32-week premature rupture of membranes caused by oropharyngeal microbiota

Introduction. Preterm premature rupture of membranes (PPROM) usually has a multifactorial etiology that is often unknown, although the most frequently reported cause is infection by group B Streptococcus. Therefore, the etiology of PPROM, although probably infectious, remains unknown in most cases. This case describes a PPROM caused by infection from oropharyngeal microbiota. Case presentation. We report the case of a 26-yr-old pregnant woman. The gestational age was 32 weeks+5 days. Examinations in the emergency department revealed the release of clear amniotic fluid and a closed multiparous cervix with a length of 22 mm. Endocervical culture evidenced the growth of Staphylococcus aureus, serogroup B Neisseria meningitidis and Haemophilus influenzae. Conclusion. Preventive antibiotic therapy should consider: opportunistic infections by normal genital microbiota, infections due to sexual activity, opportunist microorganisms derived from oral sex, and the hematogenous spread of oral bacteria.S

Systematic Review of Plasmid AmpC Type Resistances in Escherichia coli and Klebsiella pneumoniae and Preliminary Proposal of a Simplified Screening Method for ampC

Beta-lactamase (BL) production is a major public health problem. Although not the most frequent AmpC type, AmpC-BL is increasingly isolated, especially plasmid AmpC-BL (pAmpCBL). The objective of this study was to review information published to date on pAmpC-BL in Escherichia coli and Klebsiella pneumoniae, and on the epidemiology and detection methods used by clinical microbiology laboratories, by performing a systematic review using the MEDLINE PubMed database. The predictive capacity of a screening method to detect AmpC-BL using disks with cloxacillin (CLX) was also evaluated by studying 102 Enterobacteriaceae clinical isolates grown in CHROMID ESBL medium with the addition of cefepime (FEP), cefoxitin (FOX), ertapenem (ETP), CLX, and oxacillin with CLX. The review, which included 149 publications, suggests that certain risk factors (prolonged hospitalization and previous use of cephalosporins) are associated with infections by pAmpC-BL-producing microorganisms. The worldwide prevalence has increased over the past 10 years, with a positivity rate ranging between 0.1 and 40%, although AmpC was only detected when sought in a targeted manner. CMY-2 type has been the most prevalent pAmpC-BLproducing microorganism. The most frequently used phenotypic method has been the double-disk synergy test (using CLX disks or phenyl-boronic acid and cefotaxime [CTX] and ceftazidime) and the disk method combined with these inhibitors. In regard to screening methods, a 1- g oxacillin disk with CLX showed 88.9% sensitivity, 100% specificity, 100% positive predictive value (PPV), 98.9% negative predictive value (NPV), and 98.9% validity index (VI). This predictive capacity is reduced with the addition of extended-spectrum beta-lactamases, showing 62.5% sensitivity, 100% specificity, 100% PPV, 93.5% NPV, and 94.1% VI. In conclusion, there has been a worldwide increase in the number of isolates with pAmpC-BL, especially in Asia, with CMY-2 being the most frequently detected pAmpC-BL-producing type of microorganism. Reduction in its spread requires routine screening with a combination of phenotypic methods (with AmpC inhibitors) and genotypic methods (multiplex PCR). In conclusion, the proposed screening technique is an easy-to-apply and inexpensive test for the detection of AmpC-producing isolates in the routine screening of multidrugresistant microorganisms

Antibiotic Resistances of Enterobacteriaceae with Chromosomal Ampc in Urine Cultures: Review and Experience of a Spanish Hospital

