Search

Here we describe the clinical, microbiological, epidemiological, and molecular characterization of an outbreak of multidrug-resistant Acinetobacter baumannii (MRAB) involving 5 patients admitted to the internal medicine ward of our hospital. Over a 6-week period, 5 MRAB isolates were recovered from 5 patients, including 1 with fatal meningitis, 3 with skin and soft tissue infections, and 1 with respiratory colonization. One sample obtained during environmental monitoring in the ward was A. baumannii-positive. According to the pulsed-field gel electrophoresis typing results, the strains isolated from all patients and the environmental sample belonged to a single clone, identified as ST79 by multilocus sequence typing. The blaOXA-24 and blaOXA-51 carbapenemases were detected in all isolates. Four patients died, but only the death of the meningitis patient was probably related to the A. baumannii infection. The infection source was probably the hands of the healthcare workers because the outbreak strain was isolated from the surface of a serum container. The results of the present study revealed the importance of strict adherence to control measures by all healthcare workers because the consequences of noncompliance can be very serious.

Staphylococcus lugdunensis is an unusually virulent coagulase-negative Staphylococcus (CoNS). The aim of the present study was to investigate the clinical and microbiological characteristics of 20 cases of skin and soft tissue infections (SSTIs) due to S. lugdunensis that occurred in our area. The frequency of SSTIs due to this organism was 0.42%. The infection was secondary to trauma, surgery or skin disease in 15 patients (75%). Abscesses (7 cases), surgical wound infections (6 cases) and cellulitis (3 cases) were the most common clinical presentations. Breast, abdomen and lower limbs were the most frequent locations. Twelve infections were community-acquired (60%) and S. lugdunensis was the only pathogen isolated from 15 of the 20 specimens (75%). All patients were cured after therapy with antibiotics, associated or not with surgical drainage. The duration of antibiotic treatment ranged from 5 to 21 days. All isolates were susceptible to most of the antibiotics tested including oxacillin. In conclusion, S. lugdunensis is a CoNS that should be considered a potential pathogen when isolated from SSTIs, especially in patients with skin diseases or after trauma or surgery. S. lugdunensis can be underrated if microbiology laboratories do not routinely identify CoNS to the species level in these infections.

Urinary tract infection (UTI) due to Achromobacter xylosoxidans is rare. The aims were to know the frequency and clinical characteristics of this infection in our area. We performed a retrospective analysis of 9 patients with UTI caused by this organism diagnosed over a period of 13 y. The mean age was 63.1 y. All patients had underlying diseases or urological abnormalities. The most frequent underlying diseases were solid or hematological malignancies (3 cases). Seven patients (77.7%) had urological abnormalities. Eight patients had symptoms of cystitis and 1 remained asymptomatic. Seven patients had community acquired UTIs. Clinical outcome was favourable in 5 patients after antibiotic treatment and recurrence occurred in 3 patients who had urological abnormalities. All isolates were susceptible to imipenem and piperacillin-tazobactam, 88.8% were susceptible to ceftazidime and 77.7% were susceptible to trimethoprim-sulfamethoxazole. High frequencies of resistance to ampicillin (100%), amoxicillin/clavulanic acid (78%), cefuroxime (100%), cefotaxime (67%), norfloxacin (89%), ciprofloxacin (78%), nitrofurantoin (89%) and gentamicin (67%) were observed. UTI due to A. xylosoxidans was predominantly observed in elderly patients with predisposing factors, especially urological abnormalities, malignancies and immunosuppression. Treatment can be difficult due to the high level of antibiotic resistance. Trimethoprim-sulfamethoxazole may be useful for treatment, particularly in outpatients with community acquired infections.

