Monitorización continúa de la colonización por bacterias multirresistentes en una unidad neonatal de cuidados intensivos. relación entre colonización e infección

Las infecciones adquiridas durante el periodo postnatal están producidas principalmente por bacterias que forman parte de la flora humana normal o del medio ambiente. La adquisición de multirresistencia por parte de estas bacterias (BMR) constituye un problema muy grave ya que los neonatos son una población muy susceptible a los procesos infecciosos. El número de antibióticos disponibles para tratar estas infecciones es muy limitado, y algunos son tóxicos, por ello es muy importante conocer el número y la dinámica de las colonizaciones y esclarecer si son un determinante de infección y en qué proporción. Así mismo es relevante conocer en números absolutos y porcentuales el significado de estas infecciones en relación a otras infecciones bacterianas y al total de todas ellas. Esta información ayudaría a establecer la importancia de los cultivos regulares para controlar las colonizaciones, la necesidad de efectuar o no aislamientos de los niños para evitar la difusión de estas bacterias y establecer los tratamientos empíricos adecuados. Existen pocos datos disponibles en la literatura acerca de la incidencia de la infección nosocomial en las Unidades de Cuidados Intensivos neonatales (UCIN) españolas. Los objetivos de este trabajo son observar el grado de colonización por bacterias multirresistentes de los niños de la UCIN del Hospital Vall d'Hebron y determinar la capacidad de estas bacterias para causar enfermedades infecciosas en los niños colonizados. Para ello, se ha determinado a lo largo de un periodo de cinco meses, la flora grampositiva y gramnegativa multirresistente que coloniza el intestino de los niños a su ingreso, así como su su evolución durante su permanencia en la Unidad. Además se he estudiado la transmisión cruzada de los microorganismos resistentes entre los distintos niños de la UCIN y las enfermedades infecciosas esporádicas o endémicas desarrolladas por ellos a lo largo del periodo de estudio, en relación con la flora multirresistente de colonización intestinal. Por último, en este trabajo se han determinado los mecanismos genéticos implicados en la resistencia de las bacterias detectadas con el fin de conocer si ha existido transferencia genética entre las bacterias de la Unidad. Los resultados de este estudio han mostrado que durante el periodo de estudio, el 51% de los niños que han estado ingresados en la UCIN se han colonizado por una bacteria multirresistente, siendo Klebsiella pneumoniae y Enterobacter cloacae, las especies más prevalentes. La colonización por una BMR se asoció a un mayor tiempo de estancia en UCIN y los principales factores que se asociaron a la colonización fueron la prematuridad extrema (nacimiento antes de la semana 30 de gestación), el bajo peso, la lactancia materna, la administración de nutrición parenteral y la toma de antibióticos. Se observó una enorme dinámica en la colonización de los niños condicionada por la duración variable de la estancia en la Unidad, por los cambios de box, la salida a otras unidades y en ocasiones al reingreso, así como la aparición y difusión entre los niños de las diversas especies multirresistentes detectadas. En total, fueron diecisietes los brotes detectados. De estos, 6 afectaron a entre 4 y 46 niños y los once restantes a entre 1 y 3 niños. A lo largo del periodo de estudio, las infecciones sistémicas fueron más frecuentes que las superficiales estando las primeras causadas por bacterias multirresistentes en menor proporción que las superficiales. Las especies bacterianas multirresistentes que causaron mayor proporción de infección respecto a la colonización fueron K. pneumoniae, E. cloacae y C freundi. Todo esto pone de manifiesto la complejidad de las colonizaciones por bacterias multirresistentes tanto debido a las propias bacterias, por sus variedades clonales, su dinámica de permanencia, difusión, desaparición y reaparición, como por la propia complejidad que presentan los niños en sus procesos patológicos, su movilidad y otros factores indeterminados.Infections acquired during the postnatal period are mainly produced by bacteria that are part of normal human flora or the environment. The acquisition of multidrug resistance by these bacteria (MRB) is a very serious problem because neonates are highly susceptible to infections. The number of antibiotics available to treat these infections is very limited, and some are toxic, so it is very important to know the number and dynamics of colonization and to clarify whether they are determinates of infection and in what proportion. Also is important to know the proportion of these infections in relation to other bacterial infections and the total of all of them. This information would help to establish the importance of making regular screenings to control colonization, the need for isolation of children to prevent the spread of these bacteria and to establish appropriate empirical treatments. There are few data available in the literature on the incidence of nosocomial infection in Spanish Neonatal Intensive Care Units (NICU). The objectives of this work are to observe the level of colonization by multiresistant bacteria of children in the NICU of the Hospital Vall d'Hebron and to determine the ability of these bacteria to cause infectious disease in colonized children. To do this, it has been determined over a period of five months, the multidrug-resistant Gram-positive and Gram-negative bacteria that colonizes the intestine of children at the income as well as their evolution during their stay in the NICU. In addition, it has been studied cross-transmission events of resistant bacteria between different NICU infants and sporadic or endemic infectious diseases developed by them throughout the study period, in relation to its colonizing antibiotic-resistant intestinal flora. Finally, in this study the genetic mechanisms involved in the resistance of bacteria detected has been determined, in order to determine whether there has been gene transfer between the bacteria at the Unit. The results of this study have shown that during the study period, 51% of children who have been admitted to the NICU were colonized by multiresistant bacteria, being Klebsiella pneumoniae and Enterobacter cloacae, the most prevalent species. Colonization by a MRB was associated with a longer stay in NICU and the main factors associated with colonization were extreme prematurity (birth before 30 weeks of gestation), low birth weight, breastfeeding, parenteral nutrition and taking antibiotics. A high dynamic in the colonization of children was detected. This was conditioned by the variable length of stay in the unit, by box changes, discharge to other units and sometimes re-entry. Altogether, there were detected seventeen outbreaks. Of these, 6 affected between 4 and 46 children and the remaining eleven between 1 and 3. Throughout the study period, systemic infections were more frequent than superficial being the first ones caused by multidrug-resistant bacteria to a lesser extent than surface. All this shows the complexity of colonization by multiresistant bacteria both because the bacteria themselves, for their clonal varieties, dynamics of permanence, dissemination, disappearance and reappearance, and the complexity itself of children in their pathological processes, mobility and other undetermined factors

