Adenovirus-Associated Urethritis, a Not So Uncommon Entity. A Review of 91 Cases.

BACKGROUND: Human adenovirus (HAdV) is likely an underdiagnosed cause of urethritis, although it was already associated with urethritis in descriptions published more than 40 years ago. Differential clinical features of this entity, such as meatitis, conjunctivitis, and a predominance of mononuclear white blood cells in first-void urine and/or urethral smear, can be useful to increase diagnostic suspicion. METHODS: We retrospectively studied 91 episodes of HAdV-associated urethritis diagnosed for 9 years and 6 months after optimizing efforts to detect the pathogen mainly in patients with features suggestive of this condition. RESULTS: Dysuria was the main symptom (84%), whereas meatitis was observed in 34% of cases. Furthermore, 40% of patients had conjunctivitis. Human adenovirus type D was the most prevalent HAdV (56%), although HAdV-C6, a type not previously associated with urethritis, was observed in 12 patients (13%). CONCLUSIONS: Urethritis due to HAdV is not uncommon, and it is important to screen for it to avoid unnecessary treatments, contact tracing studies, and checkups. The use of multiplex polymerase chain reaction assays that include HAdV, for the diagnosis of urethritis, would raise awareness of its role in this entity.

Increases in the Macrolide Resistance of Mycoplasma genitalium and the Emergence of the A2058T Mutation in the 23S rRNA Gene: Clonal Spread?

The management of Mycoplasma genitalium sexually transmitted infection (STI) is hindered by increasing resistance to the recommended antibiotics, macrolides and quinolones, worldwide. In Gipuzkoa (Basque Country, Spain), macrolide and quinolone resistance rates in 2014−2018 were reported as <20% and <10%, respectively. The aims of this study were to compare these rates with those in 2019−2021 and analyse the genetic and epidemiological features of the strains and cases associated with striking changes in the resistance trends. Resistance to macrolides (n = 1019) and quinolones (n = 958) was studied, analysing mutations in 23S rRNA and parC/gyrA genes, respectively. The rate of macrolide resistance increased from 17.3% in 2014−2018 to 32.1% in 2019−2021, as much in the more prevalent A2058/2059G mutations (16.6−27.8%) as in the emergent A2058T mutations (0.5−4.1%) but with differences in the odds ratios and the relative risk increase between A2058T and A2058/2059G mutations. MG191 adhesin and MG309 lipoprotein of the 27 emergent strains detected with A2058T mutations were amplified, sequenced, and typed using phylogenetic and variable number tandem repeat analysis, respectively. Genetic clonal spread was ruled out, but most of the A2058T cases were men who had sex with men (24/27) with a history of STI and antibiotic treatments (19/27). No changes were observed in quinolone resistance trends, but the rate of resistance to both antibiotics rose from 2.9% to 8.3%, especially in cases with A2058T mutations. The genetic characterisation of strains and epidemiological surveillance of cases are needed to detect populations at increased risk of treatment failure in this infection.

Neisseria gonorrhoeae antimicrobial resistance in Spain: a prospective multicentre study.

OBJECTIVES: Gonococcal infection is one of the most reported sexually transmitted infections and antimicrobial resistance in Neisseria gonorrhoeae (NG) is challenging for the treatment of this infection. This observational study aimed to describe antimicrobial resistance of NG and epidemiological data from patients with gonococcal infection in eight regions of Spain, for updating the local therapeutic guidelines. METHODS: MICs of penicillin, cefixime, ceftriaxone, azithromycin, ciprofloxacin, fosfomycin and gentamicin were determined by Etest for all NG isolates recovered from 1 April 2018 to 30 September 2019 from 10 hospitals in Spain. Resistance determinants were identified using logistic regression analysis. Differences with a P value <0.05 were considered statistically significant. RESULTS: Antimicrobial susceptibility testing was performed for 2571 gonococci isolated from 2429 patients. 44.5% (945/2124) of patients were MSM. The resistance rate to extended-spectrum cephalosporins was low, with 0.2% (6/2561) of isolates resistant to ceftriaxone and 1.7% (44/2517) of isolates resistant to cefixime. The overall azithromycin resistance rate was 12.1% (310/2560), but differed greatly depending on the area. 56.2% (1366/2429) of the strains studied were ciprofloxacin resistant. MIC50 and MIC90 values of gentamicin and fosfomycin were 4 and 8 mg/L and 24 and 48 mg/L, respectively. CONCLUSIONS: Our study shows that NG susceptibility to extended-spectrum cephalosporins remains high in Spain. The azithromycin resistance rate questions the suitability of dual therapy. This study provides data of interest for updating the national treatment guidelines and highlights the need to develop and implement a national sentinel gonococcal antimicrobial susceptibility programme.

