Dispersal history of SARS-CoV-2 in Galicia, Spain.

The dynamics of SARS-CoV-2 transmission are influenced by a variety of factors, including social restrictions and the emergence of distinct variants. In this study, we delve into the origins and dissemination of the Alpha, Delta, and Omicron variants of concern in Galicia, northwest Spain. For this, we leveraged genomic data collected by the EPICOVIGAL Consortium and from the GISAID database, along with mobility information from other Spanish regions and foreign countries. Our analysis indicates that initial introductions during the Alpha phase were predominantly from other Spanish regions and France. However, as the pandemic progressed, introductions from Portugal and the USA became increasingly significant. Notably, Galicia's major coastal cities emerged as critical hubs for viral transmission, highlighting their role in sustaining and spreading the virus. This research emphasizes the critical role of regional connectivity in the spread of SARS-CoV-2 and offers essential insights for enhancing public health strategies and surveillance measures.

Sample pooling for SARS-CoV-2 RT-PCR screening.

OBJECTIVE: To evaluate the efficacy of sample pooling compared to the individual analysis for the diagnosis of coronavirus disease 2019 (COVID-19) by using different commercial platforms for nucleic acid extraction and amplification. METHODS: A total of 3519 nasopharyngeal samples received at nine Spanish clinical microbiology laboratories were processed individually and in pools (342 pools of ten samples and 11 pools of nine samples) according to the existing methodology in place at each centre. RESULTS: We found that 253 pools (2519 samples) were negative and 99 pools (990 samples) were positive; with 241 positive samples (6.85%), our pooling strategy would have saved 2167 PCR tests. For 29 pools (made out of 290 samples), we found discordant results when compared to their correspondent individual samples, as follows: in 22 of 29 pools (28 samples), minor discordances were found; for seven pools (7 samples), we found major discordances. Sensitivity, specificity and positive and negative predictive values for pooling were 97.10% (95% confidence interval (CI), 94.11-98.82), 100%, 100% and 99.79% (95% CI, 99.56-99.90) respectively; accuracy was 99.80% (95% CI, 99.59-99.92), and the kappa concordant coefficient was 0.984. The dilution of samples in our pooling strategy resulted in a median loss of 2.87 (95% CI, 2.46-3.28) cycle threshold (Ct) for E gene, 3.36 (95% CI, 2.89-3.85) Ct for the RdRP gene and 2.99 (95% CI, 2.56-3.43) Ct for the N gene. CONCLUSIONS: We found a high efficiency of pooling strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA testing across different RNA extraction and amplification platforms, with excellent performance in terms of sensitivity, specificity and positive and negative predictive values.

Direct, indirect and total effectiveness of bivalent HPV vaccine in women in Galicia, Spain.

Bivalent human papillomavirus (HPV) vaccine was incorporated into the childhood vaccination calendar in Galicia, Spain in 2008. The objectives of this study were to estimate direct, indirect and total effectiveness of HPV vaccine and to identify sexual habits changes in the post-vaccination period in Galicia, Spain.Endocervical scrapings of 745 women attending 7 Health Areas of the Galician Public Health Service were collected in the post-vaccination period, from 2014-2017. Two groups were studied: women born between 1989 and 1993 (n = 397) and women born in 1994 or later (n = 348). Twelve high-risk human papillomavirus (HR-HPV) genotypes were detected by Cobas® 4800 HPV test (Roche Diagnostics, Mannheim, Germany). The Linear Array® HPV Genotyping Test (Roche Diagnostics) was used for HR-HPV genotype detection other than HPV 16/18. Information about sexual habits was collected by a self-filled questionnaire. Post-vaccination data were compared to previously published pre-vaccination data obtained between 2008 and 2010 in Galicia from women of the same age (18-26 years old, n = 523). The Stata 14.2 software was employed for statistical analyses.Data from 392 unvaccinated and 353 vaccinated women were compared. For unvaccinated and vaccinated women, HPV 16/18 prevalence was 9.2% and 0.8%, respectively, and HPV 31/33/45 prevalence was 8.4% and 1.1%, respectively. Direct, indirect and total effectiveness of the HPV vaccine were (%, 95% CI): 94 (72-99), 30 (-11-56) and 95 (79-99), respectively, for HPV 16/18 and 83 (46-94), -10 (-88-33) and 84 (54-94), respectively, for HPV 31/33/45. The number of women with first intercourse before 17 years old and 3 or more sexual partners along life was higher in the post-vaccination period (p < 0.05). A positive impact of bivalent HPV vaccine was observed, both on direct and cross protection. Sexual habits could have changed in the post-vaccination period.

