Concerning the presumptive identification of Candida kefyr on Uriselect™4 agar / Sobre la identificación presuntiva de Candida kefyr en agar Uriselect™4

Introduction. Non-albicans Candida species, such as Candida kefyr, are emerging pathogens. Chromogenic media are highly useful for the diagnosis of urinary tract infections (UTIs). The aim was to describe the behavior of this specie on a non-specific chromogenic medium. Material and methods. A retrospective study of cases of candiduria detected in the Microbiology laboratory of the Virgen de las Nieves Hospital in Granada (Spain) between 2016 and 2021 (N=2,130). Urine samples were quantitatively seeded on non-selective UriSelect™4 chromogenic agar. Results. Between 2016 and 2021, C. kefyr was the seventh most frequent Candida species responsible for candiduria in our setting (n=15). The macroscopic appearance of C. kefyr colonies, punctiform and bluish, allowed the direct identification of these microorganisms. Conclusions. This study provides the first description of the specific behavior of C. kefyr on UriSelect™4 agar, which differentiates it from other Candida species based on its enzymatic characteristics. (AU)

Introducción. Las especies de Candida no-albicans, como Candida kefyr, son patógenos emergentes. Los medios cromogénicos son muy útiles para el diagnóstico de infecciones del tracto urinario (ITU). El objetivo era describir el comportamiento de esta especie en un medio cromogénico no específico. Material y métodos. Estudio retrospectivo de casos de candiduria detectados en el laboratorio de Microbiología del Hospital Virgen de las Nieves de Granada (España) entre 2016 y 2021 (N=2.130). Las muestras de orina se sembraron cuantitativamente en agar cromogénico no selectivo Uri Select™4. Resultados. C. kefyr fue la séptima especie de Candida responsables de la candiduria en nuestro medio (n = 15). El aspecto macroscópico de las colonias de C. kefyr, puntiformes y azuladas, permitió su identificación presuntiva directamente. Conclusiones. Este estudio proporciona la primera descripción del comportamiento específico de C. kefyr en agar Uri Select™4, que lo diferencia de otras especies de Candida en función de sus características enzimáticas. (AU)

Aislamiento de Haemophilus no ducreyi en muestras del aparato genital de varones: relación con la clínica / Isolation of Haemophilus no ducreyi in samples from the genital tract of men: Its clinical relationship

Introducción: Con el avance de los métodos microbiológicos, cada vez es más frecuente el aislamiento de patógenos menos típicos en cuadros de infección uretral y rectal, además de los agentes etiológicos clásicos. Uno de ellos está formado por especies de Haemophilus no ducreyi (HND). El objetivo de este trabajo es describir la frecuencia, la sensibilidad antibiótica y las características clínicas de las uretritis y proctitis por HND en varones. Pacientes y métodos: Se realizó un estudio observacional descriptivo y retrospectivo, a partir de los resultados emitidos por el Laboratorio de Microbiología del Hospital Universitario Virgen de las Nieves de Granada, de los aislamientos, entre 2016 y 2019, de HND en episodios infecciosos genitales y rectales de varones adultos. Resultados: Se aisló HND en 135 (7%) episodios. La especie más frecuente fue H. parainfluenzae (34/45; 75,6%). Los síntomas más frecuentes de las proctitis fueron: tenesmo rectal (31,6%) y adenopatías (10,5%); en aquellos con uretritis, fueron disuria (71,6%), supuración uretral (46,7%) y lesiones en el glande (27%), siendo manifestaciones similares a las infecciones provocadas por los genitopatógenos habituales. Un 43% de los pacientes eran VIH positivos. Las tasas de resistencia a antibióticos de H. parainfluenzae fueron elevadas a levofloxacino, ampicilina, tetraciclina y azitromicina. Conclusión: Las especies de HND deberían tenerse en cuenta como posibles agentes etiológicos en episodios de infección uretral y rectal en varones, sobre todo en los casos con pruebas de detección negativas para agentes productores habituales de infecciones de transmisión sexual. Su detección microbiológica es fundamental para la instauración de un tratamiento efectivo dirigido. (AU)

