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Background Before the COVID-19 pandemic, Sexually transmitted infections (STIs) were increasing in Europe, and Spain and Catalonia were not an exception. Catalonia has been one of the regions with the highest number of COVID-19 confirmed cases in Spain. The objective of this study was to estimate the magnitude of the decline, due to the COVID-19 pandemic, in the number of STI confirmed cases in Catalonia during the lockdown and de-escalation phases. Methods Interrupted time series analysis was performed to estimate the magnitude of decline in the number of STI reported confirmed cases - chlamydia, gonorrhoea, syphilis, and lymphogranuloma venereum- in Catalonia since lockdown with historical data, from March 13th to August 1st 2020, comparing the observed with the expected values. Results We found that since the start of COVID-19 pandemic the number of STI reported cases was 51% less than expected, reaching an average of 56% during lockdown (50% and 45% during de-escalation and new normality) with a maximum decrease of 72% for chlamydia and minimum of 22% for syphilis. Our results indicate that fewer STIs were reported in females, people living in more deprived areas, people with no previous STI episodes during the last three years, and in the HIV negative. Conclusions The STI notification sharp decline was maintained almost five months after lockdown started, well into the new normality. This fact can hardly be explained without significant underdiagnosis and underreporting. There is an urgent need to strengthen STI/HIV diagnostic programs and services, as well as surveillance, as the pandemic could be concealing the real size of the already described re-emergence of STIs in most of the European countries.

Background. More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). Methods. A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal beta-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed. Results. Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI},.30-.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI,.14-.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25-1.31); model with PS, 0.69 (.29-1.65); and PS-based matched pairs, 0.98 (.76-1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay. Conclusions. De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.

To update the knowledge of the epidemiology of fungaemia episodes in Spain, the species implicated and their in vitro antifungal susceptibilities. Episodes were identified prospectively over 13 months at 44 hospitals. Molecular methods were used to determine the cryptic species inside the Candida parapsilosis and Candida glabrata complexes. Susceptibility to amphotericin B, anidulafungin, caspofungin, fluconazole, flucytosine, itraconazole, micafungin, posaconazole and voriconazole was determined by a microdilution colorimetric method. New species-specific clinical breakpoints (SSCBPs) for echinocandins, fluconazole and voriconazole were applied. The incidence of the 1357 fungaemia episodes evaluated was 0.92 per 1000 admissions. The incidence of Candida albicans fungaemia was the highest (0.41 episodes/1000 admissions), followed by Candida parapsilosis sensu stricto (0.22). Candida orthopsilosis was the fifth cause of fungaemia (0.02), outnumbered by Candida glabrata and Candida tropicalis. Interestingly, the incidence of fungaemia by C. parapsilosis was 11 and 74 times higher than that by C. orthopsilosis and Candida metapsilosis, respectively. Neither Candida nivariensis nor Candida bracarensis was isolated. Fungaemia was more common in non-intensive care unit settings (65.2) and among elderly patients (46.4), mixed fungaemia being incidental (1.5). Overall susceptibility rates were 77.6 for itraconazole, 91.9 for fluconazole and 96.599.8 for the other agents. Important resistance rates were only observed in C. glabrata for itraconazole (24.1) and posaconazole (14.5), and in Candida krusei for itraconazole (81.5). Fungaemia is more common in non-critical patients. C. albicans is the most common species, followed by C. parapsilosis and C. glabrata. Nearly 90 of yeasts are susceptible to all antifungal agents tested. Resistance rates change moderately when applying the new SSCBPs.

