Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008-2018): Epidemiology, Clinical Characteristics and Outcomes.

BACKGROUND: The epidemiology of community-acquired pneumonia (CAP) has changed, influenced by sociosanitary conditions and vaccination status. We aimed to analyze the recent epidemiology of bacterial CAP in hospitalized children in a setting with high pneumococcal vaccination coverage and to describe the clinical characteristics of pediatric Staphylococcus aureus CAP. METHODS: Children <17 years old hospitalized from 2008 to 2018 with bacterial CAP in 5 tertiary hospitals in Spain were included. Cases with pneumococcal CAP were randomly selected as comparative group following a case-control ratio of 2:1 with S. aureus CAP. RESULTS: A total of 313 bacterial CAP were diagnosed: Streptococcus pneumoniae CAP (n = 236, 75.4%), Streptococcus pyogenes CAP (n = 43, 13.7%) and S. aureus CAP (n = 34, 10.9%). Throughout the study period, the prevalence of S. pyogenes increased (annual percentage change: +16.1% [95% CI: 1.7-32.4], P = 0.031), S. pneumoniae decreased (annual percentage change: -4.4% [95 CI: -8.8 to 0.2], P = 0.057) and S. aureus remained stable. Nine isolates of S. aureus (26.5%) were methicillin-resistant. Seventeen cases (50%) with S. aureus CAP had some pulmonary complication and 21 (61.7%) required intensive care. S. pneumoniae CAP showed a trend toward higher prevalence of pulmonary complications compared with S. aureus CAP (69.1% vs. 50.0%, P = 0.060), including higher frequency of pulmonary necrosis (32.4% vs. 5.9%, P = 0.003). CONCLUSIONS: The incidence of S. aureus CAP in children remained stable, whereas the prevalence of pneumococcal CAP decreased and S. pyogenes CAP increased. Patients with S. aureus presented a high frequency of severe outcomes, but a lower risk of pulmonary complications than patients with S. pneumoniae.

[Invasive Streptococcus pyogenes infections (2011-2018): EMM-type and clinical presentation]. / Infecciones invasoras por Streptococcus pyogenes (2011-2018): serotipos y presentación clínica.

INTRODUCTION: Streptococcus pyogenes (S. pyogenes) is an important human pathogen that is responsible for a broad range of infections, from uncomplicated to more severe and invasive diseases with high morbidity/mortality. The M protein (emm type) is a critical virulence factor. Several studies have shown an increased incidence of invasive S. pyogenes disease. This was associated with an increase in the prevalence of M1 and M3 types, well-recognised virulent M types. The aim of the present study was to confirm the resurgence of invasive S. pyogenes disease during 2011-2018 and to identify the relationship between specific M types with disease presentation. MATERIAL AND METHODS: Isolates were confirmed using standard techniques: colony morphology, ß-haemolysis, biochemical tests, and agglutination with specific antisera (DiaMondiaL Strep Kit, DiaMondiaL, Langenhagen, Germany). The antibiotic sensitivity was performed using microdilution (Vitek®2 Compact, bioMeriéux, Inc., Durham, NC). Molecular analysis included the determination of the emm gene and superantigen profile. RESULTS: A total of 29 invasive isolates were collected (2011-2018) from blood (16), pleural fluid (9), synovial fluid (3), and cerebrospinal fluid (1). One strain per year was isolated between 2011 and 2013, with 2, 5, 4, 6, and 9 strains being isolated between 2014 and 2018, respectively. The most frequent clinical presentations were bacteraemia and pneumonia (10 and 9 cases). The predominant types were M1 (11 isolates) and M3 (3 isolates). A correlation was found between M1 and M3 types, and pneumonia (6/7 cases) and deep soft tissue infections (3/3 cases). CONCLUSIONS: An increased incidence of invasive S. pyogenes disease was observed during the study period, with M1 and M3 types being those most commonly isolated and associated with pneumonia and deep soft tissue infections.