Introduction: With the advancement of microbiological methods, the isolation of less typical pathogens in cases of urethral and rectal infection is more frequent, apart from the classic etiological agents. One of them is formed by species of Haemophilus no ducreyi (HND). The objective of this work is to describe frequency, susceptibility to antibiotics, and clinical features of HDN urethritis and proctitis in adult males. Patients and methods: This is an observational retrospective descriptive study of the results obtained by the Microbiology laboratory of the Virgen de las Nieves University Hospital on the isolates of HND in genital and rectal samples from males between 2016 and 2019. Results: HND was isolated in 135 (7%) of the genital infection episodes diagnosed in men. H. parainfluenzae was the most commonly isolated (34/45; 75.6%). The most frequent symptoms in men with proctitis were rectal tenesmus (31.6%) and lymphadenopathy (10.5%); in those with urethritis, dysuria (71.6%), urethral suppuration (46.7%) and gland lesions (27%), so differentiating it from infections caused by other genitopathogens is difficult. 43% of patients were HIV positive. Antibiotic resistance rates for H. parainfluenzae were high to quinolons, ampicillin, tetracycline and macrolides. Conclusion: HND species should be considered as possible etiologic agents in episodes of urethral and rectal infection in men, especially in cases with negative screening tests for agents that cause sexually transmitted infections (STIs). Its microbiological identification is essential for the establishment of an effective targeted treatment. (AU)

Importancia clínica del aislamiento de Haemophilus spp. (excluyendo H. ducreyi) en muestras genitales. Revisión sistemática / Clinical significance of isolation of Haemophilus no ducreyi in genital samples. Systematic review

Introducción y objetivos Actualmente el diagnóstico microbiológico de las infecciones genitales se realiza con métodos moleculares, los cuales permiten detectar agentes etiológicos menos frecuentes, pero con potencial importancia patogénica, como Haemophilus spp. El objetivo de esta revisión es analizar y resaltar la importancia clínica del aislamiento de Haemophilus spp. en infecciones genitales y rectales, excluyendo H. ducreyi. Material y métodos Se ha realizado una revisión sistemática en base a una búsqueda exhaustiva de las publicaciones incluidas en la base de datos MEDLINE hasta el 5 de agosto de 2021, sobre la presencia de Haemophilus spp. en infecciones genitales y rectales, excluyendo H. ducreyi. Resultados Tras revisar lo descrito en la literatura, las especies de Haemophilus (excluyendo H. ducreyi: HSNOD) se detectaron en 2397 episodios de infección genital, siendo las especies más frecuentemente aisladas H. influenzae y H. parainfluenzae. La mayoría de los episodios (87,6%) están constituidos por aislamiento único. Existe un ligero predominio en mujeres (48,3%) donde puede producir cuadros de vaginitis, salpingitis, endometritis o complicaciones durante el embarazo. En hombres, el cuadro clínico suele corresponder a una uretritis. La mayoría de las muestras corresponde a exudados vaginales y uretrales, con una representación minoritaria a nivel rectal (2,3%). Conclusión HSNOD desempeña un papel patogénico relevante en episodios de infección genital, por lo que los protocolos de diagnóstico microbiológico deben incluir métodos que permitan su detección, así como incluirlos en el espectro etiológico de este tipo de cuadros clínicos (AU)

Introduction and objectives Currently, the microbiological diagnosis of genital infections is carried out with molecular methods, which allow the detection of less frequent etiological agents but with potential pathogenic importance, such as Haemophilus spp. The objective of this review is to analyze and highlight the clinical importance of the isolation of Haemophilus spp. in genital and rectal infections, excluding H. ducreyi. Material and methods A systematic review was carried out based on an exhaustive search of the publications included in the MEDLINE database up to August 5, 2021, on the presence of Haemophilus spp. in genital and rectal infections, excluding H. ducreyi. Results After reviewing what was described in the literature, Haemophilus spp. (excluding H. ducreyi: HSNOD) was detected in 2397 episodes of genital infection, the most frequently isolated species being H. influenzae and H. parainfluenzae. Most of the episodes (87.6%) are constituted by single isolation. There is a slight predominance in women (48.3%) where it can cause vaginitis, salpingitis, endometritis or complications during pregnancy. In men, the clinical picture usually corresponds to urethritis. Most of the samples correspond to vaginal and urethral exudates, with a minority representation at the rectal level (2.3%). Conclusion HSNOD plays a relevant pathogenic role in episodes of genital infection, so microbiological diagnostic protocols must include methods that allow their detection, as well as include them in the etiological spectrum of this type of clinical picture (AU)

Antibiotic Resistance Changes in Gram-Positive Bacteria from Urine Cultures: Development Analysis in a Health Area of South-East Spain.