An increase in erythromycin resistance in methicillin-susceptible Staphylococcus aureus from blood correlates with the use of macrolide/lincosamide/streptogramin antibiotics. EARS-Net Spain (2004–2020)

Objectives: To describe and analyse erythromycin resistance trends in blood isolates of Staphylococcus aureus (EARS-Net Spain, 2004–2020) and the association of these trends with the consumption of macrolide, lincosamide, and streptogramin B (MLSB) antibiotics. To assess molecular changes that could be involved in erythromycin resistance trends by whole genome analysis of representative isolates. Materials and methods: We collected antibiotic susceptibility data for all firstblood S. aureus isolates in patients from 47 Spanish hospitals according to EARS-Net criteria. MLSB antibiotic consumption was obtained from the Spanish Agency for Medicines and Medical Devices (2008–2020). We sequenced 137 representative isolates for core genome multilocus sequence typing, resistome and virulome analysis. Results: For the 36,612 invasive S. aureus isolates, methicillin resistance decreased from 26.4% in 2004 to 22.4% in 2020. Erythromycin resistance in methicillin-susceptible S. aureus (MSSA) increased from 13.6% in 2004 to 28.9% in 2020 (p < 0.001); however, it decreased from 68.7 to 61.8% (p < 0.0001) in methicillin-resistant S. aureus (MRSA). Total consumption of MLSB antibiotics increased from 2.72 defined daily doses per 1,000 inhabitants per day (DID) in 2014 to 3.24 DID in 2016. By WGS, the macrolide resistance genes detected were erm (59.8%), msrA (46%), and mphC (45.2%). The erm genes were more prevalent in MSSA (44/57, 77.2%) than in MRSA (38/80, 47.5%). Most of the erm genes identified in MSSA after 2013 differed from the predominant ermC gene (17/22, 77.3%), largely because ermT was significantly associated with MSSA after 2013 (11/29, 37.9%). All 13 ermT isolates in this study, except one, belonged to ST398 and came from 10 hospitals and six Spanish provinces. Conclusion: The significant increase in erythromycin resistance in blood MSSA correlated with the consumption of the MLSB antibiotics in Spain. These preliminary data seem support the hypothesis that the human ST398 MSSA clade with ermT-mediated resistance to erythromycin may be involved in this trend.This research was supported by CIBER—Consorcio Centro de Investigación Biomédica en Red (CB21/13/00095, CB21/13/00006, CB21/13/00054, CB21/13/00068, CB21/13/00084, CB21/13/00099 groups of CIBERINFEC; CB06/06/0058 group of CIBERES), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea-NextGenerationEU. This research was also supported by Personalized and precision medicine grant from the Instituto de Salud Carlos III (MePRAM Project, PMP22/00092), and by the Antibiotic Resistance and Staphylococcus aureus Surveillance Programs of the National Center for Microbiology, Instituto de Salud Carlos III.S