The Enterobacteriaceae Citrobacter freundii, Enterobacter cloacae, Klebsiella aerogenes, Morganella morganii, Providencia stuartii, and Serratia marcescens (CESPM group) produce numerous urinary tract infections (UTIs) which are difficult to treat due to their high multiresistance rate. The objectives of this study were to carry out a systematic review of antibiotic resistances by UTIs and to determine changes over time in urine cultures from a reference hospital in southern Spain. The literature was searched for European data on the resistance rates of each microorganism, and a retrospective cross-sectional descriptive study was performed in samples with suspicion of UTI from patients in Virgen de las Nieves University Hospital (Granada, Spain) between 2016 and the first half of 2021. Among 21,838 positive urine cultures, 1.85% were caused by E. cloacae, 0.77% by M. Morganii, 0.65% by K. aerogenes, 0.46% by C. freundii, 0.29% by P stuartii, and 0.25% by S. marcescens. The lowest resistance rates by microorganism were: E. cloacae to amikacin (3.47%) and imipenem (5.28%); M. morganii to piperacillin–tazobactam (1.79%), cefepime (4.76%), and tobramycin (7.74%); K. aerogenes to tobramycin (3.55%), gentamicin (4.25%), trimethoprim–sulfamethoxazole (4.96%), imipenem (5.75%), and cefepime (6.43%); C. freundii to imipenem (no resistance), nitrofurantoin (1.96%), fosfomycin (2.80%), and ertapenem (6.12%); P. stuartii to cefepime (3.28%) and ceftazidime (3.28%); and S. marcescens to gentamicin (1.8%), ciprofloxacin (3.64%), cefepime (3.70%), piperacillin–tazobactam (3.70%), and trimethoprim–sulfamethoxazole (5.45%). In our setting, CESMP Enterobacteriaceae showed the lowest resistance to piperacillin–tazobactam, cefepime, imipenem, gentamicin, and colistin, which can therefore be recommended for the empirical treatment of UTIs. The COVID-19 pandemic may have had a clinical impact in relation to the increased resistance of E. cloacae and M. morgani to some antibiotics

Antibiotic resistances of Pseudomonas aeruginosa and Acinetobacter baumannii in urine cultures: experience in a hospital of Southeast Spain

The objectives of this study were to perform a systematic review of publications between 2010 and 2021 on the antibiotic resistance of Pseudomonas aeruginosa and Acinetobacter baumannii from urinary tract infections and to analyze changes over time in hospital urine cultures from 2016 through 2021. The literature was searched, and a retrospective cross-sectional descriptive study was performed in the hospital. Out of 21 838 positive urine cultures, 3.86% were due to P. aeruginosa and 0.44% were due to A. baumannii. For P. aeruginosa, lower resistance rates were observed to virtually all tested antibiotics than were obtained in the systematic review, and the present series of hospital samples showed an in vitro resistance rate <10% to ceftazidime, cefepime, meropenem, piperacillin-tazobactam, amikacin, tobramycin, and colistin. For A. baumannii, the resistance rates to almost all antibiotics were higher in the present series than in the systematic review, being lowest to colistin (10%). Both microorganisms show reduced in vitro susceptibility to some antibiotics during the years of the COVID-19 pandemic in comparison to previous years. In our setting, both piperacillin-tazobactam and meropenem can be recommended for the empirical treatment of UTIs by P. aeruginosa, whereas only colistin can be recommended for UTIs by A. baumannii.Universidad de Granada/CBU

Presence and Relevance of Emerging Microorganisms in Clinical Genitourinary Samples

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/microorganisms11040915/s1Abstract: Microorganisms responsible for genitourinary infections increasingly include species other than conventional etiological agents that are of clinical and pathogenic relevance and therapeutic interest. This cross-sectional descriptive study selected samples from clinical genitourinary episodes between January 2016 and December 2019 in which emerging microbiological agents were detected. The patients’ epidemiological characteristics, clinical presentation, antibiotic treatment, and outcome were studied to identify their pathogenic role. The emerging microorganisms most frequently detected in urinary tract infections were Streptococcus bovis (58.5%) and Gardnerella spp. (23.6%) in females and S. bovis (32.3%), Aerococcus urinae (18.6%), and Corynebacterium spp. (16.9%) in males, while the most frequently detected in genital infections were S. viridans (36.4%) in females and C. glucuronolyticum (32.2%) and Gardnerella spp. (35.6%) in males. All cases in female children were produced by S. bovis. Symptomatic episodes were more frequent with Aerococcus spp. and S. bovis and the presence of leukocytosis more frequent with Aerococcus spp. Quinolones and doxycycline were most often prescribed antibiotics for genital infections and quinolones and amoxicillin-clavulanic acid for urinary infections. Urinary infection by Aerococcus spp. was more frequent in males of advanced age, Corynebacterium spp. was more frequent in permanent vesical catheter carriers, and episodes of asymptomatic bacteriuria by Gardnerella spp. were more frequent in patients with kidney transplant and chronic consumers of corticosteroid therapy. Lactobacillus spp. should be considered in urinary infections of patients of advanced age and with a previous antibiotic load. Genital infection by Gardnerella spp. was significantly associated with a history of risky sexual relations