This study analyzed the epidemiology and antibiotic susceptibility profile of significant bacteriuria and assessed the impact of adopting EUCAST criteria on antibiotic resistances. A systematic review was performed on publications in English or Spanish between 1 January 2010 and 30 June 2021 on the susceptibility of Gram-positive bacteria isolated in urinary samples in Europe. A retrospective descriptive study was also conducted on the results of 21,838 urine cultures with presumptive urinary tract infection (UTI) obtained during the past five years by the Department of Microbiology of the Virgen de las Nieves University Hospital (Granada, Spain). The activity of various antibiotics was determined, differentiated among various populations, and interpretations compared according to the application of EUCAST or CLSI criteria. Among 21,838 cases of significant bacteriuria, 27.69% were by Gram-positive bacteria, which were Enterococcus faecalis in 19.04% and Enterococcus faecium in 3.92%. The susceptibility profile remained stable for most antibiotics except for levofloxacin for E. faecalis and Staphylococcus aureus and nitrofurantoin for E. faecium. The resistance of Enterococcus spp. and Staphylococcus spp. to glycopeptides was exceptionally low in our setting. No significant difference in the prevalence of methicillin-resistant Staphylococcus aureus was observed between hospital (26.67%) and community (28.85%) samples. Resistances in our local setting remain stable and appear to be lower than reported in other studies. The adoption of EUCAST vs. CLSI criteria did not produce a general change in resistance rates. Findings suggest the need to revise certain empirical criteria, such as aminoglycoside synergy for Enterococcus and for community-origin S. aureus.

[Isolation of Haemophilus no ducreyi in samples from the genital tract of men: Its clinical relationship]. / Aislamiento de Haemophilus no ducreyi en muestras del aparato genital de varones: relación con la clínica.

INTRODUCTION: With the advancement of microbiological methods, the isolation of less typical pathogens in cases of urethral and rectal infection is more frequent, apart from the classic etiological agents. One of them is formed by species of Haemophilus no ducreyi (HND). The objective of this work is to describe frequency, susceptibility to antibiotics, and clinical features of HDN urethritis and proctitis in adult males. PATIENTS AND METHODS: This is an observational retrospective descriptive study of the results obtained by the Microbiology laboratory of the Virgen de las Nieves University Hospital on the isolates of HND in genital and rectal samples from males between 2016 and 2019. RESULTS: HND was isolated in 135 (7%) of the genital infection episodes diagnosed in men. H. parainfluenzae was the most commonly isolated (34/45; 75.6%). The most frequent symptoms in men with proctitis were rectal tenesmus (31.6%) and lymphadenopathy (10.5%); in those with urethritis, dysuria (71.6%), urethral suppuration (46.7%) and gland lesions (27%), so differentiating it from infections caused by other genitopathogens is difficult. 43% of patients were HIV positive. Antibiotic resistance rates for H. parainfluenzae were high to quinolons, ampicillin, tetracycline and macrolides. CONCLUSION: HND species should be considered as possible etiologic agents in episodes of urethral and rectal infection in men, especially in cases with negative screening tests for agents that cause sexually transmitted infections (STIs). Its microbiological identification is essential for the establishment of an effective targeted treatment.

