The present study was carried out to evaluate the prevalence of the clonal subgroup O16:H5-ST131 and the H30 and H30-Rx subclones among E. coli isolates causing extraintestinal infections and to know ...their virulence potential. The ST131 clonal group accounted for 490 (16%) of the 2995 isolates obtained from clinical samples in five Spanish hospitals during the study period (2005–2012). Among those 490 ST131 isolates, 456 belonged to serotype O25b:H4, 27 to O16:H5 and seven were O-non-typeable:H4 (ONT:H4). All 27 O16:H5 isolates showed fimH41, whereas fimH30 and fimH22 alleles were the most frequently detected among O25b:H4 isolates. The majority (381/490; 78%) of ST131 isolates belonged to H30 subclone, and 302 of 381 (79%) H30 isolates belonged to the H30-Rx subclone. Of the 27 O16:H5 isolates, 48% produced CTX-M-14; however, none produced CTX-M-15. In contrast, 46% of O25b:H4 isolates produced CTX-M-15 while only 2% produced CTX-M-14. More than a half of the O16:H5 isolates (56%) showed the ExPEC status which was significantly more prevalent within O25b:H4 isolates (81%) (P<0.01), especially among H30-Rx (97%) isolates. In the present study, a modified virotype scheme was applied within which approximately half (52%) of the O16:H5 isolates showed the C1 specific virotype. Despite their low virulence-gene score (mean of virulence genes 6.4 versus 8.5 in O25b:H4 isolates), six out of the 10 O16:H5 isolates assayed showed high virulence in the mouse model of sepsis (killed 90–100% of mice challenged). Furthermore, four O16:H5 isolates of virotypes A and C1, carrying K2 variant of group II capsule, showed lethality at 24h. Thus, certain O16:H5 fimH41 isolates show a similar in vivo virulence to that reported with the highly virulent O25b:H4 H30-Rx isolates (Mora et al., PLOS ONE 2014, e87025), supporting their potential virulence for humans.
Abstract Having shown that Lucus Augusti Hospital in Lugo, Spain, has been affected by Escherichia coli clone O25:H4-ST131 producing CTX-M-15, the present study was carried out to evaluate the ...prevalence of this clone among the extended-spectrum β-lactamase (ESBL)-producing E. coli isolates and to identify novel variants of this clone. Of the 77 ESBL-producing E. coli isolated between January and April 2012, 47 (61%) were identified as belonging to the ST131 clonal group, comprising 38 O25b:H4-B2-ST131 (34 CTX-M-15, 2 CTX-M-14, 1 CTX-M-1 and 1 CTX-M-27), 7 O-non-typeable:H4-B2-ST131 (all CTX-M-15) and 2 O16:H5-B2-ST131 (both CTX-M-14). The 47 isolates of ST131 exhibited a significantly higher virulence score (mean of 9.1 virulence genes) compared with the 30 non-ST131 isolates (mean of 4.3 virulence genes). A new virulence profile ( fimH , papG II , sat , cnf1 , hlyA , iucD , kpsM II-K5 , traT , malX , usp ) was detected among O25b:H4-B2-ST131 isolates belonging to the new Pasteur sequence type PST621. To our knowledge, this is the first study to report the O-non-typeable:H4-B2-ST131 and O16:H5-B2-ST131 variants in Europe.
Abstract CTX-M enzymes, mainly CTX-M-14 and CTX-M-15, have emerged as the most prevalent extended-spectrum β-lactamase (ESBL) type produced by Escherichia coli in Spain, with successful dissemination ...of clonal group O25b:H4-B2-ST131 producing CTX-M-15 within the hospital and community settings. However, until now CTX-M-14-producing E. coli in Spain had been shown to belong to a wide variety of serotypes with no predominance of a certain clonal group. In the present study, 654 E. coli strains positive for ESBL production obtained between 2005 and 2008 from inpatients and outpatients of four hospitals in Galicia, northwest Spain, were analysed. The strains were characterised with regard to ESBL enzymes, serotype, virulence genes, phylogenetic group, multilocus sequence type, and pulsed-field gel electrophoresis of Xba I-digested DNA. As a result, the emergence of certain clonal groups of extraintestinal pathogenic E. coli producing CTX-M-14 has been detected in this geographic area, including O1:HNM-D-ST59, O15:H1-D-ST393/ST1394, O20:H34/HNM-D-ST354, O25b:H4-B2-ST131 and ONT:H21,42-B1-ST101. These five clonal groups showed a high virulence potential as they harboured more than eight virulence factors, which could explain their successful dissemination.
Escherichia coli (E. coli) es el responsable de la mayoría de las infecciones del tracto urinario comunitarias. El objetivo del estudio es conocer el espectro de sensibilidad de E. coli en ...infecciones del tracto urinario para recomendar el tratamiento antibiótico empírico adecuado.
Estudio transversal, multicéntrico, retrospectivo.
Ocho hospitales públicos gallegos, prácticamente toda la población de Galicia (España).