Resumen Introduccion Aeromonas spp. es una causa habitual de gastroenteritis pero ocasionalmente puede producir infecciones extraintestinales. El objetivo de este estudio es conocer las caracteristicas clinicas y microbiologicas de las infecciones extraintestinales producidas por este microorganismo en nuestro medio. Pacientes y metodos Se revisaron retrospectivamente las historias clinicas de los enfermos con infecciones extraintestinales por Aeromonas spp., diagnosticadas en el Hospital Universitario de Guadalajara entre enero de 1990 y diciembre de 2005. La identificacion microbiologica y la susceptibilidad antimicrobiana de las cepas aisladas se realizaron mediante el sistema automatico MicroScan WalkAway-40 (DadeBerhing). Resultados Se diagnosticaron 38 casos: 18 infecciones abdominales, 11 de piel y partes blandas, 3 del tracto urinario, 3 del aparato respiratorio y 3 bacteriemias sin foco primario. La especie mas frecuente fue A. hydrophila (16 casos). El 76,3% de los enfermos presentaron patologias de base predisponentes, siendo las de naturaleza neoplasica las mas frecuentes (34,2%), seguida de diabetes mellitus (21%). El 50% de las infecciones fueron polimicrobianas y el 21% de origen nosocomial. La mortalidad global fue del 16,2%. Los antibioticos con mayor porcentaje de sensibilidad fueron gentamicina, amikacina, cefotaxima y ciprofloxacino. Conclusiones Aeromonas spp. debe ser tenida en cuenta en infecciones del sistema biliar, infecciones de heridas quirurgicas abdominales y celulitis postraumaticas. La infeccion extraintestinal con frecuencia es polimicrobiana, suele aparecer en enfermos con patologias de base y en general el pronostico es bueno. Los antibioticos mas activos in vitro fueron gentamicina, amikacina, cefotaxima y ciprofloxacino.

Fundamento El descenso de la prevalencia de hepatitis A en Espana puede modificar las caracteristicas de esta infeccion por el aumento de la poblacion adulta susceptible. El objetivo de este estudio es conocer la incidencia de esta enfermedad, asi como las caracteristicas epidemiologicas y las complicaciones de los pacientes diagnosticados en la provincia de Guadalajara entre 1991 y 1999. Pacientes y metodos El criterio de inclusion fue la presencia de IgM especifica junto con el aumento de la cifra de alanino aminotransferasa y/o clinica compatible con hepatitis aguda. Resultados La incidencia media del estudio fue de 7,13 casos/ 105 habitantes, existiendo grandes diferencias entre los anos debido a la presencia de un brote. La mayoria de los casos ocurrieron en ninos y en adultos jovenes. El factor de riesgo encontrado globalmente con mayor frecuencia fue el contacto con una persona infectada, pero la distribucion de factores de riesgo fue diferente en ninos y en adultos. Conclusiones El descenso de la prevalencia de hepatitis A en nuestro pais conlleva un aumento de poblacion adulta susceptible. Por este motivo, la hepatitis A puede pasar de ser una enfermedad tipicamente infantil a ser una enfermedad que afecte tambien a adultos jovenes, en los que puede tener caracteristicas diferentes. Este hecho debe tenerse en cuenta a la hora de disenar una estrategia de vacunacion.

Fundamento Espana junto con los paises de Europa del sur era considerada zona de endemia de grado intermedio. Este hecho tiene consecuencias de cara a los viajeros que visitan estas zonas y a la estrategia de vacunacion. Se plantea realizar un estudio de prevalencia para conocer la situacion de la infeccion en la provincia de Guadalajara Metodos Se seleccionaron 284 muestras de suero de pacientes que fueron clasificadas por edad, sexo y lugar de residencia (mayor o menor de 10.000 habitantes). En ellos se estudio la presencia de anticuerpos frente al virus de la hepatitis A mediante enzimoinmunoensayo de microparticulas (MEIA) (Abbott) Resultados Se observo un aumento de prevalencia con la edad de forma que existe una poblacion de baja prevalencia (≤ 5%) entre los 0-29 anos junto con otra de alta prevalencia (>80%) en los adultos entre 30 y 74 anos. No se observaron diferencias en funcion del sexo. En el analisis estratificado por edad se observaron diferencias entre los grupos de procedencia rural y urbana Conclusiones La baja prevalencia de hepatitis A encontrada en la poblacion mas joven, al igual que en otros estudios nacionales, junto con el descenso de la incidencia nos incluye dentro de los paises de baja endemia. Este hecho tiene consecuencias en cuanto a los viajeros que visiten nuestro pais y de cara a una estrategia vacunal debido al aumento de adultos susceptibles a la infeccion