Cambios en la resistencia antibiótica en episodios de bacteriospermia sintomática: Evolución en un área de salud del sudeste español / Antibiotic resistance changes in episodes of symptomatic bacteriospermia: development in a health area of southeast Spain

Objetivo: La prostatitis crónica bacteriana (PCB) es una entidad de difícil diagnóstico clínico y tratamiento, siendo el estudio microbiológico del semen la principal prueba diagnóstica. Este estudio tuvo como objetivo determinar la etiología y la resistencia antibiótica en pacientes con bacteriospermia sintomática (BPS) en nuestro medio. Material y métodos: Se ha realizado un estudio descriptivo, transversal y retrospectivo, en un Hospital Regional del sudeste español. Los participantes fueron pacientes asistidos en las consultas del Hospital con clínica compatible con PCB entre 2016 y 2021. Se recogieron y analizaron los resultados del estudio microbiológico de la muestra de semen. Se evaluó la etiología y la tasa de resistencia antibiótica de los episodios de BPS. Resultados: El principal microorganismo detectado es Enterococcus faecalis (34,89%), seguido por Ureaplasma spp. (13,74%) y Escherichia coli (10,98%). La tasa de resistencia antibiótica de E. faecalis a las quinolonas (11%) es inferior a estudios previos, mientras que, para E. coli ha sido superior (35%). Destaca la baja tasa de resistencia que muestran E. faecalis y E. coli a fosfomicina y nitrofurantoína. Conclusiones: En las BPS las bacterias grampositivas y las atípicas se establecen como los principales agentes causales de esta entidad. Esto obliga a replantear la estrategia terapéutica utilizada, lo cual evitará el aumento en las resistencias antibióticas, las recidivas y la cronicidad de esta patología. (AU)

Background: Chronic bacterial prostatitis (CBP) is an entity of difficult clinical diagnosis and treatment, being the microbiological study of semen the main diagnostic test. This study aimed to determine the etiology and antibiotic resistance in patients with symptomatic bacteriospermia (SBP) in our environment. Material and methods: A cross-sectional and retrospective descriptive study has been carried out from a Regional Hospital of the Spanish Southeast. The participants were patients assisted in the consultations of the Hospital with clinic compatible with CBP, between 2016 and 2021. The interventions were collection and analysis of the results derived from the microbiological study of the semen sample. The main determinations were the etiology and rate of antibiotic resistance of BPS episodes are analyzed. Results: The main isolated microorganism is Enterococcus faecalis (34.89%), followed by Ureaplasma spp. (13.74%) and Escherichia coli (10.98%). The rate of antibiotic resistance of E. faecalis to quinolones (11%) is lower than previous studies, while for E. coli it has been higher (35%). The low rate of resistance shown by E. faecalis and E. coli to fosfomycin and nitrofurantoin stands out. Conclusions: In the SBP, gram-positive and atypical bacteria are established as the main causative agents of this entity. This forces us to rethink the therapeutic strategy used, which will avoid the increase in antibiotic resistance, recurrences, and chronicity of this pathology.

Presence and Relevance of Emerging Microorganisms in Clinical Genitourinary Samples.

Microorganisms responsible for genitourinary infections increasingly include species other than conventional etiological agents that are of clinical and pathogenic relevance and therapeutic interest. This cross-sectional descriptive study selected samples from clinical genitourinary episodes between January 2016 and December 2019 in which emerging microbiological agents were detected. The patients' epidemiological characteristics, clinical presentation, antibiotic treatment, and outcome were studied to identify their pathogenic role. The emerging microorganisms most frequently detected in urinary tract infections were Streptococcus bovis (58.5%) and Gardnerella spp. (23.6%) in females and S. bovis (32.3%), Aerococcus urinae (18.6%), and Corynebacterium spp. (16.9%) in males, while the most frequently detected in genital infections were S. viridans (36.4%) in females and C. glucuronolyticum (32.2%) and Gardnerella spp. (35.6%) in males. All cases in female children were produced by S. bovis. Symptomatic episodes were more frequent with Aerococcus spp. and S. bovis and the presence of leukocytosis more frequent with Aerococcus spp. Quinolones and doxycycline were most often prescribed antibiotics for genital infections and quinolones and amoxicillin-clavulanic acid for urinary infections. Urinary infection by Aerococcus spp. was more frequent in males of advanced age, Corynebacterium spp. was more frequent in permanent vesical catheter carriers, and episodes of asymptomatic bacteriuria by Gardnerella spp. were more frequent in patients with kidney transplant and chronic consumers of corticosteroid therapy. Lactobacillus spp. should be considered in urinary infections of patients of advanced age and with a previous antibiotic load. Genital infection by Gardnerella spp. was significantly associated with a history of risky sexual relations.