Concerning the presumptive identification of Candida kefyr on Uriselect™4 agar

OBJECTIVE

Non-albicans Candida species, such as Candida kefyr, are emerging pathogens. Chromogenic media are highly useful for the diagnosis of urinary tract infections (UTIs). The aim was to describe the behavior of this specie on a non-specific chromogenic medium.

METHODS

A retrospective study of cases of candiduria detected in the Microbiology laboratory of the Virgen de las Nieves Hospital in Granada (Spain) between 2016 and 2021 (N=2,130). Urine samples were quantitatively seeded on non-selective UriSelect™4 chromogenic agar.

RESULTS

Between 2016 and 2021, C. kefyr was the seventh most frequent Candida species responsible for candiduria in our setting (n=15). The macroscopic appearance of C. kefyr colonies, punctiform and bluish, allowed the direct identification of these microorganisms.

CONCLUSIONS

This study provides the first description of the specific behavior of C. kefyr on UriSelect™4 agar, which differentiates it from other Candida species based on its enzymatic characteristics.

[Microbial etiology of bacterial chronic prostatitis: systematic review]

OBJECTIVE

The importance of Gram-positive microorganisms and atypical bacteria in chronic bacterial prostatitis (CBP) has recently been described. For this reason, this study analyzes the etiology of CBP, as well as the evolution of antibiotic resistance through a systematic review.

METHODS

A systematic review of studies obtained through the MEDLINE (PubMed) database, related to the etiology and antibiotic resistance profile of CBP, published up July 1, 2021.

RESULTS

The most frequent isolated microorganisms that we have found in publications are Enterococcus faecalis (46.90%), Staphylococcus spp. (22.30%), Escherichia coli (15.09%) and atypical bacteria (6.04%).

CONCLUSIONS

CBP is undergoing and unprecedented change of paradigm. Gram-positive bacteria and atypical bacteria are the main pathogens involved in the aetiology of this entity. This forces us to rethink the therapeutic strategy used, since it is necessary to use antibiotics that assume the etiological change and the profile of antibiotic resistance described.

[Shigellosis attended in the emergency department of a regional hospital in southeastern Spain: from their presence to multiresistance]

OBJECTIVE

In the bacterial etiology of severe acute infectious diarrhea, except that caused by Clostridioides difficile, most of them have an invasive character and antibiotic treatment will be necessary in specific situations. Shigella is a classic pathogen, in which it is crucial to know the sensitivity to different classic and alternative antimicrobials. The objective of this work was to analyze the presence of shigellosis and the rate of antibiotic resistance.

METHODS

A descriptive-retrospective study of the reports of shigellosis of stool cultures issued between January 2016 and April 2022 was conducted.

RESULTS

A total of 34 episodes (16 -47.1%- by Shigella sonnei) were observed, as of 2018. There were only 2 pediatric cases. The overall resistance rate to azithromycin, trimethoprim-sulfamethoxazole and ciprofloxacin was 52.9%, 64.7% and 44.1%, respectively. 26.5% were resistant to the 3 groups of antibiotics. There was a higher rate of resistance for S. sonnei. The emergence of resistance to cephalosporins in recent years stands out. Episodes of multidrug-resistant shigellosis were detected between 2020 (1 by S. flexneri) and 2022 (4 by S. sonnei).

CONCLUSIONS

The episodes of shigellosis are emerging in our environment with a higher rate of multi-resistance. In this context, current empirical treatments for acute enteroinvasive enteritis are at risk of failure, if necessary.

[Antibiotic resistance changes in episodes of symptomatic bacteriospermia: development in a health area of southeast Spain]

OBJECTIVE

Chronic bacterial prostatitis (CBP) is an entity of difficult clinical diagnosis and treatment, being the microbiological study of semen the main diagnostic test. This study aimed to determine the etiology and antibiotic resistance in patients with symptomatic bacteriospermia (SBP) in our environment.

METHODS

A cross-sectional and retrospective descriptive study has been carried out from a Regional Hospital of the Spanish Southeast. The participants were patients assisted in the consultations of the Hospital with clinic compatible with CBP, between 2016 and 2021. The interventions were collection and analysis of the results derived from the microbiological study of the semen sample. The main determinations were the etiology and rate of antibiotic resistance of BPS episodes are analyzed.

RESULTS

The main isolated microorganism is Enterococcus faecalis (34.89%), followed by Ureaplasma spp. (13.74%) and Escherichia coli (10.98%). The rate of antibiotic resistance of E. faecalis to quinolones (11%) is lower than previous studies, while for E. coli it has been higher (35%). The low rate of resistance shown by E. faecalis and E. coli to fosfomycin and nitrofurantoin stands out.

