Prevalencia y factores de riesgo de infección por Staphylococcus aureus resistente ameticilina en niños / Prevalence and risk factors for methicillinresistant Staphylococcus aureus infection in children

Introducción. Los objetivos de este trabajo fueron conocer la prevalencia de infecciones por Staphylococcus aureus resistente a meticilina (SARM) en la población pediátrica de nuestro departamento de salud, describir los factores de riesgo para infección por SARM frente a las producidas por S. aureus sensible a meticilina (SASM) y conocer el perfil de sensibilidad antibiótica de los aislados de SARM y SASM. Pacientes y métodos. Se realizó un estudio retrospectivo descriptivo y analítico de las infecciones producidas por SARM frente a las producidas por SASM durante los años 2014 al 2018. Se estudiaron las variables predictoras de SARM mediante un modelo de regresión logística binaria. Resultados. Se identificaron 162 pacientes con infecciones por S. aureus, 15,4% resistentes a meticilina. Los porcentajes mayores de infección por SARM se dieron entre los niños que precisaron ingreso hospitalario (23,4%). En el análisis univariante alcanzaron significación estadística la necesidad de ingreso hospitalario, el antecedente de haber recibido tratamiento antibiótico en los 3 meses previos, el tipo de infección y el antecedente de infección o colonización previa por SARM. En el modelo de regresión logística la necesidad de ingreso hospitalario y el tratamiento antibiótico reciente mantuvieron significación estadística. Solo recibieron tratamiento antibiótico correcto el 26,7% de los niños que ingresaron con infección por SARM. Conclusiones. Nuestros resultados sugieren la necesidad de revisar las pautas de tratamiento empírico usando fármacos activos frente a SARM en las infecciones de probable origen estafilocócico que ingresen en el hospital en niños sobre todo si han recibido tratamiento antibiótico reciente. (AU)

Introduction. The objectives of this work were to know the prevalence of methicillin-resistant S. aureus (MRSA) infections in the paediatric population of our health department, to describe the risk factors for infection by MRSA compared to those produced by methicillin-susceptible S. aureus (MSSA) and to know the antibiotic sensitivity profile of MRSA and MSSA isolates. Material and methods. A retrospective, descriptive and analytical study of infections produced by MRSA versus those produced by MSSA was carried out during the years 2014 to 2018. Risk factors for MRSA infection were studied using a binary logistic regression model. Results, 162 patients with S. aureus infections were identified. Of these, 25 (15.4%) were MRSA. The highest percentages of MRSA infection occurred among children who required hospital admission (23.4%). In the univariate analysis the need of hospital admission, antibiotic treatment in the last 3 months, the kind of infection and past MRSA infection or colonisation reached statistical significance. However, only the need of hospital admission and antibiotic treatment in the last 3 months maintained statistical significance in the binary logistic regression model. Correct antibiotic treatment was only prescribed in 26.7% of the MRSA infection cases admitted to the hospital. Conclusions. Our results suggest the need to review empirical local treatment regimen using drugs active against MRSA in infections of probable staphylococcal origin admitted to the hospital, especially if they have received antibiotic treatment in the last 3 months. (AU)

Antibiotic susceptibility and genotypic characterization of Neisseria gonorrhoeae isolates in the Comunidad Valenciana (Spain): GONOvig project.