Human infection due to Bacillus pumilus is exceptional. We report 3 cases of cutaneous infection caused by B. pumilus that occurred in 3 shepherds, 2 of whom were members of the same family. The lesions appeared to have a morphology similar to that of cutaneous anthrax lesions. Two patients were cured after treatment with amoxicillin-clavulanate, and the third patient was cured after prolonged treatment with ciprofloxacin. To our knowledge, primary cutaneous infection due to B. pumilus has not been reported. B. pumilus should be considered in patients who develop lesions suggestive of cutaneous anthrax.

Here we describe the clinical, microbiological, epidemiological, and molecular characterization of an outbreak of multidrug-resistant Acinetobacter baumannii (MRAB) involving 5 patients admitted to the internal medicine ward of our hospital. Over a 6-week period, 5 MRAB isolates were recovered from 5 patients, including 1 with fatal meningitis, 3 with skin and soft tissue infections, and 1 with respiratory colonization. One sample obtained during environmental monitoring in the ward was A. baumannii-positive. According to the pulsed-field gel electrophoresis typing results, the strains isolated from all patients and the environmental sample belonged to a single clone, identified as ST79 by multilocus sequence typing. The blaOXA-24 and blaOXA-51 carbapenemases were detected in all isolates. Four patients died, but only the death of the meningitis patient was probably related to the A. baumannii infection. The infection source was probably the hands of the healthcare workers because the outbreak strain was isolated from the surface of a serum container. The results of the present study revealed the importance of strict adherence to control measures by all healthcare workers because the consequences of noncompliance can be very serious.

The genus Abiotrophia comprises fastidious Gram-positive bacteria previously classified as nutritionally variant streptococci (NVS). The isolation of NVS from the central nervous system (CNS) is very rare. We describe a case of meningitis due to Abiotrophia defectiva in a patient who underwent a total hip arthroplasty 4 days previously. It is possible that the organism could be introduced through the spinal anesthesia. We also review all cases of CNS infections caused by NVS.

Necrotizing soft-tissue infection due to Vibrio parahaemolyticus is unusual. We report a case of necrotizing fasciitis due to V. parahaemolyticus in a 92-year-old woman with a history of chronic renal failure, diabetes mellitus and malnutrition. Clinical evolution was fulminant and the patient died 6 h after admission. A review of all cases previously reported showed that the infection occurred in patients with underlying diseases through ingestion of raw oysters or inoculation via traumatic injury in marine environments. The mortality rate of all reviewed cases was 42.8 %. In conclusion, V. parahaemolyticus should be considered a possible causative agent of necrotizing fasciitis, especially in patients with underlying disease. Early diagnosis and prompt aggressive debridement associated with antibiotic therapy are essential in order to save the patient's life, because clinical evolution can be fulminant and mortality rates are high.

Gastrointestinal and wound infections are the most common clinical presentation of Aeromonas. Surgical site infections (SSIs) due to this microorganism are rare. We studied the clinical and microbiological characteristics of 9 cases that appeared at 2 Spanish hospitals and reviewed 15 cases available in the literature. All patients (including our cases) had gastrointestinal or biliary diseases. 21 patients (91.3%) developed SSIs after abdominal or pelvic surgery. The mean duration from surgery to the onset of wound infection was 2.2 d in our 9 patients. The infection was polymicrobial in 17 patients (77.2%) and 19 cases were nosocomial (95%). Clinical outcome of all cases was uniformly good after treatment except for 2 patients. Two patients were cured only with surgical drainage. In conclusion, SSIs due to Aeromonas species have a probable endogenous source after abdominal or pelvic surgery and the onset is rapid in most cases. Clinical outcome is good after antibiotic treatment but surgical drainage without antibiotic therapy can be sufficient to clear the infection in some cases.

