concentración de motos en Valladolid. Se recogió información de 112 afectados pertenecientes a 7 Comunidades Autónomas. La investigación epidemiológica asoció el brote al consumo de bocadillos de carne de cerdo asada con salsa que vendía un puesto ambulante en dicho evento

This report presents an outbreak of monophasic Salmonella enteric serovar Typhimurium fagotipe 4, 5, 12: i:-, in a motorcycle concentration in Valladolid. Information was collected to one hundred and twelve affected from seven Spanish Autonomous Communities. The epidemiological investigation associated the outbreak with the consumption of roast pork with sauce sandwiches sold at a street market in that event

Contribución de la microbiología al diagnóstico de la tuberculosis en Castilla y León: conclusiones del estudio GRUMICALE 2013 / Contribution of microbiology in the diagnosis of tuberculosis in Castile and León (Spain): Findings of the GRUMICALE 2013 study

Introducción y objetivos: Estudio retrospectivo que recoge datos microbiológicos de tuberculosis (TB) en Castilla y León durante el año 2013 para conocer los datos microbiológicos de incidencia y distribución de TB, resistencias a los fármacos antituberculosos y compararlos con los datos epidemiológicos ofrecidos por los servicios de vigilancia epidemiológica (SIVE). Material y métodos: Microbiólogos de los 14 hospitales de la red sanitaria pública de Castilla y León (GRUMICALE) han recogido datos epidemiológicos, microbiológicos y de funcionamiento de los laboratorios de microbiología de la comunidad durante el año 2013. Se consideró un solo aislamiento de Mycobacterium tuberculosis complex (MTC) por paciente. Resultados: Se obtuvieron 270 aislamientos de MTC (tasa de incidencia de 11,63 casos/100.000 hab./año). Según datos epidemiológicos, se recogieron un total de 288 casos de TB (11,43 casos/100.000 hab./año), 243 confirmados, 29 sospechosos y 16 probables. Predomina la localización pulmonar, seguida de lejos por la pleural y por el resto. Se procesaron un total de 27.620 muestras para micobacterias. En un 3,46% de los medios de cultivos líquidos se obtuvo crecimiento de micobacterias, y en un 50,37% la tinción directa (baciloscopia) fue positiva. Dieciséis aislamientos de Mycobacterium tuberculosis (MT) presentaron resistencia a algún fármaco antituberculoso, predominando la resistencia a isoniazida (5,92%). La provincia con mayor incidencia y número de aislamientos fue León (24,23 casos/100.000 hab./año), siendo la máxima en el área sanitaria de El Bierzo (30,46 casos/100.000 hab./año). Conclusiones: Una adecuada recogida de la información microbiológica es fundamental para el conocimiento de la epidemiologia de la TB en nuestra comunidad (AU)

Introduction and objectives: A retrospective study was conducted by collecting microbiological tuberculosis (TB) data in Castile and León during the year 2013 in order to determine the incidence and distribution of TB, and resistance to the tuberculostatic drug, and compare them with the epidemiological data provided by the Department of Epidemiological Surveillance (SIVE). Material and methods: Microbiologists of the 14 hospitals of the Castile and León public health network (GRUMICALE) collected epidemiological, microbiological, and management data from the Microbiology laboratories in the community during the year 2013. A single isolate of Mycobacterium tuberculosis complex (MTC) per patient was considered. Results: The study included a total of 270 MTC isolates (an incidence rate of 11.63 cases/100,000 inhab./year). A total of 288 cases of TB (11.43 cases/100,000 inhab. year) were recovered using epidemiological data, which included 243 confirmed, 29 suspected, and 16 as probable cases. Pulmonary TB was predominant, followed a long way off by the pleural TB and the remaining locations. A total of 27,620 samples were processed for mycobacterial detection. Mycobacterial growth was observed in 3.46% of automated fluid cultures, and 50.37% were positive by direct staining of the smear. Resistance to one tuberculostatic drug, mostly to isoniazid, was observed in 16 (5.92%) isolates of Mycobacterium tuberculosis (MT). The province with greater incidence and number of isolates was León (24.23 cases/100,000 inhab./year), with the highest being observed in El Bierzo health area (30.46 cases/100,000 inhab./year). Conclusions: An adequate collection of microbiological information is essential to determine the epidemiology of TB in our region (AU)

Brote por Enterococcus faecium ST17 resistente a glucopéptidos en una Unidad de Neonatología / Vancomycin-resistant Enterococcus faecium ST17 outbreak in a Neonatal Unit

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Contribution of microbiology in the diagnosis of tuberculosis in Castile and León (Spain): Findings of the GRUMICALE 2013 study. / Contribución de la microbiología al diagnóstico de la tuberculosis en Castilla y León: conclusiones del estudio GRUMICALE 2013.