An increase in erythromycin resistance in methicillin-susceptible Staphylococcus aureus from blood correlates with the use of macrolide/lincosamide/streptogramin antibiotics. EARS-Net Spain (2004–2020)

ObjectivesTo describe and analyse erythromycin resistance trends in blood isolates of Staphylococcus aureus (EARS-Net Spain, 2004–2020) and the association of these trends with the consumption of macrolide, lincosamide, and streptogramin B (MLSB) antibiotics. To assess molecular changes that could be involved in erythromycin resistance trends by whole genome analysis of representative isolates.Materials and methodsWe collected antibiotic susceptibility data for all first-blood S. aureus isolates in patients from 47 Spanish hospitals according to EARS-Net criteria. MLSB antibiotic consumption was obtained from the Spanish Agency for Medicines and Medical Devices (2008–2020). We sequenced 137 representative isolates for core genome multilocus sequence typing, resistome and virulome analysis.ResultsFor the 36,612 invasive S. aureus isolates, methicillin resistance decreased from 26.4% in 2004 to 22.4% in 2020. Erythromycin resistance in methicillin-susceptible S. aureus (MSSA) increased from 13.6% in 2004 to 28.9% in 2020 (p &lt; 0.001); however, it decreased from 68.7 to 61.8% (p &lt; 0.0001) in methicillin-resistant S. aureus (MRSA). Total consumption of MLSB antibiotics increased from 2.72 defined daily doses per 1,000 inhabitants per day (DID) in 2014 to 3.24 DID in 2016. By WGS, the macrolide resistance genes detected were erm (59.8%), msrA (46%), and mphC (45.2%). The erm genes were more prevalent in MSSA (44/57, 77.2%) than in MRSA (38/80, 47.5%). Most of the erm genes identified in MSSA after 2013 differed from the predominant ermC gene (17/22, 77.3%), largely because ermT was significantly associated with MSSA after 2013 (11/29, 37.9%). All 13 ermT isolates in this study, except one, belonged to ST398 and came from 10 hospitals and six Spanish provinces.ConclusionThe significant increase in erythromycin resistance in blood MSSA correlated with the consumption of the MLSB antibiotics in Spain. These preliminary data seem support the hypothesis that the human ST398 MSSA clade with ermT-mediated resistance to erythromycin may be involved in this trend

The CARBA-MAP study: national mapping of carbapenemases in Spain (2014–2018)

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

Monitorización continúa de la colonización por bacterias multirresistentes en una unidad neonatal de cuidados intensivos. relación entre colonización e infección