Colorectal neoplasm in cases of Clostridium septicum and Streptococcus gallolyticus subsp. gallolyticus bacteraemia.

BACKGROUND: Bacteremia with Clostridium septicum (CS) and Streptococcus gallolyticus subsp. gallolyticus (SGG) have both been associated with colorectal neoplasms (CRN) and colonoscopic examination is advised, however the differences and similarities in colorectal findings are not well known. METHODS: This is a multicenter, comparative study of patients with CS bacteremia [44 of 664 cases (6.6%) of Clostridium spp.] and SGG bacteremia [257 of 596 cases (44.2%) of S. bovis group], carried out in three hospitals from Spain. Clinical findings related to bacteremia and associated CRN were collected. RESULTS: The main sources of infection were abdominal (77.7%) for CS bacteremia and endovascular (75%) for SGG bacteremia. CS bacteremia was more often associated with malignancies, (72.6% vs. 19.4%) and neutropenia (29.5% vs. 3.1%), and was more acute, with shock at presentation (63.6% vs. 3.9%) and higher 30-day mortality (47.7% vs. 9.7%) compared to SGG (P<0.05 for all). Both, patients with CS and SGG bacteremia often had concomitant CRN (43.1% vs. 49.8%) and most of them presented as occult CRN (73.7% vs. 91.4%; P=0.02). CS cases more often had invasive carcinomas (94.7% vs. 19.5%), location of CRN in the right colon (73.7% vs. 23.4%), larger tumor size (median 7 vs. 1.5cm), and a higher overall CRN related mortality rate (68.4% vs. 7.8%) compared to SGG cases (P<0.05 for all). CONCLUSIONS: Both, CS and SGG bacteremia are associated with occult CRN. CS cases more often had advanced carcinomas than SGG cases, suggesting a distinct temporal association with CRN.

Confirmed case of Zika virus congenital infection, Spain, March 2016.

We describe Zika virus (ZIKV) vertical transmission in an imported case in Spain, in a 17-week pregnant woman. ZIKV IgG, IgM and RNA were detected in serum in week 17. At 19 weeks, ultrasound scan revealed fetal malformations and ZIKV was detected in the amniotic fluid. Pregnancy was terminated at week 21; autopsy of the fetus revealed bilateral hydrocephalus, brain microcalcifications and arthrogryposis multiplex congenita. ZIKV was detected in the umbilical cord and brain tissue.

Vigilancia de la sensibilidad a antimicrobianos de Escherichia coli productor de infecciones del tracto urinario comunitarias en Galicia / Surveillance of antimicrobial susceptibility of Escherichia coli producing urinary tract infections in Galicia (Spain)

