Luis López-Urrutia

Brote de Serratia marcescens producido por clorhexidina acuosa al 2% contaminada ☆

INTRODUCTION AND OBJECTIVE An outbreak of Serratia marcescens infections outbreak is described, as well as the epidemiological study that linked the outbreak to the use of 2% aqueous chlorhexidine antiseptic. METHOD In late November 2014 an increasing incidence of S. marcescens isolates was detected in patients treated in the emergency department. It was considered a possible outbreak, and an epidemiological investigation was started. RESULT S. marcescens was isolated in 23 samples from 16 patients and in all new bottles of two lots of 2% aqueous chlorhexidine. The contaminated disinfectant was withdrawn, and the Spanish Drugs Agency was alerted (COS 2/2014). The epidemiological study showed that strains isolated from clinical samples and from chlorhexidine belonged to the same clone. No further isolates were obtained once the disinfectant was withdrawn. CONCLUSION The suspicion of an outbreak and the epidemiological study were essential to control the incidence.

Correlación entre la prescripción de antibióticos y el descenso de las resistencias a antimicrobianos en el área de salud de Zamora

OBJECTIVE To describe the trends in prescribing antibiotics and analyze a possible relationship with the evolution of antimicrobial sensitivity in respiratory pathogens isolated in the health area of Zamora (Spain). MATERIALS AND METHODS Descriptive study investigating the prescription of antimicrobials and the evolution of resistance in Streptococcus pyogenes, Streptococcus pneumoniae and Haemophilus influenzae, from 1996 to 2005. Antibiotic use is expressed in doses per 1,000 inhabitants per day (DHD). The chi(2) test, exact tests, Spearman correlation coefficients, and a time series analysis were used to analyze the trends. RESULTS A total of 1301 S. pyogenes strains were isolated. All were sensitive to penicillin, with decreasing percentages of resistance to erythromycin and increasing percentages of resistance to clindamycin. Among 579 pneumococcal strains isolated, a significant decreasing resistance to penicillin, amoxicillin-clavulanic, cefotaxime and cefuroxime was observed; resistance to erythromycin and azithromycin increased during the first few years, but decreased later. Among a total of 769 strains of H. influenzae, all were sensitive to cefotaxime and highly sensitive to amoxicillin-clavulanic acid and cefuroxime; resistance to ampicillin was maintained and there was a significant decreasing resistance to azithromycin. Simultaneously, there was a progressive decrease in overall antibiotic use (20.45 DHD in 1996; 18.90 DHD in 2005). Prescription of penicillins remained stable, with increased use of amoxicillin-clavulanic, decreased use of cephalosporins and macrolides (except azithromycin), and increased use of fluorquinolones. We observed a significant correlation between prescription and resistance. CONCLUSIONS A recovery of sensitivity to antibiotics was seen in respiratory pathogens parallel to a progressive decrease in prescription of antibiotics.

OriginalCorrelación entre la prescripción de antibióticos y el descenso de las resistencias a antimicrobianos en el área de salud de ZamoraCorrelation between antibiotic prescription and decreased antimicrobial resistance in the health area of Zamora

OBJECTIVE To describe the trends in prescribing antibiotics and analyze a possible relationship with the evolution of antimicrobial sensitivity in respiratory pathogens isolated in the health area of Zamora (Spain). MATERIALS AND METHODS Descriptive study investigating the prescription of antimicrobials and the evolution of resistance in Streptococcus pyogenes, Streptococcus pneumoniae and Haemophilus influenzae, from 1996 to 2005. Antibiotic use is expressed in doses per 1,000 inhabitants per day (DHD). The chi(2) test, exact tests, Spearman correlation coefficients, and a time series analysis were used to analyze the trends. RESULTS A total of 1301 S. pyogenes strains were isolated. All were sensitive to penicillin, with decreasing percentages of resistance to erythromycin and increasing percentages of resistance to clindamycin. Among 579 pneumococcal strains isolated, a significant decreasing resistance to penicillin, amoxicillin-clavulanic, cefotaxime and cefuroxime was observed; resistance to erythromycin and azithromycin increased during the first few years, but decreased later. Among a total of 769 strains of H. influenzae, all were sensitive to cefotaxime and highly sensitive to amoxicillin-clavulanic acid and cefuroxime; resistance to ampicillin was maintained and there was a significant decreasing resistance to azithromycin. Simultaneously, there was a progressive decrease in overall antibiotic use (20.45 DHD in 1996; 18.90 DHD in 2005). Prescription of penicillins remained stable, with increased use of amoxicillin-clavulanic, decreased use of cephalosporins and macrolides (except azithromycin), and increased use of fluorquinolones. We observed a significant correlation between prescription and resistance. CONCLUSIONS A recovery of sensitivity to antibiotics was seen in respiratory pathogens parallel to a progressive decrease in prescription of antibiotics.