Aeromonas spp. typically cause gastroenteritis, but can occasionally produce extraintestinal infections. The aim of this study was to determine the clinical and microbiological characteristics of extraintestinal infections caused by Aeromonas spp. in our area.The clinical histories of patients with extraintestinal infections by Aeromonas spp. diagnosed in Hospital Universitario de Guadalajara (Guadalajara, Spain) from January 1990 to December 2005 were reviewed. Identification and susceptibility testing of the strains were performed by the MicroScan WalkAway-40 automated method (DadeBerhing).Thirty-eight cases of extraintestinal infections were diagnosed: 18 abdominal infections, 11 skin and soft tissue infections, 3 urinary tract infections, and 3 episodes of bacteremia with no primary focus. The species most frequently found was A. hydrophila (16 cases). Infection occurred most often in patients with underlying diseases (76.3%), including malignancy (34.2%) and diabetes mellitus (21%). Polymicrobial infections were detected in 50% and the etiology was nosocomial in 21%. The mortality rate was 16.2%. Gentamicin, amikacin, cefotaxime and ciprofloxacin had the highest activity against the Aeromonas species isolated.Aeromonas spp. as the causative infectious agent should be kept in mind in patients with infections of the biliary system, surgical wounds in the abdomen and posttraumatic cellulitis. Extraintestinal infection is usually polymicrobial, appears most commonly in patients with underlying diseases, and generally has a good prognosis. The most active antibiotics in vitro were gentamicin, amikacin, cefotaxime and ciprofloxacin.

Prosthetic joint infection (PJI) due to Brucella spp. is extremely rare. We report the case of a prosthetic hip infection due to Brucella melitensis in a 51-year-old male patient. The initial presentation was a gluteal abscess. There was radiographic evidence of implant loosening. The patient was cured after prolonged treatment with streptomycin, rifampicin, and doxycycline, followed by 2-stage exchange of the prosthesis. Brucella spp. should be considered in the differential diagnosis of PJI in countries where brucellosis is endemic. The review of all cases previously reported shows that a conservative approach using antibiotics alone can be followed in patients without signs of implant loosening. In contrast, prolonged antibiotic treatment and prosthetic joint revision should be considered in patients with evidence of implant loosening.

Summary Objectives Urinary tract infection (UTI) caused by non-typhoidal Salmonella (NTS) is rare. The aims were to know the frequency and clinical characteristics of this infection in our area. Patients and methods We performed a retrospective analysis of patients with bacteriuria due to NTS diagnosed in our hospital from January 1990 to December 2005. Results Nineteen patients with bacteriuria caused by NTS were diagnosed, representing 0.07% of the UTIs diagnosed in our area over the same period. The mean age was 62.5years old. Eighteen patients (94.7%) had symptoms of UTI (12, cystitis; 6, pyelonephritis), and 1 remained asymptomatic. Fourteen patients (73.6%) had chronic diseases; diabetes mellitus was present in 8 of them (42.1%) and 7 patients (36.8%) were undergoing immunosuppressor treatment. Eight patients (42.1%) had urologic abnormalities. S. enteritidis was the most common serotype isolated (16 cases). Eleven patients required antibiotic treatment over 2 or more weeks. Four patients had recurrent Salmonella UTIs (22.2%), and in 2 of them recurrence occurred after prolonged treatment during 3.5 and 5weeks, respectively. Conclusions UTI due to NTS was predominantly observed in elderly patients with underlying diseases, especially diabetes mellitus , urologic abnormalities and immunosuppression. Prolonged antibiotic treatment should be considered due to the high frequency of complicating conditions, although the infection can be recurrent despite prolonged treatment.

Brucella spp. should be considered in the differential diagnosis of acute meningitis of children living in areas where brucellosis is endemic.