INTRODUCTION: The increase in sexually transmitted infections (STI) caused by Neisseria gonorrhoeae (NG) worldwide, together with the decrease in antibiotic susceptibility, forced us to understand the epidemiology of gonococcal infection. METHODS: The GONOvig project analyzed, comparatively following CLSI and EUCAST criteria, the antibiotic susceptibility of 227 NG strains collected in thirteen representative hospitals of the Valencia Community (CV) between 2013 and 2018. Additionally, molecular typing of 175 strains using the NG multi-antigen sequence typing technique (NG-MAST) was performed. RESULTS: High rates of resistance to tetracycline (38.2% by CLSI and 50.9% by EUCAST) and ciprofloxacin (49.1% CLSI and 54% EUCAST), and low percentages of resistance to spectinomycin (0%), cefixime (0.5% CLSI but 5.9% EUCAST), and ceftriaxone (1.5% CLSI and 2.4% EUCAST) were detected. Azithromycin resistance was 6% (both CLSI and EUCAST). Molecular analysis revealed the presence of 86 different sequence types (ST), highlighting ST2992 (7.4%), ST3378 (6.9%), ST2400 (4.6%) and ST13288 (6.9%), which was associated with resistance to cefixime (P=.031). The main genogroups (G) were G1407 (13.1%), G2992 (10.3%), G2400 (6.3%) and G387 (3.4%). G1407 and G2400 were associated with resistance to ciprofloxacin (P<.03). CONCLUSION: Low resistance to ceftriaxone, a worrying resistance to azithromycin and a wide variety of circulating sequence types have been detected, some of which show correlation with certain resistance profiles.

The CARBA-MAP study: national mapping of carbapenemases in Spain (2014-2018).

Introduction: Infections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018. Methods: A national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0. Results: A total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017-2018 compared to 2014-2016. Discussion: Data from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms.

Susceptibilidad antibiótica y caracterización genotípica de aislados de Neisseria gonorrhoeae circulantes en la Comunidad Valenciana (España): proyecto GONOvig / Antibiotic susceptibility and genotypic characterization of Neisseria gonorrhoeae isolates in the Comunidad Valenciana (Spain): GONOvig project

Introducción: El aumento de las infecciones de transmisión sexual (ITS) producidas por Neisseria gonorrhoeae (NG) a nivel mundial, junto con la disminución de la susceptibilidad antibiótica, obliga a profundizar en la epidemiología de la infección gonocócica (IG). Métodos: El proyecto GONOvig analizó, comparativamente siguiendo criterios CLSI y EUCAST, la sensibilidad antibiótica de 227 cepas de NG recogidas en trece hospitales representativos de la Comunidad Valenciana (CV) entre los años 2013 y 2018. Adicionalmente, se pudo realizar la tipificación molecular de 175 cepas mediante la técnica NG multi-antigen sequence typing (NG-MAST). Resultados: Se detectaron elevadas tasas de resistencia a tetraciclina (38,2% por CLSI y 50,9% por EUCAST) y ciprofloxacino (49,1% CLSI y 54% EUCAST), y bajos porcentajes de resistencia a espectinomicina (0%), cefixima (0,5% CLSI pero 5,9% EUCAST) y ceftriaxona (1,5% CLSI y 2,4% EUCAST). La resistencia a azitromicina fue de 6% (tanto CLSI como EUCAST). El análisis molecular reveló la presencia de 86 secuenciotipos (ST) distintos, destacando el ST2992 (7,4%), ST3378 (6,9%), ST2400 (4,6%) y ST13288 (6,9%) el cual presentaba asociación con resistencia a cefixima (p = 0,031). Los genogrupos (G) mayoritarios fueron el G1407 (13,1%), G2992 (10,3%), G2400 (6,3%) y G387 (3,4%); G1407 y G2400 mostraron asociación con resistencia a ciprofloxacino (p < 0,03). Conclusión: Se ha detectado una baja resistencia a ceftriaxona, una preocupante resistencia a azitromicina y una gran variedad de ST circulantes, algunos de los cuales presentan correlación con determinados perfiles de resistencia.(AU)

