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Rivera A, Viñado B, Benito N, Docobo-Pérez F, Fernández-Cuenca F, Fernández-Domínguez J, Guinea J, López-Navas A, Moreno MÁ, Larrosa MN, Oliver A, Navarro F. Recommendations of the Spanish Antibiogram Committee (COESANT) for in vitro susceptibility testing of antimicrobial agents by disk diffusion. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:571-576. [PMID: 36610835 DOI: 10.1016/j.eimce.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/27/2022] [Indexed: 01/07/2023]
Abstract
Disk diffusion is a well standardized method that provides reliable categorical results to guide antimicrobial therapy in numerous types of infections. Based on the guidelines of the European Committee on Antimicrobial Susceptibility Testing (EUCAST), which are widely implemented in Spain, the Spanish Antibiogram Committee (COESANT) has drawn up recommendations for antimicrobial selection by the disk diffusion technique, including selective reporting and its use for the detection of resistance mechanisms. Factors affecting disk diffusion results, along with advantages and shortcomings of the method, are also discussed.
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Affiliation(s)
- Alba Rivera
- Servicio de Microbiología, Hospital de la Santa Creu i Sant Pau, Departamento de Genética y de Microbiología de la Universitat Autònoma de Barcelona, Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Belén Viñado
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Natividad Benito
- Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Fernando Docobo-Pérez
- Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - Felipe Fernández-Cuenca
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Fernández-Domínguez
- Servicio de Microbiología, Hospital Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Guinea
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Antonio López-Navas
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Miguel Ángel Moreno
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense, Madrid, Spain
| | - María Nieves Larrosa
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - Antonio Oliver
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Ferran Navarro
- Servicio de Microbiología, Hospital de la Santa Creu i Sant Pau, Departamento de Genética y de Microbiología de la Universitat Autònoma de Barcelona, Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain.
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2
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Gracia-Ahufinger I, López-González L, Vasallo FJ, Galar A, Siller M, Pitart C, Bloise I, Torrecillas M, Gijón-Cordero D, Viñado B, Castillo-García J, Campo R, Mulet X, Madueño-Alonso A, Chamizo-López FJ, Arrastia-Erviti M, Galán-Sánchez F, Fernández-Quejo M, Rodríguez-Díaz JC, Gutiérrez-Zufiaurre MN, Rodríguez-Maresca MA, Ortega-Lafont MDP, Yagüe-Guirao G, Chaves-Blanco L, Colomina-Rodríguez J, Vidal-Acuña MR, Portillo ME, Franco-Álvarez de Luna F, Centelles-Serrano MJ, Azcona-Gutiérrez JM, Delgado-Iribarren García Campero A, Rey-Cao S, Muñoz P, Calvo-Montes J, Zboromyrska Y, Grandioso D, Càmara J, Cantón R, Larrosa-Escartín N, Díaz-Regañón J, Martínez-Martínez L. The CARBA-MAP study: national mapping of carbapenemases in Spain (2014-2018). Front Microbiol 2023; 14:1247804. [PMID: 37744921 PMCID: PMC10516297 DOI: 10.3389/fmicb.2023.1247804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Infections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018. Methods A national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0. Results A total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017-2018 compared to 2014-2016. Discussion Data from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms.
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Affiliation(s)
- Irene Gracia-Ahufinger
- Unit of Microbiology, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Laura López-González
- Clinical Microbiology Service, IML, San Carlos Clinical University Hospital, Madrid, Spain
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco José Vasallo
- Microbiology Service, Vigo University Hospital Complex (CHUVI), Vigo, Spain
- Health Research Institute Galicia Sur (IISGS), Vigo, Spain
| | - Alicia Galar
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Health Research Institute Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain
| | - María Siller
- Microbiology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Marqués de Valdecilla Health Research Institute (IDIVAL), Santander, Spain
| | - Cristina Pitart
- Microbiology Service, Hospital Clinic, Barcelona, Spain
- Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
- Institute of Global Health of Barcelona, Barcelona, Spain
| | - Iván Bloise
- Clinical Microbiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Miriam Torrecillas
- Clinical Microbiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Desirée Gijón-Cordero
- Microbiology Service, Ramón y Cajal University Hospital, Madrid, Spain
- Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
| | - Belén Viñado
- Microbiology Service, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Javier Castillo-García
- Microbiology Service, Lozano Blesa Clinical University Hospital, Zaragoza, Spain
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Rainer Campo
- Microbiology Service, Asturias Central University Hospital, Oviedo, Spain
| | - Xavier Mulet
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Microbiology Service, Son Espases University Hospital, Palma de Mallorca, Spain
- Institute for Health Research Illes Balears (IdISBa), Palma, Spain
| | - Ana Madueño-Alonso
- Microbiology Service, University Hospital of the Canary Islands, Tenerife, Spain
| | | | | | | | | | - Juan Carlos Rodríguez-Díaz
- Microbiology Service, General University Hospital Dr. Balmis, Alicante, Spain
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | | | | | | | - Genoveva Yagüe-Guirao
- Virgen de la Arrixaca University Hospital, Murcia, Spain
- Department of Genetics and Microbiology, University of Murcia, Murcia, Spain
- Murcian Institute for Biomedical Research (IMIB), Murcia, Spain
| | - Lucía Chaves-Blanco
- Microbiology Service, San Cecilio Clinical University Hospital, Granada, Spain
| | | | | | - María Eugenia Portillo
- Clinical Microbiology Service, University Hospital of Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IdiSNA), Pamplona, Spain
| | | | - María José Centelles-Serrano
- Microbiology Area, Clinical Laboratory, Hospital of Tortosa Virgen de la Cinta, Tortosa, Spain
- Institute for Health Research Pere Virgili, Tortosa, Spain
| | | | | | - Sonia Rey-Cao
- Microbiology Service, Vigo University Hospital Complex (CHUVI), Vigo, Spain
- Health Research Institute Galicia Sur (IISGS), Vigo, Spain
| | - Patricia Muñoz
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Health Research Institute Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Calvo-Montes
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Microbiology Service, Marqués de Valdecilla University Hospital, Santander, Spain
- Marqués de Valdecilla Health Research Institute (IDIVAL), Santander, Spain
| | - Yuliya Zboromyrska
- Microbiology Service, Hospital Clinic, Barcelona, Spain
- Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
| | - David Grandioso
- Clinical Microbiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Jordi Càmara
- CIBER de Enfermedades Respiratorias (CIBERes), Instituto de Salud Carlos III, Madrid, Spain
- Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
- Clinical Microbiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- Institut Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Rafael Cantón
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Microbiology Service, Ramón y Cajal University Hospital, Madrid, Spain
- Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain
| | - Nieves Larrosa-Escartín
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Microbiology Service, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - Luis Martínez-Martínez
- Unit of Microbiology, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- Center for Biomedical Research in Infectious Diseases (CIBERINFEC), Carlos III Health Institute (ISCIII), Madrid, Spain
- Department of Agricultural Chemistry, Soil Science and Microbiology, University of Cordoba, Cordoba, Spain
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Moreno-Mingorance A, Mir-Cros A, Goterris L, Rodriguez-Garrido V, Sulleiro E, Barberà MJ, Alberny M, Hoyos-Mallecot Y, Descalzo V, Bravo A, Roca-Grande J, Viñado B, Pumarola T, Larrosa MN, González-López JJ. Increasing trend of antimicrobial resistance in Shigella associated with MSM transmission in Barcelona, 2020-21: outbreak of XRD Shigella sonnei and dissemination of ESBL-producing Shigella flexneri. J Antimicrob Chemother 2023; 78:975-982. [PMID: 36760088 PMCID: PMC10068420 DOI: 10.1093/jac/dkad031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Several countries have recently reported the detection of ESBL-producing Shigella sonnei associated with transmission among MSM. In a previous study by our group, 2.8% of Shigella spp. obtained from MSM in Barcelona between 2015 and 2019 were ESBL producers. OBJECTIVES To describe and characterize the emerging ESBL-producing Shigella spp. associated with sexual transmission among MSM detected from 2020 to 2021 in Barcelona, elucidating their connectivity with contemporaneous ESBL-producing Shigella spp. from other countries. RESULTS From 2020 to 2021, we identified that among MSM, 68% of S. sonnei were XDR harbouring blaCTX-M-27 and 14% of Shigella flexneri were MDR harbouring blaCTX-M-27. WGS analysis showed that the ESBL-producing S. sonnei were part of a monophyletic cluster, which included isolates responsible for the prolonged outbreak occurring in the UK. Our data also reveal the first emergence and clonal dissemination of ESBL-producing and fluoroquinolone-resistant S. flexneri 2a among MSM. CONCLUSIONS We report an increasing trend of antimicrobial resistance in Shigella spp. among MSM in Barcelona since 2021, mainly as a consequence of the dissemination of XDR ESBL-producing S. sonnei, previously reported in the UK. These results highlight the importance of international collaborative surveillance of MDR/XDR S. sonnei and S. flexneri for rapid identification of their emergence and the prevention of the transmission of these pathogens.
