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This report describes a 49-year-old male construction worker who acquired a Bacillus anthracis infection after working on a sheep farm. He experienced a severe respiratory infection, septic shock, and hemorrhagic meningoencephalitis with severe intracranial hypertension. After several weeks with multiple organ dysfunction syndrome, he responded favorably to antibiotic treatment. Three weeks into his hospitalization, an intracranial hemorrhage and cerebral edema led to an abrupt deterioration in his neurological status. A single dose of raxibacumab was added to his antimicrobial regimen on hospital day 27. His overall status, both clinical and radiographic, improved within a few days. He was discharged 2 months after admission and appears to have fully recovered.

Introduction. The disease caused by SARS-CoV-2 (COVID-19) has been a challenge for healthcare professionals since its appearance. Staphylococcus aureus has been described as one of the main pathogens causing bacterial infections in viral pandemics. However, co- infection with S. aureus causing bacteremia in patients with COVID-19 has yet to be well studied. Methods. We performed a e study of S. aureus bacteremia (SAB) at Hospital Miguel Servet (Zaragoza) from March 2020 to February 2021. The clinical characteristics, mortality and risk factors of adults hospitalized patients with BSA associated COVID-19 compared to patients without COVID-19. Results. A total of 95 patients with SAB were identified. 27.3% were positive for SARS-CoV-2. SAB represented 9.9% of bacteremia, being the second agent in frequency after E. coli. Nosocomial bacteremia was more frequent in the group of COVID-19 patients. The most frequent source of BSA in these patients was the respiratory source (26.9% vs 0%; P 6 mg/day (62.5% vs. 37.5%, P

Introduction: The reasons for the decrease in blood cultures were investigated and the rate and aetiology of bacteremia and contaminated blood cultures collected from COVID and non-COVID patients were assessed. Methods: We performed a retrospective analysis in a tertiary hospital in Spain during the COVID period from 4th March 2020 to 21thJune 2020. Results: The number of blood cultures processed was 5313, representing 22.7 % and 18.8 % of decrease compared to the same months of 2019 and 2018, respectively (p=0.173). The rate of bacteremia was 1.2% higher among COVID-patients than among non-COVID patients (p

Purpose Gordonia species are known to be opportunistic human pathogens causing secondary infections. We present the second case in the world of endocarditis caused by Gordonia bronchialis and a review of all the cases of endocarditis caused by Gordonia spp. Methods The identification was performed by matrix-assisted desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing were performed to confirm the identification. Antimicrobial susceptibility was performed by MIC test Strip on Mueller-Hinton agar supplemented with 5% defibrinated sheep blood according to Clinical and Laboratory Standards Institute. Results Pacemaker-induced endocarditis due to Gordonia bronchialis infection was determined in an 88-year old woman. The patient was treated with ceftriaxone and ciprofloxacin until completing 6 weeks from the pacemaker explant with a good evolution. Conclusion The case presented supports the pathogenic role of Gordonia bronchialis as an opportunistic pathogen and highlights the high risk of suffering infections caused by environmental bacteria.

Introduction. Staphylococcus aureus bacteremia patients characteristics at a tertiary hospital are described, and complications, mortality and associated factors are analyzed. Methods. Data from patients with S. aureus bacteremia admitted between March 2020 and February2021 at Miguel Servet university hospital in Zaragoza were retrospectively analyzed. Results. Results showed a 14 days mortality of 24.2% and an 30 days mortality of 40%. Overall survival decreased with complications appearance [HR 3.1 (1.2-8.05)] and age over 65 years [HR 3.1 (1.4-6.6)]. The adjusted analysis showed correlation between a higher mortality at 14 and 30 days with age over 65 years [OR 6.3 (1.7-23.1)], sepsis presence [OR 19.3 (5.4-68.7)] and number of positive (+) blood cultures ≥3 [OR 5.4 (0.8-34.1)]. Mortality at 14 days was associated with sepsis presence [OR 58.2 (5.7-592.9)], number of positive (+) blood cultures ≥3 [OR 14.1 (1.1-173.7)] and an older age [OR 1.1 (1.03-1.1)]. Analyzing time to positive blood cultures ≤12 hours and number of positive blood cultures ≥ 3 at the same time, frequency of sepsis increased [30 patients (66.6%) vs 15 patients (33.3%); OR 3.4 (IC95% 1.5-8)]. Conclusions. High 14- and 30-days mortality were found, as well as a worse evolution in older age patients, with sepsis presence, and with greater number of positive blood cultures and times to positive blood cultures ≤12 h.