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

Objetivo. Debido a que existen pocos estudios sobre las implicaciones clínicas de la colonización por bacterias gramnegativas resistentes a carbapenémicos (BRC) se analizó ésta en frotis rectales (FR) y faríngeos (FF) y su relación con la capacidad de predecir infección/colonización. Material y métodos. Se realizó un estudio transversal, retrospectivo de los pacientes adultos hospitalizados entre enero del 2016 y diciembre del 2019. Los aislamientos fueron caracterizados mediante MicroScan y espectrometría de masas, aplicando los puntos de corte EUCAST 2018. La detección de carbapenemasas se realizó mediante PCR y secuenciación Sanger; se asignó el secuenciotipo mediante MLST. La relación genética entre los aislados se hizo mediante electroforesis de campo pulsado usando las enzimas Xbal, Spel o Apal. Resultados. Se detectaron 308 (86,03 %) FR y 50 (13,97%) FF positivos, teniendo el FR una sensibilidad del 85%, especificidad del 100%, VPP 100% y VPN 97%. En los FR se aislaron: 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 y 13% (n=40) Stenotrophomonas maltophilia. En los FF se aislaron un 44% (n=22) S. maltophilia, 40% (n=20) A. baumannii, 8% (n=4) P. aeruginosa y 8% (n=4) Enterobacterales (3 VIM, 1 OXA). De los pacientes con tomas simultáneas de FR y FF, 41 (40,6%) tuvieron positividad en ambos frotis, 45 (44,6%) sólo en FR y 15 (14,9%) sólo en FF. En el 81,3% (n=13) de los episodios la colonización precedió a la infección, existiendo asociación entre infección y colonización (p<0,001; χ2) y en todos en los que se conservó la información del pulsotipo los aislados de las muestras clínicas y de los frotis fueron similares. Conclusiones. La probabilidad de predecir la infección a través del colonizado por BRC en diferentes muestras clínicas es factible, teniendo el FR una mayor sensibilidad para detectar colonización.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. Methodology. 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

Emerging Presence of Culturable Microorganisms in Clinical Samples of the Genitourinary System: Systematic Review and Experience in Specialized Care of a Regional Hospital

The detection of emerging pathogens responsible for genitourinary infections has increased with technological advances. We conducted a systematic review of publications on the involvement of these microorganisms in genitourinary samples, and we also investigated their presence and antibiotic susceptibility in samples from patients at our regional hospital (Granada, Spain). The MEDLINE database was searched up to 31 December 2020, and a cross-sectional descriptive study was performed of results obtained in urine samples and genital exudates from January 2016 through December 2019. The review highlighted the frequent involvement of Neisseria meningitidis in genital infections, while the data on other microorganisms were consistent with findings in our patient series. The emerging microorganisms most often responsible for urinary tract infections were Streptococcus bovis (58.5%) and Gardnerella vaginalis (23.6%) in females, and S. bovis (32.3%), Aerococcus urinae (18.6%), and Corynebacterium spp. (16.9%) in males; those most frequently reported in genital infections were S. viridans (36.4%) in females and C. glucuronolyticum (32.2%) and G. vaginalis (35.6%) in males. In general, emerging pathogens are resistant to conventional antibiotics such as penicillin. However, there has also been an increase in beta-lactam resistance by the S. bovis group and Corynebacterium spp. The systematic review showed that emerging microorganisms are responsible for only a small percentage of genitourinary infections but are of major clinical interest, with a predominance of the S. bovis group, G. vaginalis, Lactobacillus spp., Aerococcus spp., and Corynebacterium spp. in urine samples and of G. vaginalis and C. glucuronolyticum in genital samples. Given the increasing resistance to antibiotics empirically prescribed in patients with genitourinary infections, it is recommended to create an antibiogram in all cases

Unusual Manifestation of Toscana Virus Infection, Spain

This study was supported in part by project 05/305, Junta de Andalucía, SpainYe

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.Introduction. Infections by genitopathogens are a frequent reason for consultation in Primary Health Care and in the specialties of Infectious Diseases, Urology, Gynecology, and Dermatology. The most common causes are opportunistic microorganisms and responsible for sexually transmitted infections associated with unprotected sex. The objective is to determine the microorganisms that cause these infections in patients treated at the Hospital Universitario Virgen de las Nieves in Granada and Neisseria gonorrhoeae susceptibility to antibiotics. Material and methods. A transversal-descriptive and retrospective study was carried out, which included the results issued, between January 2018 and December 2019, in the Microbiology Laboratory from all the episodes studied using standardized working procedures. Results. The most frequently detected microorganisms were Gardnerella vaginalis (23.81%) followed by Candida spp. (20.9%), especially in females, and N. gonorrhoeae (11.36%) and Ureaplasma urealyticum (11.99%), in males. Many times, they were presented in combination. Regarding herpes simplex viruses, infection by both species had a similar prevalence (50%) in males, while type 1 was more prevalent (76.52%) in females. The most active antibiotics against N. gonorrhoeae were cefotaxime (98%) and cefixime (100%). Tetracycline (39.02%) a poorly active antibiotic. Conclusions. The most frequent pathogens corresponded to those that usually caused infections in females, although N. gonorrhoeae was the most frequent in males and mixed infections are not an accidental finding. HSV-1 infections were more frequent than HSV-2, confirming the trend of a change in the epidemiology of genital herpes

