Dissemination of extensively drug-resistant NDM-producing Providencia stuartii in Europe linked to patients transferred from Ukraine, March 2022 to March 2023.

BackgroundThe war in Ukraine led to migration of Ukrainian people. Early 2022, several European national surveillance systems detected multidrug-resistant (MDR) bacteria related to Ukrainian patients.AimTo investigate the genomic epidemiology of New Delhi metallo-ß-lactamase (NDM)-producing Providencia stuartii from Ukrainian patients among European countries.MethodsWhole-genome sequencing of 66 isolates sampled in 2022-2023 in 10 European countries enabled whole-genome multilocus sequence typing (wgMLST), identification of resistance genes, replicons, and plasmid reconstructions. Five bla NDM-1-carrying-P. stuartii isolates underwent antimicrobial susceptibility testing (AST). Transferability to Escherichia coli of a bla NDM-1-carrying plasmid from a patient strain was assessed. Epidemiological characteristics of patients with NDM-producing P. stuartii were gathered by questionnaire.ResultswgMLST of the 66 isolates revealed two genetic clusters unrelated to Ukraine and three linked to Ukrainian patients. Of these three, two comprised bla NDM-1-carrying-P. stuartii and the third bla NDM-5-carrying-P. stuartii. The bla NDM-1 clusters (PstCluster-001, n = 22 isolates; PstCluster-002, n = 8 isolates) comprised strains from seven and four countries, respectively. The bla NDM-5 cluster (PstCluster-003) included 13 isolates from six countries. PstCluster-001 and PstCluster-002 isolates carried an MDR plasmid harbouring bla NDM-1, bla OXA-10, bla CMY-16, rmtC and armA, which was transferrable in vitro and, for some Ukrainian patients, shared by other Enterobacterales. AST revealed PstCluster-001 isolates to be extensively drug-resistant (XDR), but susceptible to cefiderocol and aztreonam-avibactam. Patients with data on age (n = 41) were 19-74 years old; of 49 with information on sex, 38 were male.ConclusionXDR P. stuartii were introduced into European countries, requiring increased awareness and precautions when treating patients from conflict-affected areas.

Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain.

BACKGROUND: Community-acquired (CA) and healthcare-associated (HCA) infections caused by carbapenemase-producing Enterobacterales (CPE) are not well characterized. The objective was to provide detailed information about the clinical and molecular epidemiological features of nosocomial, HCA and CA infections caused by carbapenemase-producing Klebsiella pneumoniae (CP-Kp) and Escherichia coli (CP-Ec). METHODS: A prospective cohort study was performed in 59 Spanish hospitals from February to March 2019, including the first 10 consecutive patients from whom CP-Kp or CP-Ec were isolated. Patients were stratified according to acquisition type. A multivariate analysis was performed to identify the impact of acquisition type in 30-day mortality. RESULTS: Overall, 386 patients were included (363 [94%] with CP-Kp and 23 [6%] CP-Ec); in 296 patients (76.3%), the CPE was causing an infection. Acquisition was CA in 31 (8.0%) patients, HCA in 183 (47.4%) and nosocomial in 172 (48.3%). Among patients with a HCA acquisition, 100 (54.6%) had been previously admitted to hospital and 71 (38.8%) were nursing home residents. Urinary tract infections accounted for 19/23 (82.6%), 89/130 (68.5%) and 42/143 (29.4%) of CA, HCA and nosocomial infections, respectively. Overall, 68 infections (23%) were bacteremia (8.7%, 17.7% and 30.1% of CA, HCA and nosocomial, respectively). Mortality in infections was 28% (13%, 14.6% and 42.7% of CA, HCA and nosocomial, respectively). Nosocomial bloodstream infections were associated with increased odds for mortality (adjusted OR, 4.00; 95%CI 1.21-13.19). CONCLUSIONS: HCA and CA infections caused by CPE are frequent and clinically significant. This information may be useful for a better understanding of the epidemiology of CPE.

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.

Community Emergence of Cefixime-Resistant Escherichia coli Belonging to ST12 with Chromosomal AmpC Hyperproduction.