Objectives: To investigate theepidemiology and clinical features of infections caused by Enterobacteria producing plasmid-mediated AmpC beta-lactamases (pAmpC), which are emerging as a cause of resistance to extended-spectrum cephalosporins. Methods: A prospective multicentre cohort of patients with infection/colonisation due to pAmpC-producing Enterobacteriaceae was performed in 7 Spanish hospitals from February throughout July 2009. pAmpCs were characterised by PCR and sequencing. Results: 140 patients were included; organisms isolated were Escherichia coli (n=100), Proteus mirabilis (n=20), Klebsiella pneumoniae (n=17), and others (n=3). Overall, 90% had a chronic underlying condition. The acquisition was nosocomial in 43%, healthcare-associated in 41% (14% of those were nursing home residents), and community in 16%. Only 5% of patients had no predisposing feature for infection with multidrug-resistant bacteria. Nineteen percent of patients were bacteraemic. Inappropriate empirical therapy was administered to 81% of bacteraemic patients, who had a crude mortality rate of 48%. The most frequent enzyme was CMY-2 (70%, predominantly in E. coli and P. mirabilis) followed by DHA-1 (19%, predominantly in K. pneumoniae). Conclusion: pAmpC-producing Enterobacteriaceae caused nosocomial, healthcare-associated and community infections mainly inpredisposed patients. Invasive infections were associated with high mortality which might be partly related to inappropriate empirical therapy. (C) 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Pneumonia is a common cause of mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT) but updated and prospective information is partial. The aim of this nationwide prospective study is to determine the current epidemiology, etiology, and outcome of pneumonia in allo-HSCT recipients. From September-2003 to November-2005, 112 episodes in 427 consecutive allo-HSCT recipients were included (incidence 52.2 per 100 allo-HSCT/yr), and 72 of them (64.3%) were microbiologically defined pneumonia. Bacterial pneumonia (44.4%) was more frequent than fungal (29.2%) and viral pneumonia (19.4%). The most frequent microorganisms in each group were: Escherichia coli (n = 7, 8.9%), Streptococcus pneumoniae (n = 4, 5.0%), cytomegalovirus (n = 12, 15.4%), and Aspergillus spp. (n = 12, 15.4%). The development of pneumonia and chronic graft-versus-host disease (GVHD) was associated with increased mortality after allo-HSCT, and the probability of survival was significantly lower in patients that had at least one pneumonia episode (p < 0.01). Pneumonia development in the first 100 d after transplantation, fungal etiology, GVHD, acute respiratory failure, and septic shock were associated with increased mortality after pneumonia. Our results show that pneumonia remains a frequent infectious complication after allo-HSCT, contributing to significant mortality, and provide a large current experience with the incidence, etiology and outcome of pneumonia in these patients.

Background: In haematopoietic stem cell transplant (HSCT) recipients, cytomegalovirus (CMV) infection contributes significantly to morbidity and mortality in both the early and late post-transplant period. Ganciclovir (GCV) is the treatment of choice for CMV, but requires intravenous administration, a fact that complicates its long-term use. Oral valganciclovir (VGCV) and intravenous GCV were recently shown to have similar efficacy for pre-emptive CMV treatment in solid organ transplant recipients, but relatively limited data are available in HSCT recipients. The objectives of this study were to compare the efficacy of VGCV versus intravenous GCV or foscarnet (FOS) for pre-emptive therapy of active CMV infection in allogeneic HSCT and to determine the incidence of adverse effects and relapses. Methods: This was a 2-year prospective, comparative cohort study in which 237 episodes of pre-emptive therapy for active CMV infection were collected in 166 allogeneic HSCT recipients out of 717 included in the Spanish Network for Research on Infection in Transplantation (RESITRA/REIPI) database. Intravenous GCV was the first-line treatment in 112 episodes, intravenous FOS in 38 episodes, and oral VGCV in 87 episodes. Results: VGCV was used as pre-emptive therapy for active CMV infection in 87 episodes. Excluding episodes considered as relapse, VGCV was as successful (91.4% [74/81]) as GCV (83.7% [87/14]) or FOS (75.8% [25/33]). In the VGCV arm, 7 (8.6%) cases were considered treatment failures: 4 (4.9%) because of adverse events, 1 (1.2%) due to persistent viral activity and 2 (2.5%) based on clinical decision. There were also 6 (7.4%) cases of recurrent infection. No statistically significant differences were found when compared to GCV or FOS. Conclusions: In allogeneic HSCT recipients, VGCV seemed effective and safe in the pre-emptive therapy of active CMV infection.