Sociodemographic characteristics and risk factors associated to significative bacteriuria in a Spanish health area

Objetivo. Determinar las características epidemiológicas de las bacteriurias significativas (BS) y su relación con factores sociodemográficos, así como analizar los factores de riesgo en pacientes hospitalizados. Material y métodos. Estudio descriptivo transversal realizado sobre el conjunto de registros obtenidos a partir del procesamiento de todas las muestras de urocultivos recibidas en el laboratorio de Microbiología del Hospital Universitario Virgen de las Nieves (Granada, España) entre enero de 2016 y diciembre de 2020, diferenciando entre población infantil y adulta. Como variables dependientes se analizaron la presencia de BS, las variables independientes fueron la edad en años, sexo, año y mes de la muestra, tipo de muestra, procedencia de la muestra y número de aislamientos. En los urocultivos obtenidos de pacientes ingresados se evaluó la presencia de factores de riesgo asociados a partir del Conjunto Mínimo Básico de Datos. Resultados. Se analizaron 68.587 registros válidos (un 96,3% del total). El 40,8% (IC95%: 40,4%-41,2%) de los urocultivos en adultos y el 33,8% (IC95%: 32,9%-34,7%) en niños fueron positivos. La incidencia en adultos descendió de 18,2 casos/1.000 habitantes en el año 2016 a 14,6 casos/1.000 habitantes en 2020. Para estos mismos años, la incidencia en menores disminuyó de 21,1 a 8,4 casos/1.000 habitantes, respectivamente. Los urocultivos positivos fueron más frecuentes en niños del ámbito urbano frente al ámbito rural (OR=1,37; p<0,01), sin significación en adultos. En adultos hospitalizados, por cada año de edad transcurrido, el riesgo de BS aumentó un 2%, (OR=1,02), fue un 36% mayor en mujeres (OR=1,36), un 18% superior en obesos (OR=1,18) y un 17% más frecuente en pacientes con enfermedad renal (OR=1,17), todas ellas de forma significativa (p<0,01). No se observó relación entre BS y diagnóstico de COVID-19. Conclusión. Las características sociodemográficas de la población con BS atendida en nuestra área de salud, tanto en adultos como en niños, son similares a las encontradas en otras áreas geográficas a nivel mundial, observando una tendencia decreciente en la incidencia de BS en los años estudiados. La frecuencia de BS en niños es mayor en el ámbito urbano.Objective. To determine the epidemiological characteristics of significative bacteriuria (SB) and their relationship with sociodemographic factors and to analyze risk factors in inpatients. Material and methods. Cross-sectional descriptive study carried out on urine culture samples received between 2016- 2020 in the Microbiology laboratory, differentiating between minors and adults. The dependent variable was the presence of SB and the independent variables were age, sex, year, type of sample and source of the sample. In urine cultures of inpatients, risk factors were evaluated from the Minimum Basic Data Set. Results. A total of 68,587 valid records (96.3% of the total) were analyzed. 40.8% (95% CI: 40.4%-41.2%) of urine cultures in adults and 33.8% (95% CI: 32.9%-34.7%) in children were positive, with an incidence that ranged in adults between 18.2 cases/1,000 inhabitants in 2016 and 14.6 cases/ 1,000 inhabitants in 2020 and 21.1 and 8.4 cases/1,000 inhabitants respectively in minors. Positive urine cultures were more frequent in children from urban areas compared to rural areas (OR=1.37; p<0.01). In hospitalized adults, for each year of age the risk of SB increased by 2%, it was 36% higher in women, 18% higher in obese patients and 17% more frequent in patients with kidney disease, (p<0.01). No relationship was observed between SB and diagnosis of COVID-19. Conclusion. The sociodemographic characteristics of the population with SB in our health area are similar to those found in other geographical areas worldwide, observing a decreasing trend in incidence in the years studied. The frequency of SB in children is higher in urban areas