Escherichia coli isolates that are resistant to cefixime and amoxicillin/clavulanic acid, but apparently susceptible to cefuroxime, with no ESBL identified, were initially detected in Madrid from urine samples in 2019. Throughout 2020 and 2021, all cases of community UTI by E. coli from six health areas in Madrid were studied. A representative sample of 23 cases was selected for further studies. The broth microdilution method and the agar diffusion method were performed to determine the antibiotic susceptibility. WGS was carried out for phylogeny, resistome and virulome analysis. Community consumption of third-generation oral cephalosporins in Madrid (2017-2021) was analyzed. A total of 582 (1.3%) E. coli isolates had the mentioned resistance profile. The mutation at position -32 (T > A) of the AmpC promoter was found in 21 isolates. No plasmid AmpC- or ESBL-encoding genes were detected. A cluster of 20 ST12 isolates was detected by cgMLST. A 6.2% increase in the consumption of third-generation oral cephalosporins, especially cefixime, was observed in Madrid. Chromosomal AmpC-hyperproducing ST12 E. coli isolates could be implicated in the increase in community UTI cases by cefixime-resistant isolates, which correlates with an increasing trend of cefixime consumption.

Clinical, microbiological, and molecular characterization of pediatric invasive infections by Streptococcus pyogenes in Spain in a context of global outbreak.

In December 2022, an alert was published in the UK and other European countries reporting an unusual increase in the incidence of Streptococcus pyogenes infections. Our aim was to describe the clinical, microbiological, and molecular characteristics of group A Streptococcus invasive infections (iGAS) in children prospectively recruited in Spain (September 2022-March 2023), and compare invasive strains with strains causing mild infections. One hundred thirty isolates of S. pyogenes causing infection (102 iGAS and 28 mild infections) were included in the microbiological study: emm typing, antimicrobial susceptibility testing, and sequencing for core genome multilocus sequence typing (cgMLST), resistome, and virulome analysis. Clinical data were available from 93 cases and 21 controls. Pneumonia was the most frequent clinical syndrome (41/93; 44.1%), followed by deep tissue abscesses (23/93; 24.7%), and osteoarticular infections (11/93; 11.8%). Forty-six of 93 cases (49.5%) required admission to the pediatric intensive care unit. iGAS isolates mainly belonged to emm1 and emm12; emm12 predominated in 2022 but was surpassed by emm1 in 2023. Spread of M1UK sublineage (28/64 M1 isolates) was communicated for the first time in Spain, but it did not replace the still predominant sublineage M1global (36/64). Furthermore, a difference in emm types compared with the mild cases was observed with predominance of emm1, but also important representativeness of emm12 and emm89 isolates. Pneumonia, the most frequent and severe iGAS diagnosed, was associated with the speA gene, while the ssa superantigen was associated with milder cases. iGAS isolates were mainly susceptible to antimicrobials. cgMLST showed five major clusters: ST28-ST1357/emm1, ST36-ST425/emm12, ST242/emm12.37, ST39/emm4, and ST101-ST1295/emm89 isolates. IMPORTANCE: Group A Streptococcus (GAS) is a common bacterial pathogen in the pediatric population. In the last months of 2022, an unusual increase in GAS infections was detected in various countries. Certain strains were overrepresented, although the cause of this raise is not clear. In Spain, a significant increase in mild and severe cases was also observed; this study evaluates the clinical characteristics and the strains involved in both scenarios. Our study showed that the increase in incidence did not correlate with an increase in resistance or with an emm types shift. However, there seemed to be a rise in severity, partly related to a greater rate of pneumonia cases. These findings suggest a general increase in iGAS that highlights the need for surveillance. The introduction of whole genome sequencing in the diagnosis and surveillance of iGAS may improve the understanding of antibiotic resistance, virulence, and clones, facilitating its control and personalized treatment.

Activity of cefiderocol and innovative ß-lactam/ß-lactamase inhibitor combinations against isogenic strains of Escherichia coli expressing single and double ß-lactamases under high and low permeability conditions.