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Affiliation(s)
- Albert Moreno-Mingorance
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alba Mir-Cros
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Lidia Goterris
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Virginia Rodriguez-Garrido
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Elena Sulleiro
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - M Jesús Barberà
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Mireia Alberny
- Primary Health-Care Division, Catalan Institute of Health, Barcelona, Spain
| | - Yannick Hoyos-Mallecot
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Vicente Descalzo
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Albert Bravo
- Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Josep Roca-Grande
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Viñado
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Tomàs Pumarola
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - M Nieves Larrosa
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Juan José González-López
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Ciruela P, Soldevila N, García-Garcia JJ, González-Peris S, Díaz-Conradi A, Redin A, Viñado B, Izquierdo C, Muñoz-Almagro C, Domínguez A. Effect of COVID-19 Pandemic on Invasive Pneumococcal Disease in Children, Catalonia, Spain. Emerg Infect Dis 2022; 28:2321-2325. [PMID: 36220135 PMCID: PMC9622259 DOI: 10.3201/eid2811.211741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We analyzed the effect of COVID-19 on healthcare demand and invasive pneumococcal disease in children in Catalonia, Spain. Compared with 2018–2019, we noted large reductions in healthcare activities and incidence of invasive pneumococcal disease in 2020. These changes likely resulted from nonpharmaceutical measures implemented during the COVID-19 pandemic.
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Gómez CI, Pidemunt NS, García-García J, Viñado B, Díaz-Conradi A, de trabajo Barcino G. IR-7968. Enfermedad invasiva por neumococo en 2021. Impacto de la pandemia de COVID-19. Vacunas 2022. [PMCID: PMC9578740 DOI: 10.1016/j.vacun.2022.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
El objetivo del estudio es analizar los cambios provocados por la pandemia de COVID-19 en la demanda asistencial hospitalaria, solicitud de pruebas diagnósticas para neumococo y casos confirmados de enfermedad neumocócica invasiva (ENI) en la población pediátrica en 2021 respecto al periodo prepandémico (2018-2019). Métodos El estudio se realizó en 3 hospitales de nuestra comunidad autónoma que atienden el 32% de la población pediátrica hospitalizada en la misma. En 2021 y en 2018-2019 (promedio) se recogieron: visitas a urgencias, solicitudes de PCR diagnóstica de ENI, casos de ENI, y distribución por serotipos (incluidos en vacuna antineumocócica conjugada-13v [PCV13] y no incluidos [noPCV13]), y por grupos de edad (< 5 y ≥ 5 años). Se compararon las tasas de incidencia (TI) en 2021 respecto 2018-2019 mediante el cálculo de razón TI (RTI), con IC 95%. El cambio porcentual en RTI se expresó según fórmula: (1-RTI) × 100. Resultados El número de visitas a urgencias en 2018-19 fue de 227.148 y de 178.243 en 2021 (-21%; p < 0,0001). La variación en visitas a urgencias en < 5 años fue de + 4% y de -38% en ≥ 5 años. El número de PCR solicitadas en 2018-19 fue de 641 y de 754 en 2021 (+ 19%; p = 0,001) y el de casos por ENI en 2018-19 de 57 y de 19 en 2021 (-66%; p < 0,0001). El número de serotipos PCV13 en 2018-19 fue de 25 y de 8 en 2021 (-68%; p = 0,003), y el de serotipos no-PCV13 fue de 29 en 2018-19 y de 10 en 2021 (-65%; p = 0,002); siendo esta variación especialmente marcada en < 5 años. Conclusiones En 2021 se observó una disminución de carga asistencial en visitas a urgencias respecto al periodo prepandémico, pero un incremento en las pruebas diagnósticas solicitadas. La disminución de casos de ENI ha sido del 66% en 2021. Las medidas no farmacológicas de prevención podrían explicar estos resultados.