Introducción. Escherichia coli es el microorganismo responsable de la mayoría de las infecciones del tracto urinario (ITU) comunitarias. Nuestro propósito fue conocer la sensibilidad de E. coli asociado a ITU en Galicia y considerar los antibióticos más apropiados para su tratamiento empírico. Métodos. Estudio retrospectivo durante el período 2011-2012 de los aislamientos de E. coli en muestras de orina procedentes de prácticamente toda la población gallega. Se recogieron variables demográficas, concentración mínima inhibitoria y categoría de interpretación para: amoxicilina/clavulánico, cefotaxima, gentamicina, amikacina, ciprofloxacino, cotrimoxazol, fosfomicina y nitrofurantoína. La identificación y estudios de sensibilidad se realizaron principalmente mediante sistemas automatizados. La interpretación de los resultados se realizó de acuerdo con los criterios de CLSI. Resultados: En el período estudiado se aislaron 55.046 E. coli en ITU. Los porcentajes de resistencia fueron: cotrimoxazol 30%; ciprofloxacino 33%; amoxicilina/clavulánico 23% y del 10% para cefalosporinas de 3ª generación. Fosfomicina y nitrofurantoína son los que mantienen mayor actividad, con más de un 96% de sensibilidad en nuestro estudio. La tendencia lineal de las resistencias en relación a la edad fue estadísticamente significativa (p<0,0001) y también lo fue en relación al sexo masculino (p<0,00001) para todos los antibióticos. Conclusiones. En Galicia los antibióticos más activos frente a E. coli asociado a ITU son fosfomicina y nitrofurantoína por lo que deberían ser considerados como tratamiento empírico de elección de la ITU comunitaria no complicada por E. coli (AU)

Introduction. Escherichia coli is the microorganism responsible for most of the community-acquired urinary tract infections (UTI). Our purpose was to determine the susceptibility of E. coli associated with UTI in Galicia and consider the most appropriate antibiotics for empirical treatment. Methods. Retrospective study during the period 2011-2012 of the isolation of E. coli in urine samples from almost all the Galician population. Demographic variables, minimum inhibitory concentration, and reading data were collected: amoxicillin-clavulanate, cefotaxime, gentamicin, amikacin, ciprofloxacin, cotrimoxazole, nitrofurantoin and fosfomycin. The identification and susceptibility studies were mainly conducted by automated systems. The interpretation of the results was performed according to CLSI criteria. Results. During the study period 55,046 E. coli were isolated in UTI. The percentages of resistance were: cotrimoxazole, 30%; ciprofloxacin, 33%; amoxicillin-clavulanate, 23% and 10% for 3rd generation cephalosporins. Fosfomycin and nitrofurantoin showed the highest activity with more than 96% of susceptibility in our study. The linear trend of resistance regarding age was statistically significant (p <0.0001) as it was regarding males (p <0.00001) for all antibiotics. Conclusions. In Galicia, the most active antibiotics against E. coli associated with UTI are fosfomycin and nitrofurantoin so they should be considered as empirical treatment of choice by the community-acquired UTI not complicated by E. coli (AU)

[Surveillance of antimicrobial susceptibility of Escherichia coli producing urinary tract infections in Galicia (Spain)]. / Vigilancia de la sensibilidad a antimicrobianos de Escherichia coli productor de infecciones del tracto urinario comunitarias en Galicia.

OBJECTIVE: Escherichia coli is the microorganism responsible for most of the community-acquired urinary tract infections (UTI). Our purpose was to determine the susceptibility of E. coli associated with UTI in Galicia and consider the most appropriate antibiotics for empirical treatment. METHODS: Retrospective study during the period 2011- 2012 of the isolation of E. coli in urine samples from almost all the Galician population. Demographic variables, minimum inhibitory concentration, and reading data were collected: amoxicillin-clavulanate, cefotaxime, gentamicin, amikacin, ciprofloxacin, cotrimoxazole, nitrofurantoin and fosfomycin. The identification and susceptibility studies were mainly conducted by automated systems. The interpretation of the results was performed according to CLSI criteria. RESULTS: During the study period 55,046 E. coli were isolated in UTI. The percentages of resistance were: cotrimoxazole, 30%; ciprofloxacin, 33%; amoxicillin-clavulanate, 23% and 10% for 3rd generation cephalosporins. Fosfomycin and nitrofurantoin showed the highest activity with more than 96% of susceptibility in our study. The linear trend of resistance regarding age was statistically significant (p <0.0001) as it was regarding males (p <0.00001) for all antibiotics. CONCLUSIONS: In Galicia, the most active antibiotics against E. coli associated with UTI are fosfomycin and nitrofurantoin so they should be considered as empirical treatment of choice by the community-acquired UTI not complicated by E. coli.