Introduction: The increase in sexually transmitted infections (STI) caused by Neisseria gonorrhoeae (NG) worldwide, together with the decrease in antibiotic susceptibility, forced us to understand the epidemiology of gonococcal infection. Methods: The GONOvig project analyzed, comparatively following CLSI and EUCAST criteria, the antibiotic susceptibility of 227 NG strains collected in thirteen representative hospitals of the Valencia Community (CV) between 2013 and 2018. Additionally, molecular typing of 175 strains using the NG multi-antigen sequence typing technique (NG-MAST) was performed. Results: High rates of resistance to tetracycline (38.2% by CLSI and 50.9% by EUCAST) and ciprofloxacin (49.1% CLSI and 54% EUCAST), and low percentages of resistance to spectinomycin (0%), cefixime (0.5% CLSI but 5.9% EUCAST), and ceftriaxone (1.5% CLSI and 2.4% EUCAST) were detected. Azithromycin resistance was 6% (both CLSI and EUCAST). Molecular analysis revealed the presence of 86 different sequence types (ST), highlighting ST2992 (7.4%), ST3378 (6.9%), ST2400 (4.6%) and ST13288 (6.9%), which was associated with resistance to cefixime (p = 0.031). The main genogroups (G) were G1407 (13.1%), G2992 (10.3%), G2400 (6.3%) and G387 (3.4%). G1407 and G2400 were associated with resistance to ciprofloxacin (p < 0.03). Conclusión: Low resistance to ceftriaxone, a worrying resistance to azithromycin and a wide variety of circulating sequence types have been detected, some of which show correlation with certain resistance profiles.(AU)

Cerebellious abscesses caused by Nocardia farcinica in an immunocompromised patient

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Methicillin-resistant Staphylococcus epidermidis infectious keratitis: Clinical and microbiological profile / Queratitis infecciosa por Staphylococcus epidermidis resistente a meticilina: perfil clínico y microbiológico

Introduction. Staphylococcus epidermidis (SE) is a common cause of bacterial keratitis in certain geographic areas. Ahigh percentage of resistance to methicillin is shown, whichgives it cross resistance to beta-lactams and sometimes resistance to other antibacterial groups. We analyzed clinical andmicrobiological variables in patients with infectious keratitisdue to SE.Methods. Medical records of 43 patients with suspected infectious keratitis and microbiological confirmation for SE,between October 2017 and October 2020, were retrospectively studied. Clinical characteristics (risk factors, size of lesions,treatment, evolution) and microbiological (susceptibility toantibiotics) were analyzed, and groups of patients with methicillin-resistant (MRSE) and methicillin-susceptible (MSSE)infection were compared.Results. MRSE was present in 37.2% of infectious keratitis. All isolates were sensitive to vancomycin and linezolid.Rates of resistance to tetracyclines and ciprofloxacin were50% and 56% in the MRSE group, and 11% and 7% in theMSSE group. The clinical characteristics, including size of lesion, visual axis involvement, inflammation of anterior chamber, presence of risk factors and follow-up time, did not showstatistically significant differences between groups.Conclusions. MRSE is a common cause of infectious keratitis caused by SE and shows a high rate of multidrug resistance. Clinically, it does not differ from MSSE keratitis. Additional work is needed to confirm these findings (AU)

Introducción. Staphylococcus epidermidis (SE) es unacausa frecuente de queratitis bacteriana en ciertas áreas geográficas. Presenta un alto porcentaje de resistencia a meticilina, lo que confiere resistencia cruzada a beta-lactámicos y enalgunas ocasiones también resistencia a otros grupos de antibacterianos. Analizamos variables clínicas y microbiológicas enpacientes con queratitis infecciosa por SE.Métodos. Se analizaron retrospectivamente las historiasclínicas de 43 pacientes con sospecha de queratitis infecciosa yconfirmación microbiológica para SE, entre octubre de 2017 yoctubre de 2020. Se analizaron las características clínicas (factores de riesgo, tamaño de las lesiones, tratamiento, evolución)y microbiológicas (susceptibilidad a antibióticos) y se compararon grupos de pacientes con infección resistente (MRSE) ysensible a meticilina (MSSE).Resultados. El 37,2% de las queratitis fueron por MRSE.Todos los aislados fueron sensibles a vancomicina y linezolid.Las tasas de resistencia a tetraciclinas y ciprofloxacino fueron50% y 56% en el grupo de MRSE, y 11% y 7% en el grupode MSSE. Las características clínicas, incluido el tamaño de lalesión, la afectación del eje visual, la inflamación de la cámaraanterior, la presencia de factores de riesgo y el tiempo de seguimiento, no mostraron diferencias estadísticamente significativas entre los grupos.Conclusiones. MRSE es una causa frecuente de las queratitis infecciosas producidas por SE y presenta una alta tasade resistencia a múltiples fármacos. Clínicamente, no muestradiferencias clínicas con la queratitis por MSSE. Se necesitantrabajos adicionales para confirmar estos hallazgos. (AU)

Novel Chromogenic Medium CHROMagarTM Candida Plus for Detection of Candida auris and Other Candida Species from Surveillance and Environmental Samples: A Multicenter Study.

