Simultaneous Nasal Carriage by Methicillin-Resistant and Methicillin Susceptible Staphylococcus aureus of Lineage ST398 in a Live Pig Transporter.

Methicillin-resistant Staphylococcus aureus (MRSA) sequence type (ST)398 is a livestock associated (LA) lineage with zoonotic potential, especially in humans with live pig contact. The objective of this study was to characterize two S. aureus strains of lineage ST398 (one methicillin-resistant (MRSA), one methicillin-susceptible (MSSA)) isolated from the same nasal sample of a patient admitted in the Intensive-Care Unit of a Spanish Hospital, and with previous occupational exposure to live pigs, by whole-genome-sequencing (WGS). The sample was obtained during routine surveillance for MRSA colonization. Purified genomic DNA was sequenced using Illumina HiSeq 2000 and processed using conventional bioinformatics software. The two isolates recovered were both S. aureus t011/ST398 and showed similar resistance-phenotypes, other than methicillin susceptibility. The possession of antibiotic resistance genes was the same, except for the mecA-gene located in SCCmecV in the MRSA isolate. The MSSA isolate harbored remnants of a SCCmec following the deletion of 17342bp from a recombination between two putative primases. Both isolates belonged to the livestock-associated clade as defined by three canonical single-nucleotide-polymorphisms, and neither possessed the human immune evasion cluster genes, chp, scn, or sak. The core genome alignment showed a similarity of 99.6%, and both isolates harbored the same mobile genetic elements. The two nasal ST398 isolates recovered from the patient with previous occupational exposure to pigs appeared to have a livestock origin and could represent different evolutionary steps of animal-human interface lineage. The MSSA strain was formed as a result of the loss of the mecA gene from the livestock-associated-MRSA lineage

Skin Lesion Caused by ST398 and ST1 MRSA, Spain1

This study was financially supported by the Project SAF2009-08570 from the Ministerio de Ciencia e Innovación of Spain and FEDER. C.L. has a fellowship FPI from the Ministerio de Ciencia e Innovación of Spain.S

Staphylococcus aureus resistente a meticilina asociado a ganado porcino:implicación en clínica y epidemiología humana y evaluación del riego sanitario.

Staphylococcus aureus es un agente patógeno oportunista que forma parte habitual de personas y animales, pudiendo producir colonización asintomática, lo que va a facilitar su colonización y diseminación. Adquiere frecuentemente determinantes genéticos de resistencia antibiótica teniendo especial relevancia, la resistencia a metilina (SARM).El presente trabajo, se va a centrar en SARM asociado a ganado porcino debido a las particulares características de la Comunidad Autónoma de Aragón (3900 explotaciones de ganado porcino censadas en 2018).Así mismo puede suponer un riesgo de tipo alimentario por ingestión de productos derivados del cerdo a causa de las enterotoxinas que puede desarrollar. <br /

Epidemiología, etiología y características clínicas y microbiológicas de la bacteriemia en el adulto en el hospital Royo Villanova de Zaragoza

La bacteriemia es la presencia de microorganismos en el torrente sanguíneo. La epidemiología, etiología y características clínicas y microbiológicas de la bacteriemia ha sufrido un profundo cambio en los últimos años. La incidencia y su mortalidad global han aumentado, influidas por diversos factores (comorbilidad, etiología, lugar de adquisición, precocidad y adecuación en el tratamiento antimicrobiano empírico). Su expresividad clínica al inicio en sepsis, sepsis grave y shock séptico es importante de cara a la premura en la actitud terapéutica y al pronóstico. La situación funcional de los pacientes puede ser un factor determinante en la actitud médica y la evolución. La limitación del esfuerzo terapeútico (LET) se plantea en la práctica clínica diaria con cierta frecuencia. El hecho de conocer las características de los pacientes en los que se realiza, su incidencia e influencia en la evolución y mortalidad tiene interés. El conocimiento de las características de las bacteriemias en el medio donde se trabaja es fundamental, tanto para implementar medidas de actuación que mejoren la atención al enfermo con bacteriemia, como para mejorar la indicación del tratamiento antimicrobiano con la finalidad, además de contribuir a una disminución de la mortalidad, de minimizar la aparición y diseminación de resistencias y reducir los costes (tanto personales como económicos). En nuestro hospital, y desde el año 2007 existe un grupo de sepsis y bacteriemia, con realización de actividades formativas periódicas, generación de trípticos y documentos de consulta para médicos y enfermería, con seguimiento de los pacientes con bacteriemia de forma prospectiva. Este trabajo es un estudio epidemiológico observacional descriptivo de los pacientes con bacteriemia verdadera evaluados con recomendaciones terapéuticas y de manejo durante el año 2011. Se registraron 264 bacteriemias en 258 pacientes y se excluyeron del análisis 19 episodios por ser trasladados a otros hospitales. La incidencia fue de 25 episodios/1.000 ingresos y la prevalencia de 159/100.000 habitantes/años. Se han realizado varios análisis: estudio descriptivo de la cohorte general y por grupos de edad y de los episodios de bacteriemia según: i) lugar de adquisición, ii) foco clínico, iii) expresividad clínica, iv) estudio del tratamiento antimicrobiano empírico (precocidad y adecuación) y grado de aceptación de las recomendaciones por la unidad de bacterimiemia. Además se realizó un análisis multivariante de las formas graves de sepsis y del riesgo de mortalidad. Se analizan también las características de los pacientes con bacteriemia dados de alta desde urgencias y de aquellos en los que se realiza LET. Por último se analizan los microorganismos aislados y sus resistencias antimicrobianas, de forma global y según el lugar de adquisición. Principales conclusiones: Cada vez hay una población más envejecida y su situación funcional influye tanto en la expresividad clínica, como en la actuación médica (LET), además de en el pronóstico y su mortalidad. Las bacteriemias comunitarias (BC) fueron las más frecuentes en nuestro centro, predominado el foco urológico y el abdominal; los gérmenes aislados presentaron escasas resistencias. En las bacteriemias asociadas a cuidados sanitarios (BACS) los pacientes son de mayor edad y peor situación funcional, predominando el foco urológico y por tanto los gramnegativos, aunque con mayores resistencias que en las BC. Las bacteriemias urológicas son las más frecuentes y Escherichia coli es el principal agente etiológico. En las bacteriemias abdominales se precisó en más de una cuarta parte de actuación sobre el foco. La bacteriemia asociada a catéter (BAC) se asoció con un tratamiento más tardío y no adecuado a guías. La precocidad en la administración del tratamiento antimicrobiano y su adecuación son elevadas en nuestro hospital. La mortalidad en el análisis multivariante se asoció a variables no modificables: edad >= 80 años, índice de Charlson >= 4, índice de Barthel =< 20, formas graves (sepsis grave o shock séptico) y el foco respiratorio. El germen más frecuente fue Escherichia coli, que presentó alta resistencia a ciprofloxacino (40,8%), siendo productor de BLEEs un 7,8% y resistencia a amoxicilina-clavulánico un 9,7%. Staphylococcus aureus fue resistente a meticilina en un 31,8%, con un único caso comunitario, y predominando el foco respiratorio y el urológico