Streptococcus bovis septic arthritis and osteomyelitis: A report of 21 cases and a literature review.

BACKGROUND: The Streptococcus bovis group (SBG) is a well-known cause of endocarditis, but its role in osteoarticular infections (OAIs) has not been well described. METHODS: We analyzed all patients with OAIs by SBG diagnosed in our hospital (1988-2014). We selected those cases with septic arthritis and osteomyelitis, as defined according to clinical, microbiological, and imaging studies. Identification of the strains was performed by using the API 20 Strep and the GP card of the Vitek 2 system, and confirmed the identification by molecular methods. In addition, we reviewed the literature to select all cases of OAI by SBG during the period 1980-2015. RESULTS: From the 83 cases of OAI included in the analysis (21 from our center and 62 from the literature review), 59 were osteomyelitis (57 of them spondylodiscitis) and 24 were arthritis (2 with associated spondylodiscitis). The mean age was 66.9 years, and 79.2% of the patients were men. Endocarditis (IE) was associated with 59% of the cases and this association was greater for osteomyelitis than for arthritis (78.9% vs. 13.6%; P = 0.001). OAI was a presenting symptom in 63% of the cases of IE. Colonoscopy was performed in 64 cases, which detected colorectal neoplasm (CRN) in 46 patients (71.8%), almost all asymptomatic. Some 69.5% of these neoplasm were carcinomas or advanced adenomas. The blood cultures were positive in 78.3% cases. In 45 cases, the S. bovis species was identified; in 82.2% of the cases the cause was Streptococcus gallolyticus subsp. gallolyticus. The mortality was 7.2%, which in no case was attributable to the OAI. CONCLUSIONS: OAIs are frequently the initial manifestation of IE caused by SBG. S. gallolyticus causes most of these infections. Echocardiogram and colonoscopy are therefore mandatory, given the species' close association with IE and CRN.

[Surveillance of resistance of Staphylococcus aureus to antibiotics in Galicia: 2007-2012]. / Vigilancia de la resistencia a los antibióticos en Staphylococcus aureus en Galicia: 2007-2012.

INTRODUCTION: Since 2007 the Galician Surveillance Program on Antimicrobial Resistance has been collected data of Staphylococcus aureus susceptibility patterns. The data from 2007 to 2012 have been analyzed and are reported. METHODS: A total of 4,577 different isolates of S. aureus from cerebrospinal fluid and blood cultures were included. The Institutions involved provided the information about the susceptibility patterns, the assay methods used and the interpretative guidelines followed, and demographic data of patients. RESULTS: The rate of methicillin-resistance S. aureus (MRSA) was 22% in 2007-2010 and 26% in 2011-2012, although in some areas the percentage reached 57% (2007- 2010) or 66% (2011-2012). The higher rates of resistance were found in patients older than 75 years. Gentamycin resistance was less than 9% and for quinolones were about 25%. A strong association between methicillin and quinolone-resistance were observed (91%). The resistance against linezolid and glycopeptides were exceptional. CONCLUSIONS: The percentage of MRSA has evolved slightly along the period of this study reaching no significant differences between Galicia and the global data in Spain in 2012. Nevertheless, there are significant differences among the geographic areas studied. Most MRSA isolates were recovered from hospitalized patients, but an increase in the number of MRSA among outpatients was observed, while old patients from nursing homes are included in the outpatient group, so the MRSA rate in this group could be overestimated.

