Identification and antibiogram of Enterobacterales from direct urine samples using matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS) technology and disk-plate diffusion technique.

Identification and antibiogram of uropathogenic microorganisms from direct urine samples present a great clinical impact. Here, we present a combined procedure to determine identification (IDd) of bacteria through MALDI-TOF-MS technology and antibiogram (ATBd) using disk-plate diffusion technique, of UTI-producing Enterobacterales against the most used antibiotics. Ninety-four urine samples with presence of pyuria and Gram-negative bacilli were selected. The IDd showed a high success rate (90%). ATBd procedure showed a high correlation for tested antibiotics. This simplified, low cost and reduced work time two-step procedure significantly reduces results turnaround time and benefit the clinical management of patients with UTI.

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.

Emerging infectious diseases: streptococcus suismeningitis / Enfermedades infecciosas emergentes: meningitis por streptococcus suis

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Human Papillomavirus in the region of La Ribera-Valencia: present and future / Virus del papiloma humano en la comarca de La Ribera-Valencia: presente y futuro

INTRODUCTION: Human Papillomavirus (HPV) is the main cause of cervical cancer. The etiology and effects derived from this infection are set by molecular techniques and cytological diagnosis, respectively. In the present study, data obtained by an opportunist screening of cervical cancer in La Ribera region are revised and related statistically. MATERIAL AND METHODS: Data considering different variables such as age, degree of lesion, HPV type detected and number of virus in coinfection were collected from 1,372 HPV positive cytology samples. HPV detection was carried out by means of three molecular techniques and the degree of lesion was analyzed by cytological diagnosis (Bethesda). In order to determine the relationship between different selected variables, several statistical analyses were performed. RESULTS: Only degree of lesion variable showed a direct relationship with the rest of variables, increasing with aging process, viral oncogenicity, presence of at least one high-risk virus and with the fact of being mono-infected. The probability of presenting a higher-level degree of lesion multiplied by 28.4 when high-risk HPV was detected in mono-infection. CONCLUSIONS: HPV molecular detection is the most suitable technique to perform a cervix cancer primary screening for the management of women with negative cytological diagnose. The number of detected types is statistically related to the degree of lesion. The establishment of a properly regulated screening to identify HPV infection, and therefore, of cervical cancer risk, is essential

INTRODUCCIÓN: El virus del papiloma humano (VPH) es la principal causa de cáncer cervical. La etiología y los efectos derivados de esta infección se establecen mediante técnicas moleculares y diagnóstico citológico, respectivamente. En el presente estudio, los datos obtenidos por un cribado oportunista de cáncer cervical en la comarca de La Ribera se revisaron y se relacionaron estadísticamente. MATERIAL Y MÉTODOS: Se recopilaron datos que incluyeron diferentes variables como la edad, el grado de lesión, el tipo de VPH detectado y el número de virus en coinfección de 1.372 citologías positivas para VPH. La detección del VPH se realizó mediante tres técnicas moleculares y el grado de lesión se analizó mediante diagnóstico citológico (Bethesda). Para determinar la relación entre las diferentes variables, se realizaron varios análisis estadísticos. RESULTADOS: Sólo la variable del grado de lesión mostró una relación directa con el resto de variables, aumentando con el proceso de envejecimiento, la oncogenicidad viral, la presencia de al menos un virus de alto riesgo y el hecho de estar mono-infectado. La probabilidad de presentar un mayor nivel de lesión se multiplicó por 28,4 cuando se detectó VPH de alto riesgo en la mono-infección. CONCLUSIONES: La detección molecular del VPH es la técnica más adecuada para realizar un cribado primario del cáncer de cuello uterino para el manejo de mujeres con diagnóstico citológico negativo. El número de tipos detectados está estadísticamente relacionado con el grado de lesión. El establecimiento de un cribado regulado adecuadamente para identificar la infección por VPH y, por lo tanto, del riesgo de cáncer cervical, es esencial

[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.

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)

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.

Keratitis due to Colletotrichu gloeosporioides and Herpesvirus reactivation / Queratiris por Colletotrichum gloeosporioides y reactivación de Herpesvirus

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Réplica a "Situación de la tos ferina en la Comunidad Valenciana: ¿asistimos a una reactivación epidémica?" / Reply to "Situation of pertussis in the Community of Valencia: An epidemic revival?"

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Situación de la tos ferina en la Comunidad Valenciana: ¿asistimos a una reactivación epidémica? / Situation of pertussis in Valencian Community: An epidemic revival?