Epidemiological trends show a dramatic increase in the prevalence of fungal infections, and in the isolation of multidrug-resistant species, such as Candida auris. CHROMagarTM Candida (CC; CHROMagar, Paris, France) and other chromogenic media, which are widely used in the clinical laboratory because they allow a rapid identification of most Candida species. Recently, CHROMagarTM Candida Plus (CC-Plus; CHROMagar, Paris, France) was developed to detect and differentiate C. auris in addition to other major clinical Candida species, such as C. albicans, C. tropicalis, C. glabrata, or C. krusei. C. auris colonies display a differential light blue color with a blue halo. A multicentric study was designed to evaluate the performance of the CC-Plus medium in the detection of Candida species in patients' surveillance and environmental samples from three Spanish hospitals with active C. auris outbreaks. A total of 364 patients' surveillance samples and 212 environmental samples were tested. Samples were inoculated in CC and CC-Plus in parallel, and the plates were read at 24 and 48 h. All recovered colonies were presumptively identified according to colony color described by manufacturer, and the definitive identification was performed by mass spectrometry at 48 h. A total of 134 C. auris isolates were obtained (101 from patients' surveillance samples, and 33 from environmental samples). Sensitivity, specificity, and predictive positive and negative values were 99.5%, 100%, 100%, and 99.1%, respectively, for the main clinical Candida species, showing that CC-Plus is comparable to CC, with the advantage of being able to differentiate C. auris from C. parapsilosis. Furthermore, CC-Plus was able to detect one C. albicans, one C. glabrata, and eight C. auris that did not grow in CC. Additionally, the yeast colonies were generally larger, suggesting that this novel medium could be a richer medium, and suitable for surveillance and environmental cultures of C. auris and other clinically relevant Candida species.

Validación de un dispositivo point-of-care para la detección rápida de infección urinaria y susceptibilidad antimicrobiana / Validation of point-of-care device for rapid detection of urinary tract infection and antibiotic susceptibility

Resumen Introducción: Las infecciones del tracto urinario (ITU) presentan una elevada prevalencia en el ámbito comunitario. Un rápido diagnóstico microbiológico es esencial para asegurar una terapia adecuada y efectiva. Objetivo: Evaluar un kit de antibiograma rápido (KAR®) en formato point-of-care para la detección rápida de ITU y sensibilidad antimicrobiana. Material y Métodos: El dispositivo KAR® se diseñó y desarrolló en colaboración con ingenieros técnicos y microbiólogos clínicos. Su evaluación se realizó a través de un estudio multicéntrico en el que participaron tres hospitales españoles. Para ello, se realizaron distintos ensayos in vivo con el fin de determinar la correlación del dispositivo con las técnicas microbiológicas de referencia. Resultados: Se ensayó un total de 400 muestras de orinas procedentes de pacientes con sospecha de ITU. El dispositivo KAR® proporcionó rápidos resultados (tiempo medio de positividad de 7,8 ± 1,5 h) con 97% de sensibilidad, 89% de especificidad y 87% de concordancia para la detección de bacteriuria significativa. Los porcentajes de especificidad para los antimicrobianos testados fueron: ciprofloxacina (97%), fosfomicina (94%), cotrimoxazol (84%), ampicilina (80%) y amoxicilina/ácido clavulánico (55%). Conclusión: El dispositivo KAR® puede ser una herramienta útil para el diagnóstico de ITU en pacientes ambulatorios, especialmente en áreas de bajo nivel socio-económico.