OBJECTIVES: To analyse the impact of the most clinically relevant ß-lactamases and their interplay with low outer membrane permeability on the activity of cefiderocol, ceftazidime/avibactam, aztreonam/avibactam, cefepime/enmetazobactam, cefepime/taniborbactam, cefepime/zidebactam, imipenem/relebactam, meropenem/vaborbactam, meropenem/xeruborbactam and meropenem/nacubactam against recombinant Escherichia coli strains. METHODS: We constructed 82 E. coli laboratory transformants expressing the main ß-lactamases circulating in Enterobacterales (70 expressing single ß-lactamase and 12 producing double carbapenemase) under high (E. coli TG1) and low (E. coli HB4) permeability conditions. Antimicrobial susceptibility testing was determined by reference broth microdilution. RESULTS: Aztreonam/avibactam, cefepime/zidebactam, cefiderocol, meropenem/xeruborbactam and meropenem/nacubactam were active against all E. coli TG1 transformants. Imipenem/relebactam, meropenem/vaborbactam, cefepime/taniborbactam and cefepime/enmetazobactam were also highly active, but unstable against most of MBL-producing transformants. Combination of ß-lactamases with porin deficiency (E. coli HB4) did not significantly affect the activity of aztreonam/avibactam, cefepime/zidebactam, cefiderocol or meropenem/nacubactam, but limited the effectiveness of the rest of carbapenem- and cefepime-based combinations. Double-carbapenemase production resulted in the loss of activity of most of the compounds tested, an effect particularly evident for those E. coli HB4 transformants in which MBLs were present. CONCLUSIONS: Our findings highlight the promising activity that cefiderocol and new ß-lactam/ß-lactamase inhibitors have against recombinant E. coli strains expressing widespread ß-lactamases, including when these are combined with low permeability or other enzymes. Aztreonam/avibactam, cefiderocol, cefepime/zidebactam and meropenem/nacubactam will help to mitigate to some extent the urgency of new compounds able to resist MBL action, although NDM enzymes represent a growing challenge against which drug development efforts are still needed.

Characterization of an outbreak caused by Elizabethkingia miricola using Fourier-transform infrared (FTIR) spectroscopy.

Fourier-transform infrared (FTIR) spectroscopy has the potential to be used for bacterial typing and outbreak characterization. We evaluated FTIR for the characterization of an outbreak caused by Elizabethkingia miricola. During the 2020-2021 period, 26 isolates (23 clinical and 3 environmental) were collected and analyzed by FTIR (IR Biotyper) and core-genome MLST (cgMLST), in addition to antimicrobial susceptibility testing. FTIR spectroscopy and cgMLST showed that 22 of the isolates were related to the outbreak, including the environmental samples, with only one discordance between both methods. Then, FTIR is useful for E. miricola typing and can be easily implemented in the laboratory.

Corrigendum: CARB-ES-19 multicenter study of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli from all Spanish provinces reveals interregional spread of high-risk clones such as ST307/OXA-48 and ST512/KPC-3.

[This corrects the article DOI: 10.3389/fmicb.2022.918362.].

Recommendations of the Spanish Antibiogram Committee (COESANT) for selecting antimicrobial agents and concentrations for in vitro susceptibility studies using automated systems / Recomendaciones del Comité Español del Antibiograma (COESANT) para la selección de antimicrobianos y sus concentraciones en el estudio in vitro de la sensibilidad con métodos automáticos

Automated antimicrobial susceptibility testing devices are widely implemented in clinical microbiology laboratories in Spain, mainly using EUCAST (European Committee on Antimicrobial Susceptibility Testing) breakpoints. In 2007, a group of experts published recommendations for including antimicrobial agents and selecting concentrations in these systems. Under the patronage of the Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) and the Study Group on Mechanisms of Action and Resistance to Antimicrobial Agents (GEMARA) from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and aligned with the Spanish National Plan against Antimicrobial Resistance (PRAN), a group of experts have updated this document. The main modifications from the previous version comprise the inclusion of new antimicrobial agents, adaptation of the ranges of concentrations to cover the EUCAST breakpoints and epidemiological cut-off values (ECOFFs), and the inference of new resistance mechanisms. This proposal should be considered by different manufacturers and users when designing new panels or cards. In addition, recommendations for selective reporting are also included. With this approach, the implementation of EUCAST breakpoints will be easier, increasing the quality of antimicrobial susceptibility testing data and their microbiological interpretation. It will also benefit epidemiological surveillance studies as well as the clinical use of antimicrobials aligned with antimicrobial stewardship programs