Las infecciones adquiridas durante el periodo postnatal están producidas principalmente por bacterias que forman parte de la flora humana normal o del medio ambiente. La adquisición de multirresistencia por parte de estas bacterias (BMR) constituye un problema muy grave ya que los neonatos son una población muy susceptible a los procesos infecciosos. El número de antibióticos disponibles para tratar estas infecciones es muy limitado, y algunos son tóxicos, por ello es muy importante conocer el número y la dinámica de las colonizaciones y esclarecer si son un determinante de infección y en qué proporción. Así mismo es relevante conocer en números absolutos y porcentuales el significado de estas infecciones en relación a otras infecciones bacterianas y al total de todas ellas. Esta información ayudaría a establecer la importancia de los cultivos regulares para controlar las colonizaciones, la necesidad de efectuar o no aislamientos de los niños para evitar la difusión de estas bacterias y establecer los tratamientos empíricos adecuados. Existen pocos datos disponibles en la literatura acerca de la incidencia de la infección nosocomial en las Unidades de Cuidados Intensivos neonatales (UCIN) españolas. Los objetivos de este trabajo son observar el grado de colonización por bacterias multirresistentes de los niños de la UCIN del Hospital Vall d’Hebron y determinar la capacidad de estas bacterias para causar enfermedades infecciosas en los niños colonizados. Para ello, se ha determinado a lo largo de un periodo de cinco meses, la flora grampositiva y gramnegativa multirresistente que coloniza el intestino de los niños a su ingreso, así como su su evolución durante su permanencia en la Unidad. Además se he estudiado la transmisión cruzada de los microorganismos resistentes entre los distintos niños de la UCIN y las enfermedades infecciosas esporádicas o endémicas desarrolladas por ellos a lo largo del periodo de estudio, en relación con la flora multirresistente de colonización intestinal. Por último, en este trabajo se han determinado los mecanismos genéticos implicados en la resistencia de las bacterias detectadas con el fin de conocer si ha existido transferencia genética entre las bacterias de la Unidad. Los resultados de este estudio han mostrado que durante el periodo de estudio, el 51% de los niños que han estado ingresados en la UCIN se han colonizado por una bacteria multirresistente, siendo Klebsiella pneumoniae y Enterobacter cloacae, las especies más prevalentes. La colonización por una BMR se asoció a un mayor tiempo de estancia en UCIN y los principales factores que se asociaron a la colonización fueron la prematuridad extrema (nacimiento antes de la semana 30 de gestación), el bajo peso, la lactancia materna, la administración de nutrición parenteral y la toma de antibióticos. Se observó una enorme dinámica en la colonización de los niños condicionada por la duración variable de la estancia en la Unidad, por los cambios de box, la salida a otras unidades y en ocasiones al reingreso, así como la aparición y difusión entre los niños de las diversas especies multirresistentes detectadas. En total, fueron diecisietes los brotes detectados. De estos, 6 afectaron a entre 4 y 46 niños y los once restantes a entre 1 y 3 niños. A lo largo del periodo de estudio, las infecciones sistémicas fueron más frecuentes que las superficiales estando las primeras causadas por bacterias multirresistentes en menor proporción que las superficiales. Las especies bacterianas multirresistentes que causaron mayor proporción de infección respecto a la colonización fueron K. pneumoniae, E. cloacae y C freundi. Todo esto pone de manifiesto la complejidad de las colonizaciones por bacterias multirresistentes tanto debido a las propias bacterias, por sus variedades clonales, su dinámica de permanencia, difusión, desaparición y reaparición, como por la propia complejidad que presentan los niños en sus procesos patológicos, su movilidad y otros factores indeterminados.Infections acquired during the postnatal period are mainly produced by bacteria that are part of normal human flora or the environment. The acquisition of multidrug resistance by these bacteria (MRB) is a very serious problem because neonates are highly susceptible to infections. The number of antibiotics available to treat these infections is very limited, and some are toxic, so it is very important to know the number and dynamics of colonization and to clarify whether they are determinates of infection and in what proportion. Also is important to know the proportion of these infections in relation to other bacterial infections and the total of all of them. This information would help to establish the importance of making regular screenings to control colonization, the need for isolation of children to prevent the spread of these bacteria and to establish appropriate empirical treatments. There are few data available in the literature on the incidence of nosocomial infection in Spanish Neonatal Intensive Care Units (NICU). The objectives of this work are to observe the level of colonization by multiresistant bacteria of children in the NICU of the Hospital Vall d'Hebron and to determine the ability of these bacteria to cause infectious disease in colonized children. To do this, it has been determined over a period of five months, the multidrug-resistant Gram-positive and Gram-negative bacteria that colonizes the intestine of children at the income as well as their evolution during their stay in the NICU. In addition, it has been studied cross-transmission events of resistant bacteria between different NICU infants and sporadic or endemic infectious diseases developed by them throughout the study period, in relation to its colonizing antibiotic-resistant intestinal flora. Finally, in this study the genetic mechanisms involved in the resistance of bacteria detected has been determined, in order to determine whether there has been gene transfer between the bacteria at the Unit. The results of this study have shown that during the study period, 51% of children who have been admitted to the NICU were colonized by multiresistant bacteria, being Klebsiella pneumoniae and Enterobacter cloacae, the most prevalent species. Colonization by a MRB was associated with a longer stay in NICU and the main factors associated with colonization were extreme prematurity (birth before 30 weeks of gestation), low birth weight, breastfeeding, parenteral nutrition and taking antibiotics. A high dynamic in the colonization of children was detected. This was conditioned by the variable length of stay in the unit, by box changes, discharge to other units and sometimes re-entry. Altogether, there were detected seventeen outbreaks. Of these, 6 affected between 4 and 46 children and the remaining eleven between 1 and 3. Throughout the study period, systemic infections were more frequent than superficial being the first ones caused by multidrug-resistant bacteria to a lesser extent than surface. All this shows the complexity of colonization by multiresistant bacteria both because the bacteria themselves, for their clonal varieties, dynamics of permanence, dissemination, disappearance and reappearance, and the complexity itself of children in their pathological processes, mobility and other undetermined factors