Objetivo Realizar un análisis de las bacteriemias diagnosticadas en urgencias durante el año 2020, coincidiendo con el periodo de la pandemia Métodos Estudio retrospectivo en un hospital de tercer nivel en España durante el período COVID del 4 de marzo al 31 de diciembre de 2020. Resultados El número de pacientes atendidos en urgencias durante el periodo de estudio y el número de hemocultivos extraídos sufrieron un descenso del 46,79% y del 35.7% respecto al mismo periodo de 2019 (p

Introduction No cases of human brucellosis caused by Brucella suis has been reported in Spain. Methods This study involved interviews with the case and his co-workers, inspection of their workplace, checking infection control measures, and typing the Brucella strain isolated in the blood culture. Results Brucella suis biovar 1 strain 1330 was isolated from a patient who worked in a waste treatment plant. Food borne transmission, contact with animals, and risk jobs were ruled out. An accidental inoculation with a contaminated needle from a research laboratory waste container was identified as the most probable mode of transmission. Conclusion There should be controls to ensure that waste containers are sealed.

IntroducciOn El objetivo de nuestro trabajo consiste en revisar el resultado de los cultivos microbiologicos de Bordetella spp. durante un periodo de 19 anos, desde enero de 1984 hasta diciembre de 2002. MEtodos Toma pernasal y siembra inmediata en placas de agar-carbon suplementadas con 10% de sangre de carnero y 40 mg/l de cefalexina. Identificacion mediante pruebas bioquimicas y aglutinacion con antisueros especificos. Recopilacion de los resultados microbiologicos y aspectos epidemiologicos (edad, sexo, paciente ingresado o ambulante, periodo estacional y distribucion anual). Resultados Se cultivaron 2.064 muestras con 269 resultados positivos (13,03%): 244, B. pertussis; 23, B. parapertussis, y 2, B. bronchiseptica. El 36,9% de los casos se dio en menores de 7 meses, el 38,9% en ninos de 7 meses a 6 anos y el 24,3% en mayores de 6 anos. Conclusiones El constante numero de casos a lo largo del periodo de estudio demuestra la circulacion continua de Bordetella spp. en nuestra area de salud. Pese al limitado numero de resultados positivos en adolescentes y adultos seria conveniente considerar la investigacion de tos ferina en estos grupos de edad. El cultivo sigue siendo el metodo diagnostico de referencia y es de especial utilidad en la confirmacion de brotes.

SUMMARY Kingella kingae is a bacterium that colonizes the upper respiratory tract. Despite its low pathogenicity in this location, previous respiratory pathological processes may favor its systemic spread causing bone and joint infections, mainly in children under five years. It can be considered an emerging pathogen in osteoarticular infection in pediatric patients. We report the case of a two-year-old girl with hips pain and limitation of both abduction and extension, and fever. Radiography and ultrasonography were compatible with transitory synovitis; showed scintigraphy inflammatory pathology of the right hip. Articular puncture was performed. The material showed altered biochemical parameters. Microbiological culture yielded isolation of a strain of K. kingae susceptible to beta-lactam antibiotics, azithromycin and trimethoprim-sulfamethoxazole. Blood cultures were negative. The patient was treated empirically with cloxacillin and cefotaxime iv. and continued with amoxicillinclavulanate orally with osteoarticular improvement.

