Detection of carbapenemases and other mechanisms of enzymatic resistance to Beta-lactams in Enterobacteriaceae with diminished susceptibility to carbapenems in a tertiary care hospital / Detección de carbapenemasas y otros mecanismos de resistencia enzimáticos a Beta-lactámicos en enterobacterias con sensibilidad disminuida a carbapenems en un hospital de tercer nivel

INTRODUCTION: Our objective was to characterize the enzymatic Beta-lactam resistance in clinical Enterobacteriaceae isolates with diminished susceptibility to carbapenems from 2013 to 2014 at Hospital Universitario Miguel Servet. Material/methods: A total of 63 clinical isolates were analyzed for the presence of carbapenemases (KPC, OXA-48 and MBL), ESBLs and AmpC enzymes by combined disk methods and PCR detection of carbapenemase-encoding and beta-lactamase-encoding genes. RESULTS: Fifteen isolates had a phenotypic test compatible with carbapenemase production; two of these were confirmed by PCR as OXA-48 producers. ESBL detection was positive in 27 isolates (43%); plasmid-mediated AmpC was detected in nine isolates (14.2%) and derepressed AmpC β-lactamase was present in 18 isolates (28%). CONCLUSION: During the study period, the decreased susceptibility to carbapenems in Enterobacteriaceae in our area was not due to true carbapenemases but rather to Beta-lactamase activity (82.5% were ESBL or AmpC producers), probably in combination with decreased permeability of the outer membrane

INTRODUCCIÓN: Nuestro objetivo fue caracterizar la resistencia enzimática a Beta-lactámicos en aislados clínicos de Enterobacteriaceae con sensibilidad disminuida a carbapenems desde 2013 a 2014 en el Hospital Universitario Miguel Servet. Material/métodos: Se analizaron un total de 63 aislados clínicos para presencia de carbapenemasas (KPC, OXA-48 y MBL), BLEE y AmpC por método de discos combinados y detección de genes codificantes de carbapenemasas y betalactamasas por PCR. RESULTADOS: Quince aislados tuvieron un test fenotípico compatible con producción de carbapenemasas; dos de ellos confirmados por PCR como productores de OXA-48. La detección BLEE fue positiva en 27 aislados (43%); se detectó AmpC plasmídica en 9 aislados (14,2%) y se observó β-lactamasa AmpC desreprimida en 18 aislados (28%). CONCLUSIÓN: Durante el período de estudio, la sensibilidad disminuida a carbapenems en Enterobacteriaceae en nuestra área no se debió a verdaderas carbapenemasas sino a actividad Beta-lactamasa (82,5% eran productores de BLEE o AmpC) probablemente en combinación con permeabilidad disminuida de la membrana externa

Serotipos de neumococo en nasofaringe de niños preescolares sanos tras la vacunación antineumocócica conjugada heptavalente / Nasopharyngeal carriage of pneumococcal serotypes in healthy pre-school aged children after 7-valent pneumococcal vaccine

Fundamento y objetivo: Tras la introducción de la vacuna neumocócica conjugada heptavalente (VNC-7v) se plantea investigar en nuestro medio las características que influyen en la colonización por serotipos de neumococo en niños preescolares sanos, la distribución de serotipos y su sensibilidad a antimicrobianos.Sujetos y método: Entre febrero de 2008 y enero de 2009 se recogieron muestras nasofaríngeas a niños de entre 2 meses y 5 años de edad que acudían a revisiones del niño sano en 4 centros de atención primaria de la provincia de Zaragoza (España) para cultivo y serotipado. Mediante regresión logística se estudiaron diferentes variables relacionadas con el estado de portador y las resistencias.Resultados: De los 371 niños estudiados, un 30,7% portaban neumococo en la nasofaringe. Con una cobertura de VNC-7v del 66%, factores relacionados con el hecho de ser portador fueron el número de hermanos (odds ratio [OR] 1,44; intervalo de confianza del 95% [IC 95%] 1,05 a 1,97 por cada hermano), estar escolarizado o asistir a guardería (OR 3,99; IC 95% 2,00 a 7,96), y padecer afección leve de vías respiratorias altas en el momento de la toma (OR 1,72; IC 95% 1,02 a 2,90). Solamente correspondían a serotipos incluidos en la vacuna (STV) un 8,7%. Los serotipos no vacunales más frecuentemente aislados fueron 19A, 6A, 15B, 11 y 15A. Se detectaron significativamente más resistencias a antibióticos entre los STV. Conclusiones: Los niños menores de 6 años de nuestro medio portan neumococos más frecuentemente cuando tienen hermanos, están escolarizados o padecen afecciones leves de vías respiratorias altas. Tras la introducción de la vacuna VNC-7v, los STV son casi anecdóticos (8,7%) y los serotipos emergentes presentan mejor sensibilidad a antibióticos (AU)