CONCLUSIONS

In the SBP, gram-positive and atypical bacteria are established as the main causative agents of this entity. This forces us to rethink the therapeutic strategy used, which will avoid the increase in antibiotic resistance, recurrences, and chronicity of this pathology.

[Infections in patients colonized with carbapenem-resistant Gram-negative bacteria in a medium Spanish city]

OBJECTIVE

Because there are few studies on the clinical implications of colonization by carbapenem-resistant gram-negative bacteria (CRB) this was analyzed in rectal smears (RS) and pharyngeals (PS) and its ability to predict infection/colonization.

METHODS

A cross-sectional, retrospective study from adult inpatients between January 2016 and December 2019 was conducted. The isolates were characterized by MicroScan and spectrometry of masses applying EUCAST 2018 cutoff points. The detection of carbapenemases was performed by PCR and Sanger sequencing; sequencies was assigned by MLST. The genetic relationship between the clinical isolates was made by pulsed field electrophoresis using the enzymes Xbal, Spel or Apal.

RESULTS

A total of 308 (86.03%) RS and 50 (13.97%) positive PS were detected, the RS had a 85% sensibility, 100% specificity, 100% positive predictive value and 97% negative predictive value. In RS, the following were isolated: 44% (n=135) Acinetobacter baumannii, 26% (n =80) Enterobacterales (20 KPC, 29 OXA-48, 22 VIM, 2 IMP, 7 NDM), 17% (n=53) Pseudomonas aeruginosa and 13% (n=40) Stenotrophomonas maltophilia. In the PS were isolated 44% (n=22) S. maltophilia, 40% (n = 20) A. baumannii, 8% (n=4) P. aeruginosa and 8% (n=4) Enterobacterales (3 VIM, 1 OXA). From the patients with simultaneous RS and PS, 41 (40.6%) had positivity in both smears, 45 (44.6%) only in RS and 15 (14.9%) only in PS. Colonization preceded infection in 81.3% (n=13) of the isolates; association between infection and colonization was found (p<0.001; χ2); and the episodes where the information was found all the isolates from the clinical samples and from the smears were similar.

CONCLUSIONS

The probability of predicting infection through the CRB colonized in different clinical samples is feasible. The RS has a major sensibility to detect colonization.

[Increased infections by herpes simplex virus type 1 and polymicrobials of the genital tract, in the general population of a Spanish middle city]

Introducción

Las infecciones por genitopatógenos son un motivo de consulta frecuente en Atención Primaria y en las especialidades de Enfermedades Infecciosas, Urología, Ginecología y Dermatología. Las causas más comunes son los microorganismos oportunistas y los responsables de las infecciones de transmisión sexual asociadas a prácticas sin protección. El objetivo de este trabajo es determinar los microorganismos que causan estas infecciones en los pacientes atendidos en el Hospital Universitario Virgen de las Nieves de Granada y la sensibilidad a los antibióticos de Neisseria gonorrhoeae.

Material y métodos

Se realizó un estudio transversal y retrospectivo, en el que se incluyeron los resultados emitidos, entre enero de 2018 y diciembre de 2019, en el Laboratorio de Microbiología a partir de todos los episodios estudiados mediante procedimiento normalizados de trabajo.

Resultados:

Los microorganismos más frecuentemente detectados fueron Gardnerella vaginalis (23,81%) seguido de Candida spp. (20,9%), sobre todo en mujeres, N. gonorrhoeae (11,36%) y Ureaplasma urealyticum (11,99%), sobre todo en hombres. En multitud de ocasiones se presentaron de forma combinada. En cuanto a los virus del herpes simple, en hombres la infección por ambas especies tuvo una presencia similar (50%), mientras que en mujeres el tipo 1 fue más prevalente (76,52%). Los antibióticos más activos frente a N. gonorrhoeae fueron cefotaxima (98%) y cefixima (100%), siendo poco activo tetraciclina (39,02%).

Conclusiones

Los patógenos más frecuentes correspondieron a aquellos que han causado habitualmente infecciones en las mujeres, aunque N. gonorrhoeae fue el más frecuente en varones y las infecciones mixtas no son un hallazgo casual. Las infecciones por VHS-1 fueron más frecuentes que por VHS-2, lo cual confirma la tendencia de un cambio en la epidemiología del herpes genital.

Update on the Diagnosis of Sexually Transmitted Infections

Sexually transmitted infections (STIs) are one of the most frequent and universal Public Health problems. Health professionals should be aware of the possibility of STIs due to their high morbidity and the presence of sequelae. The delay in the diagnosis is one of the factors that justifies the difficulty to infections control. Diagnostic tests allow the introduction of aetiological treatment and also lead to treating symptomatic and asymptomatic patients more effectively, as well as to interrupt the epidemiological transmission chain without delay. In this review we have made an update of the main existing diagnostic methods for the more important STIs.

