Changes in Group A Streptococcus emm Types Associated with Invasive Infections in Adults, Spain, 2023.

An increase in invasive group A Streptococcus infection was detected in the northeast of Spain in November 2022. A postpandemic decline in the diversity of circulating emm types involved in invasive group A Streptococcus was observed, along with the emergence of emm49 in this geographic area.

Antibiotic Susceptibility and Clarithromycin Resistance Determinants in Helicobacter pylori in the Northeast of Spain: A One-Year Prospective Study.

Helicobacter pylori is one of the most widespread infections, and it is reaching alarming resistance levels worldwide. The recommended first-line empirical treatment differs according to the local rate of clarithromycin resistance. Macrolide resistance is mainly associated with three point mutations in the 23S rRNA gene. The aim of this study was to describe the antibiotic susceptibility of H. pylori in our healthcare area and the main mechanisms involved in clarithromycin resistance. Gastric biopsies (n = 641) were collected and cultured in a one-year prospective study. Antibiotic susceptibility testing was performed by gradient diffusion. A multiplex real-time PCR test (AllplexTMH.pylori & ClariR Assay, Seegene) was used to detect the most frequent mutations associated with clarithromycin resistance. Overall, 141 isolates were available for antibiotic susceptibility testing. The highest resistance rates were detected in metronidazole and levofloxacin. The rate of clarithromycin resistance was 12.1%, and the associated mutations were A2143G and A2142G. More than half of the clarithromycin-resistant isolates presented high MIC values (>256 mg/L). Tetracycline resistance was not detected, suggesting that therapies that contain tetracycline could be a suitable option. The low clarithromycin resistance rate coupled with the high rates of metronidazole resistance may support the recovery of the classical triple therapy in our healthcare area.

Características clínicas, pronóstico y factores asociados de la bacteriemia por Staphylococcus aureus en la actualidad / Clinical characteristics and prognosis of Staphylococcus aureus bacteremia

Introducción. Describimos las características de los pacientes con bacteriemia por Staphylococcus aureus en un hospital de tercer nivel y analizamos sus complicaciones, la mortalidad y los factores asociados a las mismas. Métodos. Se analizaron de manera retrospectiva los datos de los pacientes ingresados con bacteriemia por S. aureus entre marzo de 2020 y febrero de 2021 en el hospital universitario Miguel Servet de Zaragoza. Resultados. La mortalidad a los 14 días fue del 24,2% y la mortalidad a los 30 días del 40%. La aparición de complicaciones [HR 3,1 (1,2-8,05)] y la edad >65 años [HR 3,1 (IC95% 1,4-6,6)] disminuyeron la supervivencia global de manera significativa. En la regresión logística se asociaron a mayor mortalidad a los 30 días la edad >65 años [OR 6,3 (IC95% 1,7-23,1)], la presencia de sepsis [OR 19,3 (IC95% 5,4-68,7)] y solo con cierta tendencia, el número de frascos de HC (+) ≥3 [OR 5,4 (IC95% 0,8-34,1)]. Se asoció a mayor mortalidad a los 14 días el haber presentado sepsis [OR 58,2 (IC95% 5,7-592,9)], el número frascos de HC (+) ≥3 [OR 14,1 (IC95% 1,1-173,7)] y una edad >65 años [OR 1,1 (IC95% 1,03-1,1) años]. Cuando analizamos juntos aquellos con un TP ≤12 horas y un número frascos de HC (+) ≥3, la sepsis fue más frecuente [30 pacientes (66,6%) vs 15 pacientes (33,3%); OR 3,4 (IC95% 1,5-8)]. Conclusiones. La mortalidad a los 14 y a los 30 días fue elevada, observándose una peor evolución en los pacientes con mayor edad, presencia de sepsis, un mayor número de frascos de hemocultivos positivos y un tiempo hasta hemocultivos positivos ≤12 h. (AU)

