Tungiasis en paciente viajera procedente del trópico / Tungiasis in a returning traveller from the tropics

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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)

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.

Infección meningocócica en paciente vacunado y en tratamiento con eculizumab / Meningococcemia in vaccinated patient under treatment with eculizumab

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Prescripción de antibióticos y cambios en las resistencias a antimicrobianos en el área de salud de Segovia (2007-2011) / Antibiotic prescribing and changes in antimicrobial resistances in the health area of Segovia (Spain) during the period between 2007 and 2011

Introducción. Se analizó la prescripción de antibióticos y las resistencias de patógenos respiratorios y urinarios más frecuentes del Área de Salud de Segovia durante el periodo 2007-2011 para determinar su variabilidad, su tendencia temporal y su posible correlación con los cambios en los patrones de las resistencias microbianas. Material y métodos. Estudio transversal retrospectivo. El consumo de antibióticos se expresó en dosis diaria definida (DDD) por 1000 habitantes día (DHD). La resistencia se expresó en porcentajes. El análisis de tendencias se realizó con los coeficientes de correlación de Spearman y de Pearson. Resultados. La prescripción media de antibióticos fue 14,17 DHD, el coeficiente y razón de variación 38,93% y 17,94. Las penicilinas fueron el grupo más prescrito (73%). La ubicación rural, la ausencia de formación MIR, la distancia al hospital y el porcentaje de pacientes >65 años, mostraron relación significativa con mayor prescripción de antibióticos. Las resistencias de E. coli a cotrimoxazol y de H. influenzae a amoxicilina descendieron un 8% y la de S. pyogenes a eritromicina un 5%. Las resistencias de S. pneumoniae a penicilina y de E. coli a cefalosporinas aumentaron ambas un 12%. La correlación entre prescripción antibiótica y resistencias antimicrobianas no mostró resultados significativos. Conclusiones. La prescripción de antibióticos descendió un 3,2% durante el periodo mientras que el uso de fármacos de amplio espectro se incrementó. La variabilidad entre médicos prescriptores fue importante, geográfica e interindividualmente. No se obtuvieron datos concluyentes de correlación entre prescripción antibiótica y resistencias (AU)

Introduction. We analyzed the antibiotic prescribing and resistances of respiratory and urinary pathogens more common in the Health Area of Segovia in the period 2007-2011. The aim of the study was to investigate variability, time trends of antibiotic prescribing and correlation with changes in the antimicrobial resistance patterns. Material and methods. Retrospective cross-sectional study. Antibiotic consumption was expressed in defined daily doses (DDD) per 1000 inhabitants per day (DHD). The antimicrobial resistance was expressed in percentages. Trend analysis was performed testing Spearman and Pearson correlation coefficients. Results. The average antibiotic prescribing was 14.17 DHD, the coefficient and low ratio was 38.93% and 17.94. Penicillins was the most prescribed group (73%). Rural localization, lack of training MIR, distance to hospital and percentage of patients >65 years; showed significant association with increased antibiotic prescribing. Resistance of E. coli to cotrimoxazole and resistance of H. influenzae to amoxicillin decreased both by 8%. Resistance of S. pyogenes to erythromycin decreased by 5%. Resistances of S. pneumoniae to penicillin and E.coli to cephalosporins were both increased by 12%. Correlation between antibiotic prescription and resistances did not show singnificative results. Conclusions. Prescribing of antibiotics decreased by 3.2% during the period. The use of broad-spectrum antibiotics was increased. Geographic wide variation in antibiotic prescribing was detected, also between physicians. There were not obtained conclusive data from the correlation between antibiotic prescribing and antimicrobial resistance (AU)

Bacteriemia por Staphylococcus aureus resistente a meticilina de origen respiratorio / Meticillin resistant Staphylococcus aureus bacteremia of respiratory origin

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Prostatitis aguda por Ralstonia pickettii: consideraciones clínicas y epidemiológicas de una infección excepcional / Acute bacterial prostatitis by Ralstonia pickettii: clinical and epidemiological considerations of excepcional observation

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[Study of antibiotic multiresistance of Escherichia coli from urine cultures]. / Estudio de multirresistencia antibiótica de Escherichia coli en urocultivos.