Vigilancia de la resistencia a los antibióticos en Staphylococcus aureus en Galicia: 2007-2012 / Surveillance of resistance of Staphylococcus aureus to antibiotics in Galicia: 2007-2012

Introducción. Desde 2007 el Programa Gallego de Vigilancia de Resistencias Antimicrobianas recogió datos de los patrones de sensibilidad de Staphylococcus aureus. Se analizaron e informaron los datos entre 2007 y 2012. Métodos. Se incluyeron 4.577 aislamientos de S. aureus procedentes de líquido cefalorraquídeo o de sangre. Los distintos centros enviaron información sobre los patrones de sensibilidad, los métodos de ensayo, los criterios de interpretación seguidos y datos demográficos de los pacientes. Resultados. El porcentaje de aislamientos S. aureus resistentes a meticillina (SARM) fue del 22% (2007-2010) y del 26% (2011-2012), aunque en determinada área el porcentaje alcanzó el 57% (2007-2010) o 66% (2011-2012). Las tasas más altas de resistencias se encontraron en los mayores de 75 años. La resistencia a gentamicina fue menor del 9% y la de quinolonas sobre el 25%. Existe fuerte asociación entre resistencias a meticilina y quinolonas (91%). La resistencia frente a linezolid y glicopéptidos fue excepcional. Conclusiones. El porcentaje de SARM a lo largo del periodo de estudio ha presentado ciertas fluctuaciones alcanzándose en 2012 una situación similar en Galicia a la del conjunto de España. No obstante, hay importantes diferencias entre las áreas geográficas estudiadas. La mayoría de los SARM fueron aislados en pacientes hospitalizados, pero se observó un incremento entre ambulatorios. Dado que los pacientes mayores institucionalizados fueron incluidos en el grupo de los ambulatorios es posible que las tasas de SARM en este grupo hayan sido sobreestimadas (AU)

Introduction. Since 2007 the Galician Surveillance Program on Antimicrobial Resistance has been collected data of Staphylococcus aureus susceptibility patterns. The data from 2007 to 2012 have been analyzed and are reported. Methods. A total of 4,577 different isolates of S. aureus from cerebrospinal fluid and blood cultures were included. The Institutions involved provided the information about the susceptibility patterns, the assay methods used and the interpretative guidelines followed, and demographic data of patients. Results. The rate of methicillin-resistance S. aureus (MRSA) was 22% in 2007-2010 and 26% in 2011-2012, although in some areas the percentage reached 57% (2007-2010) or 66% (2011-2012). The higher rates of resistance were found in patients older than 75 years. Gentamycin resistance was less than 9% and for quinolones were about 25%. A strong association between methicillin and quinolone-resistance were observed (91%). The resistance against linezolid and glycopeptides were exceptional. Conclusions. The percentage of MRSA has evolved slightly along the period of this study reaching no significant differences between Galicia and the global data in Spain in 2012. Nevertheless, there are significant differences among the geographic areas studied. Most MRSA isolates were recovered from hospitalized patients, but an increase in the number of MRSA among outpatients was observed, while old patients from nursing homes are included in the outpatient group, so the MRSA rate in this group could be overestimated (AU)

The clinical epidemiology and malignancies associated with Streptococcus bovis biotypes in 506 cases of bloodstream infections.