Monitorización continúa de la colonización por bacterias multirresistentes en una unidad neonatal de cuidados intensivos. relación entre colonización e infección

Las infecciones adquiridas durante el periodo postnatal están producidas principalmente por bacterias que forman parte de la flora humana normal o del medio ambiente. La adquisición de multirresistencia por parte de estas bacterias (BMR) constituye un problema muy grave ya que los neonatos son una población muy susceptible a los procesos infecciosos. El número de antibióticos disponibles para tratar estas infecciones es muy limitado, y algunos son tóxicos, por ello es muy importante conocer el número y la dinámica de las colonizaciones y esclarecer si son un determinante de infección y en qué proporción. Así mismo es relevante conocer en números absolutos y porcentuales el significado de estas infecciones en relación a otras infecciones bacterianas y al total de todas ellas. Esta información ayudaría a establecer la importancia de los cultivos regulares para controlar las colonizaciones, la necesidad de efectuar o no aislamientos de los niños para evitar la difusión de estas bacterias y establecer los tratamientos empíricos adecuados. Existen pocos datos disponibles en la literatura acerca de la incidencia de la infección nosocomial en las Unidades de Cuidados Intensivos neonatales (UCIN) españolas. Los objetivos de este trabajo son observar el grado de colonización por bacterias multirresistentes de los niños de la UCIN del Hospital Vall d’Hebron y determinar la capacidad de estas bacterias para causar enfermedades infecciosas en los niños colonizados. Para ello, se ha determinado a lo largo de un periodo de cinco meses, la flora grampositiva y gramnegativa multirresistente que coloniza el intestino de los niños a su ingreso, así como su su evolución durante su permanencia en la Unidad. Además se he estudiado la transmisión cruzada de los microorganismos resistentes entre los distintos niños de la UCIN y las enfermedades infecciosas esporádicas o endémicas desarrolladas por ellos a lo largo del periodo de estudio, en relación con la flora multirresistente de colonización intestinal. Por último, en este trabajo se han determinado los mecanismos genéticos implicados en la resistencia de las bacterias detectadas con el fin de conocer si ha existido transferencia genética entre las bacterias de la Unidad. Los resultados de este estudio han mostrado que durante el periodo de estudio, el 51% de los niños que han estado ingresados en la UCIN se han colonizado por una bacteria multirresistente, siendo Klebsiella pneumoniae y Enterobacter cloacae, las especies más prevalentes. La colonización por una BMR se asoció a un mayor tiempo de estancia en UCIN y los principales factores que se asociaron a la colonización fueron la prematuridad extrema (nacimiento antes de la semana 30 de gestación), el bajo peso, la lactancia materna, la administración de nutrición parenteral y la toma de antibióticos. Se observó una enorme dinámica en la colonización de los niños condicionada por la duración variable de la estancia en la Unidad, por los cambios de box, la salida a otras unidades y en ocasiones al reingreso, así como la aparición y difusión entre los niños de las diversas especies multirresistentes detectadas. En total, fueron diecisietes los brotes detectados. De estos, 6 afectaron a entre 4 y 46 niños y los once restantes a entre 1 y 3 niños. A lo largo del periodo de estudio, las infecciones sistémicas fueron más frecuentes que las superficiales estando las primeras causadas por bacterias multirresistentes en menor proporción que las superficiales. Las especies bacterianas multirresistentes que causaron mayor proporción de infección respecto a la