BACKGROUND AND OBJECTIVE: The appearance of resistance in urinary tract infections caused by Escherichia coli constitutes an important therapeutic problem that requires the study of its evolution throughout time in order to establish a suitable empirical treatment. Our objective was to test the antimicrobial sensitivity of E. coli isolations in urine cultures performed in our area. MATERIAL AND METHOD: 5,247 isolates of E. coli from hospital and ambulatory urine cultures of patients in the area of Segovia were retrospectively analyzed. The antibiotic sensitivity of these isolations was studied for 4 years (2000-2005). Moreover, 6 phenotype patterns of resistance to betalactams were analyzed: natural, penicillinase, increased penicillinase, IRT, increased AMPc and BLEE and the difference in sensitivity between BLEE producing and non-producing stocks regarding nitrofurantoin, phosphomicin, ciprofloxacin, gentamicin, and trimetoprim-sulfametoxazol. RESULTS: 57% of isolates were resistant to ampicillin, 23% to ciprofloxacin and 31% to trimetroprim-sulfametoxazol. 48% were penicillinase producer, 6.6% increased penicillinase producer, 1.2% IRT producer, 1.1% AMPc producer and 2.2% were BLEE producer. As far as the origin of the sample is concerned, significant differences were not found. The percentages of co-resistance to ciprofloxacin and trimetoprim-sulfametoxazol were greater in BLEE producer stocks than in non-producers ones. We observed a gradual increase in the expression of this resistance mechanism throughout the studied period. CONCLUSIONS: Ampicillin, ciprofloxacin and trimetoprim-sulfametoxazol are not suitable for the empirical treatment of uncomplicated urinary infections. Research on sensitivity is essential in order to establish correct empirical treatments.

Estudio de multirresistencia antibiótica de Escherichia coli en urocultivos / Study of antibiotic multiresistance of Escherichia coli from urine cultures

Fundamento y objetivo: La aparición de resistencias en las infecciones del tracto urinario causadas por Escherichia coli constituye un importante problema terapéutico que requiere estudiar su evolución en el tiempo para instaurar un tratamiento empírico adecuado. Nuestro objetivo fue conocer la sensibilidad antimicrobiana de los aislamientos de E. coli en urocultivos en nuestra área. Material y método: Se analizaron retrospectivamente 5.247 aislamientos de E. coli procedentes de urocultivos de pacientes hospitalarios y extrahospitalarios en la provincia de Segovia. Se estudió la sensibilidad antibiótica de los aislamientos realizados en 2000-2005 y se analizaron 6 patrones fenotípicos de resistencia a betalactámicos: salvaje, producción de penicilinasa, hiperproducción de penicilinasa, productor de IRT (inhibitor resistant TEM mutants), hiperproducción de adenosinmonofosfato cíclico (AMPc) y betalactamasas de espectro extendido (BLEE), así como la diferencia de sensibilidad entre cepas productoras y no productoras de BLEE a la nitrofurantoína, la fosfomicina, el ciprofloxacino, la gentamicina y la trimetoprima-sulfametoxazol. Resultados: Un 57% fue resistente a ampicilina; un 23%, a ciprofloxacino y un 31%, a trimetoprima-sulfametoxazol. Un 48% fue productor de penicilinasa; un 6,6%, de penicilinasa incrementada; un 1,2%, de IRT; un 1,1%, de AMPc hiperproducido y un 2,2%, de BLEE, sin diferencias estadísticamente significativas en cuanto a la procedencia de la muestra. Se encontraron porcentajes de resistencia combinada a ciprofloxacino y trimetoprima-sulfametoxazol muy superiores en cepas productoras de BLEE, y se observó un incremento paulatino en la expresión de este mecanismo de resistencia durante el período estudiado. Conclusiones: Ampicilina, ciprofloxacino y trimetoprima-sulfametoxazol no son recomendables en el tratamiento empírico de las infecciones urinarias no complicadas en nuestra área. Los estudios de sensibilidad son esenciales con el fin de instaurar tratamientos empíricos correctos

Background and objective: The appearance of resistance in urinary tract infections caused by Escherichia coli constitutes an important therapeutic problem that requires the study of its evolution throughout time in order to establish a suitable empirical treatment. Our objective was to test the antimicrobial sensitivity of E. coli isolations in urine cultures performed in our area. Material and method: 5,247 isolates of E. coli from hospital and ambulatory urine cultures of patients in the area of Segovia were retrospectively analyzed. The antibiotic sensitivity of these isolations was studied for 4 years (2000-2005). Moreover, 6 phenotype patterns of resistance to betalactams were analyzed: natural, penicillinase, increased penicillinase, IRT, increased AMPc and BLEE and the difference in sensitivity between BLEE producing and non-producing stocks regarding nitrofurantoin, phosphomicin, ciprofloxacin, gentamicin, and trimetoprim-sulfametoxazol. Results: 57% of isolates were resistant to ampicillin, 23% to ciprofloxacin and 31% to trimetroprim-sulfametoxazol. 48% were penicillinase producer, 6.6% increased penicillinase producer, 1.2% IRT producer, 1.1% AMPc producer and 2.2% were BLEE producer. As far as the origin of the sample is concerned, significant differences were not found. The percentages of co-resistance to ciprofloxacin and trimetoprim-sulfametoxazol were greater in BLEE producer stocks than in non-producers ones. We observed a gradual increase in the expression of this resistance mechanism throughout the studied period. Conclusions: Ampicillin, ciprofloxacin and trimetoprim-sulfametoxazol are not suitable for the empirical treatment of uncomplicated urinary infections. Research on sensitivity is essential in order to establish correct empirical treatments

Endocarditis por Granulicatella adiacens en un paciente anciano / Endocarditis due to Granulicatella adiacens in an old patient

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