Abstract Background: Urinary tract infections (UTI) presents a high prevalence in the community setting. Rapid and accurate microbiological diagnosis is essential to ensure adequate and effective therapy. Aim: To evaluate a rapid antibiogram kit (KAR®) in point-of-care format for rapid detection of UTI and antibiotic susceptibility. Methods: The KAR® device has been designed and developed in collaboration with technical engineers and clinical microbiologists. Its evaluation has been carried out through a multicenter study in which three Spanish hospitals have participated. Thus, different in vivo tests have been implemented in order to determine device correlation with the reference microbiological techniques. Results: During the study period, a total of 400 urine samples from patients with suspected ITU were tested. The KAR® device provided fast results (mean positivity time of 7,8 ± 1,5 hours) with 97% sensitivity, 89% specificity and 87% agreement for the detection of significant bacteriuria. The percentages of specificity for the antibiotics tested were: ciprofloxacin (97%), fosfomycin (94%),cotrimoxazole (84%), ampicillin (80%) and amoxicillin/clavulanic acid (55%). Conclusion: The KAR® device could be a useful tool for diagnosing UTI in outpatients, especially in areas of low socio-economic level.

[Validation of point-of-care device for rapid detection of urinary tract infection and antibiotic susceptibility]. / Validación de un dispositivo point-of-care para la detección rápida de infección urinaria y susceptibilidad antimicrobiana.

BACKGROUND: Urinary tract infections (UTI) presents a high prevalence in the community setting. Rapid and accurate microbiological diagnosis is essential to ensure adequate and effective therapy. AIM: To evaluate a rapid antibiogram kit (KAR®) in point-of-care format for rapid detection of UTI and antibiotic susceptibility. METHODS: The KAR® device has been designed and developed in collaboration with technical engineers and clinical microbiologists. Its evaluation has been carried out through a multicenter study in which three Spanish hospitals have participated. Thus, different in vivo tests have been implemented in order to determine device correlation with the reference microbiological techniques. RESULTS: During the study period, a total of 400 urine samples from patients with suspected ITU were tested. The KAR® device provided fast results (mean positivity time of 7,8 ± 1,5 hours) with 97% sensitivity, 89% specificity and 87% agreement for the detection of significant bacteriuria. The percentages of specificity for the antibiotics tested were: ciprofloxacin (97%), fosfomycin (94%),cotrimoxazole (84%), ampicillin (80%) and amoxicillin/clavulanic acid (55%). CONCLUSION: The KAR® device could be a useful tool for diagnosing UTI in outpatients, especially in areas of low socio-economic level.

¿Qué hemos aprendido sobre rotavirus en España en los últimos 10 años? / What have we learnt about rotavirus in Spain in the last 10 years?

Introducción: En España, las vacunas frente a rotavirus (RV) están disponibles desde 2006 pero no están ni recomendadas ni financiadas por el Sistema Nacional de Salud. Sin embargo, a través de las recomendaciones de la Asociación Española de Pediatría se han alcanzado coberturas de vacunación intermedias. Material y métodos: Se ha realizado una revisión sistemática de la literatura sobre los estudios realizados en España en los últimos 12 años (2006-2018) en relación con la infección y las vacunas frente a RV. Resultados: Se identifican 43 estudios que cumplían los criterios de selección. La carga de enfermedad en población < 5 años en atención primaria oscila entre 15 y 19 casos por 1.000 niños y en hospitalaria entre 120 y 480 casos por 100.000, lo que supone una importante repercusión económica y social. Las vacunas frente a RV han mostrado en España una efectividad de entre el 83 y el 96% y un impacto de hasta un 70% de reducción de hospitalizaciones, que es dependiente de la cobertura de vacunación alcanzada. Se identifican además nuevas líneas de investigación relacionadas con el papel de la vacuna del RV y la protección frente a convulsiones, o el papel del microbiota, entre otros. Conclusiones: La información actualmente disponible refrenda la importante carga de enfermedad por RV en España y la elevada efectividad de las vacunas disponibles. Estas evidencias permiten una reevaluación de las recomendaciones nacionales sobre vacunación frente a RV