Cuarenta y tres mil ciento treinta y siete pacientes ambulatorios con infección del tracto urinario por E. coli aislados en orina en 2016/2017.
Variables analizadas: demográficas, concentración mínima inhibitoria e interpretación de la sensibilidad según criterios de CLSI y mecanismos de resistencia. Los antibióticos estudiados fueron: ampicilina, amoxicilina-ácido clavulánico, ciprofloxacino, cefotaxima, cefepime, gentamicina, nitrofurantoína, fosfomicina, cotrimoxazol, imipenem y ertapenem. La identificación y sensibilidad se hicieron principalmente por sistemas automatizados.
Los porcentajes de no sensibilidad de los aislamientos de E. coli fueron: ampicilina 49,2%, amoxicilina-ácido clavulánico 17,8%, cefotaxima 6,7%, cefepime 5,7%, ertapenem 0,04%, imipenem 0,05%, gentamicina 9,1%, ciprofloxacino 26,2%, fosfomicina 3,3%, nitrofurantoína 2,4% y cotrimoxazol 23,9%. Las no sensibilidades fueron superiores en hombres y a medida que aumenta la edad. El 6% fueron productores de betalactamasas de espectro extendido.
El tratamiento empírico en Galicia para cistitis no complicadas producidas por E. coli en mujeres continúa siendo nitrofurantoína y fosfomicina. En hombres menores de 15 años se indica fosfomicina y en hombres mayores de 15 años el tratamiento en nuestro medio debe incluir la realización de cultivo y administrar una cefalosporina de 3.a generación oral empíricamente. No se recomienda cotrimoxazol ni ciprofloxacino como tratamiento empírico por sus altos porcentajes de resistencia.
Escherichia coli (E. coli) is responsible for the majority of community urinary tract infections. The objective of the study is to know the sensitivity spectrum of E. coli in urinary tract infections to be able to recommend the appropriate empirical antibiotic treatment.
Cross-sectional, multicentric, retrospective study.
Galician 8 public hospitals, practically the entire population of Galicia (Spain).
43,137 outpatients with urinary tract infection due to E. coli isolated in urine in 2016/2017.
Analyzed variables: demographic, minimum inhibitory concentration and interpretation of sensitivity according to CLSI criteria and resistance mechanisms. The antibiotics studied were: ampicillin, amoxicillin-clavulanic acid, ciprofloxacin, cefotaxime, cefepime, gentamicin, nitrofurantoin, fosfomycin, cotrimoxazole, imipenem and ertapenem. The identification and sensitivity were made mainly by automated methods.
The percentages of non-sensitivity of E. coli isolates were: ampicillin 49.2%, amoxicillin-clavulanic acid 17.8%, cefotaxime 6.7%, cefepime 5.7%, ertapenem 0.04%, imipenem 0.05%, gentamicin 9,1%, ciprofloxacin 26.2%, fosfomycin 3.3%, nitrofurantoin 2.4% and cotrimoxazole 23.9%. The non-sensitivities were higher in men and as age increases. Six percent of E. coli were producers of extended-spectrum beta-lactamases.
The empirical treatment in Galicia for uncomplicated cystitis produced by E. coli in women continues to be nitrofurantoin and fosfomycin. In men under 15 years of age, fosfomycin is indicated and in men older than 15 years, treatment in our environment should include culture and administer a 3rd generation oral cephalosporin empirically. Cotrimoxazole and ciprofloxacin are not recommended as empirical treatment because of their high resistance rates.
Microbiological diagnosis of intra-abdominal infections García-Sánchez, José Elías; García-García, M Inmaculada; García-Garrote, Fernando ...
Enfermedades infecciosas y microbiologia clinica
31, Številka:
4
Journal Article
Recenzirano
Intra-abdominal infections represent a large and wide group of diseases which include intra- and retro-peritoneal infections. Some of them could be defined as uncomplicated, where the infectious ...process is limited to the organ or tissue of origin (appendicitis, diverticulitis, cholecystitis…). Complications occur when the infection spreads to the peritoneum, triggering localised peritonitis and abdominal abscesses. Most intra-abdominal infections are due to perforation or inflammation of the intestinal wall. The microorganisms that cause these infections come from the gastrointestinal flora, and therefore produce polymicrobial infections mixed with a predominance of anaerobic bacteria. Microbiological diagnosis is essential to determine the aetiology and the susceptibility of antimicrobial agents of the microorganism involved, especially in nosocomial infections or in community infections in predisposed patients due to increasing bacterial resistance to antimicrobial agents, multidrug resistance and fungal involvement. Despite the advances in microbiological diagnosis, in the case of intra-abdominal infections it still remains direct, being based on stains and cultures, the most notable progress is the introduction of mass spectrometry (MALDI-TOF) for the rapid identification of the pathogens involved. This review will provide recommendations on the collection, transport and microbiological processing of clinical specimens. Comments on the pathogenesis, clinical and microbiological diagnosis of peritonitis primary, secondary, tertiary and peritonitis (and other infections) associated with peritoneal dialysis, intra-abdominal abscesses (intraperitoneal, retroperitoneal and visceral), biliary tract infections, appendicitis and diverticulitis are also presented.
