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ABSTRACT: Introduction. Escherichia coli is the most important uropathogen. The appearance of extended- spectrum beta-lactamase (ESBL)-producing E.coli in urinary tract infections (UTI) constitutes an important therapeutic challenge that requires the study of its evolution throughout time in order to establish a suitable empirical treatment. Our aim was to determine the prevalence of ESBL-producing E. coli urinary isolates in 2005, 2009 and 2011. We also determined the antimicrobial coresistance to several agents, including fosfomycin. Methods. We analyzed 5053, 6324 and 6644 E. coli isolates obtained from urine cultures in 2005, 2009 and 2011 respectively. Duplicate isolates were excluded. Antimicrobial susceptibility was determined by the Wider microdilution system (Soria Melguizo S.A.) and the phenotypic pattern of resistance that indicated a BLEE-producing E.coli was selected (CLSI 2009). Results. 3.9% of strains (198) were ESBL producers in 2005, 7.3% (463) in 2009 and 8.7% (584) in 2011. Resistance to carbapenems was detected in 2009, they inhibited more than the 95% of strains in 2011. Among the non-beta-lactams, colistin was the most active antibiotic followed by nitrofurantoin. Ciprofloxacin and sulfamethoxazole-trimethoprim were not effective with 80% and 60% resistant isolates, respectively. An increasing resistance trend, from 0% to 9.3% in 2009 and 14.4% in 2011 was observed for fosfomycin. Conclusions. From 2005 our institution had an increasing prevalence of ESBL-producing E. coli rising to 8.7% in 2011. Carbapenems are still the most active agents. The increase of resistance was significant for fosfomycin.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 03/2013; 26(1):43-6. · 0.81 Impact Factor
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ABSTRACT: Respiratory virus infections are a major health concern and represent the primary cause of testing consultation and hospitalization for young children. The application of nucleic acid amplification technology, particularly multiplex PCR coupled with fluidic or fixed microarrays, provides an important new approach for the detection of multiple respiratory viruses in a single test. The aim of this study was to analyze respiratory samples from children with acute respiratory tract infection (ARTI) using a commercial array-based method (CLART® PneumoVir Genomica, Coslada, Spain). These tests were used to identify viruses in 281 nasopharyngeal samples obtained from children affected by ARTI. Samples were obtained form October 2008 to April 2009. Viruses were identified in 80% of the studied ARTI providing useful information on clinical features and epidemiology of specific agents affecting children in cold months. Multiple viral infections were found in 33.45% of the specimens.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 03/2013; 26(1):47-50. · 0.81 Impact Factor
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ABSTRACT: C. jejuni as well as some hippurate-negative Campylobacter species and related diarrheagenic organisms, are the leading cause of gastroenteritis in our environment all throughout the year. The aim of the present study was to determine the sensitivity of hippurate-negative Campylobacter and Helicobacter pullorum strains isolated from the stools of patients with diarrhea. We tested 39 Campylobacter coli, two C. lari and five Helicobacter pullorum strains identified by mass spectrometry analysis. The sensitivity to amoxicillin-clavulanic acid, erytrhomycin, azithromycin, gentamicin, ciprofloxacin, levofloxacin, tetracycline, tigecycline and chloramphenicol was tested by E-test. Most hippurate-negative Campylobacter and H. pullorum isolates studied showed high resistance to tetracycline and to the two fluorquinolones tested. On the other side, all strains were sensitive to amoxicillin-clavulanic acid, tigecycline and chloramphenicol, while most of them were sensitive to both macrolides tested and to gentamicin.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 12/2011; 24(4):213-6. · 0.81 Impact Factor
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ABSTRACT: To determine the in vitro activity of retapamulin and other topical antibiotics (mupirocin, bacitracin, and fusidic acid) usually employed for nasal decolonization, against methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and linezolid and methicillin-resistant S. aureus.
The minimum inhibitory concentrations (MICs) were determined on Mueller-Hinton agar according to the guidelines of the Clinical and Laboratory Standards Institute and of the European Committee for Antimicrobial Susceptibility Testing. Presence of the cfr gene in linezolid and methicillin-resistant S. aureus isolates was detected using polymerase chain reaction.
Retapamulin inhibited all the isolates of MSSA and MRSA at 0.125 mg/L, but the 18 linezolid-resistant-MRSA strains proved resistant, with MICs over 32 mg/L. Most MSSA isolates (9/10) were susceptible to mupirocin with MICs under 0.19 mg/L, although this value decreased to half against MRSA, and almost all linezolid-resistant MRSA (17/18) strains were resistant to mupirocin with an MIC range of between 8 mg/L and 28 mg/L. The MIC of fusidic acid increased substantially against linezolid-resistant MRSA, whereas that of bacitracin showed no differences.