Los sistemas automáticos utilizados en el estudio de la sensibilidad a los antimicrobianos están introducidos en la mayoría de los laboratorios de Microbiología Clínica en España, utilizando principalmente los puntos de corte del European Committee on Antimicrobial Susceptibility Testing (EUCAST). En 2007, un grupo de expertos publicó unas recomendaciones para incluir antimicrobianos y seleccionar concentraciones en estos sistemas. Bajo el auspicio del Comité Español del Antibiograma (COESANT) y del Grupo de Estudio de los Mecanismos de Acción y Resistencia a los Antimicrobianos (GEMARA) de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y alineado con el Plan Nacional frente a la Resistencia a los Antibióticos (PRAN), un grupo de expertos ha actualizado dicho documento. Las principales modificaciones realizadas sobre la versión anterior comprenden la inclusión de nuevos agentes antimicrobianos, la adaptación de los rangos de concentraciones para cubrir los puntos de corte clínicos y los puntos de corte epidemiológicos (ECOFF) definidos por el EUCAST, y para la inferencia de nuevos mecanismos de resistencia. Esta propuesta debería ser considerada por los diferentes fabricantes y los usuarios cuando se diseñen nuevos paneles o tarjetas. Además, se incluyen recomendaciones para realizar informes selectivos. Con este enfoque, la implementación de los puntos de corte del EUCAST será más fácil, aumentando la calidad de los datos del antibiograma y su interpretación microbiológica. También será de utilidad para los estudios de vigilancia epidemiológica, así como para el uso clínico de los antimicrobianos, de acuerdo con los programas de optimización de uso de antimicrobianos (PROA)

Rápido aumento de la resistencia a cefalosporinas de 3a generación, imipenem y de la corresistencia en 7.140 aislados de Klebsiella pneumoniae en hemocultivos (2010-2014) según datos de EARS-Net en España / Rapid increase in resistance to third generation cephalosporins, imipenem and co-resistance in Klebsiella pneumoniae from isolated from 7,140 blood-cultures (2010-2014) using EARS-Net data in Spain

Introducción: Se analizó la evolución de la resistencia a cefalosporinas de 3.a generación, imipenem y otros antibióticos en aislamientos invasivos de Klebsiella pneumoniae (K. pneumoniae) según resultados de EARS-Net entre 2010 y 2014 en España. Métodos: Participaron 42 hospitales de 16 Comunidades Autónomas, con una cobertura poblacional aproximada del 33%. Resultados: Se aislaron 7.140 cepas de K. pneumoniae de un mismo número de pacientes. Las resistencias globales (I+R) fueron: cefotaxima 15,8%, ceftazidima 13,7%, imipenem 1,7%, ciprofloxacina 20,1%, tobramicina 14,1%, gentamicina 10,4% y amikacina 1,9%. La resistencia a cefalosporinas de 3.a generación aumentó desde el 9,8% (2010) al 19% (2014); la de ciprofloxacina desde el 15,4% (2010) al 19,6% (2014); la de gentamicina desde el 6,2% (2010) al 10,3% (2014) y la de tobramicina desde el 7,1% (2010) al 14,2% (2014) (p< 0,001 en todos los casos). Las cepas resistentes a la vez a cefalosporinas de 3.a generación, ciprofloxacina y aminoglucósidos aumentaron desde el 3,3% (2010) al 9,7% (2014) (p<0,001). La resistencia a imipenem aumentó desde el 0,27% (2010) al 3,46% (2014) (p< 0,001); 121 aislados fueron resistentes a imipenem, de los cuales 104 (86%) produjeron carbapenemasas: 74 OXA-48, 14 VIM, 9 KPC (6 KPC-2 y 3 KPC-3), 6 IMP y 1 GES. Conclusiones: En un periodo de 5 años (2010-2014), la resistencia a cefalosporinas de 3.a generación en K. pneumoniae invasivas en España se ha duplicado; la resistencia combinada a cefalosporinas de 3.a generación, ciprofloxacina y aminoglucósidos se ha triplicado; la resistencia a imipenem ha aumentado casi 13 veces, principalmente por la diseminación de aislados productores de carbapenemasas (AU)