OBJECTIVES: To determine the incidence of Streptococcus bovis (Sb) biotypes causing bacteraemia and associated malignancies. METHODS: This is a retrospective analysis of patients with Sb bacteraemia, pulled out from a prospective surveillance protocol of bacteraemia cases, in three areas of Spain (1990-2013): a cattle area (Lugo), a fishing area (Ferrol) and an urban area (Barcelona). Colonoscopy and Sb biotypes (Sb-I and Sb-II) were determined in most cases. RESULTS: 506 patients with Sb bacteraemia; mean age 68.1 (±14.1) years, and 66.2% were males. The cattle area, compared with the fishing and urban areas, had higher incidence of bacteraemia by SbI (40.29 vs 9.38 vs 6.15 cases/10(6) person-years, P < 0.001) and bacteraemia by Sb-II (29.07 vs 9.84 vs 13.37 cases/10(6) person-years, P < 0.001). The Sb-I cases (n = 224), compared with Sb-II cases (n = 270), had greater rates of endocarditis (77.6% vs 9.6%, P < 0.001) and colorectal neoplasm (CRN) (50.9% vs 16.6%, P < 0.001), and smaller rates of biliary tract infection (2.2% vs 29.6%, P < 0.001) and non-colorectal malignancy (8.9% vs 31.4%, P < 0.001). CONCLUSION: There was a link between the cattle area and higher incidence of Sb bacteraemia. Sb-I differed from Sb-II cases in clinical findings and associated malignancies. Colonoscopy is mandatory in cases of endocarditis or bacteraemia caused by Sb-I.

Emergence of new variants of ST131 clonal group among extraintestinal pathogenic Escherichia coli producing extended-spectrum ß-lactamases.

Having shown that Lucus Augusti Hospital in Lugo, Spain, has been affected by Escherichia coli clone O25:H4-ST131 producing CTX-M-15, the present study was carried out to evaluate the prevalence of this clone among the extended-spectrum ß-lactamase (ESBL)-producing E. coli isolates and to identify novel variants of this clone. Of the 77 ESBL-producing E. coli isolated between January and April 2012, 47 (61%) were identified as belonging to the ST131 clonal group, comprising 38 O25b:H4-B2-ST131 (34 CTX-M-15, 2 CTX-M-14, 1 CTX-M-1 and 1 CTX-M-27), 7 O-non-typeable:H4-B2-ST131 (all CTX-M-15) and 2 O16:H5-B2-ST131 (both CTX-M-14). The 47 isolates of ST131 exhibited a significantly higher virulence score (mean of 9.1 virulence genes) compared with the 30 non-ST131 isolates (mean of 4.3 virulence genes). A new virulence profile (fimH, papG II, sat, cnf1, hlyA, iucD, kpsM II-K5, traT, malX, usp) was detected among O25b:H4-B2-ST131 isolates belonging to the new Pasteur sequence type PST621. To our knowledge, this is the first study to report the O-non-typeable:H4-B2-ST131 and O16:H5-B2-ST131 variants in Europe.

Association between bacteremia due to Streptococcus gallolyticus subsp. gallolyticus (Streptococcus bovis I) and colorectal neoplasia: a case-control study.

BACKGROUND: The association between bacteremia by Streptococcus gallolyticus subsp. gallolyticus (SGG) and colorectal neoplasia (CRN) is well established but the frequency of the association varies widely in different studies. We conducted a case-control study to assess the association between SGG bacteremia and CRN. METHODS: An analysis of all SGG bacteremias was performed during the period 1988-2011. The frequency of CRN in patients with SGG bacteremia was compared with the frequency of CRN in a symptomatic control group of patients matched at a 1:2 ratio for gender and age (±3 years) without S. bovis bacteremia and personal history of CRN and with increased risk of CRN (by the presence of symptoms, signs, or test suspicious of colonic pathology or by family history of CRN). RESULTS: One hundred nine cases of SGG bacteremia were detected (mean age, 66 years; 87% male). Colonoscopy was performed in 98 cases, diagnosing 69 cases of CRN: 57 adenomas (39 advanced adenomas) and 12 invasive carcinomas. Only 4 cases had suspected CRN before the blood culture. The prevalence of CRN was higher in patients with SGG bacteremia than in the 196 control patients (70% vs 32%; odds ratio [OR], 5.1; 95% confidence interval [CI], 3.0-8.6). This difference was not significant when comparing nonadvanced adenomas (19% vs 12%), but we found significant differences in advanced adenomas (40% vs 16%; OR, 3.5; 95% CI, 2.0-6.1) and invasive carcinomas (12% vs 5%; OR, 2.9; 95% CI, 1.2-6.9). CONCLUSIONS: The frequency of CRN among SGG infected patients is significantly increased compared with symptomatic age-matched controls, indicating that SGG infection is a strong indicator for underlying occult malignancy.