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Affiliation(s)
- C. Izquierdo Gómez
- Agencia de Salud Pública de Cataluña, Generalitat de Cataluña, Barcelona, España
| | - N. Soldevila Pidemunt
- Unidad de Medicina Preventiva y Salud Pública, Departamento de Medicina, Universidad de Barcelona, Barcelona, España
| | - J. García-García
- Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - B. Viñado
- Servicio de Microbiología, Hospital Vall d’Hebron, Barcelona, España
| | - A. Díaz-Conradi
- Servicio de Pediatría, Hospital de Nens de Barcelona, Barcelona, España
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Rivera A, Viñado B, Benito N, Docobo-Pérez F, Fernández-Cuenca F, Fernández-Domínguez J, Guinea J, López-Navas A, Moreno MÁ, Larrosa MN, Oliver A, Navarro F. Recommendations of the Spanish Antibiogram Committee (COESANT) for in vitro susceptibility testing of antimicrobial agents by disk diffusion. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Salmerón P, Viñado B, Arando M, Alcoceba E, Romero B, Menéndez B, Bernal S, Idigoras P, Colomina J, Martin-Saco G, Leal-Negredo Á, Torreblanca A, Martínez O, Serra-Pladevall J. Neisseria gonorrhoeae antimicrobial resistance in Spain: a prospective multicentre study. J Antimicrob Chemother 2021; 76:1523-1531. [PMID: 33569588 DOI: 10.1093/jac/dkab037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Gonococcal infection is one of the most reported sexually transmitted infections and antimicrobial resistance in Neisseria gonorrhoeae (NG) is challenging for the treatment of this infection. This observational study aimed to describe antimicrobial resistance of NG and epidemiological data from patients with gonococcal infection in eight regions of Spain, for updating the local therapeutic guidelines. METHODS MICs of penicillin, cefixime, ceftriaxone, azithromycin, ciprofloxacin, fosfomycin and gentamicin were determined by Etest for all NG isolates recovered from 1 April 2018 to 30 September 2019 from 10 hospitals in Spain. Resistance determinants were identified using logistic regression analysis. Differences with a P value <0.05 were considered statistically significant. RESULTS Antimicrobial susceptibility testing was performed for 2571 gonococci isolated from 2429 patients. 44.5% (945/2124) of patients were MSM. The resistance rate to extended-spectrum cephalosporins was low, with 0.2% (6/2561) of isolates resistant to ceftriaxone and 1.7% (44/2517) of isolates resistant to cefixime. The overall azithromycin resistance rate was 12.1% (310/2560), but differed greatly depending on the area. 56.2% (1366/2429) of the strains studied were ciprofloxacin resistant. MIC50 and MIC90 values of gentamicin and fosfomycin were 4 and 8 mg/L and 24 and 48 mg/L, respectively. CONCLUSIONS Our study shows that NG susceptibility to extended-spectrum cephalosporins remains high in Spain. The azithromycin resistance rate questions the suitability of dual therapy. This study provides data of interest for updating the national treatment guidelines and highlights the need to develop and implement a national sentinel gonococcal antimicrobial susceptibility programme.
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Affiliation(s)
- Paula Salmerón
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Belén Viñado
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Maider Arando
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Eva Alcoceba
- Microbiology Department, Son Espases Hospital Universitari, Mallorca, Spain
| | - Beatriz Romero
- Microbiology Department, Ramón y Cajal Hospital Universitario, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Blanca Menéndez
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Sandoval Health Centre, San Carlos Hospital Clínico, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Samuel Bernal
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Microbiology Department, Virgen de Valme Hospital Universitario, Sevilla, Spain
| | - Pedro Idigoras
- Microbiology Department, Donostia Hospital Universitario, San Sebastián, Spain
| | - Javier Colomina
- Microbiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Gloria Martin-Saco
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Microbiology Department, Miguel Servet Hospital Universitario, Zaragoza, Spain
| | - Álvaro Leal-Negredo
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Microbiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Aurora Torreblanca
- Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Microbiology Department, Cabueñes Hospital Universitario, Gijón, Spain
| | - Olalla Martínez
- Microbiology Department, La Ribera Hospital Universitario, Valencia, Spain
| | - Judit Serra-Pladevall
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Sexually Transmitted Infections Study Group (GEITS), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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8
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Salmerón P, Moreno-Mingorance A, Trejo J, Amado R, Viñado B, Cornejo-Sanchez T, Alberny M, Barbera MJ, Arando M, Pumarola T, Hoyos-Mallecot Y, Serra-Pladevall J, González-López JJ. Emergence and dissemination of three mild outbreaks of Neisseria gonorrhoeae with high-level resistance to azithromycin in Barcelona, 2016-18. J Antimicrob Chemother 2021; 76:930-935. [PMID: 33367806 DOI: 10.1093/jac/dkaa536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/02/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Neisseria gonorrhoeae (NG) isolates with high-level azithromycin resistance (HL-AziR) have emerged worldwide in recent decades, threatening the sustainability of current dual-antimicrobial therapy. OBJECTIVES This study aimed to characterize the first 16 NG isolates with HL-AziR in Barcelona between 2016 and 2018. METHODS WGS was used to identify the mechanisms of antimicrobial resistance, to establish the MLST ST, NG multiantigen sequence typing (NG-MAST) ST and NG sequence typing for antimicrobial resistance (NG-STAR) ST and to identify the clonal relatedness of the isolates with other closely related NG previously described in other countries based on a whole-genome SNP analysis approach. The sociodemographic characteristics of the patients included in the study were collected by comprehensive review of their medical records. RESULTS Twelve out of 16 HL-AziR isolates belonged to the MLST ST7823/NG-MAST ST5309 genotype and 4 to MLST ST9363/NG-MAST ST3935. All presented the A2059G mutation in all four alleles of the 23S rRNA gene. MLST ST7823/NG-MAST ST5309 isolates were only identified in men who have sex with women and MLST ST9363/NG-MAST ST3935 were found in MSM. Phylogenomic analysis revealed the presence of three transmission clusters of three different NG strains independently associated with sexual behaviour. CONCLUSIONS Our findings support the first appearance of three mild outbreaks of NG with HL-AziR in Spain. These results highlight the continuous capacity of NG to develop antimicrobial resistance and spread among sexual networks. The enhanced resolution of WGS provides valuable information for outbreak investigation, complementing the implementation of public health measures focused on the prevention and dissemination of MDR NG.
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Affiliation(s)
- P Salmerón
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - A Moreno-Mingorance
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - J Trejo
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - R Amado
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - B Viñado
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - T Cornejo-Sanchez
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - M Alberny
- Institut Català de Salut (ICS), Barcelona, Spain
| | - M J Barbera
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - M Arando
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - T Pumarola
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Y Hoyos-Mallecot
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - J Serra-Pladevall
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - J J González-López
- Department of Microbiology, Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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9
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Moreno-Mingorance A, Espinal P, Rodriguez V, Goterris L, Fàbrega A, Serra-Pladevall J, Barberà MJ, Alberny M, Martín-González H, Cornejo-Sánchez T, Armas M, Mir-Cros A, Raventós A, Viñado B, Pumarola T, Larrosa MN, González-López JJ. Circulation of multi-drug-resistant Shigella sonnei and Shigella flexneri among men who have sex with men in Barcelona, Spain, 2015-2019. Int J Antimicrob Agents 2021; 58:106378. [PMID: 34157402 DOI: 10.1016/j.ijantimicag.2021.106378] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/20/2021] [Accepted: 06/13/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND In high-income countries, shigellosis is mainly found in travellers to high-risk regions or in men who have sex with men (MSM). This study investigated the genomic characteristics and the features of antimicrobial resistance of MSM-associated Shigella flexneri and Shigella sonnei circulating in Barcelona, Spain, elucidating their connectivity with contemporaneous Shigella spp. from other countries. METHODS Antimicrobial susceptibility, whole-genome sequencing, genomic characterization and phylogenetic analysis were performed in MSM-associated Shigella spp. recovered from 2015 to 2019. Reference genomes of MSM-associated Shigella spp. were included for contextualization and to determine their connection with international outbreaks. RESULTS In total, 44 S. flexneri and 26 S. sonnei were identified among MSM. Overall, 80% showed resistance to azithromycin, 65.7% showed resistance to trimethoprim-sulphamethoxazole and 32.8% showed resistance to ciprofloxacin; 27.1% were resistant to all three antimicrobials. mphA and/or ermB, and qnrS and mutations in the quinolone resistance determining regions were found in the azithromycin- and ciprofloxacin-resistant isolates, respectively. Additionally, two isolates carried blaCTX-M-27. Single-nucleotide-polymorphism-based analysis revealed that the isolates were organized into different lineages, most of which were closely related to dominant MSM-associated lineages described previously in the UK and Australia. CONCLUSIONS This study investigated the circulation of lineages of S. flexneri and S. sonnei among MSM in Spain that were mainly resistant to first-/second-line oral treatments, and closely related to dominant MSM-associated lineages described previously in the UK and Australia. These data reinforce the urgent need for the implementation of public health measures focusing on the early detection and prevention of transmission of this emerging pathogen, which is contributing to the antimicrobial resistance crisis in sexually transmitted infections.