Introduction. Staphylococcus aureus bacteremia patients characteristics at a tertiary hospital are described, and complications, mortality and associated factors are analyzed. Methods. Data from patients with S. aureus bacteremia admitted between March 2020 and February2021 at Miguel Servet university hospital in Zaragoza were retrospectively analyzed. Results. Results showed a 14 days mortality of 24.2% and an 30 days mortality of 40%. Overall survival decreased with complications appearance [HR 3.1 (1.2-8.05)] and age over 65 years [HR 3.1 (1.4-6.6)]. The adjusted analysis showed correlation between a higher mortality at 14 and 30 days with age over 65 years [OR 6.3 (1.7-23.1)], sepsis presence [OR 19.3 (5.4-68.7)] and number of positive (+) blood cultures ≥3 [OR 5.4 (0.8-34.1)]. Mortality at 14 days was associated with sepsis presence [OR 58.2 (5.7-592.9)], number of positive (+) blood cultures ≥3 [OR 14.1 (1.1-173.7)] and an older age [OR 1.1 (1.03-1.1)]. Analyzing time to positive blood cultures ≤12 hours and number of positive blood cultures ≥ 3 at the same time, frequency of sepsis increased [30 patients (66.6%) vs 15 patients (33.3%); OR 3.4 (IC95% 1.5-8)]. Conclusions. High 14- and 30-days mortality were found, as well as a worse evolution in older age patients, with sepsis presence, and with greater number of positive blood cultures and times to positive blood cultures ≤12 h. (AU)

Impacto de la bacteriemia por Staphylococcus aureus en pacientes con COVID-19 / Impact of Staphylococcus aureus bacteremia in COVID-19 patients

Introducción. La enfermedad causada por SARS-CoV-2 (COVID-19) ha supuesto un desafío para los profesionales sanitarios desde su aparición. Staphylococcus aureus es uno de los principales patógenos causantes de infecciones bacterianas en pandemias virales. Sin embargo, se debe estudiar bien la co-infección por S. aureus causante de bacteriemia en pacientes con COVID-19. Métodos. Se analizaron los casos de bacteriemia por S. aureus (BSA) atendidos en el Hospital Miguel Servet (Zaragoza) desde marzo de 2020 hasta febrero de 2021. Se compararon las características clínicas, los factores de riesgo y mortalidad de los pacientes con BSA asociada a COVID-19 respecto los pacientes no-COVID-19. Resultados. Se identificaron 95 pacientes con BSA. El 27,3% fueron COVID-19 positivos. La BSA representó el 9,9% de las bacteriemias, siendo el segundo microorganismo en frecuencia tras E. coli. La bacteriemia nosocomial fue más frecuente en el grupo de pacientes con COVID-19. La fuente de BSA fue desconocida en el 46,2% de los pacientes con COVID-19. La fuente de BSA más frecuente en estos pacientes fue la respiratoria (26,9% vs 0%; P<0,001) seguida de la cutánea (15,5% vs 15,9%; P=1). El desarrollo de sepsis fue más frecuente en los pacientes con COVID-19 (61,5% vs 7,8%; P=0,336) y de ellos, los que recibieron dosis de dexametasona >6 mg/día (62,5% vs 37,5%; P< 0,05). Conclusiones. Nuestros datos sugieren que la BSA influye negativamente en la evolución de los pacientes con COVID-19. Sin embargo, se requieren más estudios y preferiblemente prospectivos para obtener datos sólidos sobre el impacto de la BSA en los pacientes con coronavirus. (AU)

Introduction. The disease caused by SARS-CoV-2 (COVID-19) has been a challenge for healthcare professionals since its appearance. Staphylococcus aureus has been described as one of the main pathogens causing bacterial infections in viral pandemics. However, co- infection with S. aureus causing bacteremia in patients with COVID-19 has yet to be well studied. Methods. We performed a e study of S. aureus bacteremia (SAB) at Hospital Miguel Servet (Zaragoza) from March 2020 to February 2021. The clinical characteristics, mortality and risk factors of adults hospitalized patients with BSA associated COVID-19 compared to patients without COVID-19. Results. A total of 95 patients with SAB were identified. 27.3% were positive for SARS-CoV-2. SAB represented 9.9% of bacteremia, being the second agent in frequency after E. coli. Nosocomial bacteremia was more frequent in the group of COVID-19 patients. The most frequent source of BSA in these patients was the respiratory source (26.9% vs 0%; P<0.001) followed by the skin (15.5% vs 15.9%; P=1). The development of sepsis was more frequent in COVID-19 patients (61,5% vs 7,8%; P=0,336) and among them, who received dexamethasone at doses > 6 mg/day (62.5% vs. 37.5%, P<0.05). Conclusions. Our data suggest that BSA has a negative impact on the evolution of patients with COVID-19. However, further and preferably prospective studies are required to obtain solid data on the impact of BSA on coronavirus patients. (AU)

Pacemaker-induced endocarditis by Gordonia bronchialis.