To determine risk factors for nosocomial pneumonia in critically ill trauma patients.Prospective cohort study.The trauma intensive care unit (ICU) of a 1500-bed tertiary-care hospital.All critically ill trauma patients (n = 103) admitted consecutively between November 1995 and October 1996.A comparison of data recorded at the time of ICU admission and during the clinical evolution in patients with (n = 23) and without (n = 80) nosocomial pneumonia was made. Data referred mainly to possible risk factors were recorded; they also included factors related to pneumonia etiology and evolutive factors. Predictors of nosocomial pneumonia were assessed by logistic regression analysis.The presence of significant growth on quantitative cultures of the protected specimen brush (or = 103 colony forming units/mL) was required to accept pneumonia as microbiologically proven, as well as the concurrence of a cohort of clinical and radiologic signs. Twenty-three (22.3%) patients developed nosocomial pneumonia. The mean age of these patients was 41.7 yrs; 18 of them (78.3%) were men. The microorganisms isolated in significant concentrations were Acinetobacter baumanii (ten cases), Staphylococcus aureus (11 cases), Pseudomonas aeruginosa (five cases), Haemophilus influenzae (two cases), and Klebsiella pneumoniae, Citrobacter freundii, Serratia marcescens, Enterococcus spp., Enterobacter spp., coagulase-negative Staphylococcus, and Streptococcus intermedius (one case each one). Risk factors for pneumonia by univariate analysis included nasogastric tube; continuous enteral feeding; prolonged mechanical ventilation (1 day); use of H2-receptor antagonist, sucralfate, muscle relaxants, corticosteroids, barbiturates, and inotropic agents; positive end-expiratory pressure; intense sedation; re-intubation; tracheotomy; urgent brain computed tomography (CT) scan; craniotomy; iatrogenic event; and hyperventilation. The mortality rate was 43.5% (10 of 23) in the nosocomial pneumonia group and 18.8% in patients without nosocomial pneumonia (p =.02). Also, the mean stay in the ICU, the therapeutic charge (measured with total and mean punctuation of the Therapeutic Intervention Scoring System) and the complications, infectious and noninfectious, of the clinical evolution were significantly more frequent in patients with nosocomial pneumonia than in those without pneumonia (p.05). In the multivariate analysis, continuous enteral feeding, craniotomy, prolonged mechanical ventilation (24 hrs), use of positive end-expiratory pressure, and corticotherapy were independent predictors of nosocomial pneumonia.It seems that factors related to the patient's clinical course, rather than variables registered on the first days of ICU admission, are those that would exert an influence on the development of nosocomial pneumonia in critically ill trauma patients. In this way, from our point of view, in our study the main risk factors are the use of prolonged mechanical ventilation (4 hrs) and positive end-expiratory pressure. At the same time, we can conclude that the reduction of this infection incidence could decrease the mean stay in the ICU, the therapeutic charge, and the prognosis in terms of mortality and morbidity.

Kingella kingae is a bacterium that colonizes the upper respiratory tract. Despite its low pathogenicity in this location, previous respiratory pathological processes may favor its systemic spread causing bone and joint infections, mainly in children under five years. It can be considered an emerging pathogen in osteoarticular infection in pediatric patients. We report the case of a two-year-old girl with hips pain and limitation of both abduction and extension, and fever. Radiography and ultrasonography were compatible with transitory synovitis; showed scintigraphy inflammatory pathology of the right hip. Articular puncture was performed. The material showed altered biochemical parameters. Microbiological culture yielded isolation of a strain of K. kingae susceptible to beta-lactam antibiotics, azithromycin and trimethoprim-sulfamethoxazole. Blood cultures were negative. The patient was treated empirically with cloxacillin and cefotaxime iv. and continued with amoxicillin-clavulanate orally with osteoarticular improvement.

Nocardia ignorata is a recently described species identified on the basis of a single isolate of unknown origin. Here we describe the epidemiological, phenotypic, and phylogenetic characteristics of this new species, based on five new clinical and soil isolates.