INTRODUCCIÓN: La tos ferina es una enfermedad prevenible mediante vacunación. En los últimos ańos se ha detectado un aumento de la incidencia en varios países. El propósito del presente estudio ha sido analizar la situación de la tos ferina en la Comunidad Valenciana, con el objetivo de verificar el aumento de la incidencia de la enfermedad. MÉTODOS: Se ha realizado un análisis descriptivo de los casos de tos ferina, tanto probables como confirmados, detectados durante el ańo 2011. Los métodos para la detección de Bordetella pertussis a partir de muestras clínicas han sido: aislamiento mediante cultivo, detección de ADN bacteriano mediante reacción en cadena de la polimerasa (PCR) y/o detección de anticuerpos específicos de tipo IgM. Se ha estimado la incidencia de la enfermedad, así como otras variables epidemiológicas, y se han comparado con los ańos previos (2008, 2009 y 2010). Las fuentes de información utilizadas han sido los siguientes sistemas integrados: Análisis de Vigilancia Epidemiológica (AVE) y Red de Vigilancia Microbiológica (RedMIVA) de la Conselleria de Sanidad. RESULTADOS: En el ańo 2011 se detectaron 249 casos (tasa de incidencia de 4,89 × 105 habitantes). Esta tasa es estadísticamente muy superior a las detectadas en los ańos 2008 (0,73 × 105 habitantes), 2009 (0,53 × 105 habitantes) y 2010 (0,36 × 105 habitantes). La tasa de incidencia más elevada se ha observado en los menores de un ańo (252,97 × 105 habitantes), con diferencias muy marcadas en relación al resto de grupos de edad. El 69% de los casos fueron confirmados mediante una prueba de laboratorio. La detección de IgM anti-Bordetella pertussis en suero fue positiva en el 10% de los casos, el cultivo fue positivo en el 17% y la detección de ADN mediante técnica de PCR en el 35% de los casos. CONCLUSIONES: Los resultados de este estudio muestran un claro incremento de la incidencia de la tos ferina en la Comunidad Valenciana en el ańo 2011

INTRODUCTION: Pertussis is a highly contagious vaccine-preventable disease. An increasing incidence has been reported in several countries around the world in the last few years. The aim of this study is to analyze the situation of pertussis in the Valencian Community (Spain), with the purpose of verifying the increased incidence of the illness. METHODS: A descriptive analysis of probable and confirmed cases detected during 2011 was conducted. Methods used for Bordetella pertussis detection from clinical samples were: culture isolation, polymerase chain reaction (PCR)-based detection of bacterial DNA, and/or detection of specific IgM antibodies. The disease incidence and other epidemiological variables were estimated. These results were compared to data collected in previous years (2008-2010). The Epidemiological Surveillance Analysis and Microbiological Surveillance Network integrated systems of the regional Department of Health were used as sources of information. RESULTS: In 2011, 249 cases of pertussis were detected (incidence rate of 4.89 × 105 inhabitants). This rate is statistically significantly higher than those reported in 2008 (0.73 × 105 inhabitants), 2009 (0.53×105 inhabitants), and 2010 (0.53 × 105 inhabitants). The highest incidence rate was observed in cases younger than one year old (252.97 × 105 inhabitants), with marked differences compared to the rest of age groups. More than two-thirds (69%) of reported cases were confirmed by a laboratory test. Detection of specific serum IgM antibodies was positive in 10% of cases, culture isolation was positive in 17%, and PCR-based detection of bacterial DNA in 35% of cases. CONCLUSIONS: The results of this study show a clear increase of pertussis incidence in the Valencian Community during 2011

[Situation of pertussis in Valencian Community: an epidemic revival?]. / Situación de la tos ferina en la Comunidad Valenciana: ¿asistimos a una reactivación epidémica?

INTRODUCTION: Pertussis is a highly contagious vaccine-preventable disease. An increasing incidence has been reported in several countries around the world in the last few years. The aim of this study is to analyze the situation of pertussis in the Valencian Community (Spain), with the purpose of verifying the increased incidence of the illness. METHODS: A descriptive analysis of probable and confirmed cases detected during 2011 was conducted. Methods used for Bordetella pertussis detection from clinical samples were: culture isolation, polymerase chain reaction (PCR)-based detection of bacterial DNA, and/or detection of specific IgM antibodies. The disease incidence and other epidemiological variables were estimated. These results were compared to data collected in previous years (2008-2010). The Epidemiological Surveillance Analysis and Microbiological Surveillance Network integrated systems of the regional Department of Health were used as sources of information. RESULTS: In 2011, 249 cases of pertussis were detected (incidence rate of 4.89×10(5) inhabitants). This rate is statistically significantly higher than those reported in 2008 (0.73×10(5) inhabitants), 2009 (0.53×10(5) inhabitants), and 2010 (0.53×10(5) inhabitants). The highest incidence rate was observed in cases younger than one year old (252.97×10(5) inhabitants), with marked differences compared to the rest of age groups. More than two-thirds (69%) of reported cases were confirmed by a laboratory test. Detection of specific serum IgM antibodies was positive in 10% of cases, culture isolation was positive in 17%, and PCR-based detection of bacterial DNA in 35% of cases. CONCLUSIONS: The results of this study show a clear increase of pertussis incidence in the Valencian Community during 2011.