INTRODUCTION AND OBJECTIVES: A retrospective study was conducted by collecting microbiological tuberculosis (TB) data in Castile and León during the year 2013 in order to determine the incidence and distribution of TB, and resistance to the tuberculostatic drug, and compare them with the epidemiological data provided by the Department of Epidemiological Surveillance (SIVE). MATERIAL AND METHODS: Microbiologists of the 14 hospitals of the Castile and León public health network (GRUMICALE) collected epidemiological, microbiological, and management data from the Microbiology laboratories in the community during the year 2013. A single isolate of Mycobacterium tuberculosis complex (MTC) per patient was considered. RESULTS: The study included a total of 270 MTC isolates (an incidence rate of 11.63 cases/100,000 inhab./year). A total of 288 cases of TB (11.43 cases/100,000 inhab. year) were recovered using epidemiological data, which included 243 confirmed, 29 suspected, and 16 as probable cases. Pulmonary TB was predominant, followed a long way off by the pleural TB and the remaining locations. A total of 27,620 samples were processed for mycobacterial detection. Mycobacterial growth was observed in 3.46% of automated fluid cultures, and 50.37% were positive by direct staining of the smear. Resistance to one tuberculostatic drug, mostly to isoniazid, was observed in 16 (5.92%) isolates of Mycobacterium tuberculosis (MT). The province with greater incidence and number of isolates was León (24.23 cases/100,000 inhab./year), with the highest being observed in El Bierzo health area (30.46 cases/100,000 inhab./year). CONCLUSIONS: An adequate collection of microbiological information is essential to determine the epidemiology of TB in our region.

Fecal Microbiota of Toxigenic Clostridioides difficile-Associated Diarrhea.

Clostridioides difficile infection (CDI) is currently one of the most important causes of infectious diarrhea in developed countries and the main cause in healthcare settings. Here, we characterized the gut microbiota from the feces of 57 patients with diarrhea from nosocomial and community-acquired CDI. We performed an ecological analysis by high-throughput sequencing of the V3-V4 region of 16S rRNA amplicons and evaluated the association of the various ecological profiles with CDI risk factors. Among all samples Bacteroidaceae 31.01%, Enterobacteriaceae 9.82%, Lachnospiraceae 9.33%, Tannerellaceae 6,16%, and Ruminococcaceae 5.64%, were the most abundant families. A reduced abundance of Bacteroides was associated with a poor CDI prognosis, with severe diarrhea and a high incidence of recurrence. This reduction was associated with a weakened host immune system and previous aggressive antibiotherapy. Peptostreptococcaceae family was 1.56% overall and within the family the only identified member was the genus Clostridioides, positively correlated with the presence of Akkermansia that may be predictive of the presence of a CDI. Finally, a relevant aspect that must be considered in clinical practice is the misdiagnosis of CDI, as patients with a stool sample that tests positive for C. difficile are usually diagnosed with CDI and subsequently treated as such. However, co-infection with other pathogenic agents often plays an important role in the development of diarrhea, and must be considered when prescribing antibiotic treatment.

Brote de Serratia marcescens producido por clorhexidina acuosa al 2% contaminada / Serratia marcescens outbreak due to contaminated 2% aqueous chlorhexidine

Introducción y objetivo: Describimos un brote de infección por Serratia marcescens (S. marcescens) y la investigación epidemiológica que asoció el brote al uso de clorhexidina acuosa al 2% como antiséptico. Método: A finales del mes de noviembre del 2014 detectamos un aumento en la incidencia de infecciones por S. marcescens en pacientes atendidos en Urgencias, por lo que nos planteamos la posibilidad de estar ante un brote e iniciamos una investigación epidemiológica. Resultado: Se aisló S. marcescens en 23 muestras de 16 pacientes y en todos los frascos nuevos de 2 lotes de clorhexidina acuosa al 2%. Se ordenó retirar el desinfectante y se alertó a la Agencia Española del Medicamento (COS 2/2014). El estudio epidemiológico demostró que los aislamientos de las muestras clínicas y las recuperadas de la clorhexidina pertenecían al mismo clon. Una vez retirados los lotes contaminados, no se produjeron más casos. Conclusión: La sospecha del brote y la investigación epidemiológica fueron fundamentales para controlar la incidencia (AU)