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Affiliation(s)
- Albert Moreno-Mingorance
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paula Espinal
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Virginia Rodriguez
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Lidia Goterris
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Anna Fàbrega
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Judit Serra-Pladevall
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - M Jesús Barberà
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Mireia Alberny
- Primary Healthcare Division, Catalan Institute of Health, Barcelona, Spain
| | - Héctor Martín-González
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Thais Cornejo-Sánchez
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Mayuli Armas
- Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Alba Mir-Cros
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Raventós
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Belén Viñado
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Tomàs Pumarola
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - M Nieves Larrosa
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain.
| | - Juan José González-López
- Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain.
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10
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Salmerón P, Viñado B, El Ouazzani R, Hernández M, Barbera MJ, Alberny M, Jané M, Larrosa N, Pumarola T, Hoyos-Mallecot Y, Serra-Pladevall J. Antimicrobial susceptibility of Neisseria gonorrhoeae in Barcelona during a five-year period, 2013 to 2017. Euro Surveill 2020; 25:1900576. [PMID: 33094716 PMCID: PMC7651876 DOI: 10.2807/1560-7917.es.2020.25.42.1900576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/05/2020] [Indexed: 11/20/2022] Open
Abstract
IntroductionIncreasing rates of antimicrobial resistance in Neisseria gonorrhoeae cause problems for treating gonorrhoea.AimThis observational study aimed to describe isolates from all patients found infected with N. gonorrhoeae, in Barcelona, Spain, between 2013 and 2017, and with available antimicrobial susceptibility data.MethodsMinimum inhibitory concentrations (MICs) of penicillin (PEN), cefixime (CFM), ceftriaxone (CRO), azithromycin (AZM), ciprofloxacin (CIP), spectinomycin (SPT), fosfomycin (FOF) and gentamicin (GEN) were determined by E-test. Susceptibility was assessed using clinical breakpoints from the European Committee on Antimicrobial Susceptibility Testing. Time trends for PEN, CFM, AZM and CIP were investigated using logistic regression.ResultsOf 1,979 patients with infection (2,036 isolates), 1,888 (95.4%) were men. Patient median age was 32 years. The proportions of isolates resistant to extended-spectrum cephalosporins were low, with 0.3% (5/1,982) resistant to CRO and 4.9% (98/1,985) to CFM. AZM resistance prevalence was 2.7% (52/1,981), including 16 isolates detected in 2016 and 2017, with high-level resistance. For CIP, 51.3% (1,018/1,986) of isolates were resistant, and for PEN, 20.1% (399/1,985). All isolates were susceptible to SPT. MIC50 and MIC90 values of GEN were 4 and 6 mg/L and of FOF 12 and 24 mg/L, respectively. Between 2013 and 2017, PEN and CFM resistance rates each decreased from 28.1% (92/327) to 12.2% (70/572) and from 8.3% (27/327) to 4.4% (25/572) (p ≤ 0.0073). In contrast, AZM resistance prevalence appeared to increase from 1.5% in 2014 (5/340) to 3.0% (17/572) in 2017. No trend was identified for CIP.ConclusionAntimicrobial susceptibility surveillance is important to timely detect new phenotypes and trends.
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Affiliation(s)
- Paula Salmerón
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Belén Viñado
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Rachid El Ouazzani
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Marta Hernández
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - María Jesús Barbera
- Drassanes-Vall d'Hebron Sexually Transmitted Infections Unit, Department of Infectious Diseases, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Mireia Alberny
- Medical Management of Primary Care Services, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Mireia Jané
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Nieves Larrosa
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Microbiology group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Tomás Pumarola
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Microbiology group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Yannick Hoyos-Mallecot
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Microbiology group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Judit Serra-Pladevall
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Microbiology group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
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11
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Piedra-Carrasco N, Miguel L, Fàbrega A, Viñado B, Campany D, Mir A, Fox ML, Almirante B, Larrosa N, Ruiz-Camps I, González-López JJ. Effectiveness of a Double-Carbapenem Regimen in a KPC-Producing Klebsiella pneumoniae Infection in an Immunocompromised Patient. Microb Drug Resist 2017; 24:199-202. [PMID: 28708458 DOI: 10.1089/mdr.2017.0129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The progressive increase of infections produced by extensively drug-resistant carbapenemase-producing Klebsiella pneumoniae (XDR-CPKP) represents an important threat to public health. Unfortunately, optimal therapeutic options are scarce. Retrospective studies have recommended combined therapy with more than one antibiotic and, more recently, a double-carbapenem regimen has been reported to be an effective alternative therapy. Here, we describe an episode of sepsis in an immunocompromised patient after allogeneic hematopoietic stem cell transplantation, caused by an XDR-CPKP. Several in vitro synergy tests revealed a synergistic effect combining ertapenem and meropenem, which were used as combination therapy achieving clinical and microbiological success.
