Vigilancia activa y control de enterobacterias productoras de carbapenemasas en un hospital de media/larga estancia de la Comunidad de Madrid / Active surveillance and control of carbapenemase-producing enterobacteriaceae in a non-acute rehabilitation hospital in Madrid

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Epidemiología de la diseminación de enterobacterias productoras de carbapenemasas en un hospital comarcal y un hospital de media estancia en Madrid / Epidemiology of the carbapenemase-producing Enterobacteriaceae spread in a community acute hospital and a non-acute rehabilitation hospital in Madrid

Introducción. La prevalencia de enterobacterias productoras de carbapenemasas (EPC) es creciente en España. El objetivo de este trabajo ha sido describir las características epidemiológicas, clínicas y microbiológicas de los casos de infección y/o colonización por EPC en dos centros sanitarios del noroeste de Madrid: un hospital comarcal de agudos (HCA) y un hospital de media estancia (HME). Material y métodos. Se recogieron durante los años 2013 y 2014 datos microbiológicos, epidemiológicos y clínicos de todos los pacientes colonizados o infectados por EPC. Desde la aparición del primer caso, en marzo de 2013, se detectaron un total de 197 nuevos casos. Resultados. Un 33,5% de los pacientes presentaron infección clínica y el 66,5% restante fueron colonizaciones. Klebsiella pneumoniae fue la especie predominante (87,8%) y OXA-48 la carbapenemasa más frecuente (91,9%), observándose diferencias entre ambos centros. El análisis de las cepas mostró una mayor diversidad genética en el HME con respecto al HMA. Conclusión. Al estudiar el patrón de transmisión se encontró un aumento de la incidencia en un corto periodo de tiempo y una rápida diseminación de las cepas entre ambos hospitales. Esto pone de manifiesto la necesidad de estandarizar medidas de cribado de posibles portadores y de instaurar programas de control de la infección en este tipo de hospitales (AU)

Introduction. In Spain, the overall prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is increasing. We describe the epidemiological, clinical and microbiological characteristics features of patients with colonization or infection due to CRE in two hospitals in the north-west of Madrid during two years. One hospital was a community acute hospital and the second one was a non-acute rehabilitation hospital. Material and methods. A total of 197 CPE isolates were detected during 2013-2014. Microbiological, epidemiological and clinical data were collected, since the first isolate was found in March 2013. Results. A 33.5% of patients with CRE had symptomatic infection and the remaining 66.5% were colonizations. Klebsiella pneumoniae (87.8%) was the most prevalent species and OXA-48 the most frequent carbapenemase (91.9%). We found intra-interhospital spread and some differences in the epidemiology of CRE depending on the hospital, such as more genetic variability in the non-acute rehabilitation hospital. Conclusions. Studying the CRE transmission we founded an increased incidence in a short period of time and a rapid dissemination of strains between both hospitals. This highlights the need to standardize screening measures for potential carriers and infection control programs in our hospitals (AU)

¿Somos lo que comemos? Un estudio sobre la composición tisular y microbiológica de la carne picada de vacuno / Are we what we eat? A study of the tissue composition and microbiology of minced beef

En los últimos años en nuestro país se ha incrementado el consumo de carne picada, como reflejo de la actual crisis económica. Con el objeto de conocer la composición tisular y microbiológica de estos preparados cárnicos, se diseñó un estudio en el que se adquirieron siete envases de carne picada de vacuno en grandes superficies elegidas al azar, en el territorio de la comunidad de Madrid. Estos casos fueron procesados de forma convencional (fijación en formol e inclusión en parafina) para realizar un examen de su composición tisular y evaluar su estado de preservación con métodos convencionales de microscopía óptica. Se procedió a realizar antes de la fijación tisular, un cultivo microbiológico adicional. Los datos obtenidos reflejan en general la existencia de productos alimentarios de baja calidad y mal preservados, contaminados frecuentemente con flora bacteriana de tipo fecal (AU)

During recent years, probably due to the economic crisis, there has been an increase in the consumption of minced beef in Spain. A study was carried out to determine the tissue and microbiological composition of the minced beef on sale. Seven packets were bought randomly from shops throughout the region of Madrid and their contents processed with formalin fixation and paraffin embedding and examined by optical microscopy to examine tissue composition and the state of preservation. A microbiological study was also carried out. We found that these meat products were of poor quality, badly preserved and frequently contaminated with faecal bacteria (AU)

Emergence of OXA-48-producing Klebsiella pneumoniae and the novel carbapenemases OXA-244 and OXA-245 in Spain.

OBJECTIVES: To describe the molecular and population-level characterization of a selected group of OXA-48-like-producing Klebsiella pneumoniae isolates collected in Spain between January 2011 and May 2012. METHODS: During the study period, 151 OXA-48-like-producing K. pneumoniae isolates were collected from 10 hospitals in six different Spanish regions. From these, a representative sample of 21 isolates that caused hospital outbreaks and single infections was selected for further in-depth analysis. Molecular epidemiology was investigated using PFGE and multilocus sequence typing (MLST). Resistance genes were characterized by PCR and sequencing. Plasmids carrying bla(OXA-48-like) were studied by PFGE with S1 nuclease digestion. RESULTS: All 21 isolates had ertapenem MICs ≥ 1 mg/L, but 47.6% remained susceptible to imipenem and meropenem; bla(OXA-48) was identified in 19 isolates (90.5%) and the novel bla(OXA-244) and bla(OXA-245) genes were detected in 1 isolate each. With one exception, all isolates that contained bla(OXA-48-like) also contained bla(CTX-M-15). PFGE typing revealed six clusters comprising isolates that belonged to MLST types ST11, ST16, ST392, ST405, ST437 and ST663, respectively. Two main clusters were identified: PFGE cluster 1 (12 isolates, belonging either to ST405 or ST663, from seven hospitals), and PFGE cluster 2 (4 ST16 isolates from two hospitals). Six of seven donor isolates conjugated successfully; bla(OXA-48-like) (but not bla(CTX-M-15)) was carried on ≈ 60 kb Inc L/M plasmids. CONCLUSIONS: Multidrug-resistant K. pneumoniae producing OXA-48-like carbapenemase are emerging as important pathogens in Spain due to intra- and inter-hospital, clonal and non-clonal dissemination.

Pancreatitis de repetición en colecistectomizada / Recurrent pancreatitis after cholecystectomy

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