colonización fueron K. pneumoniae, E. cloacae y C freundi. Todo esto pone de manifiesto la complejidad de las colonizaciones por bacterias multirresistentes tanto debido a las propias bacterias, por sus variedades clonales, su dinámica de permanencia, difusión, desaparición y reaparición, como por la propia complejidad que presentan los niños en sus procesos patológicos, su movilidad y otros factores indeterminados.Infections acquired during the postnatal period are mainly produced by bacteria that are part of normal human flora or the environment. The acquisition of multidrug resistance by these bacteria (MRB) is a very serious problem because neonates are highly susceptible to infections. The number of antibiotics available to treat these infections is very limited, and some are toxic, so it is very important to know the number and dynamics of colonization and to clarify whether they are determinates of infection and in what proportion. Also is important to know the proportion of these infections in relation to other bacterial infections and the total of all of them. This information would help to establish the importance of making regular screenings to control colonization, the need for isolation of children to prevent the spread of these bacteria and to establish appropriate empirical treatments. There are few data available in the literature on the incidence of nosocomial infection in Spanish Neonatal Intensive Care Units (NICU). The objectives of this work are to observe the level of colonization by multiresistant bacteria of children in the NICU of the Hospital Vall d'Hebron and to determine the ability of these bacteria to cause infectious disease in colonized children. To do this, it has been determined over a period of five months, the multidrug-resistant Gram-positive and Gram-negative bacteria that colonizes the intestine of children at the income as well as their evolution during their stay in the NICU. In addition, it has been studied cross-transmission events of resistant bacteria between different NICU infants and sporadic or endemic infectious diseases developed by them throughout the study period, in relation to its colonizing antibiotic-resistant intestinal flora. Finally, in this study the genetic mechanisms involved in the resistance of bacteria detected has been determined, in order to determine whether there has been gene transfer between the bacteria at the Unit. The results of this study have shown that during the study period, 51% of children who have been admitted to the NICU were colonized by multiresistant bacteria, being Klebsiella pneumoniae and Enterobacter cloacae, the most prevalent species. Colonization by a MRB was associated with a longer stay in NICU and the main factors associated with colonization were extreme prematurity (birth before 30 weeks of gestation), low birth weight, breastfeeding, parenteral nutrition and taking antibiotics. A high dynamic in the colonization of children was detected. This was conditioned by the variable length of stay in the unit, by box changes, discharge to other units and sometimes re-entry. Altogether, there were detected seventeen outbreaks. Of these, 6 affected between 4 and 46 children and the remaining eleven between 1 and 3. Throughout the study period, systemic infections were more frequent than superficial being the first ones caused by multidrug-resistant bacteria to a lesser extent than surface. All this shows the complexity of colonization by multiresistant bacteria both because the bacteria themselves, for their clonal varieties, dynamics of permanence, dissemination, disappearance and reappearance, and the complexity itself of children in their pathological processes, mobility and other undetermined factors