[Microbiological diagnosis of urinary tract infections]. / Diagnóstico microbiológico de las infecciones del tracto urinario.

For the diagnosis of urinary tract infection (UTI), besides the quantification of bacteria in the urine, cellular elements contained in the urine, the collection method used and the clinical syndrome should also be considered. Therefore, the microbiological diagnosis of UTI should be performed by an experienced person who takes into account the diversity of situations that may influence the result of each of the cultures. The processing of urine samples depends on the number of samples received daily. In laboratories with a high number, it is impossible to culture each of them, so negative urines have to be ruled out by using automated systems and cultivate only those that are positive. This review includes an analysis of the methods currently available for this screening. It also includes procedures to be performed in special situations such as prostatitis, UTI caused by fastidious microorganisms and other kind of infections that may be diagnosed in a urine test.

Diagnóstico microbiológico de las infecciones del tracto urinario / Microbiological diagnosis of urinary tract infections

Para el diagnóstico de la infección urinaria (IU), además del recuento de bacterias en orina, debe tenerse en cuenta los elementos formes contenidos en la misma, el tipo de entidad clínica y el método de recogida empleado. Por ello, el diagnóstico microbiológico de la IU debe ser realizado por una persona experta que tenga en cuenta la diversidad de situaciones que traduce cada uno de los urocultivos que interpreta. El procesamiento de las muestras de orina depende del numero de muestras recibidas diariamente. En laboratorios con un alto número es imposible el cultivo de cada una de ellas, por lo que se impone descartar las orinas negativas mediante sistemas automatizados y cultivar sólo aquellas positivas. La presente revisión incluye un análisis de los métodos disponibles actualmente para hacer este cribado. Incluye también procedimientos a realizar en situaciones especiales como prostatitis, IU por microorganismos fastidiosos e infecciones que se diagnostican con el examen de la orina (AU)

For the diagnosis of urinary tract infection (UTI), besides the quantification of bacteria in the urine, cellular elements contained in the urine, the collection method used and the clinical syndrome should also be considered. Therefore, the microbiological diagnosis of UTI should be performed by an experienced person who takes into account the diversity of situations that may influence the result of each of the cultures. The processing of urine samples depends on the number of samples received daily. In laboratories with a high number, it is impossible to culture each of them, so negative urines have to be ruled out by using automated systems and cultivate only those that are positive. This review includes an analysis of the methods currently available for this screening. It also includes procedures to be performed in special situations such as prostatitis, UTI caused by fastidious microorganisms and other kind of infections that may be diagnosed in a urine test (AU)

Recent emergence of clonal group O25b:K1:H4-B2-ST131 ibeA strains among Escherichia coli poultry isolates, including CTX-M-9-producing strains, and comparison with clinical human isolates.