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Affiliation(s)
- Nuria Piedra-Carrasco
- 1 Department of Clinical Microbiology, Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Lucia Miguel
- 2 Department of Infectious Diseases, Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Anna Fàbrega
- 1 Department of Clinical Microbiology, Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Belén Viñado
- 1 Department of Clinical Microbiology, Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona , Barcelona, Spain
| | - David Campany
- 3 Department of Pharmacy, Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Alba Mir
- 1 Department of Clinical Microbiology, Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona , Barcelona, Spain
| | - María Laura Fox
- 4 Hematology Department, Hospital Vall d'Hebron, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona, Spain
| | - Benito Almirante
- 2 Department of Infectious Diseases, Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Nieves Larrosa
- 1 Department of Clinical Microbiology, Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Isabel Ruiz-Camps
- 2 Department of Infectious Diseases, Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Juan José González-López
- 1 Department of Clinical Microbiology, Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona , Barcelona, Spain
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12
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Bartolí R, Mañé J, Cabré E, Lorenzo-Zúñiga V, Planas R, Viñado B, Ausina V, Gassull MA. Effect of the administration of fermentable and non-fermentable dietary fibre on intestinal bacterial translocation in ascitic cirrhotic rats. Clin Nutr 2007; 26:383-7. [PMID: 17376565 DOI: 10.1016/j.clnu.2007.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 11/13/2006] [Accepted: 01/31/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bacterial infections are frequent in cirrhosis. Experimental studies suggest a pathogenic role of intestinal bacterial translocation in them. Both fermentable and non-fermentable fibre avoided intestinal bacterial translocation (IBT) in animal models of gut starvation and critical illness. AIM To assess the effect of fermentable (pectin) or non-fermentable (lignin) fibre on IBT in ascitic cirrhotic rats. METHODS Thirty-six rats induced to cirrhosis with oral CCl4 were randomized (6 weeks after the first CCl4 dose) to receive rat chow+5% lignin (LIG, n=13), rat chow+5% pectin (PEC, n=13), or rat chow only (CON, n=10). Once ascites developed, animals were laparotomized and samples of mesenteric lymph nodes (MLN), ascitic fluid, portal and peripheral blood and liver, were obtained for culture. RESULTS IBT rate was: LIG=5/13, PEC=4/13, CON=5/10 (P=N.S.). The median amount of translocated bacteria in rats with IBT was lower in the PEC group (2 x 10(2) CFU/g MLN), than in LIG (10(5) CFU/g MLN) and CON (10(4) CFU/g MLN) groups (P<0.05). All other samples were sterile except for a portal blood sample (Enterococcus faecalis) of the LIG group. CONCLUSIONS IBT incidence is not decreased by either pectin or lignin in ascitic cirrhotic rats, but pectin supplementation reduces the amount of translocated bacteria.
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Affiliation(s)
- Ramon Bartolí
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain
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13
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Vallano A, Rodríguez D, Barceló ME, López A, Cano A, Viñado B, Diogene E. [Antimicrobial susceptibility of uropathogens and outcome following antibiotic treatment for urinary tract infections in primary health care]. Enferm Infecc Microbiol Clin 2006; 24:418-25. [PMID: 16956529 DOI: 10.1157/13091778] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE An increase in the resistance to antimicrobial agents among bacteria causing urinary tract infections (UTI) has been reported. The aim of this study was to relate uropathogen susceptibility to prescribed antibiotics for UTI to the clinical outcome after therapy in primary health care patients. METHODS A prospective longitudinal study, including 118 women diagnosed with UTI was carried out in primary health care centers. The results of urine culture, antimicrobial susceptibility testing and the prescribed antibiotic treatment were recorded. The patients' clinical outcome and the results of follow-up urine cultures after therapy were also recorded. RESULTS The uropathogens isolated were susceptible to the prescribed antibiotic in 86% of patients. Clinical improvement at two weeks was observed in 91% of patients with bacteria sensitive to the prescribed antibiotics and 7% of patients with resistant bacteria (P = 0.06). At 4-6 weeks, there were no clinical symptoms in 88% of patients with sensitive bacteria and 71% of patients with resistant bacteria (p = 0.23). In follow-up urine cultures, bacteria had been eradicated in 74% of patients with sensitive bacteria and 50% with resistant bacteria (p = 0.34). CONCLUSIONS The majority of women diagnosed with UTI in primary health care had uropathogens sensitive to the prescribed antibiotic and treatment was effective at short term in this study. The results of antimicrobial susceptibility testing were not always related to the clinical outcome; bacterial resistance may overestimate the risk of therapeutic failure in UTI.
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Affiliation(s)
- Antonio Vallano
- Fundación Instituto Catalán de Farmacología. Servicio de Farmacología Clínica. Hospital Universitario Vall d'Hebron. Universidad Autónoma de Barcelona. España.
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14
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Lorenzo-Zúñiga V, Bartolí R, Planas R, Hofmann AF, Viñado B, Hagey LR, Hernández JM, Mañé J, Alvarez MA, Ausina V, Gassull MA. Oral bile acids reduce bacterial overgrowth, bacterial translocation, and endotoxemia in cirrhotic rats. Hepatology 2003; 37:551-7. [PMID: 12601352 DOI: 10.1053/jhep.2003.50116] [Citation(s) in RCA: 228] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Experiments were performed to test whether conjugated bile acid administration would decrease bacterial overgrowth, bacterial translocation, and endotoxemia in ascitic cirrhotic rats. Cholylsarcosine, a deconjugation-dehydroxylation resistant and cholylglycine, a deconjugation-dehydroxylation susceptible bile acid were used. Rats with CCl(4)-induced cirrhosis and ascites were fed cholylsarcosine, cholylglycine (both at 70 mg/kg/d), or placebo for 2 weeks. Healthy rats, as controls, were treated similarly. In cirrhotic rats receiving placebo, bile secretion from an acute biliary fistula was lower than in healthy rats (27.2 +/- 6.5 vs. 53.0 +/- 3.1 microL/kg/min; mean +/- SE, P<.05). The administration of conjugated bile acids to cirrhotic rats normalized bile secretion (cholylsarcosine, 51.8 +/- 6.29; cholylglycine, 52.72 +/- 8.9 microL/kg/min). Total ileal bacterial content was 6-fold higher in ascitic cirrhotic rats than in healthy rats. Conjugated bile acid administration reduced bacterial content to normal levels. Bacterial translocation was less in cirrhotic animals receiving conjugated bile acids (cholylsarcosine, 33%; cholylglycine, 26%) than in animals receiving placebo (66%). Endotoxemia was decreased in cirrhotic rats by conjugated bile acid feeding (cholylsarcosine, 0.098 +/- 0.002; cholylglycine 0.101 +/- 0.007 EU/mL) compared with placebo (0.282 +/- 0.124, P <.001). Survival was greater in animals receiving conjugated bile acids (cholylsarcosine, 10/15; cholylglycine, 11/15; placebo, 5/15). In conclusion, the administration of conjugated bile acids to ascitic cirrhotic rats increased bile acid secretion, eliminated intestinal bacterial overgrowth, decreased bacterial translocation, decreased endotoxemia, and increased survival. Oral conjugated bile acids may be useful in preventing bacterial translocation, endotoxemia, and spontaneous bacterial perotonitis in cirrhotic patients.