Introduction and objective: An outbreak of Serratia marcescens infections outbreak is described, as well as the epidemiological study that linked the outbreak to the use of 2% aqueous chlorhexidine antiseptic. Method: In late November 2014 an increasing incidence of S. marcescens isolates was detected in patients treated in the emergency department. It was considered a possible outbreak, and an epidemiological investigation was started. Result: S. marcescens was isolated in 23 samples from 16 patients and in all new bottles of two lots of 2% aqueous chlorhexidine. The contaminated disinfectant was withdrawn, and the Spanish Drugs Agency was alerted (COS 2/2014). The epidemiological study showed that strains isolated from clinical samples and from chlorhexidine belonged to the same clone. No further isolates were obtained once the disinfectant was withdrawn. Conclusion: The suspicion of an outbreak and the epidemiological study were essential to control the incidence (AU)

Descriptivo de Hafnia alvei aisladas en coprocultivo: aproximación a su valoración en clínica / A descriptive study of Hafnia alvei isolated from stool samples: an approach to its clinical assessment

Introducción. El papel de Hafnia alvei en la etiología de diarrea en humanos es todavía muy controvertido; el objetivo del estudio fue describir la población en cuyos coprocultivos se aisló H. alvei y el manejo terapéutico de estos casos en nuestro Área de Salud. Material y métodos. Para ello se realizó un estudio descriptivo retrospectivo de 2014 y 2015. Se recogieron en la historia clínica informatizada, variables epidemiológicas, clínicas, tratamiento y evolución. Resultados. Se procesaron 7.290 coprocultivos, 3.321 en 2014, 58 (1,7%) en los que se aisló H. alvei y 3.969 en 2015, 53 (1,3%) positivos. El 60,4% de las muestras fueron aisladas en mujeres. La edad media fue de 38,68 años. El 68,5% provenían de Atención Primaria. En el 71,2% se recogió clínica asociada, siendo el más frecuente la diarrea en el 57,7%. En el 75,7% de los casos no existía patología de base asociada. El 43,2% de los casos recibió tratamiento de los cuales el 66,7% de los pacientes procedían de Atención Primaria. La duración media del tratamiento fue de 8 días. En el 85,4% de los casos tratados, la evolución fue favorable. Todas las cepas fueron sensibles a ciprofloxacino y trimetoprim/sulfametoxazol. Conclusiones. Faltan estudios que establezcan de forma concluyente la enteropatogenicidad o no de H. alvei (AU)

Introduction. The importance in human diarrhoeal disease of Hafnia alvei is unclear. The objective of the study was to describe the population which was isolated H. alvei in stool cultures and the therapeutic management of these cases in our Health Area. Material and methods. A descriptive retrospective study was carried out in 2014 and 2015. Epidemiological, clinical, treatment and evolution variables were collected in the computerized clinical history. Result. A collection of 7,290 stool specimens were processed, 3,321 in 2014 and 3,969 in 2015, of which 58 (1.7%) and 53 (1.3%) were positive for H. alvei, respectively. A 60.4% of samples were isolated in women. The mean age was 38.68 years. A 68.5% of samples were from primary care. In 71.2% there was related clinic, diarrhoea in 57.7%. In 75.7% of the cases there was not associated underlying disease. A 43.2% of the cases received treatment. A 66.7% of treated patients came from Primary Care. The mean duration of treatment was 8 days. The evolution was favourable in 85.4% of the cases treated. All strains were susceptible to ciprofloxacin and trimethoprim/sulfamethoxazole. Conclusions. More evidence is needed to support H. alvei as a cause of gastroenteritis (AU)

Prevalencia de virus del papiloma humano en mujeres españolas de un programa de cribado poblacional / Prevalence of human papillomavirus in Spanish women from a population screening program

