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Introduction Onychomycosis is a frequent and underdiagnosed condition. Approximately 90% of toenail onychomycosis infections are caused by dermatophytes, but classical diagnosis based on culture and microscopy observation is slow and has low sensitivity. Both limitations can be solved incorporating molecular techniques to routine diagnosis of onychomycosis. Objective Prospective evaluation of the utility of incorporating in the clinical laboratory workflow a commercial real time PCR (qPCR) for dermatophytes detection in nails after potassium hydroxide direct observation screening. Materials and methods 152 nail samples were included (34 KOH negative and 118 KOH positive) and processed by culture and qPCR. Results In the negative KOH group, only one dermatophyte grew in culture and three were detected by qPCR. In the group of positive KOH, 57 dermatophytes grew in culture and 81 were detected by qPCR. In this group, 25% of diagnosed dermatophytes were detected only by qPCR. The sensitivity of qPCR compared to culture is 92.8% and time of response decreases from days to hours. Conclusion Based in our results, we propose a workflow algorithm for a clinical laboratory that eliminates culture for qPCR positive samples.

BACKGROUND We studied the impact of 13-valent pneumococcal conjugate vaccine (PCV13) on the incidence of invasive pneumococcal disease (IPD) and serotype distribution in a region with intermediate levels of vaccination (around 64% in children aged

Objectives The aim of this study was to monitor the spread, persistence and antibiotic resistance patterns of Legionella spp. strains found in a hospital water distribution system. These environmental studies are intended to help detect the presence of antibiotic resistant strains before they infect patients. Methods: Antimicrobial surveillance tests were performed at 27 different sampling points of the water network of a large Spanish hospital over two years. Water samples were screened for Legionella according to ISO 11731:2007. Legionella spp. isolates were identified by serotyping and by mass spectrometry (MALDI-ToF). Epidemiological molecular typing was done by Pulse-Field Gel Electrophoresis (PFGE) and by Sequence-Based Typing (SBT). Antibiotic susceptibility tests were performed using disk diffusion and ETEST®. Results Legionella spp. were recurrently isolated for 2 years. All isolates belonged the same group, L. pneumophila serogroups 2–14. Isolates were all attributed by SBT to sequence type (ST) ST328, although PFGE revealed 5 different patterns. No significant change in antibiotic susceptibility could be observed for this study period, irrespectively of the method used. Conclusion Colonization of water systems by Legionella spp. is still occurring, although all the prevention rules were strictly followed. Antibiotic resistance monitoring may help us to find resistance in bacteria with environmental reservoirs but difficult to isolate from patients. The knowledge of the antibiotic susceptibility in environmental strains may help us to predict changes in clinical strains. This study might also help reconsidering Legionnaires’ disease (LD) diagnostic methods. L. pneumophila serogroups 2–14 present all along the time of the investigation in the water distribution system can cause LD. However, they may not be detected by routine urine tests run on patients, thereby missing an ongoing LD infection.

Resumen Introduccion VINCat es un programa de vigilancia de la infeccion nosocomial en los hospitales de Cataluna. El objetivo del estudio fue evaluar el cumplimiento de las medidas de control de Staphylococcus aureus resistente a meticilina (SARM) en dichos centros. Metodos De enero a marzo de 2013 se realizo una encuesta por correo sobre las caracteristicas de los hospitales y la aplicacion de las medidas de control de SARM. Resultados Respondieron 53 hospitales (> 500 camas: 7; 200-500 camas: 14; Conclusiones Este estudio informa sobre la implementacion de medidas preventivas de SARM en hospitales del programa VINCat. Aunque la mayoria de los hospitales disponen de un protocolo especifico, el cumplimento de las medidas es mejorable, especialmente la deteccion activa en pacientes de riesgo, la adherencia a la higiene de manos, la limpieza mas frecuente de la habitacion y la optimizacion del uso de antibioticos.

VINCat is a nosocomial infection surveillance program in hospitals in Catalonia. The aim of the study was to determine the surveillance and control measures of methicillin-resistant Staphylococcus aureus (MRSA) in these centres.An e-mail survey was carried out from January to March 2013 with questions related to the characteristics of the hospitals and their control measures for MRSA.A response was received from 53 hospitals (500 beds: 7; 200-500 beds: 14;200 beds: 32; had ICU: 29). Computer alert of readmissions was available in 63%. There was active surveillance of patients admitted from another hospital (46.2%) or a long-term-care centre (55.8%), both being significantly more common measures in hospitals with a rate of MRSA≤22% (global median). Compliance with hand hygiene was observed in 77.4% of the centres, and was greater than 50% in 69.7% of them. All hospitals had contact precautions, although 62.3% did not have exclusive frequently used clinical material in bedrooms. The room cleaning was performed more frequently in 54.7% of hospitals, and 67.9% of them had programs for the appropriate use of antibiotics.This study provides information on the implementation of measures to prevent MRSA in hospitals participating in the VINCat program. Most of the centres have an MRSA protocol, however compliance with it should be improved, especially in areas such as active detection on admission in patients at risk, hand hygiene adherence, cleaning frequency and optimising the use of antibiotics.

Background and objective In Catalonia the current surveillance systems do not allow to know the true incidence or the health care utilization of acute gastroenteritis (AGE) caused by Campylobacter and Salmonella infections. The aim of this study is to analyze these characteristics. Patients and methods Descriptive study of Campylobacter and Salmonella infections reported in 2002 and 2012 in Catalonia, Spain. We included cases isolated and reported by the laboratory to a regional Surveillance Unit. Results The estimated incidence of Salmonella and Campylobacter AGE decreased by almost 50% and 20% respectively in 2012. Children between one and 4 years old were the most affected in both years. Significant differences in the clinical characteristics and disease duration were observed between Campylobacter and Salmonella. Visits to the Emergency Department and hospitalization rates were 63.7% and 15%, being more frequent among salmonellosis cases. Conclusion The estimated incidence of Campylobacter and Salmonella infections has decreased, however rates are still important, as well as it is the health care utilization in both diseases. Current surveillance systems need appropriateness improvements to reach a better control of these infections.

Introduction We describe the pertussis epidemic, based only on confirmed whooping cough cases. We have analyzed data on the diagnosis, epidemiology and vaccine history in order to understand the factors that might explain the trends of the disease. Methods A descriptive study of the confirmed pertussis cases reported during 2011 in the Valles region (population 1,283,000). Laboratory criteria for confirmed pertussis cases include isolation of Bordetella pertussis from a clinical specimen or detection of B. pertussis by PCR in nasopharyngeal swabs. Results A total of 421 pertussis confirmed cases were reported, which was the highest incidence reported in the last decade (33 cases/100,000 people/year in 2011). The highest incidence rate was among infants less than 1 year old (448/100,000), followed by children 5–9 years old (154/100,000). Pertussis cases aged 2 months–1 year were 90% vaccinated following the current DTaP schedule for their age group in Catalonia, and cases of 5–9 years were 87% fully vaccinated with 5 doses of DTaP vaccine. There were no deaths, although 8% of cases were hospitalized. Pertussis was more severe in infants, 30% required hospitalization despite having received the vaccine doses corresponding to their age. Children of 5–9 years were most often identified as primary cases in households or school clusters. Conclusion Despite high levels of vaccination coverage, pertussis circulation cannot be controlled at all. The results question the efficacy of the present immunization programmes.