PURPOSE: Gordonia species are known to be opportunistic human pathogens causing secondary infections. We present the second case in the world of endocarditis caused by Gordonia bronchialis and a review of all the cases of endocarditis caused by Gordonia spp. METHODS: The identification was performed by matrix-assisted desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing were performed to confirm the identification. Antimicrobial susceptibility was performed by MIC test Strip on Mueller-Hinton agar supplemented with 5% defibrinated sheep blood according to Clinical and Laboratory Standards Institute. RESULTS: Pacemaker-induced endocarditis due to Gordonia bronchialis infection was determined in an 88-year old woman. The patient was treated with ceftriaxone and ciprofloxacin until completing 6 weeks from the pacemaker explant with a good evolution. CONCLUSION: The case presented supports the pathogenic role of Gordonia bronchialis as an opportunistic pathogen and highlights the high risk of suffering infections caused by environmental bacteria.

Pacemaker-induced endocarditis by Gordonia bronchialis / Endocarditis del marcapasos debido a infección por Gordonia bronchialis

PurposeGordonia species are known to be opportunistic human pathogens causing secondary infections. We present the second case in the world of endocarditis caused by Gordonia bronchialis and a review of all the cases of endocarditis caused by Gordonia spp.MethodsThe identification was performed by matrix-assisted desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing were performed to confirm the identification. Antimicrobial susceptibility was performed by MIC test Strip on Mueller-Hinton agar supplemented with 5% defibrinated sheep blood according to Clinical and Laboratory Standards Institute.ResultsPacemaker-induced endocarditis due to Gordonia bronchialis infection was determined in an 88-year old woman. The patient was treated with ceftriaxone and ciprofloxacin until completing 6 weeks from the pacemaker explant with a good evolution.ConclusionThe case presented supports the pathogenic role of Gordonia bronchialis as an opportunistic pathogen and highlights the high risk of suffering infections caused by environmental bacteria.

ObjetivoLas especies de Gordonia son patógenos humanos oportunistas que causan infecciones secundarias. Presentamos el segundo caso en el mundo de endocarditis causada por Gordonia bronchialis, así como una revisión de todos los casos de endocarditis causados por Gordonia spp.MétodosLa identificación fue realizada mediante espectrometría de masas MALDI-TOF MS, y se confirmó mediante secuenciación del gen 16S rRNA. La susceptibilidad antimicrobiana se realizó mediante tiras reactivas MIC en agar Müller-Hinton suplementado con un 5% de sangre ovina desfibrinada, conforme al Clinical and Laboratory Standards Institute (CLSI).ResultadosLa endocarditis del marcapasos debido a infección por Gordonia bronchialis se encontró en una mujer de 88 años. La paciente fue tratada con ceftriaxona y ciprofloxacina hasta completar el periodo de 6 semanas desde el explante del marcapasos, con buena evolución.ConclusiónEste caso respalda el rol patogénico de Gordonia bronchialis como patógeno oportunista, subrayando el alto riesgo de padecer infecciones causadas por bacterias ambientales.

Bacteremia during COVID-19 pandemic in a tertiary hospital in Spain.

INTRODUCTION: The reasons for the decrease in blood cultures were investigated and the rate and aetiology of bacteremia and contaminated blood cultures collected from COVID and non-COVID patients were assessed. METHODS: We performed a retrospective analysis in a tertiary hospital in Spain during the COVID period from 4th March 2020 to 21st June 2020. RESULTS: The number of blood cultures processed was 5313, representing 22.7% and 18.8% of decrease compared to the same months of 2019 and 2018, respectively (p=0.173). The rate of bacteremia was 1.2% higher among COVID-patients than among non-COVID patients (p<0.001). COVID patients had a higher proportion of nosocomial bacteremia (95.5%) than non-COVID patients (30.5%) (p<0.001). In COVID-positive patients, the contamination rate was 12.3% vs 5.7% in non-COVID patients (p<0.001). CONCLUSION: There was a decrease in the number of blood cultures collected during the COVID period compared to previous years. Bacteremia in COVID patients was mainly nosocomial and catheter-related.