West Nile virus outbreak in humans and epidemiological surveillance, west Andalusia, Spain, 2016

In Andalusia, Spain, West Nile virus (WNV) surveillance takes place from April to November, during the active vector period. Within this area seroconversion to this virus was evidenced in wild birds in 2004, affecting horses and two humans for the first time in 2010. Since 2010, the virus has been isolated every year in horses, and national and regional surveillance plans have been updated with the epidemiological changes found. WNV is spreading rapidly throughout southern Europe and has caused outbreaks in humans. Here we describe the second WNV outbreak in humans in Andalusia, with three confirmed cases, which occurred between August and September 2016, and the measures carried out to control it. Surveillance during the transmission season is essential to monitor and ensure prompt identification of any outbreaks.

Evolution of the antibiotic-resistance of microorganisms causing urinary tract infections: A 4-year epidemiological surveillance study in a hospital population

BACKGROUND

Urinary tract infections (UTIs) are the leading cause of infection in hospitalised patients. In this study, we describe the most common pathogens involved in the development of UTIs in hospitalised patients, their antibiotic-sensitivity profile and the activity evolution of antibiotics in standard use for treating these infections.

METHODS

We retrospectively assessed the results of cultures and antibiograms from urine samples from adult patients hospitalised in the Hospital Complex Virgen de la Nieves (Granada, Spain) with a microbiological confirmation of UTI between January 2013 and December 2016.

RESULTS

We identified 4,347 microorganisms (3,969 bacteria and 378 yeasts). During the 4years of the study, Escherichia coli was the most common species isolated in both sexes; however, 62.9% of the UTIs were caused by other microorganisms. The presence of multiresistant microorganisms such as Acinetobacterspp. (1.2%) and extended-spectrum beta-lactamase-producing enterobacteria (10.0%) and carbapenemase-producing enterobacteria (0.3%) were also relevant findings. Imipenem, piperacillin-tazobactam and fosfomycin presented activity rates above 80%, considering all causal microorganisms of UTI, while the other tested antibiotics presented activity rates below 70%.

CONCLUSION

Imipenem and piperacillin-tazobactam were the most active antibiotics in hospital use, which makes them first-line antibiotics in the empiric treatment of UTIs in this healthcare setting. The use of other antibiotics should be limited to conditions of demonstrated or highly probable sensitivity.

Urinary tract infection by aerococcus sanguinicola. An emerging opportunistic pathogen

Elderly patients with underlying urological disease have a greater risk of urinary tract infections due to uncommon pathogens. The disease caused by Aerococcus has been underestimated, but mass spectrometry could be a simple method for identifying this pathogen. In this study, we report 2 cases of urinary tract infection by Aerococcus sanguinicola. A descriptive clinical-microbiological study was conducted on the presence of A. sanguinicola causing urinary tract infections. The presence of A. sanguinicola occurred in elderly patients with previous urological disease and a significant count in urine obtained through bladder catheterisation. Correct identification was achieved through mass spectrometry, and the clinical outcome of administering amoxicillin and cefuroxime was satisfactory. In this study, we also report the pathogenic capacity of A. sanguinicola. When there is a significant number of alpha-haemolytic microorganisms in the urine cultures, A. sanguinicola should be ruled out before reporting a result as urogenital microbiota.

[Performance of the KAtex test in screening and diagnosis for visceral leishmaniasis in a reference hospital]

OBJECTIVE

Performing of diagnostic test simple using samples not invasive in the diagnosis of visceral leishmaniasis (VL) may be very beneficial, being necessary comparing to traditional methods. The objective of this study was to know the reliability of test KAtex in the urine of patients with suspicion of VL.

METHODS

Retrospectively were reviewed the medical histories of patients with suspected of VL to which are performed the test between 2009 and 2015. For its analysis were selected the patients to which is them had made study of the parasite in bone marrow.

RESULTS

A total of 110 patients were studied, and bone marrow biopsy for research of Leishmania was performed in 44 (40%). In these patients the sensitivity of the test was 50%, the specificity of 96.7%, positive predictive value of 87.5% and negative predictive value of 80.5%.

CONCLUSIONS

KAtex antigenuria sensitivity is too low recommending it as a unique method in the detection of VL in our medium.

Clinical and microbiological findings of septic arthritis caused by Haemophilus parainfluenzae

OBJECTIVES

To report a case of septic arthritis due to H. parainfluenzae and to review the clinical and microbiological characteristics of published case patients.