Introduction: An analysis was made about the evolution of resistance to 3rd generation cephalosporins, imipenem, and other antibiotics in invasive isolates of Klebsiella pneumoniae (K. pneumoniae)according to the Spanish EARS-Net database (2010-2014). Methods: Forty-two hospitals from 16 Autonomous Communities with an approximate population coverage of 33% participated. Results: A total 7,140 pneumoniae corresponding to the same number of patients were studied. Overall resistance percentages (I+R) were: cefotaxime 15.8%, ceftazidime 13.7%, imipenem 1.7%, ciprofloxacin 20.1%, tobramycin 14.1%, gentamicin 10.4%, and amikacin 1.9%. Resistance to 3rd generation cephalosporins increased from 9.8% (2010) to 19% (2014); to ciprofloxacin from 15.4% (2010) to 19.6% (2014); to gentamicin from 6.2% (2010) to 10.3% (2014) and to tobramycin from 7.1% (2010) to 14.2% (2014) (p<.001 in all cases). Combined resistance to 3rd generation cephalosporins, ciprofloxacin, and aminoglycosides increased from 3.3% (2010) to 9.7% (2014) (p<.001). Resistance to imipenem also increased from 0.27% (2010) to 3.46% (2014) (p<.001). A total of 121 isolates were resistant to imipenem, of which 104 (86%) produced carbapenemases: 74 OXA-48, 14 VIM, 9 KPC (6 KPC-2 and 3 KPC-3), 6 IMP, and 1 GES. Conclusions: Over the 5 year period (2010-2014), resistance to 3rd generation cephalosporins in invasive K. pneumoniae in Spain has doubled. The combined resistance to 3rd generation cephalosporins, ciprofloxacin, and aminoglycosides has tripled, and imipenem resistance has increased almost 13 times, mostly due to the spread of carbapenemase-producing isolates (AU)

Evolution of carbapenemase-producing Enterobacteriaceae at the global and national level: What should be expected in the future? / Evolución de las enterobacterias productoras de carbapenemasas a nivel global y nacional: ¿qué deberíamos esperar en el futuro?

In recent years, Enterobacteriaceae isolates have increased their potential to become highly drug resistant by acquiring resistance to carbapenems, primarily due to the production of acquired carbapenemases. The carbapenemases detected in Enterobacteriaceae are largely of the KPC, VIM, NDM, IMP and OXA-48 types. Although the epidemiological origin and geographic distribution of carbapenemases are clearly different, they all first appeared in the late 20th Century. Only a decade later, these enzymes have already become established and have expanded globally. An important epidemiological change has occurred in Spain in recent years, characterized by a rapid increase in the number of cases of carbapenemase-producing Enterobacteriaceae (CPE), causing both nosocomial outbreaks and single infections. The impact of CPE in Spain is primarily due to OXA-48- producing and VIM-1-producing Klebsiella pneumoniae isolates, although other species such as Escherichia coli and Enterobacter cloacae are also increasing. The emergence of CPE as a cause of community-onset infections is a matter of great concern. Taking into account recent experience, and considering the fact that increasing numbers of patients are becoming infected by CPE and reservoirs of carbapenemases are growing globally, the trend of the CPE epidemic points toward a rise in its incidence. To prevent a massive CPE pandemic, a well-coordinated response from all health professionals and national and supranational authorities is clearly needed (AU)