Prevalence and Genetic Characteristics of Staphylococcus aureus CC398 Isolates From Invasive Infections in Spanish Hospitals, Focusing on the Livestock-Independent CC398-MSSA Clade

Background: Livestock-associated (LA)-CC398-MRSA is closely related to pigs, being unfrequently detected in human invasive infections. CC398-MSSA is emerging in human invasive infections in some countries, but genetic and epidemiological characteristics are still scarcely reported. Objectives: To determine the prevalence of Staphylococcus aureus (SA) CC398, both MRSA and MSSA, among blood cultures SA isolates recovered in Spanish hospitals located in regions with different pig-farming densities (PD) and characterize the recovered isolates. Methods: One thousand twenty-two SA isolates (761 MSSA, 261 MRSA) recovered from blood cultures during 6–12 months in 17 Spanish hospitals (2018–2019) were studied. CC398 lineage identification, detection of spa-types, and antibiotic resistance, virulence and human immune evasion cluster (IEC) genes were analyzed by PCR/sequencing. Results: Forty-four CC398-MSSA isolates (4.3% of SA; 5.8% of MSSA) and 10 CC398-MRSA isolates (1% of SA; 3.8% of MRSA) were detected. Eleven spa-types were found among the CC398-MSSA isolates with t571 and t1451 the most frequent spa-types detected (75%). Most of CC398-MSSA isolates were Immune-Evasion-Cluster (IEC)-positive (88.6%), tetracycline-susceptible (95.5%) and erythromycin/clindamycin–inducible-resistant/erm(T)-positive (75%). No statistical significance was detected when the CC398-MSSA/MSSA rate was correlated to PD (pigs/km2) (p = 0.108). On the contrary, CC398-MRSA isolates were all IEC-negative, predominately spa-t011 (70%), and the CC398-MRSA/MRSA rate was significantly associated to PD (p < 0.005). Conclusion: CC398-MSSA is an emerging clade in invasive infections in Spanish hospitals. CC398-MRSA (mostly t011) and CC398-MSSA (mostly t571 and t1451) show important differences, possibly suggesting divergent steps in host-adaptation evolutionary processes. While CC398-MRSA is livestock-associated (lacking IEC-system), CC398-MSSA seems to be mostly livestock-independent, carrying human-adaptation markers.Agencia Estatal de Investigación (AEI) (project SAF2016-76571- R) and by the Fondo Europeo de Desarrollo Regional (FEDER

Utilization of lactose and presence of the phospho-β-galactosidase (lacG) gene in Lactococcus garvieae isolates from different sources

This study evaluates the utilization of lactose (Lac) and the presence of the phospho-&beta;-galactosidase (lacG) gene as markers for distinguishing between fish (Lac-/lacG-) and dairy isolates (Lac+/lacG+) of Lactococcus garvieae, using a panel of L. garvieae isolates from different sources. None of the fish isolates produced acid from lactose (Lac-), however Lac-/lacG- isolates were observed in pigs, cows, birds and humans. Most of the dairy isolates (77.8%) were Lac+/lacG+, but some dairy isolates did not produce acid from this sugar. Data in the present study show that the ability to metabolize lactose and the presence of the lacG gene are heterogeneously scattered among L. garvieae isolates of different sources. Therefore, the use of these criteria as markers to differentiate between L. garvieae isolates of dairy and fish origin should be considered with caution. [Int Microbiol 2010; 13(4):189-193