Introduction: Vaccines against rotavirus (RV) have been available in Spain since 2006, but they are neither recommended nor financed by the National Health System. Nevertheless, through recommendations of the Spanish Association of Paediatrics vaccination has achieved intermediate coverage. Material and methods: A systematic literature review was performed on studies carried out in Spain in the last 12 years (2006-2018) on RV infection and vaccination. Results: A total of 43 studies were identified that met the inclusion criteria. The disease burden in children less than 5 years in the Primary Care setting ranged from 15 to 19 cases per 1,000 children, and between 120 and 480 cases per 100,000 in the hospital setting, which has a significant economic and social impact. Vaccines against RV have shown an effectiveness of between 83% and 96%, and an impact of up to 70% in reducing hospital admissions, which is dependent on the achieved vaccine coverage. New research lines are identified, such as the role of the rotavirus vaccine and protection against seizures or the impact on the gut microbiota. Conclusions: The current available information supports the significant burden of rotavirus disease in Spain and the high effectiveness of the available vaccines. This evidence should allow for an updated re-evaluation of the national recommendations on rotavirus vaccination

[What have we learnt about rotavirus in Spain in the last 10 years?] / ¿Qué hemos aprendido sobre rotavirus en España en los últimos 10 años?

INTRODUCTION: Vaccines against rotavirus (RV) have been available in Spain since 2006, but they are neither recommended nor financed by the National Health System. Nevertheless, through recommendations of the Spanish Association of Paediatrics vaccination has achieved intermediate coverage. MATERIAL AND METHODS: A systematic literature review was performed on studies carried out in Spain in the last 12 years (2006-2018) on RV infection and vaccination. RESULTS: A total of 43 studies were identified that met the inclusion criteria. The disease burden in children less than 5 years in the Primary Care setting ranged from 15 to 19 cases per 1,000 children, and between 120 and 480 cases per 100,000 in the hospital setting, which has a significant economic and social impact. Vaccines against RV have shown an effectiveness of between 83% and 96%, and an impact of up to 70% in reducing hospital admissions, which is dependent on the achieved vaccine coverage. New research lines are identified, such as the role of the rotavirus vaccine and protection against seizures or the impact on the gut microbiota. CONCLUSIONS: The current available information supports the significant burden of rotavirus disease in Spain and the high effectiveness of the available vaccines. This evidence should allow for an updated re-evaluation of the national recommendations on rotavirus vaccination.

Vigilancia de la sensibilidad antibiótica de anaerobios gramnegativos: RedMiVa 2010-2016 / Antibiotic susceptibility surveillance of Gram-negative anaerobes: RedMiVa 2010-2016

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Brote comunitario de leishmaniasis cutánea en la comarca de La Ribera: a propósito de las medidas de Salud Pública / Community outbreak of cutaneous leishmaniasis in La Ribera region of Valencia, Spain: Public Health measures

Introducción: Los brotes de leishmaniasis humana no son muy frecuentes en España, a pesar de ser considerada una enfermedad con carácter endémico. A través del presente estudio se comunica un brote nuevo detectado en la Comunidad Valenciana, con el objetivo principal de describir las características clinicoepidemiológicas y de referir las principales medidas, en materia de Salud Pública, instauradas para la contención del brote. Métodos: Se consideró caso a toda persona con domicilio en la localidad de Tous (en la Comunidad Valenciana), diagnóstico de leishmaniasis según los criterios clínicos y de laboratorio definidos por la Red de Vigilancia Epidemiológica, y fecha de inicio de síntomas entre el 1 de enero de 2012 y el 31 de diciembre de 2015. Se realizó un análisis descriptivo de las distintas variables epidemiológicas recogidas. Resultados: Desde la semana 28ª del año 2012 hasta la semana 30ª del 2013 se notificaron un total de 19 casos. La edad adulta fue la más afectada (73%). La forma clínica más frecuente fue la leishmaniasis de tipo cutáneo (89%). Un 79% de los casos se confirmaron mediante técnica de PCR; en 7 muestras pudo realizarse la tipificación, siendo el parásito identificado como Leishmania infantum. La evolución de los pacientes fue favorable tras el tratamiento físico (31%) o farmacológico (69%). El 37% presentaron algún tipo de lesión residual. Se aplicaron diversas medidas dirigidas a los profesionales sanitarios y al control del vector y del reservorio, así como recomendaciones generales a la población para la contención del brote. Conclusiones: Este brote de leishmaniasis cutánea confirma el carácter endémico y la elevada prevalencia de la enfermedad en la cuenca mediterránea. El tratamiento más utilizado fue el antimoniato de meglumina intralesional. Para el control del brote fue necesario desarrollar un plan integral de actuación (AU)