Recuperación de Chlamydia trachomatis y otros patógenos en la orina de varones con piuria estéril atendidos en urgencias / Recovery of Chlamydia trachomatis and other pathogens in urine from men with sterile pyuria attended in an emergency department

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Molecular Typing of Mycoplasma genitalium-Positive Specimens Discriminates between Persistent and Recurrent Infections in Cases of Treatment Failure and Supports Contact Tracing.

Mycoplasma genitalium causes a sexually transmitted infection that sometimes persists or recurs despite adequate antibiotic treatment. Between 2014 and 2018, molecular typing was applied to 75 M. genitalium-positive samples from 48 patients with repeated infection and/or couples/groups of other infected sexual contacts. MG191 adhesin, MG309 lipoprotein, and the rRNA operon were amplified, sequenced, and typed using phylogenetic, variable number tandem repeat, and single-nucleotide polymorphism analysis, respectively. Amplicons were obtained in 74/75 samples, and the combination of locus patterns gave 44 different genetic profiles (discriminatory index of 0.987), with 43 considering only MG191 and MG309. Interestingly, 15/17 patients who presented a first sample sensitive and a second resistant to macrolides had the same genetic variant in the samples (persistence of the same strain). In 2/17 patients, discordant variants (one mixed infection and one recurrence due to incomplete contact tracing) were detected. In 31 additional not related and randomly distributed samples, MG191 typing obtained 23 different genotypes, with no appreciable clustering over time. The typing method allowed persistent and recurrent infections to be distinguished, indicating that macrolide resistance-associated mutations mostly developed during treatment. To detect these secondary resistant strains, prevent reinfections, and improve the control of M. genitalium infections, tests of cure and contact tracing of sexual partners should be mandatory.

Whole-genome sequencing of Neisseria gonorrhoeae in a forensic transmission case.

Molecular epidemiology and phylogenetic analyses are frequently used in the investigation of viral transmission cases in forensic contexts. Here, we present the methods and results of the analysis of a bacterial transmission episode in an alleged child abuse case using complete genome sequences obtained by high-throughput sequencing (HTS) methods. We obtained genomes of Neisseria gonorrhoeae from the victim, the suspect, and 29 unrelated controls. The analysis of the genomes revealed that the victim and suspect isolates had identical sequences in both the bacterial chromosome and the single plasmid present in them. One of the local controls was very similar (differing in only 2 SNPs) to the case sequences, but the remaining controls were very divergent. Additional cases of identity and very high similarity among controls were observed occasionally, pointing at recent transmission cases. These results were more discriminative than the previous molecular epidemiology analyses performed at the hospital's Microbiology Service, as Multi-Locus Sequence Typing (MLST) could not distinguish between the suspect/victim and the controls isolates, and Pulse Field Gel Electrophoresis (PFGE) was not able to distinguish between the suspect/victim and one of the local controls. These results lead us to conclude that complete bacterial genome sequences obtained with HTS technologies may be a valuable tool for establishing recent transmission cases and, although more studies are needed, they have a great potential for being used in forensic analyses.

Tratamiento antibiótico dirigido en infecciones por Mycoplasma genitalium: análisis de mutaciones asociadas con resistencia a macrólidos y fluoroquinolonas / Guided antibiotic therapy for Mycoplasma genitalium infections: Analysis of mutations associated with resistance to macrolides and fluoroquinolones

INTRODUCCIÓN: El objetivo de este trabajo fue analizar la susceptibilidad de Mycoplasma genitalium a macrólidos y fluoroquinolonas mediante técnicas moleculares. MÉTODOS: La susceptibilidad a macrólidos se analizó (Gipuzkoa, 2014-2017) mediante PCR en tiempo real con sondas (gen 23S ARNr) y a fluoroquinolonas mediante secuenciación tras PCR convencionales (genes parC/gyrA). RESULTADOS: Se detectaron mutaciones asociadas con resistencia a macrólidos en 43/263 (16,3%) casos y con posible resistencia a fluoroquinolonas en 21/267 (7,9%). La resistencia a macrólidos fue más frecuente tras tratamiento previo con azitromicina (76,5 vs. 7,4%; p < 0,001) y con la pauta única de 1 g (31,3 vs. 7% pauta ampliada, p < 0,001). Se detectaron 5/245 (2%) casos con mutaciones de posible resistencia para ambos antibióticos. CONCLUSIONES: La técnica empleada para el estudio de la susceptibilidad de Mycoplasma genitalium a la azitromicina permitió una respuesta rápida con un tratamiento antibiótico dirigido. Moxifloxacino puede ser una buena alternativa en casos con resistencia a macrólidos