Bacteremia during COVID-19 pandemic in a tertiary hospital in Spain / Bacteriemia durante la pandemia de COVID-19 en un hospital terciario de España

IntroductionThe reasons for the decrease in blood cultures were investigated and the rate and aetiology of bacteremia and contaminated blood cultures collected from COVID and non-COVID patients were assessed.MethodsWe performed a retrospective analysis in a tertiary hospital in Spain during the COVID period from 4th March 2020 to 21st June 2020.ResultsThe number of blood cultures processed was 5313, representing 22.7% and 18.8% of decrease compared to the same months of 2019 and 2018, respectively (p=0.173). The rate of bacteremia was 1.2% higher among COVID-patients than among non-COVID patients (p<0.001). COVID patients had a higher proportion of nosocomial bacteremia (95.5%) than non-COVID patients (30.5%) (p<0.001). In COVID-positive patients, the contamination rate was 12.3% vs 5.7% in non-COVID patients (p<0.001).ConclusionThere was a decrease in the number of blood cultures collected during the COVID period compared to previous years. Bacteremia in COVID patients was mainly nosocomial and catheter-related.

IntroducciónInvestigar la causa de la disminución de los hemocultivos recibidos y evaluar la tasa y la etiología de la bacteriemia y la contaminación de los hemocultivos extraídos en pacientes con COVID-19 y sin COVID-19.MétodosEstudio retrospectivo en un hospital de tercer nivel en España durante el periodo de COVID-19 del 4 de marzo al 21 de junio de 2020.ResultadosSe procesaron 5.313 hemocultivos, representando una disminución del 22,7 y 18,8% respecto de los mismos meses de 2019 y 2018 (p = 0,173). La tasa de bacteriemia fue 1,2% superior en pacientes con COVID-19 (p < 0,001). Los pacientes positivos en COVID-19 tenían una mayor proporción de bacteriemia nosocomial (95,5%) que los pacientes sin COVID-19 (30,5%) (p < 0,001). En pacientes positivos en COVID-19, la tasa de contaminación fue del 12,3 vs. 5,7% en pacientes sin COVID-19 (p < 0,001).ConclusiónDurante el periodo de COVID-19 disminuyó el número de hemocultivos recibidos, en comparación con años anteriores. La bacteriemia en pacientes con COVID-19 fue principalmente nosocomial y se asoció con el catéter.

Detection and pathological role of intestinal protozoa in children.

INTRODUCTION: Intestinal parasites are considered a growing public health problem, being protozoa the main cause of intestinal disease. The objective of our study is to compare the detection of intestinal protozoa by microscopy versus real-time PCR, as well as to determine the most prevalent protozoa in our environment in the paediatric population. METHOD: An observational longitudinal study was carried out, both by microscopy and real time-PCR in stool samples from children (0- 15 years) received from April 2019 to March 2021.Children were classified in two groups according if they had or not had clinical parasitosis. Microscopic examination was performed in all samples using the Ritchie concentration technique with the commercial Mini PARASEP system (Movaco-Grifols®). The presence of Cryptosporidium sp. was evaluated with the modified Ziehl-Neelsen acid-fast stain. The real-time PCR was performed to all samples using the Allplex ™ gastrointestinal parasite panel 4 (Seegene®). RESULTS: During the study period, 500 samples were received, being positive 31 (6.2%) by microscopy and 256 (51.2 %) by PCR. By microscopy, Blastocystis hominis was the most frequently observed (4.8%), followed by Giardia lamblia (1.6%), Dientamoeba fragilis (0.2%) and Cryptosporidium species (0.2%). Regarding the identification by PCR, D. fragilis (35.2%) was mainly identified, followed by B. hominis (28.1%), G. lamblia (7%) and Cryptosporidium sp. (0.8%) without finding clear differences in aetiology according to age. In the case of B. hominis and D. fragilis, there were not differences in the detection of these protozoa between the control group and children with clinical parasitosis (p = 0.11). CONCLUSIONS: Real-time PCR increases the detection of intestinal protozoa, being underdiagnosed by microscopy, especially D. fragilis, in which PCR is considered the most appropriate method for its detection.

Impacto del SARS-CoV-2 en el diagnóstico de bacteriemia comunitaria en un hospital terciario / Impact of SARS-COV-2 on the diagnosis of community bacteremia in a tertiary hospital