This retrospective study reviews the findings from cultures positive for Bordetella spp. obtained over a 19-year period, from January 1984 to December 2002.Nasopharyngeal swabs were directly plated onto charcoal agar supplemented with 10% sheep blood and cephalexin (40 mg/L). Identification of suspected colonies was done by biochemical testing and slide agglutination with specific antisera for B. pertussis and B. parapertussis. The study includes microbiological findings and epidemiological data (age, sex, yearly distribution, seasonal period and number of inpatients and outpatients).The 2064 nasopharyngeal specimens yielded 269 positive cultures: B. pertussis was isolated from 244 patients, B. parapertussis from 23 and B. bronchiseptica from two. Among the positive patients, 36.9% were younger than 7 months, 38.8% were 7 months to 6 years old and 24.3% were older than 6 years of age.The constant number of cases along the 19 years of the study shows that Bordetella spp. continues to circulate in our area. A high percentage of positive cultures were obtained from the group of children theoretically immunized by vaccination. Despite the low number of cases in young people and adults, adult pertussis seems to be a greater public health threat than was previously suspected and probably deserves to be further investigated. The gold standard for the diagnosis of Bordetella spp. infection is still recovery of the organism by culture, and it is especially useful for confirming outbreaks.

The object of our research is to analyse the microbiological results of the samples which have been obtained by means of fibronchoscopy (FB) from HIV positive patients from 1991 until 1993.Sixty fibrobronchoscopies were carried out on fifty-seven HIV positive patients. In every case, samples of bronchoaspirate (BAS), bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) were cultured; the last two in a quantitative way. Pneumocystis carinii was investigated in BAL by means of immunofluorescence with monoclonal antibodies.Some microorganisms were isolated in forty-seven bronchoscopies. Thirteen episodes resulted negative. The most frequent etiologic agent was Pneumocystis carinii (seventeen cases). The etiology of fifteen episodes was polymicrobial. The intersticial radiological pattern was the predominant one. It was observed in twenty-seven cases. With regard to immunity, 91% of the patients showed CD4200.In our research work, the samples that have been obtained by means of FB showed a high percentage of diagnoses; that is the reason why we regard this technique as very useful for the diagnosis of pneumonia in patients with AIDS. Due to the large number of bacterian pneumonia, we consider necessary not only the use of BAL, but also that of TPC in these processes.

sugirieron que podian ser miembros de dos nuevas especies de estreptococos, S. defectivus y S. adjacens. En 1995, Kawamura et al2, basandose en secuencias del 16S rRNA de los NVS, demostraron que pertenecian a otro grupo diferente y propusieron el nuevo genero Abiotrophia, con dos especies, A. adiacens y A. defectiva. Posteriormente, se describieron dos especies mas, A. elegans3 y A. balaenopterae sp. nov4. Actualmente se ha reclasificado como genero Granulicatella con las especies: G. adiacens, G. elegans y G. balaenopterae5. Su morfologia microscopica depende del medio de cultivo, adoptando formas variables, desde cocos grampositivos, hasta cocobacilos pleomorficos gramvariable cuando no crecen en medios de cultivo Caso clinico

Nocardia is an opportunistic pathogen that causes respiratory infections in immunocompromised patients. The aim of this study was to analyze the epidemiology, clinical significance and antimicrobial susceptibility of Nocardia species isolated from eight children with cystic fibrosis. The isolated species were identified as Nocardia farcinica, Nocardia transvalensis, Nocardia pneumoniae, Nocardia veterana and Nocardia wallacei. N. farcinica was isolated in three patients and all of them presented lung affectation with a chronic colonization and pneumonia. N. farcinica showed resistance against gentamicin, tobramycin, cefotaxime, but was susceptible to trimethoprim-sulfamethoxazole and amikacin. N. transvalensis, which was isolated from two patients, showed an association with chronic colonization. N. transvalensis was resistant to tobramycin and amikacin, but susceptible to ciprofloxacin, trimethoprim-sulfamethoxazole and cefotaxime. N. veterana, N. pneumoniae and N. wallacei were isolated from three different patients and appeared in transitory lung colonization. N. veterana and N. pneumoniae were susceptible to imipenem, trimethoprim-sulfamethoxazole, amikacin, tobramycin, and cefotaxime. N. wallacei was resistant to amikacin, tobramycin, imipenem, and trimethoprim-sulfamethoxazole and susceptible to ciprofloxacin and cefotaxime. All the isolates were identified up to species level by 16S rRNA gene sequencing. The presence of Nocardia in the sputum of patients with cystic fibrosis is not always an indication of an active infection; therefore, the need for a treatment should be evaluated on an individual basis. The detection of multidrug-resistant species needs molecular identification and susceptibility testing, and should be performed for all Nocardia infections.