PATIENTS AND METHODS

Data was collected on age, sex, infection localization, underlying risk factors, symptom onset-diagnosis interval, analytical findings, microbiological diagnosis, treatment, outcome, and follow-up of the present patient (presenting with septic arthritis of the pubic symphysis due to H. parainfluenzae) and those identified in a literature analysis.

RESULTS

Data of 18 patients, including 17 reported case patients, was collected. Mean age at presentation was 51±9 years. Underlying diseases for septic arthritis were recorded in 11 patients. The infection site was the knee in eight patients, hip and/or acromioclavicular joint in five. Pain was observed in 15 patients and fever in 10; the mean symptom onset-diagnosis interval was 9.4 days. Diagnosis was obtained from synovial fluid aspirate in 12 patients and from blood cultures in four. Susceptibility of H. parainfluenzae strains was reported in 12 cases. Eight patients were treated with cephalosporins and 10 with penicillins. A favorable outcome was observed in 13 patients.

CONCLUSIONS

Septic arthritis caused by H. parainfluenzae is a rare entity that requires a high level of suspicion before application of laboratory methods for rapid diagnosis and treatment.

Pleural effusion due to Parvimonas micra. A case report and a literature review of 30 cases

The clinical and microbiological characteristics of infections caused by Parvimonas micra is described, including 30 cases in the literature and a new case handled at the present centre. Out of the 31 patients, 18 were male; mean age at diagnosis was 65.1 ± 13.0 years. Infection site was the vertebral spine in 14 patients and joints and heart valves in 5 each one; pain was present in all patients with articular localization and in almost all patients with vertebral involvement. The diagnosis was obtained from fluid aspirate or drainage in 13 cases and blood cultures in 11. In 8 cases, molecular techniques were also applied. The most frequently used antimicrobials were clindamycin, penicillin, amoxicillin and ceftriaxone. The outcome was positive with the medical treatment in 28 patients. P. micra infections are uncommon and requires a high index of suspicion.

First report of NDM-1-producing clinical isolate of Leclercia adecarboxylata in Spain

We describe the case of NDM-1-producing Leclercia adecarboxylata recovered from the clinical sample of a patient hospitalized for a trauma-related injury to his foot. The isolate was resistant to all beta-lactams, quinolones, trimetroprim-sulfametoxazol, gentamicin and tobramicyn. The bla_NDM-1 gene was located in a conjugative plasmid that also contained the bla_SHV-12 gene and was preceded by a disrupted insertion sequence of ISAba125. The plasmid belongs to the incompatibility group X3, which is known to be an important vector for NDM-1 dissemination in China. This is the first reported case of NDM-1L. adecarboxylata in our country and evidences that species of uncertain clinical relevance can act as hidden sources of clinically important resistance determinants.

A new case report of urinary tract infection due to KPC-3-producing klebsiella pneumoniae (ST258) in Spain

OBJECTIVE

We describe the characterization of a new isolated in Spain of Klebsiella pneumoniae ST258 producing KPC-3, carbapenems non-susceptible, recovered from a sample of urine from a patient with urinary tract infection and no history of carbapenems exposure.

METHODS

After the isolation, identification of K. pneumoniae was performed by biochemical tests and mass spectrometry. The carbapenems susceptibility testing was performed by microdilution and E-test in cation-adjusted Mueller-Hinton. The study was completed by Rapidec® Carba NP. In order to determine the genetic basis of resistance to carbapenems we used Xpert® Carba-R for carbapenemase type and subtype was subsequently analyzed by amplification by PCR and sequencing.

RESULT

We demonstrated by MLST that the strain belonged to the clone of high-risk ST258.

CONCLUSIONS

This is the first characterization, in our media, of a clinical isolated of K. pneumoniae ST258 producing KPC-3 and no history of carbapenems exposure.

[Tuberculous prosthetic knee joint infection: a case report and literature review]

OBJECTIVE

Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized.

CASE

Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago. Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014.

CONCLUSIONS

Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection.

Clinical interest of Streptococcus bovis isolates in urine

OBJECTIVE

Streptococcus bovis includes variants related to colorectal cancer and non-urinary infections. Its role as urinary pathogen is unknown. Our objective was to assess the presence of urinary infection by S. bovis, analysing the patients and subsequent clinical course.

METHODS

Observational study, with longitudinal data collection, performed at our centre between all the cultures requested between February and April 2015. Clinical course of the patients and response to treatment were analysed.