Introduction: Outbreaks of human leishmaniasis are not very common in Spain, despite being considered an endemic disease. In this study, a new outbreak in the Valencian Community is presented. Its principal objective is to describe the clinical-epidemiological characteristics and to present the main Public Health measures established to contain the outbreak. Methods: A case was defined as anyone residing in the village of Tous (in Valencian Community), diagnosed with leishmaniasis according to clinical and laboratory criteria, defined by the Epidemiological Surveillance Network, and date of symptoms onset between 1 January 2012 and 31 December 2013. A descriptive analysis was performed on the epidemiological variables collected. Results: A total of 19 cases were reported from the 28th week of 2012 to the 30th week of 2013. Adults were most affected by the disease (73%). The most common clinical form was cutaneous leishmaniasis (89%). More than three-quarters (79%) of cases were confirmed by PCR. Species typing was performed on seven samples, with the parasite Leishmania infantum being identified. Patient outcome was favourable after physical (31%), or pharmacological (69%) treatment. Some kind of residual damage was observed in 37% of cases. Different measures were applied, aimed at health professionals, and vector and reservoir control, as well as general recommendations to the population for the containment of the outbreak. Conclusions: This cutaneous leishmaniasis outbreak confirms the endemic nature and the high prevalence of the disease in the Mediterranean area. The most commonly used treatment was intralesional meglumine antimoniate. A comprehensive plan of action had to be developed in order to control the outbreak (AU)

Actividad in vitro de azitromicina en aislados fecales de Aeromonas hydrophila / In-vitro activity of azithromycin in faecal isolates of Aeromonas hydrophila

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Community outbreak of cutaneous leishmaniasis in La Ribera region of Valencia, Spain: Public Health measures. / Brote comunitario de leishmaniasis cutánea en la comarca de La Ribera: a propósito de las medidas de Salud Pública.

INTRODUCTION: Outbreaks of human leishmaniasis are not very common in Spain, despite being considered an endemic disease. In this study, a new outbreak in the Valencian Community is presented. Its principal objective is to describe the clinical-epidemiological characteristics and to present the main Public Health measures established to contain the outbreak. METHODS: A case was defined as anyone residing in the village of Tous (in Valencian Community), diagnosed with leishmaniasis according to clinical and laboratory criteria, defined by the Epidemiological Surveillance Network, and date of symptoms onset between 1 January 2012 and 31 December 2013. A descriptive analysis was performed on the epidemiological variables collected. RESULTS: A total of 19 cases were reported from the 28th week of 2012 to the 30th week of 2013. Adults were most affected by the disease (73%). The most common clinical form was cutaneous leishmaniasis (89%). More than three-quarters (79%) of cases were confirmed by PCR. Species typing was performed on seven samples, with the parasite Leishmania infantum being identified. Patient outcome was favourable after physical (31%), or pharmacological (69%) treatment. Some kind of residual damage was observed in 37% of cases. Different measures were applied, aimed at health professionals, and vector and reservoir control, as well as general recommendations to the population for the containment of the outbreak. CONCLUSIONS: This cutaneous leishmaniasis outbreak confirms the endemic nature and the high prevalence of the disease in the Mediterranean area. The most commonly used treatment was intralesional meglumine antimoniate. A comprehensive plan of action had to be developed in order to control the outbreak.