INTRODUCTION: The objective of this study was to analyse the susceptibility of Mycoplasma genitalium to macrolides and fluoroquinolones using molecular techniques. METHODS: Susceptibility to macrolides was tested (Gipuzkoa, 2014-2017) by a rapid probe-based real-time polymerase chain reaction assay (23S rRNA gene) and to fluoroquinolones by sequencing the parC and gyrA genes. RESULTS: Mutations associated with macrolide resistance were detected in 43/263 (16.3%) cases and potential fluoroquinolone resistance in 21/267 (7.9%). Macrolide resistance was more frequent in patients previously treated with azithromycin (76.5% vs 7.4%, P < .001) as well as in those treated with a single 1g dose (31.3%) vs the extended regimen (7%, P < .001). There were 5/245 (2%) cases with mutations probably associated with resistance to both antibiotics. CONCLUSIONS: The technique used for testing Mycoplasma genitalium susceptibility to azithromycin allowed the rapid implementation of resistance-guided antibiotic therapy. Moxifloxacin could be a good option in cases of macrolide resistance

Role of age and comorbidities in mortality of patients with infective endocarditis.

PURPOSE: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. METHODS: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. RESULTS: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. CONCLUSION: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.

Guided antibiotic therapy for Mycoplasma genitalium infections: Analysis of mutations associated with resistance to macrolides and fluoroquinolones. / Tratamiento antibiótico dirigido en infecciones por Mycoplasma genitalium: análisis de mutaciones asociadas con resistencia a macrólidos y fluoroquinolonas.

INTRODUCTION: The objective of this study was to analyse the susceptibility of Mycoplasma genitalium to macrolides and fluoroquinolones using molecular techniques. METHODS: Susceptibility to macrolides was tested (Gipuzkoa, 2014-2017) by a rapid probe-based real-time polymerase chain reaction assay (23S rRNA gene) and to fluoroquinolones by sequencing the parC and gyrA genes. RESULTS: Mutations associated with macrolide resistance were detected in 43/263 (16.3%) cases and potential fluoroquinolone resistance in 21/267 (7.9%). Macrolide resistance was more frequent in patients previously treated with azithromycin (76.5% vs 7.4%, P<.001) as well as in those treated with a single 1g dose (31.3%) vs the extended regimen (7%, P<.001). There were 5/245 (2%) cases with mutations probably associated with resistance to both antibiotics. CONCLUSIONS: The technique used for testing Mycoplasma genitalium susceptibility to azithromycin allowed the rapid implementation of resistance-guided antibiotic therapy. Moxifloxacin could be a good option in cases of macrolide resistance.

Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) score algorithm for identification of Gordonia species.

Gordonia species differentiation is a tedious task. Herein, Gordonia identification was performed according to the standard Bruker score system and a recently proposed score for Gram positive rods identification (≥ 1.5 genus level and ≥ 1.7 species level). New scores significantly improved the identification at genus and species level.

Uretritis y conjuntivitis simultánea por adenovirus tipo 56 / Simultaneous urethritis and conjunctivitis caused by adenovirus type 56

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Susceptibility of 186 Nocardia sp. isolates to 20 antimicrobial agents.

This study determined the antimicrobial susceptibilities of 186 clinical isolates of Nocardia spp. isolated in Gipuzkoa, northern Spain, between 1998 and 2009. Most isolates were recovered from respiratory samples, Nocardia nova, N. farcinica, N. cyriacigeorgica, N. abscessus, and N. carnea being the species most frequently isolated. Linezolid and amikacin were the only two antimicrobials to which all isolates were susceptible. The majority of N. flavorosea, N. carnea, and N. farcinica isolates were trimethoprim-sulfamethoxazole resistant.