Antimicrobial resistance in Gram-negative bacilli in Spain: an experts’ view

Antibiotic resistance in Gram-negative bacilli poses a serious problem for public health. In hospitals, in addition to high mortality rates, the emergence and spread of resistance to practically all antibiotics restricts therapeutic options against serious and frequent infections. The aim of this work is to present the views of a group of experts on the following aspects regarding resistance to antimicrobial agents in Gram-negative bacilli: 1) the current epidemiology in Spain, 2) how it is related to local clinical practice and 3) new therapies in this area, based on currently available evidence. After reviewing the most noteworthy evidence, the most relevant data on these three aspects were presented at a national meeting to 99 experts in infectious diseases, clinical microbiology, internal medicine, intensive care medicine, anaesthesiology and hospital pharmacy. Subsequent local debates among these experts led to conclusions in this matter, including the opinion that the approval of new antibiotics makes it necessary to train the specialists involved in order to optimise how they use them and improve health outcomes; microbiology laboratories in hospitals must be available throughout a continuous timetable; all antibiotics must be available when needed and it is necessary to learn to use them correctly; and the Antimicrobial Stewardship Programs (ASP) play a key role in quickly allocating the new antibiotics within the guidelines and ensure appropriate use of them

Table_1_An increase in erythromycin resistance in methicillin-susceptible Staphylococcus aureus from blood correlates with the use of macrolide/lincosamide/streptogramin antibiotics. EARS-Net Spain (2004–2020).XLSX

ObjectivesTo describe and analyse erythromycin resistance trends in blood isolates of Staphylococcus aureus (EARS-Net Spain, 2004–2020) and the association of these trends with the consumption of macrolide, lincosamide, and streptogramin B (MLSB) antibiotics. To assess molecular changes that could be involved in erythromycin resistance trends by whole genome analysis of representative isolates.Materials and methodsWe collected antibiotic susceptibility data for all first-blood S. aureus isolates in patients from 47 Spanish hospitals according to EARS-Net criteria. MLSB antibiotic consumption was obtained from the Spanish Agency for Medicines and Medical Devices (2008–2020). We sequenced 137 representative isolates for core genome multilocus sequence typing, resistome and virulome analysis.ResultsFor the 36,612 invasive S. aureus isolates, methicillin resistance decreased from 26.4% in 2004 to 22.4% in 2020. Erythromycin resistance in methicillin-susceptible S. aureus (MSSA) increased from 13.6% in 2004 to 28.9% in 2020 (p B antibiotics increased from 2.72 defined daily doses per 1,000 inhabitants per day (DID) in 2014 to 3.24 DID in 2016. By WGS, the macrolide resistance genes detected were erm (59.8%), msrA (46%), and mphC (45.2%). The erm genes were more prevalent in MSSA (44/57, 77.2%) than in MRSA (38/80, 47.5%). Most of the erm genes identified in MSSA after 2013 differed from the predominant ermC gene (17/22, 77.3%), largely because ermT was significantly associated with MSSA after 2013 (11/29, 37.9%). All 13 ermT isolates in this study, except one, belonged to ST398 and came from 10 hospitals and six Spanish provinces.ConclusionThe significant increase in erythromycin resistance in blood MSSA correlated with the consumption of the MLSB antibiotics in Spain. These preliminary data seem support the hypothesis that the human ST398 MSSA clade with ermT-mediated resistance to erythromycin may be involved in this trend.</p