RESULTS

Two thousand five hundred and twenty urine cultures were analysed, of which 831 (33%) had a significant microbial count. S. bovis was isolated in 8 patients (0.96%). In 75% of these cases the urine culture was requested because of urinary tract infection symptoms; the remaining 25% because of fever of uncertain source; during the follow-up period no evidence of cancer or endocarditis was detected. S. gallolyticus subspecie pasteurianus was the only variant observed (100%). The clinical response to initial treatment was favourable in all cases.

CONCLUSIONS

S. bovis bacteriuria may have clinical significance, especially when S. gallolyticus subspecies pasteurianus is isolated in cases with underlying urinary tract disease.

[Detection of unusual uropathogens during a period of three years in a regional hospital]

Urinary tract infections (UTIs) are one of the most frequent both in the community and in hospitals infectious diseases. The etiology of urinary tract infections is well established but may vary depending on various factors such as age, the presence of underlying diseases such as diabetes, instrumental procedures such as urinary catheterization or exposure to antibiotics or previous hospitalizations. UTIs diagnosed cases were retrospectively reviewed for unusual microorganisms over a period of 3 years (2011-2013) in the Microbiology Laboratory of the Hospital Virgen de las Nieves of Granada (Spain), following the standard operating procedure, which we describe four cases caused by Trichosporon asahii, Aerococcus urinae, Pasteurella bettyae and Neisseria sicca. Hence the importance of having in the Clinical Microbiology Laboratory of the tools necessary to detection UTIs and reach a correct identification in all cases.

Human rhabdomyosarcoma cells for rapid detection of enteroviruses by shell-vial assay

The ability of the RD (rhabdomyosarcoma) and MRC-5 cell-lines to detect enteroviruses in 33 clinical samples (cerebrospinal fluid, stools and throat swabs) was evaluated. The samples had previously tested enterovirus-positive by traditional tube-culture and had been frozen after their initial processing. By traditional tube-culture, 100 and 85 % of samples were positive for enterovirus in RD and MRC-5 cells, respectively. By rapid shell-vial assay, 94 and 45.5 % were positive after 48 h incubation in RD and MRC-5 cells, respectively. RD cells supported growth of all enterovirus serotypes, whereas MRC-5 cells were not able to detect any of the three coxsackieviruses that were found (one coxsackievirus A9 and two coxsackievirus B5). The shell-vial assay with RD cell-lines may be a useful tool for rapid diagnosis of enteroviral infection.

The impact of influenza viruses on hospitalizations in infants younger than two years old during epidemics of respiratory syncytial virus infection

In order to evaluate the association of influenza viruses with hospitalizations for acute respiratory infection in infants younger than two years old during epidemics of respiratory syncytial virus infection, we studied 512 nasal washes from this population. The samples were obtained from 1997 to 2000. A total of 337 viruses were isolated: 264 respiratory syncytial viruses, 62 influenza viruses, eight parainfluenza viruses, two adenovirus and one rhinovirus. Hospitalizations for acute respiratory infection were owing to influenza and respiratory syncytial viruses in 18.3% vs. 78.3% of all cases, and 32.5% vs. 65.8%, respectively, in the group of infants between 6 months and 2 years old.

Rapid detection of respiratory viruses by shell vial assay using simultaneous culture of HEp-2, LLC-MK2, and MDCK cells in a single vial

A shell vial assay with simultaneous culture of HEp-2, LLC-MK2, and MDCK cell lines in a single tube (CoHLM SV assay) was compared with traditional tube culture (TC) for the detection of the main respiratory viruses in 358 nasal wash specimens. A total of 170 strains were isolated from 168 virus-positive samples. A total of 94. 1% of the strains (160 strains; 128 respiratory syncytial viruses and 32 other viruses) were detected by the CoHLM SV assay in 48 h, whereas 98.2% of the strains (167 strains; 132 respiratory syncytial viruses and 35 other viruses) were detected by TC in a mean time of 6 days. The CoHLM SV assay may be useful for the rapid detection of respiratory viruses.

Infections due to sandfly fever virus serotype Toscana in Spain

Of the sandfly fever viruses known to be human pathogens (serotypes Toscana [TOS], Sicilian [SFS], and Naples [SFN]), only TOS has demonstrated neurotropic activity. Infections by TOS have been reported in Mediterranean countries, but the virus was previously isolated only in Italy and Portugal. We isolated 15 strains of TOS between 1988 and 1996 from the cerebrospinal fluid of patients with acute aseptic meningitis in Granada, Spain. This finding led us to study the presence of antibodies to TOS, SFS, and SFN in 1,181 adults and 87 children from different regions of Spain. We found that the prevalence of antibodies to these viruses was 26.2%, 2.2, and 11.9%, respectively; these rates imply that TOS infections are common in Spain.