Retapamulin demonstrated excellent in vitro activity against MSSA and MRSA strains, but not against MRSA isolates harbouring the cfr gene. The results of this in vitro study support cut-off values for retapamulin of ≤ 0.5, 1, and ≥ 2 mg/L for susceptible, intermediate, and resistant strains, respectively.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 09/2011; 24(3):127-30. · 0.81 Impact Factor
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ABSTRACT: The in vitro activity of ceftobiprole was compared with that of seven antimicrobial agents against invasive Streptococcus pneumoniae isolated from adult patients (>15 years old). Characterization of erythromycin-resistant strains and serotype distribution of all pneumococci were also evaluated. Seventy invasive S. pneumoniae strains were isolated from December 2007 to January 2009. Serotyping was carried out by Quellung reaction. Antibiotic susceptibility was tested by broth microdilution (CLSI guidelines). The comparator agents were penicillin, cefotaxime, erythromycin, clindamycin, telithromycin, tetracycline and moxifloxacin. Phenotypic characterization of macrolide resistance was performed by the double disk method. Macrolide resistance genes [erm(B) and mef(A/E)] and the promoter of erm(B) were detected by PCR. Twenty-five different serotypes were detected of which 87% were non-PCV7 types. The percentages of resistance to erythromycin, clindamycin and tetracycline were 20%, 8.6% and 16%, respectively. A penicillin MIC ≥0.12 mg/L was observed in 14 of the 70 invasive pneumococci strains. The cefotaxime and ceftobiprole MIC(50)/MIC(90) of these 14 strains were 1/4 and 0.03/1 mg/L, respectively. Ceftobiprole showed higher in vitro activity than penicillin and cefotaxime with all isolates being inhibited by ≤1 mg/L. Its high in vitro activity should make ceftobiprole a very promising drug for the treatment of pneumococcal infections.
European Journal of Clinical Microbiology 07/2011; 30(12):1621-5. · 2.86 Impact Factor
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ABSTRACT: The objective of this study was to evaluate the activity of daptomycin and other agents against methicillin-resistant Staphylococcus aureus (MRSA) isolates collected from 2001 to 2010, in order to determine changes and to detect resistance trends.
The study included a total of 1,130 MRSA isolates collected as part of a multicenter surveillance program for antibiotic resistance, Estudio de Vigilancia de Resistencia a los Antimicrobianos (VIRA study), from 51 medical centers throughout Spain between 2001 and 2010. Broth microdilution test was performed according to the Clinical Laboratory Standards Institute guidelines.
Daptomycin showed excellent activity and maintained its activity over time; only one MRSA isolate collected in 2001 was nonsusceptible to this agent (MIC=2 mg/L). Based on the MIC90, daptomycin was 2-4 dilutions more active than vancomycin, teicoplanin and linezolid. Daptomycin retained activity against MRSA isolates that were resistant to linezolid, to quinupristin-dalfopristin, or showed intermediate susceptibility to vancomycin.
Our data and those of other studies, coupled with daptomycin's rapid bactericidal activity, suggest that this antimicrobial could be an alternative in the treatment of severe infections caused by multiresistant S. aureus.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 06/2011; 24(2):107-11. · 0.81 Impact Factor
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Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 03/2011; 24(1):50-1. · 0.81 Impact Factor
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ABSTRACT: Nine isolates of Klebsiella pneumoniae were isolated from a renal transplant patient suffering from recurrent urosepsis over a period of 4 months. Imipenem resistance was detected after imipenem-ertapenem therapy. When treatment was switched to tigecycline the K. pneumoniae developed resistance to tigecycline (MIC = 8 mg/L). The nine isolates were tested by determination of agar dilution MICs, phenotypic carbapenemase, extended-spectrum beta-lactamases and metallo-beta-lactamase (MBL) testing and pulsed-field gel electrophoresis. Polymerase chain reaction and sequencing analysis were employed for identification of bla genes and mapping of the integron carrying the MBL gene. The nine isolates were clonally related and all produced the SHV-12 enzyme. Five MBL-producing isolates showed imipenem MICs ranging from 2 to 64 mg/L and all were detected by testing with imipenem and EDTA. The five isolates harboured the bla(VIM-1) gene. Three isolates showed increased tigecycline MICs (4-8 mg/L). Serial blood cultures obtained on the same day resulted in a VIM-positive/tigecycline-susceptible and a VIM-negative/tigecycline-resistant K. pneumoniae isolate. No isolate developed concurrent imipenem and tigecycline resistance. The patient had a persistent urinary tract infection and recurrent bacteraemia caused by a mixed population of Klebesiella pneumoniae isolates adapting to the selective pressure of antimicrobial therapy at the time. The present study is a worrisome example of what could happen when an immunocompromised host is subjected to the pressures of antimicrobial therapy. In addition, we report the first treatment-emergent MIC increase of tigecycline from 0.5 to 8 mg/L in K. pneumoniae.