To the Editor: Increased atmospheric CO2 concentrations promote the growth of fastidious microorganisms. However, the possibility that a strain of Escherichia coli can be CO2 dependent is exceptional (1). An isolate of capnophilic E. coli was responsible for a urinary tract infection (UTI) in a 77-year-old woman at the University Hospital of Guadalajara (Spain) in November 2002. Urine was cultured on a cystine-lactose-electrolyte-deficient agar plate and incubated at 37°C in an atmosphere containing 6% CO2 for 1 day. After 24 hours, the culture yielded gram-negative rods (>105 CFU/mL) in pure culture. The organism was motile, catalase positive, and oxidase negative. The strain could not be identified by using the MicroScan WalkAway-40 system (DadeBerhing, Inc., West Sacramento, CA, USA). A subculture was performed, and the organism did not grow on sheep blood agar and MacConkey agar plates at 37°C in ambient air. However, a subculture incubated at 37°C for 24 hours in an atmosphere of 6% CO2 produced smooth colonies 2–3 mm in diameter on sheep blood agar and MacConkey agar plates. The organism fermented lactose, and the indole reaction (BBL DrySlidet, Becton Dickinson Co., Sparks, MD, USA) performed on sheep blood agar was negative. The strain grew well on Schaedler agar plates after anaerobic incubation for 48 hours. The isolate remained capnophilic after 5 subcultures. The strain was identified as E. coli by using the Biolog GN2 panel (Biolog, Inc., Hayward, CA, USA) (100%, T = 0,534), after incubation of the panel in an atmosphere containing 6% CO2 for 1 day. The API 20E system (bioMerieux, Marcy-l’Etoile, France) according to the manufacturer’s instructions without C02 incubation also identified E. coli (profile 5004512). The identification was confirmed by means of 16S rDNA sequence analysis (1,472 bp obtained by PCR amplification by a previously reported method [2]), which showed 99% similarity with E. coli sequence (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"CP000802","term_id":"157065147"}}CP000802). The 16S sequence showed similarity with Shigella species; however, this identification was not considered because the strain fermented lactose on MacConkey agar and agglutinations with Shigella antiserum were negative. The original 16S rDNA sequence was deposited in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"EU555536","term_id":"171262526"}}EU555536). The antimicrobial drug susceptibility profile was determined by incubating Mueller-Hinton agar plates at 37°C in an atmosphere containing 6% CO2 by the disk diffusion method, according to National Committee for Clinical Laboratory Standards recommendations (3). The isolate was susceptible to ampicillin, amoxicillin/clavulanic acid, piperacillin, cefazolin, cefuroxime, cefotaxime, nitrofurantoin, fosfomycin, trimethoprim-sulfamethoxazole, gentamicin, tobramycin, amikacin, norfloxacin, and ciprofloxacin. MICs were obtained for the following antimicrobial agents with the E-test method (AB Biodisk, Solna, Sweden), performed on Mueller-Hinton agar plates incubated in a 6% CO2 atmosphere: ampicillin (1.5 μg/mL), amoxicillin (3 μg/mL), cefotaxime (0.064 μg/mL), imipenem (0.094 μg/mL), piperacillin (2 μg/mL), and ciprofloxacin (0.008 μg/mL). E. coli is the most common pathogen among patients with uncomplicated UTIs (4). Two cases of UTIs due to carbon dioxide–dependent strains of E. coli have been reported (1). The mechanisms for development of CO2 dependence are unknown (5). CO2 can play a role in the growth of E. coli as a substrate for carboxylation reactions (6). Other members of the family Enterobacteriaceae (such as some strains of Klebsiella spp.) and other organisms (such as Staphylococcus aureus), can have similar requirements (7,8). There is not 1 best way of performing urine cultures. Guidelines for the diagnosis of UTI includes the use of sheep blood agar and either MacConkey agar or a similar selective medium for routine urine culture. The plates should be incubated overnight (at least 16 hours) at 37°C in ambient air; alternatively, the blood agar plate can be incubated in elevated (3%–8%) CO2 (9). For fastidious microorganisms, chocolate agar can be added to the MacConkey agar and the plates incubated in 5% CO2 for 2 days (9). The real incidence of these infections is unknown, but the rarity of these strains suggests that the incidence is low. However, the real incidence of UTI caused by capnophilic E. coli may be underestimated because urine cultures are not usually incubated in CO2. In addition, urine cultures are not performed for many women with uncomplicated cystitis. Other fastidious uropathogens such as Haemophilus influenzae and H. parainfluenzae, also require special media and incubation in an atmosphere of CO2 (9). The low frequency of these strains suggests that incubation of routine urine cultures in an atmosphere containing CO2 is not necessary. Incubation in CO2 should be ordered only if the patient has pyuria and a previous negative urine culture after incubation in ambient air or if the patient is unresponsive to empiric therapy and routine urine culture is negative. Good clinician–laboratory communication is vital. Further studies should be performed to ascertain the real incidence of UTIs caused by capnophilic strains of E. coli. Because no breakpoints are available for antimicrobial agents against capnophilic strains of E. coli, we used published interpretative criteria or Enterobacteriaceae (3). The strain was susceptible to all antimicrobial agents that we tested. The impact of CO2 on the susceptibility of capnophilic strains of E. coli is unknown. Susceptibility of some antimicrobial agents such as quinolones can be influenced by the pH change and enhanced growth that occur during CO2 incubation when testing capnophilic organisms (10).