Sensibilidad a azitromicina en Salmonella no tifoidea: opción terapéutica / Susceptibility to azithromycin in non-typhoid Salmonella: A therapeutic option

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Vigilancia activa de cepas de Salmonella entericano tifoidea con fenotipo no clásico de resistencia a quinolonas (2014-2019) / Active surveillance of nontyphoidal Salmonella enterica strains with nonclassical quinolone resistance phenotype (2014-2019)

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[New methodological advances: algorithm proposal for management of Clostridium difficile infection]. / Nuevos avances metodológicos: propuesta de algoritmo para el manejo de la infección por Clostridium difficile.

INTRODUCTION: Clostridium difficile infection (CDI) is considered the most common cause of health care-associated diarrhea and also is an etiologic agent of community diarrhea. The aim of this study was to assess the potential benefit of a test that detects glutamate dehydrogenase (GDH) antigen and C. difficile toxin A/B, simultaneously, followed by detection of C. difficile toxin B (tcdB) gene by PCR as confirmatory assay on discrepant samples, and to propose an algorithm more efficient. MATERIAL AND METHODS: From June 2012 to January 2013 at Hospital Infantil Universitario Niño Jesús, Madrid, the stool samples were studied for the simultaneous detection of GDH and toxin A/B, and also for detection of toxin A/B alone. When results between GDH and toxin A/B were discordant, a single sample for patient was selected for detection of C. difficile toxin B (tcdB) gene. RESULTS: A total of 116 samples (52 patients) were tested. Four were positive and 75 negative for toxigenic C. difficile (Toxin A/B, alone or combined with GDH). C. difficile was detected in the remaining 37 samples but not toxin A/B, regardless of the method used, except one. Twenty of the 37 specimens were further tested for C. difficile toxin B (tcdB) gene and 7 were positive. DISCUSSION: The simultaneous detection of GDH and toxin A/B combined with PCR recovered undiagnosed cases of CDI. In accordance with our data, we propose a two-step algorithm: detection of GDH and PCR (in samples GDH positive). This algorithm could provide a superior cost-benefit ratio in our population.

[Salmonella enterica with nonclassical quinolone resistance phenotype in pediatric patients]. / Salmonella enterica con fenotipo no clásico de resistencia a quinolonas en pacientes pediátricos.

INTRODUCTION: Decreased susceptibility to fluoroquinolones in Salmonella spp. may lead to treatment failures. The use of ciprofloxacin for extraintestinal and serious intestinal Salmonella infections in children is controversial and therefore the clinical relevance of these strains is not significant. Consequently little is know about the quinolone resistance of strains Salmonella of our paediatric population. The objective of this study was to assess the incidence of nonclassical quinolone resistance phenotype in paediatric patients. MATERIAL AND METHODS: Two hundred and sixty eight Salmonella spp. from Hospital Infantil Universitario Niño Jesús of Madrid (2009-2013) were tested against nalidixic acid and ciprofloxacin by microdilution. Moreover, 146 strains (2011-2013) were tested against ciprofloxacin by E-test. Reduced ciprofloxacin susceptibility was defined as a MIC of 0.125-1 mg/L. RESULTS: Of 42 isolates with reduced ciprofloxacin susceptibility, four isolates showing nonclassical quinolone resistance phenotype. Three were confirmed as carrying of plasmid-mediated quinolone resistance-conferring genes qnr. CONCLUSIONS: The percentage of strains with a genotype that confers a nonclassical quinolone resistance phenotype is low in our series. The identification of these isolates is difficult using conventional methods, but its ability of horizontal spread recommends an appropriate identification. Taking into account the low isolation rate of these strains in this study, evaluation of ciprofloxacin MIC on every nalidixic acid susceptible strain would not be cost effective. Alternatively, we propose to evaluate periodically any changing trend.

[Phenotypes of resistance in community urinary tract isolates of Escherichia coli: therapeutic implications]. / Fenotipos de resistencia en aislamientos urinarios de Escherichia coli en la comunidad: implicaciones terapéuticas.