Objetivo. Realizar un análisis de las bacteriemias diagnosticadas en urgencias durante el año 2020, coincidiendo con el periodo de la pandemia Métodos. Estudio retrospectivo en un hospital de tercer nivel en España durante el período COVID del 4 de marzo al 31 de diciembre de 2020. Resultados. El número de pacientes atendidos en urgencias durante el periodo de estudio y el número de hemocultivos extraídos sufrieron un descenso del 46,79% y del 35.7% respecto al mismo periodo de 2019 (p<0.05). Se produjeron 320 bacteriemias mientas que en 2019 se produjeron 507, suponiendo un descenso del 36,8% (p<0,05). La tasa de positividad de los hemocultivos fue del 7,09 % en 2020 y del 7,23 % en 2019 y la tasa de contaminación del 7,07 % en 2020 y 5,67 % en 2019. El microorganismo más frecuente aislado fue Escherichia coli, seguido de Staphylococcus aureus y de Klebsiella pneumoniae. El 6,62% de los E. coli aislados fueron portadores de beta-lactamasas de espectro extendido (BLEE). El porcentaje de S. aureus resistente a meticilina fue de 12,9 % y el de K. pneumoniae BLEE fue del 11,54 %. Conclusión. Durante la pandemia por SARS-CoV-2 se ha producido una disminución en el número de diagnósticos de bacteriemia, es posible que la atención estuviera centrada especialmente en la COVID descuidando otras enfermedades, como es el caso de la bacteriemia. (AU)

Objective. We carry out an analysis of the bacteremia diagnosed in the Emergency Department during 2020, coinciding with the period of the pandemic. Method. We performed a retrospective analysis from March 4, 2020 to December 31, 2020. Results. The number of patients who went to the Emergency Department during the study period and the number of extracted blood cultures decreased by 46.79% and 35.7% compared to the same period in 2019 (p <0.05). 320 bacteremia occurred while 507 occurred in 2019, assuming a decrease of 36.8% (p <0.05). The positivity rate of blood cultures was 7.09% in 2020 and 7.23% in 2019 and the contamination rate was 7.07 % in 2020 and 5.67% in 2019. The most frequently isolated microorganism was Escherichia coli, followed by Staphylococcus aureus and Klebsiella pneumoniae. A 6.62% of the isolated E. coli were carriers of extended-spectrum beta-lactamases (ESBL). The percentage of methicillin-resistant S. aureus was 12.9 % and that of K. pneumoniae ESBL was 11.54%. Conclusion. During the SARS-CoV-2 pandemic there has been a decrease in the number of bacteremia diagnoses, it is possible that attention was focused especially on COVID, forgetting other diseases, such as bacteremia. (AU)

Report of sexually transmitted infections prevalence in asymptomatic pregnant women under 25 years old in Lleida, Spain

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Bacteremia during COVID-19 pandemic in a tertiary hospital in Spain.

INTRODUCTION: The reasons for the decrease in blood cultures were investigated and the rate and aetiology of bacteremia and contaminated blood cultures collected from COVID and non-COVID patients were assessed. METHODS: We performed a retrospective analysis in a tertiary hospital in Spain during the COVID period from 4th March 2020 to 21st June 2020. RESULTS: The number of blood cultures processed was 5313, representing 22.7% and 18.8% of decrease compared to the same months of 2019 and 2018, respectively (p=0.173). The rate of bacteremia was 1.2% higher among COVID-patients than among non-COVID patients (p<0.001). COVID patients had a higher proportion of nosocomial bacteremia (95.5%) than non-COVID patients (30.5%) (p<0.001). In COVID-positive patients, the contamination rate was 12.3% vs 5.7% in non-COVID patients (p<0.001). CONCLUSION: There was a decrease in the number of blood cultures collected during the COVID period compared to previous years. Bacteremia in COVID patients was mainly nosocomial and catheter-related.

Pacemaker-induced endocarditis by Gordonia bronchialis.

PURPOSE: Gordonia species are known to be opportunistic human pathogens causing secondary infections. We present the second case in the world of endocarditis caused by Gordonia bronchialis and a review of all the cases of endocarditis caused by Gordonia spp. METHODS: The identification was performed by matrix-assisted desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing were performed to confirm the identification. Antimicrobial susceptibility was performed by MIC test Strip on Mueller-Hinton agar supplemented with 5% defibrinated sheep blood according to Clinical and Laboratory Standards Institute. RESULTS: Pacemaker-induced endocarditis due to Gordonia bronchialis infection was determined in an 88-year old woman. The patient was treated with ceftriaxone and ciprofloxacin until completing 6 weeks from the pacemaker explant with a good evolution. CONCLUSION: The case presented supports the pathogenic role of Gordonia bronchialis as an opportunistic pathogen and highlights the high risk of suffering infections caused by environmental bacteria.

Application of a new method for the detection of catheter colonization and catheter-related bacteraemia in newborns / Aplicación de un nuevo método para la detección de colonización y bacteriemia relacionada con catéter en neonatos

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Arthrobacter creatinolyticus: An emerging human pathogen causing urinary tract infection / Arthrobacter creatinolyticus: un patógeno emergente en el ser humano causante de infecciones del tracto urinario

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