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Affiliation(s)
- Vicente Lorenzo-Zúñiga
- Departments of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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15
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Cardona PJ, Llatjós R, Gordillo S, Díaz J, Viñado B, Ariza A, Ausina V. Towards a 'human-like' model of tuberculosis: intranasal inoculation of LPS induces intragranulomatous lung necrosis in mice infected aerogenically with Mycobacterium tuberculosis. Scand J Immunol 2001; 53:65-71. [PMID: 11169208 DOI: 10.1046/j.1365-3083.2001.00842.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is well known that one of the differences between murine and human tuberculosis is the lack of intragranulomatous necrosis in the former. The aim of this study was to create a feasible and reproducible model of an experimental model of murine tuberculosis in which this necrosis should be present. Considering the Shwartzman reaction as a possible explanation for intragranulomatous necrosis in human tuberculosis, C57Bl/6 mice, infected aerogenically with a virulent strain of Mycobacterium tuberculosis, were intranasally inoculated with lipopolysaccharide (LPS) on day 19 postinfection (p.i.). Twenty-four hours later, neutrophils infiltrated the lung parenchyma in a significant level, and 10 days after necrosis could be detected in the centres of primary granulomas, that showed scanty macrophages and large amounts of collagen on an eosinophilic background. On the other hand, a significant decrease in the concentration of colony forming units (CFU) could be appreciated 24 h after the LPS inoculation. Afterwards, nonbronchogenic spreading of granulomas increased and higher levels of interferon (IFN)-gamma mRNA were detected. These results lend support to the Shwartzman reaction as the origin of the intragranulomatous necrosis in the M. tuberculosis infection, and provides a useful tool to improve experimental murine models in tuberculosis.
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MESH Headings
- Administration, Intranasal
- Aerosols
- Animals
- Cytokines/biosynthesis
- Cytokines/genetics
- Disease Models, Animal
- Female
- Gene Expression Regulation
- Humans
- Interferon-gamma/biosynthesis
- Interferon-gamma/genetics
- Lipopolysaccharides/administration & dosage
- Lipopolysaccharides/toxicity
- Lung/metabolism
- Lung/pathology
- Macrophages, Alveolar/physiology
- Mice
- Mice, Inbred C57BL
- Models, Animal
- Mycobacterium tuberculosis
- Necrosis
- Neutrophil Infiltration
- RNA, Messenger/biosynthesis
- Shwartzman Phenomenon
- Species Specificity
- Specific Pathogen-Free Organisms
- Tuberculoma/etiology
- Tuberculoma/pathology
- Tuberculosis, Pulmonary/etiology
- Tuberculosis, Pulmonary/genetics
- Tuberculosis, Pulmonary/pathology
- Tuberculosis, Pulmonary/transmission
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Affiliation(s)
- P J Cardona
- Unitat de Tuberculosi Experimental, Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Catalonia, Spain.
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16
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Pardo A, Bartolí R, Lorenzo-Zúñiga V, Planas R, Viñado B, Riba J, Cabré E, Santos J, Luque T, Ausina V, Gassull MA. Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis. Hepatology 2000; 31:858-63. [PMID: 10733540 DOI: 10.1053/he.2000.5746] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Deranged intestinal motility, which occurs in cirrhosis, may facilitate the development of intestinal bacterial overgrowth (IBO), which can lead to bacterial translocation (BT). To assess the effect of cisapride on IBO and BT in cirrhosis, cirrhotic rats received cisapride or a placebo for 7 days, and measurements of jejunal bacterial content and BT studies were performed. In addition, jejunal fluid from 46 cirrhotic patients was obtained for quantitative bacterial culture. Those patients in whom gram-negative IBO was detected were randomized to receive or not to receive cisapride (20 mg twice per day) for 1 week. Cisapride significantly reduced IBO in cirrhotic rats. In addition, no BT was documented in treated animals, whereas it occurred in 40% in nontreated cirrhotic rats. Total IBO was documented in 23 of 46 cirrhotic patients, which was caused by gram-negative organisms in 10 cases. Orocecal transit time (OCT) significantly decreased after cisapride therapy, and was associated with the abolishment of bacterial overgrowth caused by gram-negative organisms in 4 out of 5 treated patients, whereas it persisted in nontreated cases. Cisapride administration to cirrhotic rats resulted in a reduction of the IBO, which is associated with a marked decrease in BT. On the other hand, cisapride facilitates the abolition of IBO caused by gram-negative organisms in cirrhotic patients.
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Affiliation(s)
- A Pardo
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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17
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Viñado B, Domínguez J, Rodrigo C, Matas L. [Resistance to erythromycin in strains of Streptococcus pyogenes isolated in the province of Barcelona]. Med Clin (Barc) 1999; 112:556. [PMID: 10363246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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18
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Manterola JM, Gamboa F, Padilla E, Lonca J, Matas L, Hernández A, Giménez M, Cardona PJ, Viñado B, Ausina V. Comparison of a nonradiometric system with Bactec 12B and culture on egg-based media for recovery of mycobacteria from clinical specimens. Eur J Clin Microbiol Infect Dis 1998; 17:773-7. [PMID: 9923517 DOI: 10.1007/s100960050183] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The MB/BacT (Organon-Teknika, USA) is a fully automated, rapid, nonradiometric system for the culture of mycobacteria from clinical samples. The rate of recovery of mycobacteria and the time to detection obtained with the MB/ BacT were compared with those obtained with Löwenstein-Jensen and Coletsos solid media and Bactec 7H12 (12B) (Becton-Dickinson, USA) broth when 600 processed specimens were inoculated into all media in parallel. Specimens included 383 respiratory samples, 20 urine samples, 23 purulent exudates, 13 stool samples, 103 blood samples, 14 bone marrow aspirates, and 44 body fluid samples or aspirates. Overall, 106 mycobacterial isolates comprising six species were recovered, of which 100 (94.3%) were detected with MB/BacT, 98 (92.5%) with egg-based media, and 96 (90.2%) with Bactec 12B. The recovery rates of Mycobacterium tuberculosis complex with MB/BacT, egg-based media, and Bactec 12B were 98.7%, 93.7, and 89.9%, respectively. The average number of days to detection of single mycobacterial isolates was 14.2 days for MB/BacT, 26.1 days for egg-based media, and 11.7 days for Bactec 12B. The contamination rates were higher in MB/BacT (5%) than in Bactec 12B (1.8%) or egg-based media (1.5%). MB/BacT is a reliable, nonradiometric, less labor-intensive alternative to Bactec 12B for recovery of mycobacteria, but, as with other liquid culture methods, MB/BacT should be used in combination with a solid medium, not on its own.
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Affiliation(s)
- J M Manterola
- Servicio de Microbiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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19
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Gamboa F, Manterola JM, Lonca J, Matas L, Cardona PJ, Padilla E, Viñado B, Domínguez J, Hernández A, Ausina V. Comparative evaluation of two commercial assays for direct detection of Mycobacterium tuberculosis in respiratory specimens. Eur J Clin Microbiol Infect Dis 1998; 17:151-7. [PMID: 9665295 DOI: 10.1007/bf01691110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Two commercial systems for the amplification and detection of Mycobacterium tuberculosis directly from respiratory samples were compared. The Roche Cobas Amplicor MTB Test and the Roche manual Amplicor MTB Test (Roche Diagnostic Systems, USA) were applied to 755 decontaminated respiratory specimens collected from 470 patients. Results were compared with those of acid-fast staining and culture. A total of 251 specimens were collected from 156 patients diagnosed with pulmonary tuberculosis, including 28 specimens corresponding to 13 patients that were receiving antituberculous treatment. Given the overall positivity rate of 33.2% (251/755), the sensitivity, specificity, and positive and negative predictive values were 92.4, 100, 100, and 96.5%, respectively, for the Cobas Amplicor MTB Test and 90.8, 100, 100, and 95.8%, respectively, for the Amplicor MTB Test. For 204 (81.3%) smear positive specimens and 47 (19.7%) smear negative specimens, the sensitivity values were 100 and 59.6%, respectively, for the Cobas Amplicor MTB Test and 100 and 51%, respectively, for the Amplicor MTB Test. There were no statistically significant differences in sensitivity or specificity between the two assays and culture (p>0.05). The overall results of both assays were concordant for 99.5% of the samples. It is concluded that although both nucleic acid amplification methods are rapid and specific for the detection of Mycobacterium tuberculosis complex in respiratory specimens, the Cobas Amplicor MTB Test appears to be slightly more sensitive than the Amplicor MTB Test when smear negative specimens are investigated.