Introducción. El virus del papiloma humano (VPH), es causa necesaria para el desarrollo de cáncer de cuello uterino. El objetivo del estudio fue estimar la prevalencia de mujeres con infección por VPH, adheridas al Programa de Prevención y Detección precoz de Cáncer de cuello de útero de Castilla y León (España). Material y métodos. Se han evaluado los resultados del análisis de VPH en las muestras de las mujeres incluidas en el programa de cribado poblacional. El estudio incluye un total de 120.326 muestras de frotis de cérvix, recogidas en el periodo comprendido entre enero de 2012 y diciembre de 2014. Resultados. Se obtuvieron 12.183 muestras con detección positiva de ADN de VPH, correspondiendo a una prevalencia de 9,6‰ (IC 95% 9,5%-9,8%), en la población femenina. Los VPH asociados a un alto riesgo de transformación celular se encuentran en mayor proporción que los de bajo riesgo (5,9% vs 2,23%). La prevalencia está inversamente relacionada con la edad de las mujeres del cribado. La presencia de infecciones múltiples de VPH se demuestra en un tercio de las mujeres analizadas. Conclusiones. Estos resultados son los primeros y más amplios de un programa de cribado poblacional estructurado en España y deben servir como referencia para futuros estudios y medir el impacto futuro de la vacunación (AU)

Introduction. The human papillomavirus (HPV), is necessary to cause a woman developing cervical cancer. The aim of the study was to estimate the prevalence of women with HPV infection, covered by the program of prevention and early detection of cervical cancer of Castile and León (Spain). Material and methods. Samples of women included in the screening program were analyzed. Including a total of 120,326 cervical swab samples, collected in the period from January 2012 to December 2014. Results. 12,183 HPV positive samples were detected, representing a prevalence of 9.6 ‰, (IC 95% 9.5%-9.8%) in the female population. High-risk HPV were found in higher proportion that HPV low-risk genotypes. HPV prevalence correlates inversely with women age. Coinfections of multiple genotypes were found in one third of screened women population. Conclusions. Data showed in this study are the first and wider Spanish results from a cervical cancer screening program population non opportunistic based on HPV detection. These results would serve as a reference for future prevalence studies and to evaluate the future impact of HPV vaccination campaigns (AU)

Serratia marcescens outbreak due to contaminated 2% aqueous chlorhexidine. / Brote de Serratia marcescens producido por clorhexidina acuosa al 2% contaminada.

INTRODUCTION AND OBJECTIVE: An outbreak of Serratia marcescens infections outbreak is described, as well as the epidemiological study that linked the outbreak to the use of 2% aqueous chlorhexidine antiseptic. METHOD: In late November 2014 an increasing incidence of S. marcescens isolates was detected in patients treated in the emergency department. It was considered a possible outbreak, and an epidemiological investigation was started. RESULT: S. marcescens was isolated in 23 samples from 16 patients and in all new bottles of two lots of 2% aqueous chlorhexidine. The contaminated disinfectant was withdrawn, and the Spanish Drugs Agency was alerted (COS 2/2014). The epidemiological study showed that strains isolated from clinical samples and from chlorhexidine belonged to the same clone. No further isolates were obtained once the disinfectant was withdrawn. CONCLUSION: The suspicion of an outbreak and the epidemiological study were essential to control the incidence.

Resistencias a fármacos de Mycobacterium tuberculosis en la Comunidad de Castilla y León (España), 2001–2005: tercer estudio multicéntrico / Drug-resistance in Mycobacterium tuberculosis in Castilla y León, Spain, 2001–2005: Third collaborative study

Introducción Durante el período 2001–2005 se llevó a cabo el tercer estudio de resistencia a los fármacos antituberculosos de primera línea en Castilla y León, España, en casos nuevos de tuberculosis (TB).Métodos Se estudiaron 918 cepas de Mycobacterium tuberculosis procedentes de pacientes virus de la inmunodeficiencia humana negativos correspondientes a 6 hospitales que atienden al 46,7% del total de la población de la comunidad, y se utilizó el método de las proporciones en medio sólido. Resultados La proporción de resistencias (resistencia primaria) fue del 4,2% y la resistencia simple (monorresistencia) fue del 2,6%. El 1,2% fueron resistentes a estreptomicina; el 3,2% a isoniacida (I); el 0,3% a rifampicina (R); el 0,1% a etambutol, y el 0,5% a pirazinamida, y se observó una cepa (0,1%) multirresistente (resistencia a I y a R). No hubo diferencias significativas con los estudios previos. Conclusiones La incidencia de resistencia primaria y de multirresistencia en la Comunidad de Castilla y León es baja, asimismo, la resistencia a I es aceptable. Consecuentemente, la pauta de tratamiento de la TB puede incluir solamente a los 3 fármacos (R, I y etambutol). Es conveniente, de acuerdo con los programas de control de la TB, realizar estudios de resistencia a los fármacos antituberculosos para optimizar las pautas de tratamiento (AU)