Contribución de la microbiología al diagnóstico de la tuberculosis en Castilla y León: conclusiones del estudio GRUMICALE 2013

INTRODUCTION AND OBJECTIVES A retrospective study was conducted by collecting microbiological tuberculosis (TB) data in Castile and León during the year 2013 in order to determine the incidence and distribution of TB, and resistance to the tuberculostatic drug, and compare them with the epidemiological data provided by the Department of Epidemiological Surveillance (SIVE). MATERIAL AND METHODS Microbiologists of the 14 hospitals of the Castile and León public health network (GRUMICALE) collected epidemiological, microbiological, and management data from the Microbiology laboratories in the community during the year 2013. A single isolate of Mycobacterium tuberculosis complex (MTC) per patient was considered. RESULTS The study included a total of 270 MTC isolates (an incidence rate of 11.63 cases/100,000 inhab./year). A total of 288 cases of TB (11.43 cases/100,000 inhab. year) were recovered using epidemiological data, which included 243 confirmed, 29 suspected, and 16 as probable cases. Pulmonary TB was predominant, followed a long way off by the pleural TB and the remaining locations. A total of 27,620 samples were processed for mycobacterial detection. Mycobacterial growth was observed in 3.46% of automated fluid cultures, and 50.37% were positive by direct staining of the smear. Resistance to one tuberculostatic drug, mostly to isoniazid, was observed in 16 (5.92%) isolates of Mycobacterium tuberculosis (MT). The province with greater incidence and number of isolates was León (24.23 cases/100,000 inhab./year), with the highest being observed in El Bierzo health area (30.46 cases/100,000 inhab./year). CONCLUSIONS An adequate collection of microbiological information is essential to determine the epidemiology of TB in our region.

Brote por Enterococcus faecium ST17 resistente a glucopéptidos en una Unidad de Neonatología

The incidence of glycopeptide-resistant Enterococcus faecium (GRE) as a nosocomial pathogen has been increasing in recent years in Spain, due to its high capacity to colonise patients and staff for long periods, as well as to persist in the hospital environment, where it can survive for a long time. The main epidemiological presentation of GRE is in the form of sporadic outbreaks,1 such as the one that occurred in the Neonatal Intensive Care Unit (NICU) of our hospital in 2015, and which we discuss below. From 21 April to 23 June 2015, GRE was isolated in the surveillance rectal swabs (SRS) of 10 neonates admitted to the NICU of our hospital (third level university hospital). The Level IIIA Neonatal Unit (which does not include surgery), consists of six intensive care stations (CIV) and 11 intermediate care stations (CIM) in separate rooms. The personnel responsible for the unit include five on-duty neonatologists plus two on call, a morning shift of four nurses and three auxiliary nurses, and afternoon and night shifts of three nurses and two auxiliary nurses. In 2015, there were 282 admissions with an average stay of 9.10 days, a total recorded use of vancomycin of only 6.5 g for the whole year (2.0 g in 2014) and no recorded use of ceftazidime in either 2014 or 2015. Newborns are subject to surveillance cultures at the time of admission (nasal, pharyngeal and ear swabs cultured on blood agar for 48 h at 35 ◦C in an atmosphere with 5% CO2), and surveillance cultures for extendedspectrum -lactamase (ESBL)-producing Enterobacteriaceae, by culture of SRS on chromID-ESBL ® plates (bioMérieux), are taken weekly. Following the isolation of GRE, a selective chromogenic plate was added to screen for GRE: chromID-VRE ® (bioMérieux). Both plates are incubated aerobically for 48 h at 37 ◦C.2 The first GRE isolates were detected in the SRS on 21 April in two patients (colonisation rate [CR]: 33%, 2 patients of 6 admitted). Both GRE were resistant to ampicillin and fluoroquinolones, had high-level resistance to gentamicin and streptomycin, and were resistant to vancomycin and teicoplanin with MIC >16 mg/l, but were still susceptible to linezolid. When these results were notified on Friday, 24 April (23 holiday), contact isolation and cleaning precautions were established twice a day with SANIT P20 ® (4.5% didecyldimethylammonium chloride and 8% monoethanolamine), taking further SRS again that same day, which showed the colonisation of a third neonate (CR 30%, 3 of 10). In the weekly surveillance