The newborn may acquire infections during delivery due to maternal colonization of the birth canal, by microorganisms such as Streptococcus agalactiae that caused early neonatal infection, or ...acquisition through the placenta, amniotic fluid or birth products. After birth, the newborn that needs hospitalization can develop nosocomial infections during their care and exceptionally through lactation by infectious mastitis or incorrect handling of human milk, which does not require to stop breastfeeding in most cases. It is important and necessary to perform microbiological diagnosis for the correct treatment of perinatal infections, especially relevant in preterm infants with low or very low weight with high mortality rates.
The in vitro activity of the oxazolidinone linezolid was compared with the activities of vancomycin and teicoplanin against 450 Gram-positive clinical isolates, including a variety of multiply ...resistant strains. Linezolid inhibited all microorganisms tested at ≤4 mg/L, including methicillin- and teicoplanin-resistant staphylococci, glycopeptide-resistant enterococci, penicillin- and multiply resistant pneumococci and viridans streptococci, and erythromycin-resistant β-haemolytic streptococci. The MIC90 of linezolid for all isolates was 2 mg/L.
Introduction. The aim of this study is to know the antibiotic sensitivity
of the Pseudomonas aeruginosa, which produces invasive infections in
Galicia in 2013/2014, in the framework of the ...Surveillance Study of Antimicrobial Resistance.
Methods. A total of 357 isolates of P. aeruginosa were analyzed in blood
or CSF samples from 9 hospitals in Galicia. The variables were: origin,
demographic data, sample type and antibiotic sensitivity. CLSI breakpoints
were used. For each antibiotic we analyzed frequencies, cases/100.000
inhabitants, concordance of resistance and differences between hospitals,
sex and age.
Results. The majority of patients were male gender and the not-sensitives
were superior in the 45 to 64 age group with significant differences to ciprofloxacin, imipenem, tobramycin and colistin. The overall not-sensitivity
isolates was: piperacillin/tazobactam 18%, ciprofloxacin 28.7%, ceftazidime 17.1%, cefepime 19.7%, imipenem 23.1%, meropenem 22.1%,
tobramycin 13.0%, amikacin 7.3% and colistin 4.4%. The cases/100,000
inhabitants were higher in men as age increasing. Without analyzing colistin, the 57.1% of the isolates were sensitives to other antibiotics studied
(piperacillin/tazobactam, quinolones, ceftazidime, aminoglycosides, carbapenems), 19.4% were not-susceptible to only one antibiotic, 12. 2% to
two, 3.7% to three, 5.1% to four and 2.0% to all antibiotics tested.
Conclusions. Of the antibiotics tested, the most susceptible to P. aeruginosa were amikacin and colistin. Our data are consistent with the observed ones nationwide except colistin. Sensitivity patterns of P. aeruginosa
should be periodically evaluated in each area and each hospital in order to
assess the different therapeutic regimens.
Introducción. El objetivo de este estudio es conocer la sensibilidad antibiótica de Pseudomonas aeruginosa productora de enfermedad invasiva
en Galicia en 2013/2014, en el marco del Estudio de Vigilancia de las
Resistencias Antimicrobianas.
Métodos. Se analizaron 357 aislamientos de P. aeruginosa en muestras
de sangre o LCR en 9 hospitales de Galicia. Las variables fueron: procedencia, datos demográficos, tipo de muestra y sensibilidad antibiótica.
Se usaron puntos de corte de CLSI. Para cada antibiótico se analizaron
frecuencias, casos/100.000 habitantes, concordancia de la resistencia y
diferencias entre hospitales, sexo y edad.
Resultados. El sexo predominante fue el masculino y la no sensibilidad
superior en el grupo de 45 a 64 años con diferencias significativas a ciprofloxacino, imipenem, tobramicina y colistina. La no sensibilidad global: piperacilina/tazobactam 18%, ciprofloxacino 28’7%, ceftazidima 17’1%, cefepime 19’7%, imipenem 23’1%, meropenem 22’1%, tobramicina 13’0%;
amikacina, 7’3% y colistina 4’4%. Los casos/100.000 habitantes fueron
superiores en hombres según aumenta la edad. Sin analizar la colistina, el
57’1% de los aislamientos fueron sensibles a los otros grupos estudiados
(piperacilina/tazobactam, quinolonas, ceftazidima, aminoglucósidos, carbapenems), el 19’4% fueron no sensibles a un antibiótico, 12’2% a dos, el
3’7% a tres, el 5’1% a cuatro y el 2’0% a todos los analizados.
Conclusiones. De los antibióticos evaluados, los más activos frente a P.
aeruginosa fueron amikacina y colistina. Nuestros datos concuerdan con
lo observado a nivel nacional, excepto para colistina. Deben evaluarse
periódicamente patrones de sensibilidad de P. aeruginosa en cada zona y
cada hospital para poder valorar las diferentes pautas terapéuticas.
PDF