BACKGROUND AND OBJECTIVE: Urinary tract infectious (UTI) are very frequent in the community and are managed through empirical treatment guidelines. The knowledge of patterns of susceptibility of patients at the time of establishing an empirical treatment is fundamental to avoid therapeutic failures. The aim of this study was to know the pattern of resistance to betalactams and other antimicrobials used in the treatment of non-complicated urinary infections in the area 11 of Madrid. PATIENTS AND METHOD: Retrospective study of susceptibility of Escherichia coli isolated in cultures of urine of outpatients of area 11 of Madrid during a period of 12 months. RESULTS: We found high rates of resistance to ampicillin and trimethoprim-sulfamethoxazole (57 and 29%, respectively). We observed high rates of resistance to cefuroxime (24%) and amoxicillin-clavulanic acid (27%). Resistance to ciprofloxacine was 16%. Resistance to phosphomicin and nitrofurantoin was very low (5 and 4%). Most frequent resistance association was ampicillin + cephalothin (20,2%). The mechanisms of resistance having more clinical relevance was the production and hyper-production of betalactamase. CONCLUSIONS: Changes were detected as to the pattern of susceptibility of certain antimicrobials frequently used in the empirical treatment of UTI such as cefuroxime and amoxicillin-clavulanic acid. It is important to support a condition of active surveillance for the evolution of resistances.

Vigilancia de multirresistentes: Enterococcus spp. resistente a vancomicina / Surveillance of multiresistance: vancomycin-resistant Enterococcus spp

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Recuperación de episodios de infección por Clostridium difficile tras la aplicación de un documento de consenso / Recovery from episodes of Clostridium difficile infection following the implementation of a consensus document

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Aislamiento de Hanseniaspora opuntiae de hemocultivos de una paciente inmunodeprimida: un hallazgo infrecuente y de difícil valoración / Isolation of Hanseniaspora opuntiae from blood cultures of an immunosuppressed patient: An infrequent and difficult to assess finding

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[Incidence and susceptibility of Campylobacter jejuni in pediatric patients: involvement in bacteremia]. / Incidencia y sensibilidad de Campylobacter jejuni en pacientes pediátricos: implicación en bacteriemia.

INTRODUCTION: Invasive disease as a result Campylobacter spp. is rarely reported. Bloodstream infections have been reported in patients with immune deficiency or other serious underlying conditions. We conducted a prospective study to know the incidence of Campylobacter jejuni bacteremia in pediatric patients and its susceptibility to erythromycin and ciprofloxacin. METHODS: The identification of Campylobacter isolates was based on routine culture methods. Antimicrobial susceptibility was performed using a disk diffusion method. RESULTS: During April 2010-June 2012, at Hospital Niño Jesús of Madrid, Campylobacter spp. was isolated from 171 stool specimens in 154 patients. The median age was 2 years (3 months-21 year). One hundred and one (66%) isolates were identified as C. jejuni. Nine patients with enteritis due C. jejuni (9%) were immunocompromised. Erythromycin resistance was observed in 5% of the isolates. The resistance to ciprofloxacin was 88%. Blood cultures were obtained of 19 patients infected with C. jejuni (19%). Of these, one had C. jejuni bacteremia. During the study period, other episode of C. jejuni bacteremia was detected in one patient different without positive stool culture for C. jejuni (0.34% of all bloodstreams infections). Both patients were immunocompromised. CONCLUSIONS: Campylobacter spp. is an uncommon cause of bloodstream infection in our serie occurring in pediatric patients with immune deficiency as predisposing factor. In our institution, empirical use of fluoroquinolones for Campylobacter infections should not be recommended by the high rate of resistance. Moreover in our study the resistance to erythromycin is low, however is advisable its surveillance.

Condensación pulmonar versus absceso esplénico por Salmonella / Pulmonary consolidation versus splenic abscess due toSalmonella enterica

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