Etiología de la candidiasis en pediatría: análisis comparativo con el paciente adulto / Aetiology of candidiasis in paediatric patients: comparative analysis with adult patients

Antedecentes. El género Candida comprende un grupo de levaduras comensales que pueden actuar como patógenos y provocar candidiasis de distinta localización. Objetivos. El objetivo del presente trabajo ha sido realizar un estudio comparativo entre niños (0 a 14 años) y adultos (15 a 99 años) de las especies de Candida aisladas en muestras clínicas durante tres años (2010-2012) en la Comunidad Valenciana. Métodos. Como fuente de información se utilizaron los datos procedentes de la Red de Vigilancia Microbiológica de la Comunidad Valenciana (RedMIVA). Resultados y conclusiones. Un total de 52.436 pacientes tuvieron algún aislamiento de Candida, de los que 1.604 (3,1%) eran niños y 50.832 (96,9%) adultos. Candida albicans fue significativamente (p < 0,05) la especie predominante en los dos grupos de edad y en casi todos los tipos de muestras clínicas; la distribución del resto de las especies varió según el tipo de muestra y el grupo etario. En sangre, Candida parapsilosis seguida de C. albicans, Candida famata y Candida lusitaniae fueron las principales especies aisladas en niños, mientras que C. albicans seguida de C. parapsilosis, Candida glabrata y Candida tropicalis lo fueron en adultos. En líquidos estériles, orina y tracto respiratorio inferior, C. parapsilosis fue la segunda especie más prevalente en niños, mientras que C. glabrata y C. tropicalis lo fueron en adultos (AU)

Background. Candida spp. represents a group of commensal yeasts that can act as pathogens and cause candidiasis in different anatomical locations. Aims. The aim of this study was to perform an epidemiological and comparative analysis between the isolates of Candida spp. in clinical specimens during a three year-period (2010-2012) from children (0-14 years) and adults (15-99 years) in the Valencian Community (RedMIVA). Methods. The microbiological surveillance network of Valencian Community was used as the information source. Results and conclusions. Candida was isolated in 52,436 patients (1,604 [3.1%] children and 50,832 [96.9%] adults). Candida albicans was significantly (p < 0.05) the predominant species in both age groups, and in almost every type of clinical specimen. The distribution of other species varied depending on the sample type and age group. In blood specimens, Candida parapsilosis followed by C. albicans, Candida famata and Candida lusitaniae were the main species found in children, whereas C. albicans followed by C. parapsilosis, Candida glabrata and Candida tropicalis were the predominant species in adults. In sterile fluids, urine and lower respiratory tract samples, C. parapsilosis was the second most prevalent species in the children group, while C. glabrata and C. tropicalis were the main second species in adults (AU)

[Aetiology of candidiasis in paediatric patients: Comparative analysis with adult patients]. / Etiología de la candidiasis en pediatría: análisis comparativo con el paciente adulto.

BACKGROUND: Candida spp. represents a group of commensal yeasts that can act as pathogens and cause candidiasis in different anatomical locations. AIMS: The aim of this study was to perform an epidemiological and comparative analysis between the isolates of Candida spp. in clinical specimens during a three year-period (2010-2012) from children (0-14 years) and adults (15-99 years) in the Valencian Community (RedMIVA). METHODS: The microbiological surveillance network of Valencian Community was used as the information source. RESULTS AND CONCLUSIONS: Candida was isolated in 52,436 patients (1,604 [3.1%] children and 50,832 [96.9%] adults). Candida albicans was significantly (p<0.05) the predominant species in both age groups, and in almost every type of clinical specimen. The distribution of other species varied depending on the sample type and age group. In blood specimens, Candida parapsilosis followed by C. albicans, Candida famata and Candida lusitaniae were the main species found in children, whereas C. albicans followed by C. parapsilosis, Candida glabrata and Candida tropicalis were the predominant species in adults. In sterile fluids, urine and lower respiratory tract samples, C. parapsilosis was the second most prevalent species in the children group, while C. glabrata and C. tropicalis were the main second species in adults.