La reflexió sobre la pròpia professió ajuda els professionals i també l'organització on s'ubiquen a desenvolupar-se. Aquesta idea constitueix l'eix central dels seminaris CCUC. En el present article es dóna a conèixer una experiència continuada i no puntual de reflexió cooperativa del professorat de diverses universitats respecte al seu propi desenvolupament i el desenvolupament organitzatiu de la universitat. Es tracta d'una experiència no institucional que sorgeix a partir d'un grup d'investigació interessat en el canvi de cultura a les universitats, el core group, que dinamitza i convida diferents grups, experts i estudiosos dels temes de canvi de la nostra universitat. La fórmula escollida per fer aquesta reflexió és el seminari, que permet un tractament dels temes amb deteniment. Cada seminari té una temàtica que aglutina els diferents participants i dins d'aquesta temàtica cada grup aporta un aspecte que coneix en profunditat. S'hi expliquen aspectes i temàtiques tractades, així com les principals conclusions en l'àmbit de reflexions compartides pels participants. Reflection about one's profession contributes to the professionals' development and at the development of the institution at the same time. This idea is the central axis of the CCUC seminaries. In this article we explain an experience of cooperative reflection among teachers of diverse universities about their own development and about the university's organizational development. It is not an institutional experience, but it emerges from a research group interested in the change of culture at universities, the «core group» which invites and moderates different groups, experts and scholars of issues related to university change. The chosen formula for this reflection is the seminar which allows a thoroughly study of the different topics. Each seminar has a diverse subject matter and brings together different participants who bring expertise in one specific aspect. All the topics are extensively discussed, and conclusions are drawn from the shared reflections of the participants. La reflexión sobre la propia profesión ayuda a los profesionales y también a la organización donde se ubican a desarrollarse. Esta idea es el eje central de los seminarios CCUC. En el presente artículo se da a conocer una experiencia continuada y no puntual de reflexión cooperativa de profesorado de diversas universidades sobre su propio desarrollo y sobre el desarrollo organizativo de la universidad. Se trata de una experiencia no institucional que surge a partir de un grupo de investigación interesado en el cambio de cultura en las universidades, el core group, que dinamiza e invita a diferentes grupos, expertos y estudiosos de los temas de cambio de nuestra universidad. La fórmula elegida para esta reflexión es el seminario, que permite un tratamiento de los temas con detenimiento. Cada seminario tiene una temática que aglutina a los diferentes participantes y, dentro de ella, cada grupo aporta un aspecto que conoce en profundidad. Se explican esos aspectos y esas temáticas tratadas así como las principales conclusiones en el ámbito de reflexiones compartidas por los participantes.

Identification of Aeromonas species, emergent pathogens for humans, has long been controversial due to their phenotypic and genomic heterogeneities. Computer analysis of the published 16S rRNA gene sequences revealed that restriction fragment length polymorphism of the PCR-amplified 16S rRNA gene is a good and rapid way of assessing the identities of all known species of Aeromonas. The method was evaluated with the reference strains of all species (or DNA homology groups) and 76 clinical isolates of diverse origin. Most results from the two approaches were in agreement, but some discrepancies were discerned. Advantages over previous phenotypic and genetic methods are discussed.

During the period 1987 to 1991 a retrospective study was performed to determine the resistance of thermotolerantCampylobacter species isolated from feces to erythromycin and fluoroquinolones. Of the 672 strains studied, 614 (91.3 %) were identified asCampylobacter jejuni and 58 (8.7 %) asCampylobacter coli. During the study period the rate of resistance ofCampylobacter jejuni to erythromycin remained relatively stable (0.9–3.5 %), while resistance ofCampylobacter coli to erythromycin emerged later (1989) with much higher rates (14.8–33 %). Overall, 11.8 % and 10.7 % ofCampylobacter jejuni strains isolated after 1987 were resistant to nalidixic acid and ciprofloxacin respectively, resistance increasing from 2.3 % in 1988 to 32 % in 1991. In 1991 the first strains ofCampylobacter coli with resistance to these fluoroquinolones were detected (rates 29 % and 26 % respectively). Of the strains resistant to nalidixic acid, only 10.9 % were susceptible to ciprofloxacin.

We report a case of pneumonia, caused by Bordetella bronchiseptica, in a previously healthy, immunocompetent 37-year-old male patient who had suffered chest injury in a car accident. The patient was admitted to the Intensive Care Unit where endotracheal intubation was performed. Seventy-two hours later he presented with fever associated with pulmonary affection which was diagnosed as right lobar pneumonia. Abundant colonies of B. bronchiseptica were isolated from the pharyngeal exudate and respiratory secretions, suggesting prior oropharyngeal colonization by B. bronchiseptica, as a result of repeated contact with his dog, with subsequent infection of the lower respiratory tract assisted by the process of intubation. We review different human infections produced by B.bronchiseptica as well as the antibiotic susceptibility studies performed.