Concurrent interspecies and clonal dissemination of OXA-48 carbapenemase.

Several isolates of four different carbapenemase-producing Enterobacteriaceae species were recovered from a patient hospitalized for 4 months in a teaching hospital in Madrid. These species comprised seven Klebsiella pneumoniae belonging to ST15, four Escherichia coli belonging to ST2531, two Serratia marcescens and one Citrobacter freundii. This patient was the index case of a small outbreak of four patients infected and/or colonized by carbapenemase-producing K. pneumoniae. Molecular results identified the bla(OXA-48) gene in all Enterobacteriaceae isolates from the index case and in all isolates from the other three patients, suggesting intra- and interpatient dissemination. Our results highlight the great ability of OXA-48 carbapenemase to spread among different enterobacterial species by both clonal and nonclonal dissemination.

Extended-spectrum beta-lactamases in urinary tract infections caused by Enterobacteria: understanding and guidelines for action.

CONTEXT: Beta-lactamases are bacterial enzymes that protect microorganisms from the lethal effects of ß-lactam antibiotics. The production of beta-lactamases is the most important mechanism of resistance to these antibiotics, especially in Gram-negative bacteria. OBJECTIVE: Review the magnitude of the problem of extended-spectrum beta-lactamases (ESBL) in the urological setting and present the fundamental action guidelines on the issue, the main risk factors and the prevention strategies. ACQUISITION OF EVIDENCE: A structured search strategy for patient, problem, intervention, comparison and result was conducted in the PubMed-Medline database to identify the most relevant studies related to the management of patients with urinary tract infection by ESBL-producing microorganisms. We also present a caseload analysis of our center on this issue. SUMMARY OF THE EVIDENCE: ESBL are found in Enterobacteria, mainly Klebsiella sp. and Escherichia coli and are characterized by their hydrolytic ability compared with beta-lactam antibiotics, which entails resistance to penicillin, cephalosporin and aztreonam. They are also associated with resistance to other antibiotics. There is a high risk of infection and colonization by ESBL producers in patients with prolonged hospital stays or who required invasive devices. The prior use of antibiotics and stays in residential care are also risk factors. Prevention programs should focus on preventing nosocomial infection. It is essential that a restrictive policy on the use of antibiotics be implemented. The therapy of choice for severe infections is focused on carbapenems, although their indiscriminate use should be avoided. In uncomplicated lower urinary tract infections, fosfomycin and nitrofurantoin are the best treatment alternatives. CONCLUSION: ESBL-producing strains constitute a true global health problem. Prevention strategies should focus on nosocomial infection. We should not forget, however, that the appearance of these pathogens in community-acquired infections is increasingly frequent. Therapeutic decisions should be based on an understanding of the local distribution of microorganisms and their resistance patterns.

Fungi sensing environmental stress.

Cells need to adapt to the external environment in order to survive. Signal transduction pathways are crucial mechanisms that allow cells to sense and respond to extracellular stimuli. Among the signal transduction pathways, we point out the cascades mediated by mitogen-activated protein kinases (MAPKs). The MAPKs are conserved from yeast to human and play relevant roles in the physiology of the cell. In pathogenic fungi these MAPK pathways control virulence factors. This review describes the MAPK cascades described in Candida albicans, the most frequently isolated fungus, from fungal systemic infections among individuals in developed countries.