En los últimos años, los aislamientos clínicos de enterobacterias resistentes a múltiples antibióticos, incluyendo los antibióticos carbapenémicos, han aumentado debido principalmente a la producción de carbapenemasas. Las principales carbapenemasas detectadas en enterobacterias pertenecen a los tipos KPC, VIM, NDM, IMP y OXA-48. Aunque el origen epidemiológico y la distribución geográfica de las diferentes carbapenemasas son diversos, todas aparecieron en los últimos años del siglo XX. Solo una década más tarde, estas enzimas ya se han establecido y expandido a nivel mundial. En España se ha producido un importante cambio epidemiológico en los últimos años caracterizado por un aumento rápido del número de casos de enterobacterias productoras de carbapenemasas (EPC), causando tanto brotes nosocomiales como infecciones esporádicas. En la actualidad, el mayor impacto de las EPC en España es debido a las cepas de Klebsiella pneumoniae productoras de OXA-48 o VIM-1, aunque la prevalencia de otras especies como Escherichia coli y Enterobacter cloacae también está aumentando. La aparición de EPC como causa de infecciones de inicio en la comunidad es un asunto de gran preocupación. Teniendo en cuenta las últimas tendencias detectadas y el aumento de los reservorios de carbapenemasas a nivel mundial, la evolución futura de la incidencia de las EPC no parece ser otra que la del aumento tanto en infecciones nosocomiales como en las adquiridas en la comunidad. Para prevenir una pandemia por EPC es necesaria una respuesta rotunda, bien coordinada y protocolizada de todos los profesionales sanitarios y autoridades nacionales y supranacionales implicadas (AU)

Las estrategias internacionales y las campañas para promover el uso prudente de los antibióticos en los profesionales y los usuarios / International strategies and campaigns to promote the prudent use of antibiotics by health professionals and patients

Instituciones internacionales como la Organización Mundial de la Salud (OMS), la Unión Europea (UE), el Centro Europeo para la Vigilancia y el Control de las Enfermedades y los Centros para la Vigilancia y el Control de las Enfermedades de Estados Unidos han elaborado distintas estrategias para combatir la emergencia y diseminación de la resistencia antimicrobiana. Entre ellas se encuentran la vigilancia de la resistencia y el consumo, la reducción de la carga de la enfermedad mediante vacunación, las medidas de control de la infección y la educación de ciudadanos y profesionales sanitarios. El conocimiento de la población acerca de los antibióticos suele ser pobre, por lo que las actuaciones educativas dirigidas al público y a los profesionales de la salud forman parte de la mayoría de campañas para reducir el uso inapropiado de antibióticos. Se han celebrado 22 grandes campañas entre 1990 y 2007; en España, se realizaron 2 campañas nacionales en el otoño de 2006 y 2007 con el lema 'Uso responsable de antibióticos. Usándolos bien hoy mañana nos protegerán'. La UE y la OMS recomiendan la creación de grupos de trabajo intersectoriales, apoyados por las autoridades, para proponer el desarrollo de planes de acción y estrategias nacionales para afrontar la lucha contra la resistencia antimicrobiana. Para ser más efectivas, las campañas nacionales para el uso prudente de los antibióticos deberían continuarse en el tiempo y realizarse dentro de una estrategia nacional para mejorar el uso de los antimicrobianos

International agencies such as the World Health Organization (WHO), the European Union (EU), the European Centre for Disease Control and Prevention, and the U.S. Centers for Disease Control and Prevention have carried out various strategies to fight the emergency and spread of antimicrobial resistance. These strategies include surveillance of resistance and use, reduction of the disease burden through vaccination, and measures to control infection and to educate citizens and health professionals. Understanding of antibiotics among the general population is usually poor, so educational activities directed at the public and at health professionals are parts of the majority of campaigns to reduce inappropriate use of antibiotics. From 1990 to 2007, 22 large campaigns have been executed; in Spain, 2 national campaigns were launched in the autumn of 2006 and 2007 with the slogan, 'Responsible use of antibiotics. Using them well today will protect us tomorrow'. The EU and the WHO recommend the creation of interdisciplinary work groups, supported by the authorities, to promote the development of action plans and national strategies to combat antimicrobial resistance. To be effective, the national campaigns for prudent use of antibiotics should be continuous and carried out within a national strategy for improving the use of antimicrobials