To discern the possible spread of the Escherichia coli O25b:H4-ST131 clonal group in poultry and the zoonotic potential of avian strains, we made a retrospective search of our strain collection and compared the findings for those strains with the findings for current strains. Thus, we have characterized a collection of 19 avian O25b:H4-ST131 E. coli strains isolated from 1995 to 2010 which, interestingly, harbored the ibeA gene. Using this virulence gene as a criterion for selection, we compared those 19 avian strains with 33 human O25b:H4-ST131 ibeA-positive E. coli strains obtained from patients with extraintestinal infections (1993 to 2009). All 52 O25b:H4-ST131 ibeA-positive E. coli strains shared the fimH, kpsMII, malX, and usp genes but showed statistically significant differences in nine virulence factors, namely, papGIII, cdtB, sat, and kpsMII K5, which were associated with human strains, and iroN, kpsMII K1, cvaC, iss, and tsh, which were associated with strains of avian origin. The XbaI macrorestriction profiles of the 52 E. coli O25b:H4-ST131 ibeA-positive strains revealed 11 clusters (clusters I to XI) of >85% similarity, with four clusters including strains of human and avian origin. Cluster VII (90.9% similarity) grouped 10 strains (7 avian and 3 human strains) that mostly produced CTX-M-9 and that also shared the same virulence profile. Finally, we compared the macrorestriction profiles of the 12 CTX-M-9-producing O25b:H4-ST131 ibeA strains (7 avian and 5 human strains) identified among the 52 strains with those of 15 human O25b:H4-ST131 CTX-M-14-, CTX-M-15-, and CTX-M-32-producing strains that proved to be negative for ibeA and showed that they clearly differed in the level of similarity from the CTX-M-9-producing strains. In conclusion, E. coli clonal group O25b:H4-ST131 ibeA has recently emerged among avian isolates with the new acquisition of the K1 capsule antigen and includes CTX-M-9-producing strains. This clonal group represents a real zoonotic risk that has crossed the barrier between human and avian hosts.

Co-infection by Streptococcus anginosus and Mycobacterium tuberculosis: three case reports.

INTRODUCTION: Bacterial infections may appear as sequelae of remote tuberculous infections, especially thoracic infections. The simultaneous appearance of tuberculosis and bacterial infection is not common, and, to our knowledge, the association of infection by Streptococcus anginosus and Mycobacterium tuberculosis has not been reported previously in the literature. CASE PRESENTATION: We report three cases of dual infection with Streptococcus anginosus and Mycobacterium tuberculosis that were first diagnosed as pyogenic abscesses because of an isolation of Streptococcus anginosus. Despite a course of antibiotics and drainage, the outcome of this initial treatment was unfavourable. A re-evaluation yielded a diagnosis of mixed infection with Streptococcus anginosus and Mycobacterium tuberculosis. CONCLUSION: In a geographical area with a high prevalence of tuberculous disease, the rare possibility of dual infection with Streptococcus anginosus and Mycobacterium tuberculosis should be considered.

Verotoxin-producing Escherichia coli in Spain: prevalence, serotypes, and virulence genes of O157:H7 and non-O157 VTEC in ruminants, raw beef products, and humans.

In Spain, as in many other countries, verotoxin-producing Escherichia coli (VTEC) strains have been frequently isolated from cattle, sheep, and foods. VTEC strains have caused seven outbreaks in Spain (six caused by E. coli O157:H7 and one by E. coli O111:H- [nonmotile]) in recent years. An analysis of the serotypes indicated serological diversity. Among the strains isolated from humans, serotypes O26:H11, O111:H-, and O157:H7 were found to be more prevalent. The most frequently detected serotypes in cattle were O20:H19, O22:H8, O26:H11, O77:H41, O105:H18, O113:H21, O157:H7, O171:H2, and OUT (O untypeable):H19. Different VTEC serotypes (e.g., O5:H-, O6:H10, O91:H-, O117:H-, O128:H-, O128:H2, O146:H8, O146:H21, O156:H-, and OUT:H21) were found more frequently in sheep. These observations suggest a host serotype specificity for some VTEC. Numerous bovine and ovine VTEC serotypes detected in Spain were associated with human illnesses, confirming that ruminants are important reservoirs of pathogenic VTEC. VTEC can produce one or two toxins (VT1 and VT2) that cause human illnesses. These toxins are different proteins encoded by different genes. Another virulence factor expressed by VTEC is the protein intimin that is responsible for intimate attachment of VTEC and effacing lesions in the intestinal mucosa. This virulence factor is encoded by the chromosomal gene eae. The eae gene was found at a much less frequency in bovine (17%) and ovine (5%) than in human (45%) non-O157 VTEC strains. This may support the evidence that the eae gene contributes significantly to the virulence of human VTEC strains and that many animal non-O157 VTEC strains are less pathogenic to humans.