Utilization of lactose and presence of the phospho-β-galactosidase (lacG) gene in Lactococcus garvieae isolates from different sources

This study evaluates the utilization of lactose (Lac) and the presence of the phospho-β-galactosidase (lacG) gene as markers for distinguishing between fish (Lac-/lacG-) and dairy isolates (Lac+/lacG+) of Lactococcus garvieae, using a panel of L. garvieae isolates from different sources. None of the fish isolates produced acid from lactose (Lac-), however Lac-/lacG- isolates were observed in pigs, cows, birds and humans. Most of the dairy isolates (77.8%) were Lac+/lacG+, but some dairy isolates did not produce acid from this sugar. Data in the present study show that the ability to metabolize lactose and the presence of the lacG gene are heterogeneously scattered among L. garvieae isolates of different sources. Therefore, the use of these criteria as markers to differentiate between L. garvieae isolates of dairy and fish origin should be considered with caution

Incidence and characterization of Clostridium difficile in a secondary care hospital in Spain

INTRODUCTION: Clostridium difficile (C. difficile) is a major nosocomial infectious agent in hospitals. Previous studies have addressed the high proportion of infection episodes that are overlooked in health care facilities. OBJECTIVE: the main aim of this study was to characterize C. difficile clinical cases that occurred in a secondary care hospital during a five-month period. MATERIAL AND METHODS: for this purpose, a total of 137 stool samples from the same number of patients with diarrhea were analyzed for the presence of C. difficile by culture techniques. An enzyme immunoassay (EIA) test for the detection of C. difficile and its toxins was also used in 50 cases (36.5%) for diagnostic purposes. RESULTS: a total of 14 (10.2%) C. difficile isolates were obtained, of which nine (64.3%) were toxigenic. A mean incidence of 3.2 episodes of C. difficile infections (CDI) per 10, 000 patients-days was estimated for the study period. Around 56% of the CDI cases were determined as hospital-acquired, whereas 44% originated in the community. Among these, only two episodes (22.2%) were detected in the hospital by the EIA test, which indicated that the hospital CDI detection protocol needed to be revised. One unusual C. difficile isolate was negative for all toxin genes examined and also for the non-toxigenic strain assay, which highlights the need to perform genome sequencing to study its pathogenicity locus insertion site organization. A stable metronidazole-resistant C. difficile strain and three strains showing multidrug resistance were detected in this study, suggesting that C. difficile antimicrobial susceptibility surveillance programs should be established in this health-care facility

Prevalence and genetic characteristics of Staphylococcus aureus CC398 isolates from invasive infections in spanish hospitals, focusing on the livestock-independent CC398-MSSA clade

Background: Livestock-associated (LA)-CC398-MRSA is closely related to pigs, being unfrequently detected in human invasive infections. CC398-MSSA is emerging in human invasive infections in some countries, but genetic and epidemiological characteristics are still scarcely reported. Objectives: To determine the prevalence of Staphylococcus aureus (SA) CC398, both MRSA and MSSA, among blood cultures SA isolates recovered in Spanish hospitals located in regions with different pig-farming densities (PD) and characterize the recovered isolates. Methods: One thousand twenty-two SA isolates (761 MSSA, 261 MRSA) recovered from blood cultures during 6–12 months in 17 Spanish hospitals (2018–2019) were studied. CC398 lineage identification, detection of spa-types, and antibiotic resistance, virulence and human immune evasion cluster (IEC) genes were analyzed by PCR/sequencing. Results: Forty-four CC398-MSSA isolates (4.3% of SA; 5.8% of MSSA) and 10 CC398-MRSA isolates (1% of SA; 3.8% of MRSA) were detected. Eleven spa-types were found among the CC398-MSSA isolates with t571 and t1451 the most frequent spa-types detected (75%). Most of CC398-MSSA isolates were Immune-Evasion-Cluster (IEC)-positive (88.6%), tetracycline-susceptible (95.5%) and erythromycin/clindamycin–inducible-resistant/erm(T)-positive (75%). No statistical significance was detected when the CC398-MSSA/MSSA rate was correlated to PD (pigs/km2) (p = 0.108). On the contrary, CC398-MRSA isolates were all IEC-negative, predominately spa-t011 (70%), and the CC398-MRSA/MRSA rate was significantly associated to PD (p < 0.005). Conclusion: CC398-MSSA is an emerging clade in invasive infections in Spanish hospitals. CC398-MRSA (mostly t011) and CC398-MSSA (mostly t571 and t1451) show important differences, possibly suggesting divergent steps in host-adaptation evolutionary processes. While CC398-MRSA is livestock-associated (lacking IEC-system), CC398-MSSA seems to be mostly livestock-independent, carrying human-adaptation markers.