Caracterización y epidemiología molecular de betalacta masas de espectro extendido en Escherichia coli y Klebsiella pneumoniae en once hospitales españoles (2004) / Characterization and molecular epidemiology of ESBL in Escherichia coli and Klebsiella pneumoniae in 11 Spanish hospitals (2004)

INTRODUCCIÓN. Se analizó la distribución epidemiológica de los diferentes tipos de betalacta masas de espectro extendido (BLEE) en Escherichia coli y Klebsiella pneumoniae en distintos hospitales de España y se comparó con estudios previos. MÉTODOS. En 11 hospitales españoles se recogieron los15 primeros aislamientos de E. coli y los 5 primeros de K. pneumoniae con sospecha de ser portadores de BLEE, aislados en el primer trimestre de 2004. Los estudios de clonalidad se realizaron mediante electroforesis en gel de campos pulsantes (PFGE) tras digestión del ADN total con XbaI y mediante ERIC-PCR (Entero bacterial Repetitive Intergenic Concensus Secuences-Polimerase Chain Reaction). Las BLEE se caracterizaron mediante isoelectro enfoque, PCR y secuenciación. RESULTADOS. Se estudiaron 124 aislamientos. El análisis de los patrones de restricción obtenidos por PFGE mostró una gran diversidad clonal entre los aislamientos de E. coli, observándose cuatro agrupaciones de dos cepas en cada una de ellas. En las 92 cepas de E. coli, la caracterización de las BLEE mostró un predominio de CTX-M-14 (45,7%),CTX-M-9 (20,6%) y SHV-12 (21,7%). En las 32 cepas de K. pneumoniae se observó una menor diversidad clonal, detectándose tres agrupaciones que incluían el 53,1%de los aislamientos. Las BLEE detectadas en estas cepas fueron del tipo CTX-M en 20 casos (62,5%) (CTX-M-1,CTX-M-9, CTX-M-14 y CTX-M-15), de tipo SHV en 11(34,4%) (SHV-12 y SHV-5) y TEM-4 (3,1%) en una. CONCLUSIÓN. Las cepas de E. coli y K. pneumoniae analizadas en ese período presentan una mayor diversidad de BLEE que la observada en estudios epidemiológicos realizados con anterioridad. Además, el análisis de la relación clonal definió una gran diversidad en E. coliy menor en K. Pneumoniae (AU)

INTRODUCTION. The epidemiological distribution ofextended-spectrum beta-lactamase (ESBL) typesin Escherichia coli and Klebsiella pneumoniae wasevaluated in various hospitals in Spain and comparedwith previous studies.METHODS. A total of 11 Spanish hospitals participatedin this study. Each center collected the first 15 isolatesof E. coli and the first 5 of K. pneumoniae suspected ofbeing ESBL-producers and isolated duringthe first quarter of 2004. Clonal study was doneby PFGE after total DNA digestion with XbaI andby ERIC-PCR (Enterobacterial Repetitive IntergenicConcensus Secuences-Polimerase Chain Reaction),typing. ESBL-producers were characterized byisoelectric focusing (IEF), PCR and sequencing.RESULTS. A total of 124 strains were collected. PFGErestriction patterns showed considerable diversityamong E. coli strains; 4 clusters of 2 strains each weredetected. ESBL characterization of 92 E. coli strainsshowed a predominance of CTX-M-14 (45.7%),CTX-M-9 (20.6%) and SHV-12 (21.7%). Clonal diversityamong the 32 K. pneumoniae strains was lesspronounced than in E. coli; 3 clusters included 53.1%of strains. The ESBL detected in these strainsincluded a CTX-M type in 20 cases (62.5%)(CTX-M-1, CTX-M-9, CTX-M-14 and CTX-M-15);a SHV type in 11 (34.4%) (SHV-12 and SHV-5)and TEM-4 (3.1%) in 1 case.CONCLUSION. The E. coli and K. pneumoniae strainsanalyzed in this period displayed a greater diversityof ESBL than has been observed in previousepidemiological studies. Analysis of clonalrelationships revealed a greater diversity in E. colithan in K. pneumoniae