Caracterización de los casos de tuberculosis en población autóctona y extranjera de Guipúzcoa en el período 2003–2007 / Characterization of tuberculosis cases in the foreign- and native-born population in Guipúzcoa (Spain) from 2003–2007

Objetivo: Describir los casos de tuberculosis registrados en Guipúzcoa en función de sus características sociodemográficas, clínicas y manejo, y estudiar si existen diferencias entre los casos según su origen. Material y métodos: Estudio descriptivo poblacional de casos diagnosticados entre 2003 y 2007. La fuente de datos fue el sistema de vigilancia que incorpora una búsqueda activa de información en distintas fuentes. Para el cálculo de la incidencia, las poblaciones se obtuvieron del Instituto Vasco de Estadística y el Ikuspegi-Observatorio Vasco de Inmigración. Se utilizaron las pruebas de χ2 y exacta de Fisher para la comparación de proporciones y, la prueba U de Mann-Whitney para la comparación de medias. Resultados: Se registraron 903 casos, de los que 94 correspondían a extranjeros. La incidencia media por 100.000 habitantes fue 86,3 para los extranjeros y 24,4 para los autóctonos. No se observaron diferencias en sexo, tratamiento previo, demora diagnóstica, estudios microbiológicos realizados y resultados de éstos. Se observaron diferencias en edad (más jóvenes los extranjeros), indicación de estudio de contactos y finalización del estudio (menos en extranjeros), cumplimiento del tratamiento (peor en extranjeros), localización (más frecuente la linfática en extranjeros) y factores de riesgo (menos enfermedades crónicas en extranjeros). Conclusiones: Los casos de tuberculosis en población extranjera son más jóvenes y tienen menos patología crónica, y presentan un peor perfil en la realización del estudio de contactos y en el cumplimiento del tratamiento que los autóctonos. Es indispensable buscar los recursos asistenciales más adaptados a cada caso (AU)

Objective: To describe the sociodemographic and clinical characteristics of tuberculosis cases registered in Guipúzcoa and their management and to investigate possible differences depending on the country of origin of affected individuals. Material and methods: We performed a population-based descriptive analysis of cases diagnosed from 2003 to 2007. Cases were drawn from the surveillance system, which incorporates an active information search in distinct sources. Incidences were calculated with the populations obtained from the Basque Institute of Statistics and the Ikuspegi-Basque Immigration Observatory. Chi-squared and Fisher's exact tests were used to compare categorical variables and the Mann-Whitney U-test was used to compare means. Results: A total of 903 cases were registered, of which 94 corresponded to foreigners. During the study period, the mean incidence per 100,000 inhabitants was 86.3 for foreigners and 24.4 for native-born residents. No significant differences were found by gender, prior treatment, diagnostic delay, the microbiological tests performed or their results. Differences were found in age (foreigners were younger), contact tracing recommendation and its completion (less frequent in foreigners), treatment adherence (worse among foreigners), site of infection (more common in lymph nodes in foreigners) and risk factors (fewer chronic diseases in foreigners). Conclusions: Foreigners with tuberculosis were younger and had fewer chronic diseases than native-born individuals with tuberculosis. Study of contacts and treatment adherence were less successful among foreigners. Providing the most suitable care for each patients is essential (AU)

[Characterization of tuberculosis cases in the foreign- and native-born population in Guipúzcoa (Spain) from 2003-2007]. / Caracterización de los casos de tuberculosis en población autóctona y extranjera de Guipúzcoa en el período 2003-2007.

OBJECTIVE: To describe the sociodemographic and clinical characteristics of tuberculosis cases registered in Guipúzcoa and their management and to investigate possible differences depending on the country of origin of affected individuals. MATERIAL AND METHODS: We performed a population-based descriptive analysis of cases diagnosed from 2003 to 2007. Cases were drawn from the surveillance system, which incorporates an active information search in distinct sources. Incidences were calculated with the populations obtained from the Basque Institute of Statistics and the Ikuspegi-Basque Immigration Observatory. Chi-squared and Fisher's exact tests were used to compare categorical variables and the Mann-Whitney U-test was used to compare means. RESULTS: A total of 903 cases were registered, of which 94 corresponded to foreigners. During the study period, the mean incidence per 100,000 inhabitants was 86.3 for foreigners and 24.4 for native-born residents. No significant differences were found by gender, prior treatment, diagnostic delay, the microbiological tests performed or their results. Differences were found in age (foreigners were younger), contact tracing recommendation and its completion (less frequent in foreigners), treatment adherence (worse among foreigners), site of infection (more common in lymph nodes in foreigners) and risk factors (fewer chronic diseases in foreigners). CONCLUSIONS: Foreigners with tuberculosis were younger and had fewer chronic diseases than native-born individuals with tuberculosis. Study of contacts and treatment adherence were less successful among foreigners. Providing the most suitable care for each patients is essential.

Osteomielitis esternal posquirúrgica por Mycobacterium porcinum / Postoperative sternal osteomyelitis due to Mycobacterium porcinum

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