Background and objective: To determine the characteristics influencing pneumococcal serotype colonization in healthy pre-school aged children, the distribution of serotypes and their antimicrobial susceptibility, after the introduction of pneumococcal 7-valent conjugate vaccine (VNC-7v). Sujetos and methods: Nasopharyngeal samples were collected from children under 6years of age attending well-child examinations in the province of Zaragoza (Spain). Logistic regression was used to study different variables related to the status of the carriers. Results:Of the 371 children studied 30.7% were found to be carriers. With a vaccine coverage rate of 66%, factors related with presence of pneumococcal carriage were found to be the number of siblings (OR 1.44; CI 95% 1.05-1.97 for each sibling), attending a school or child day care centre (OR 3.99; CI 95% 2.00-7.96) and suffering from a minor upper respiratory tract infection (URTI) (OR 1.72; CI 95% 1.02-2.90). Only 8.7% corresponded to VNC-7v serotypes. The most common non VNC-7v serotypes isolated were 19A, 6A, 15B, 11, and 15A. Significantly greater resistance was detected among VNC-7v serotypes. Conclusion: Children in the setting of this study carried pneumococci more commonly when they have siblings, attend school or day care, or suffer from minor URTI. In the VNC-7v vaccine era, VNC-7v serotypes have become rare occurrences (8.7%) and emerging serotypes present better susceptibility to antibiotics (AU)

[Nasopharyngeal carriage of pneumococcal serotypes in healthy pre-school aged children after 7-valent pneumococcal vaccine]. / Serotipos de neumococo en nasofaringe de niños preescolares sanos tras la vacunación antineumocócica conjugada heptavalente.

BACKGROUND AND OBJECTIVE: To determine the characteristics influencing pneumococcal serotype colonization in healthy pre-school aged children, the distribution of serotypes and their antimicrobial susceptibility, after the introduction of pneumococcal 7-valent conjugate vaccine (VNC-7 v). SUJETOS AND METHODS: Nasopharyngeal samples were collected from children under 6 years of age attending well-child examinations in the province of Zaragoza (Spain). Logistic regression was used to study different variables related to the status of the carriers. RESULTS: Of the 371 children studied 30.7% were found to be carriers. With a vaccine coverage rate of 66%, factors related with presence of pneumococcal carriage were found to be the number of siblings (OR 1.44; CI 95% 1.05-1.97 for each sibling), attending a school or child day care centre (OR 3.99; CI 95% 2.00-7.96) and suffering from a minor upper respiratory tract infection (URTI) (OR 1.72; CI 95% 1.02-2.90). Only 8.7% corresponded to VNC-7 v serotypes. The most common non VNC-7 v serotypes isolated were 19A, 6A, 15B, 11, and 15A. Significantly greater resistance was detected among VNC-7 v serotypes. CONCLUSION: Children in the setting of this study carried pneumococci more commonly when they have siblings, attend school or day care, or suffer from minor URTI. In the VNC-7 v vaccine era, VNC-7 v serotypes have become rare occurrences (8.7%) and emerging serotypes present better susceptibility to antibiotics.

Diagnóstico serológico de los casos de toxoplasmosis congénita / Serologic diagnosis of congenital toxoplasmosis

Objetivo Conocer el diagnóstico serológico de los casos de toxoplasmosis congénita y la prevalencia de anticuerpos frente a toxoplasma en mujeres embarazadas en nuestra área.Método La seroprevalencia se estudió en 68.712 sueros correspondientes a 47.635 mujeres embarazadas pertenecientes al área del Hospital Miguel Servet durante el período 1992–2008. En el laboratorio de Microbiología se determinaron anticuerpos frente a toxoplasma: IgA, IgM, IgG y estudio de avidez.Resultados La seroprevalencia encontrada fue del 31,9%. La incidencia de infección primaria fue del 0,01% en mujeres susceptibles. Quince mujeres desarrollaron seroconversión durante el embarazo, de las que 9 tuvieron niños con toxoplasmosis congénita.Conclusión Los casos de toxoplasmosis congénita se detectaron mediante seroconversión materna durante el embarazo. La IgA fue el marcador serológico más sensible en la detección de la infección congénita en niños (AU)

Objective To investigate the serological diagnosis of congenital toxoplasmosis and the prevalence of antibodies against toxoplasma in pregnant women in our area.MethodToxoplasmosis seroprevalence was analyzed in 68 712 serum samples from 47 635 pregnant women living in the catchment area of Hospital Miguel Servet during the period of 1992 to 2008. Detection of toxoplasma-specific immunoglobulins (IgM, IgA, IgG) and IgG avidity studies were carried out in the microbiology laboratory.Results Toxoplasmosis seroprevalence was 31.9%. The incidence of primary infection was 0.01% in susceptible pregnant women. Fifteen women seroconverted during pregnancy, and 9 of them had infants with congenital toxoplasmosis. Conclusions The cases of congenital toxoplasmosis were detected by maternal seroconversion during pregnancy. IgA was the most sensitive marker for the detection of congenital infection in neonates (AU)

[Serologic diagnosis of congenital toxoplasmosis]. / Diagnóstico serológico de los casos de toxoplasmosis congénita.

OBJECTIVE: To investigate the serological diagnosis of congenital toxoplasmosis and the prevalence of antibodies against toxoplasma in pregnant women in our area. METHOD: Toxoplasmosis seroprevalence was analyzed in 68 712 serum samples from 47 635 pregnant women living in the catchment area of Hospital Miguel Servet during the period of 1992 to 2008. Detection of toxoplasma-specific immunoglobulins (IgM, IgA, IgG) and IgG avidity studies were carried out in the microbiology laboratory. RESULTS: Toxoplasmosis seroprevalence was 31.9%. The incidence of primary infection was 0.01% in susceptible pregnant women. Fifteen women seroconverted during pregnancy, and 9 of them had infants with congenital toxoplasmosis. CONCLUSIONS: The cases of congenital toxoplasmosis were detected by maternal seroconversion during pregnancy. IgA was the most sensitive marker for the detection of congenital infection in neonates.