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Affiliation(s)
- F Gamboa
- Servicio de Microbiología, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
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20
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Llovet JM, Bartolí R, March F, Planas R, Viñado B, Cabré E, Arnal J, Coll P, Ausina V, Gassull MA. Translocated intestinal bacteria cause spontaneous bacterial peritonitis in cirrhotic rats: molecular epidemiologic evidence. J Hepatol 1998; 28:307-13. [PMID: 9580278 DOI: 10.1016/0168-8278(88)80018-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS Intestinal bacterial translocation is common in cirrhotic rats with spontaneous bacterial peritonitis, and it is thought to play a major pathogenic role. There has so far been no evidence for clonality between bacteria isolated from intestine and ascites. This study aimed to use molecular epidemiology techniques to show that spontaneous bacterial peritonitis is due to translocated intestinal bacteria. METHODS Samples of ascitic fluid, portal blood, mesenteric lymph nodes and ileal contents from healthy (n=10) and ascitic cirrhotic rats with (n=12) or without (n=15) spontaneous bacterial peritonitis were cultured. In six infected rats, DNA macrorestriction fragments of 30 bacterial isolates [Escherichia coli (n=13), Enterococcus faecalis (n=12) and Proteus mirabilis (n=5)] from ascites (n=8), mesenteric lymph nodes (n=7), portal blood (n=6), and ileal flora (n=9) were compared. RESULTS Bacterial translocation was more frequent in animals with (58%) than in those without spontaneous bacterial peritonitis (20%, p=0.049) or controls (10%, p=0.026). The same bacterial strain was simultaneously isolated in ascites and in mesenteric lymph nodes and/or ileum in 7/8 (87%) instances. The identity rate for bacteria present in both ascites and mesenteric lymph nodes was 80% (4/5). Likewise, identity was demonstrated in 3/4 instances of bacteria found in both ascites and portal blood. CONCLUSIONS These results indicate that spontaneous bacterial peritonitis in cirrhotic rats is mainly due to intestinal bacteria translocated to mesenteric lymph nodes. Portal blood could be a less frequent route.
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Affiliation(s)
- J M Llovet
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
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21
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Gamboa F, Manterola JM, Lonca J, Viñado B, Matas L, Giménez M, Manzano JR, Rodrigo C, Cardona PJ, Padilla E, Dominguez J, Ausina V. Rapid detection of Mycobacterium tuberculosis in respiratory specimens, blood and other non-respiratory specimens by amplification of rRNA. Int J Tuberc Lung Dis 1997; 1:542-55. [PMID: 9487453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
SETTING Diagnostic methods employing gene technology based on amplification of DNA or RNA are expected to improve the speed, sensitivity, and specificity of Mycobacterium tuberculosis detection. The Amplified Mycobacterium Tuberculosis Direct Test (AMTDT) enables the amplification and detection of M. tuberculosis rRNA directly from respiratory specimens. OBJECTIVE To evaluate the performance of the AMTDT in direct detection of M. tuberculosis in respiratory specimens, blood and other clinical samples, and to compare this method with conventional culture and staining techniques. DESIGN A total of 554 samples from 450 patients were examined in this study. All clinical specimens (with the exception of bone marrow aspirates and blood samples) were digested and decontaminated with sodium dodecyl (lauryl) sulfate (SDS)-NaOH. Bone marrow aspirates and blood samples were treated with 10% SDS. All processed samples were stained by auramine-rhodamine fluorochrome and inoculated onto Löwenstein-Jensen and Coletsos solid media, and into BACTEC-12B medium. In addition, the blood samples were inoculated into BACTEC 13A medium. The AMTDT was performed according to manufacturer's instructions. In those cases where discrepant results were obtained for AMTDT and cultures, patients' clinical data and other microbiological results were evaluated. RESULTS The sensitivity, specificity, and positive and negative predictive values for AMTDT were 87.5, 100, 100, and 96.7%, respectively, in respiratory specimens and 86.8, 100, 100, and 92.8%, respectively, in non-respiratory specimens. The differences in sensitivity of these two groups of specimens were not highly statistically significant (P > 0.005). CONCLUSION The sensitivity and specificity of the AMTDT were satisfactory for detection of M. tuberculosis in all types of clinical samples. Some minor changes in assay format and laboratory protocols may increase the sensitivity of the AMTDT without adversely affecting its specificity.
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Affiliation(s)
- F Gamboa
- Servicio de Microbiología, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
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22
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Gamboa F, Manterola JM, Lonca J, Matas L, Viñado B, Giménez M, Cardona PJ, Padilla E, Ausina V. Detection and identification of mycobacteria by amplification of RNA and DNA in pretreated blood and bone marrow aspirates by a simple lysis method. J Clin Microbiol 1997; 35:2124-8. [PMID: 9230395 PMCID: PMC229916 DOI: 10.1128/jcm.35.8.2124-2128.1997] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A sodium dodecyl (lauryl) sulfate method was evaluated for the preparation of blood specimens and bone marrow aspirates for use in two amplification procedures (Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test [AMTDT] and Roche Amplicor M. avium/M. intracellulare [MAI] Test) for the detection and identification of Mycobacterium tuberculosis and M. avium and M. intracellulare, respectively. The AMTDT is based on amplification of rRNA, whereas the Amplicor MAI Test amplifies a specific DNA region of the 16S rRNA gene. The results of amplification techniques were compared with those of standard culture and culture in BACTEC 13A and BACTEC 12B liquid media. A total of 121 blood specimens and 15 bone marrow aspirates were collected from 136 AIDS patients. Mycobacterial growth was recovered for 103 specimens; 35 yielded M. tuberculosis, 62 yielded M. avium, 5 yielded M. genavense, and 1 yielded M. kansasii. The values of sensitivity and specificity in pretreated specimens for detection of M. tuberculosis by the AMTDT were 94.3 and 100%, respectively, and those for detection of M. avium by the Amplicor MAI Test were 91.9 and 100%, respectively. The simple lysis method described in the present work allows the recovery of mycobacteria from blood specimens and bone marrow aspirates and may be used in combination with the AMTDT and the Amplicor MAI Test to detect and identify different members of the genus Mycobacterium. This method might also be applicable for the identification of mycobacteria from blood culture fluids with acridinium-ester-labeled DNA probes.