H. nana es un cestodo descrito con mayor frecuencia en ninos de zonas tropicales y templadas del Sudeste asiatico, Oriente Medio, Africa y Sudamerica, donde se han informado cifras de prevalencia que oscilan entre el 0,2 %-24%1-4. En Espana, las comunicaciones de cestodiasis por H. nana son escasas y se ha descrito de forma ocasional como agente causal de dolor abdominal inespecifico en ninos con malas condiciones higienico-sanitarias5. El reservorio habitual es el hombre y la transmision interhumana ocurre por via fecal-oral por ingestion de alimentos contaminados. Cuando el hombre ingiere los huevos, la oncosfera se libera en el intestino delgado y penetra en las vellosidades, donde al cabo de unos 5 dias se convierte en larva cisticercoide. La larva rompe la vellosidad, sale a la luz del intestino y se fija en la parte inferior del intestino delgado, donde llega a la fase adulta en 2 semanas e inicia la oviposicion, reanudandose el ciclo. La autoinfeccion es frecuente (por via endogena o exogena) y explica la facilidad con la que se producen reinfecciones6. La intensidad de las manifestaciones clinicas depende de la carga parasitaria y de la edad. En ninos con frecuencia es un proceso asintomatico, pero los casos moderados de parasitacion pueden cursar con dolor abdominal, meteorismo, diarrea, nauseas, vomitos, irritabilidad y nerviosismo. En las formas severas pueden aparecer diarrea intensa, malabsorcion y retraso de crecimiento7. En el caso que presentamos, el retraso pondestatural podria estar relacionado con la parasitacion doble por H. nana y G. lamblia. En adultos la expresividad clinica es menor, y con mayor frecuencia que en los ninos cursa sin sintomas Correspondencia: Dra. J. Bisquert. Seccion de Microbiologia. Hospital General de Guadalajara. C/ Donantes de sangre s/n. 19002 Guadalajara.

A case is reported of splenic abscess due to Eikenella corrodens, a gram-negative rod which is found as part of normal flora in human mucous surfaces. A 64-year-old man presented with fever, chills, anorexia and abdominal pain. Abdominal ultrasound examination showed a perisplenic fluid collection which was considered to be either blood or a subcapsular spleen abscess. The presence of a splenic abscess was later confirmed during surgery and a splenectomy was performed. Splenic purulent material and blood cultures yielded Eikenella corrodens. The patient received cefotaxime for 19 days and was discharged asymptomatic.

We report a case of Hymenolepis diminuta infection in a human. The patient was a 5-year-old girl referred to us through the onset of a cyanotic attack. Treatment with a single dose (10 mg/kg of body weight) of praziquantel was ineffective, but the parasite was eradicated after three treatment cycles with the same drug at dosages of 25 mg/kg/day for 5 days.