Introduction During 2001–2005, a regional anti-tuberculosis drug resistance survey was conducted in Castilla y León, Spain, in newly treated HIV negative tuberculosis (TB) patients. Methods A total of 918 Mycobacterium tuberculosis strains were studied (one strain per patient) from six hospitals corresponding to 46.7% of the total population of Castilla y León, using the proportion method on solid medium. Results Primary drug resistance was 4.2% (streptomycin 1.2%, isoniazid 3.2%, rifampin 0.3%, ethambutol 0.1% and pyrazinamide 0.5%). Mono-resistance was observed in 24 (2.6%) and resistance to both isoniazid and rifampin (multi-drug resistance) was detected in one case (0.1%). These results were not statistically significant compared to previous studies in the same Community. Conclusion The incidence of primary drug resistance in the surveyed area was low, including isoniazid, allowing new anti-tuberculosis treatment with the standardised three-drug regimen to be started. Regular surveillance of drug resistance is recommended by the TB control programme in representative patient populations to optimize treatment regimens (AU)

[Drug-resistance in Mycobacterium tuberculosis in Castilla y León, Spain, 2001-2005: third collaborative study]. / Resistencias a fármacos de Mycobacterium tuberculosis en la Comunidad de Castilla y León (España), 2001-2005: tercer estudio multicéntrico.

INTRODUCTION: During 2001-2005, a regional anti-tuberculosis drug resistance survey was conducted in Castilla y León, Spain, in newly treated HIV negative tuberculosis (TB) patients. METHODS: A total of 918 Mycobacterium tuberculosis strains were studied (one strain per patient) from six hospitals corresponding to 46.7% of the total population of Castilla y León, using the proportion method on solid medium. RESULTS: Primary drug resistance was 4.2% (streptomycin 1.2%, isoniazid 3.2%, rifampin 0.3%, ethambutol 0.1% and pyrazinamide 0.5%). Mono-resistance was observed in 24 (2.6%) and resistance to both isoniazid and rifampin (multi-drug resistance) was detected in one case (0.1%). These results were not statistically significant compared to previous studies in the same Community. CONCLUSION: The incidence of primary drug resistance in the surveyed area was low, including isoniazid, allowing new anti-tuberculosis treatment with the standardised three-drug regimen to be started. Regular surveillance of drug resistance is recommended by the TB control programme in representative patient populations to optimize treatment regimens.

[Correlation between antibiotic prescription and decreased antimicrobial resistance in the health area of Zamora]. / Correlación entre la prescripción de antibióticos y el descenso de las resistencias a antimicrobianos en el área de salud de Zamora.

OBJECTIVE: To describe the trends in prescribing antibiotics and analyze a possible relationship with the evolution of antimicrobial sensitivity in respiratory pathogens isolated in the health area of Zamora (Spain). MATERIALS AND METHODS: Descriptive study investigating the prescription of antimicrobials and the evolution of resistance in Streptococcus pyogenes, Streptococcus pneumoniae and Haemophilus influenzae, from 1996 to 2005. Antibiotic use is expressed in doses per 1,000 inhabitants per day (DHD). The chi(2) test, exact tests, Spearman correlation coefficients, and a time series analysis were used to analyze the trends. RESULTS: A total of 1301 S. pyogenes strains were isolated. All were sensitive to penicillin, with decreasing percentages of resistance to erythromycin and increasing percentages of resistance to clindamycin. Among 579 pneumococcal strains isolated, a significant decreasing resistance to penicillin, amoxicillin-clavulanic, cefotaxime and cefuroxime was observed; resistance to erythromycin and azithromycin increased during the first few years, but decreased later. Among a total of 769 strains of H. influenzae, all were sensitive to cefotaxime and highly sensitive to amoxicillin-clavulanic acid and cefuroxime; resistance to ampicillin was maintained and there was a significant decreasing resistance to azithromycin. Simultaneously, there was a progressive decrease in overall antibiotic use (20.45 DHD in 1996; 18.90 DHD in 2005). Prescription of penicillins remained stable, with increased use of amoxicillin-clavulanic, decreased use of cephalosporins and macrolides (except azithromycin), and increased use of fluorquinolones. We observed a significant correlation between prescription and resistance. CONCLUSIONS: A recovery of sensitivity to antibiotics was seen in respiratory pathogens parallel to a progressive decrease in prescription of antibiotics.