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Affiliation(s)
- F Gamboa
- Servicio de Microbiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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23
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Gamboa F, Manterola JM, Viñado B, Matas L, Giménez M, Lonca J, Manzano JR, Rodrigo C, Cardona PJ, Padilla E, Domínguez J, Ausina V. Direct detection of Mycobacterium tuberculosis complex in nonrespiratory specimens by Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test. J Clin Microbiol 1997; 35:307-10. [PMID: 8968935 PMCID: PMC229566 DOI: 10.1128/jcm.35.1.307-310.1997] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (AMTDT) was adapted for the detection of Mycobacterium tuberculosis complex in 224 nonrespiratory specimens from 188 patients. The sensitivity and specificity of the AMTDT for such specimens, after resolution of discrepant results, were 85.7 and 100%, respectively. Pretreatment of nonrespiratory specimens with sodium dodecyl (lauryl) sulfate is mandatory to obtain consistent and reproducible AMTDT results. The use of 500 microliters of decontaminated specimen improves the sensitivity of the test. Because the AMTDT detects stable rRNA from noncultivable bacilli, it is not useful for monitoring patients receiving treatment.
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Affiliation(s)
- F Gamboa
- Servicio de Microbiología, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
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24
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Giménez M, Sopena N, Viñado B, Cardona PJ, Pedro-Botet ML, Coroleu W, Arnal J. [Invasive Streptococcus agalactiae infections at a general university hospital over a 10-year period]. Enferm Infecc Microbiol Clin 1996; 14:300-3. [PMID: 8744369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Streptococcus agalactiae is a known causal agent of neonatal meningitis, sepsis and puerperal infections. The incidence of invasive infections caused by Streptococcus agalactiae has increased in recent years in non gestating adults: in the elderly, patients receiving prolonged steroid treatment or those with chronic immunosuppressive diseases. The clinical and epidemiological characteristics and risk factors associated to invasive infections caused by S. agalactiae were analyzed. METHOD A retrospective study was undertaken in patients with invasive disease by S. agalactiae attended in the Hospital Universitari Germans Trias i Pujol in Badalona (Barcelona), Spain, from 1983 to 1993. RESULTS S. agalactiae was isolated in 51 patients including 13 (25%) neonates. Three patients presented invasive puerperal infection. Thirty-five adult patients with a mean age of 62 years presented invasive disease. Infection involved bacteremia in 26 (74.2%) patients. S. agalactiae was isolated in the ascitic fluid of 4 patients with liver cirrhosis with spontaneous bacterial peritonitis (one with bacteriemia) and in the peritoneal exudate of two patients with peritonitis secondary to intestinal perforation. Of 5 patients with septic arthritis, 3 involved bacteremia. Two patients presented empyema by S. agalactiae. Mortality was 28%, being directly related with infection in 4 cases (7.8%). CONCLUSIONS Without taking pregnant women into account, 68% of the cases of invasive infections by S. agalactiae were observed in adults with associated base disease, with liver cirrhosis, neoplasms and diabetes mellitus being the most frequent. Advanced age was also found to be an important predisposing factor.
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Affiliation(s)
- M Giménez
- Servicio de Microbiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
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25
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Llovet JM, Bartolí R, Planas R, Viñado B, Pérez J, Cabré E, Arnal J, Ojanguren I, Ausina V, Gassull MA. Selective intestinal decontamination with norfloxacin reduces bacterial translocation in ascitic cirrhotic rats exposed to hemorrhagic shock. Hepatology 1996; 23:781-7. [PMID: 8666332 DOI: 10.1002/hep.510230419] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Bacterial translocation (BT) can be involved in the pathogenesis of severe infections due to bacteria of enteric origin that complicates bleeding cirrhotic patients. To assess the effect of hemorrhagic shock (HS) on the incidence of BT and if selective intestinal decontamination (SID) reduces this incidence, we studied six groups of Sprague-Dawley rats: ascitic rats, ascitic rats exposed to HS with and without previous norfloxacin prophylaxis, healthy rats, and healthy shocked rats with and without previous norfloxacin prophylaxis. BT tended to be higher in ascitic rats with shock than without shock (69% vs. 41%, P = .15) and was significantly higher in healthy rats with than without shock (50 percent vs. 0 percent, P = .01). Norfloxacin significantly reduced translocation in ascitic shocked rats in comparison with nondecontaminated ascitic shocked rats (31 percent vs. 69 percent, P = .038). This effect was due mainly to a reduction of gram-negative BT (O percent vs. 37 percent, P = .008). In addition, norfloxacin prevented translocation in healthy shocked rats. Accordingly, aerobic gram-negative bacteria disappeared from fecal flora in all rats administered norfloxacin, except for Klebsiella species in one control rat. Cecal severe submucosal edema, chronic inflammatory infiltrate, and intestinal lymphangiectasia were significantly more frequent in ascitic rats than in control rats. Intestinal mucosal injury related with HS, particularly subepithelial cecal edema, was observed only in ascitic shocked rats. In conclusion, HS increases the incidence of BT both in ascitic cirrhotic and healthy rats. Norfloxacin reduces significantly the incidence of translocation after shock, especially in those cases caused by aerobic gram-negative bacilli.
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Affiliation(s)
- J M Llovet
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
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26
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Ausina V, Riutort N, Viñado B, Manterola JM, Ruiz Manzano J, Rodrigo C, Matas L, Giménez M, Tor J, Roca J. Prospective study of drug-resistant tuberculosis in a Spanish urban population including patients at risk for HIV infection. Eur J Clin Microbiol Infect Dis 1995; 14:105-10. [PMID: 7758474 DOI: 10.1007/bf02111867] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
From January 1988 to October 1992, the primary resistance to first-line antituberculous drugs in 501 tuberculous patients was evaluated prospectively. Three-hundred and seventeen patients were HIV-negative and 184 were HIV-positive; these patients had several different clinical forms of tuberculosis. Moreover, the acquired resistance to antituberculous drugs was studied in 295 non-AIDS patients and in 42 AIDS patients with evidence of antecedent tuberculosis treatment. The data indicated that during these five years there was no consistent and clear-cut trend toward greater frequency of primary drug resistance to any of the first-line antituberculous drugs. Primary drug resistance in HIV-positive patients (7.1%) did not differ significantly (p > 0.05) from that found in HIV-negative patients (8.2%). Among HIV-positive patients, the acquired drug resistance pattern was similar to that detected in HIV-negative patients although the frequency of resistance in the former (69%) was significantly higher (p < 0.01). During the study, resistance to isoniazid was almost constant in the acquired-resistance cases and was frequently associated with resistance to other drugs. Furthermore, the acquired resistance to isoniazid was often of a higher level (1 to 10 mg/l) than the primary resistance (0.2 mg/l), and those strains were usually catalase and peroxidase negative.
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Affiliation(s)
- V Ausina
- Microbiology Laboratory, Sta. Cruz and San Pablo Hospital, Barcelona, Spain
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