Clinical Microbiology and Infection 02/2011; 18(1):61-6. · 4.54 Impact Factor
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ABSTRACT: The in vitro activity of doripenem was evaluated against a recent collection of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and Pseudomonas aeruginosa isolates (201 ESBL-producing Enterobacteriaceae [153 Escherichia coli and 48 Klebsiella pneumoniae] and 201 P. aeruginosa). Comparator agents included amikacin, tobramycin, ciprofloxacin, cefepime, cefotaxime, ceftazidime piperacillin-tazobactam, imipenem, and meropenem. Both doripenem and meropenem inhibited 100% of the ESBL-producing Enterobacteriaceae at <or=0.5 microg/mL. For these isolates, the MIC(90) of doripenem (0.12 microg/mL) was 4-fold lower than that of imipenem (0.5 microg/mL). Against P. aeruginosa, the MIC(90) of doripenem and meropenem was 2 microg/mL, 4-fold lower than that of imipenem (8 microg/mL). At an MIC of <or=2 microg/mL, doripenem, meropenem, and imipenem inhibited 90.5%, 89.6%, and 82.1% of P. aeruginosa isolates, respectively. Doripenem maintained activity against imipenem-nonsusceptible isolates of P. aeruginosa; at an MIC of <or=4 microg/mL, it inhibited 15 of the 25 isolates with MICs for imipenem of >4 microg/mL. Doripenem is active against ESBL-producing Enterobacteriaceae and P. aeruginosa isolates. Its activity is similar to that of meropenem and slightly better than that of imipenem. The results of this study suggest that doripenem could be an alternative therapeutic agent for infections caused by these organisms.
European Journal of Clinical Microbiology 09/2010; 29(9):1179-81. · 2.86 Impact Factor
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Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 01/2008; 20(4):371-4. · 0.81 Impact Factor
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Revista Clínica Española 10/2006; 206(8):414-5. · 2.01 Impact Factor
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ABSTRACT: The objective of this study, conducted at Hospital Clínico San Carlos, Madrid, Spain, was to compare the cost of treatment of Gram-positive infections with teicoplanin and vancomycin under normal conditions. Using a prospective observational study design for drug utilization and economic assessment, we evaluated the comparability of the sample, adverse events, features of treatment with teicoplanin/vancomycin and factors influencing the consumption of resources until the end of glycopeptide treatment or discharge (whichever occurred later) using Health System perspective. Costs were assigned using the hospital's evaluation at the time of the study. Analyses made: multivariate, sensitivity (by modifying staff or acquisition costs) and simulation of reduction of stay by early discharge in the teicoplanin group. Study participants included 201 patients who had been using teicoplanin (n=100) or vancomycin (n=101) for at least four days. Data collected daily outside morning work timetable. Costs of acquisition, administration and monitoring by course of treatment (mean+/-SD, in euros) were lower in the vancomycin group (teicoplanin euro647.62+/-euro572.75 vs. vancomycin euro378.11+/-euro225.90); when total costs (including hospital stay) were considered, no differences were found (teicoplanin euro4,432.04+/-euro3,383.46 vs. vancomycin euro4,364.44+/-euro2,734.24). Conditions of use and results were similar for both antibiotics. The economic results of acquisition, administration and monitoring were advantageous for vancomycin; when global costs of care were taken into account, these differences were not evident. Tolerability was significantly advantageous in the teicoplanin group (with regard to phlebitis and elevation of creatininemia), without differences in clinical or economic outcomes. The formulation of teicoplanin did not take advantage of its potential benefits of administration.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 04/2006; 19(1):65-75. · 0.81 Impact Factor
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ABSTRACT: We present a case of bacteremic pneumonia caused by Nocardia otitidiscaviarum in a corticodependent COPD. Blood and sputum cultures on Mycobacterial media were positives and identification was done using 16S rDNA sequencing. In this article we review the most relevant communications about Nocardia spp infection and study the strain susceptibility using E-test.
Anales de medicina interna (Madrid, Spain: 1984) 11/2005; 22(10):489-92.
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ABSTRACT: To ascertain the current susceptibility patterns of members of the Bacteroides fragilis group in our hospital and to assess the in vitro activity of tigecycline against these organisms.
A total of 400 non-duplicate clinical isolates of the B. fragilis group collected from 2000 to 2002 were studied. Susceptibility testing was performed according to the reference agar dilution method described by the NCCLS. The following antimicrobials were tested: tigecycline, clindamycin, metronidazole, chloramphenicol, cefoxitin, imipenem, amoxicillin-clavulanate and piperacillin-tazobactam.
All strains were susceptible to metronidazole and chloramphenicol. For clindamycin and cefoxitin, the overall susceptibility rates were 59.5% and 83%, respectively. Imipenem and piperacillin-tazobactam were the most active beta-lactam agents tested. Tigecycline inhibited 89.8% of the strains at a concentration of 8 mg/L with an MIC range of <or=0.01 to >16 mg/L. By comparing the MIC50 and MIC90 values of tigecycline among the various species of the group, B. fragilis, Bacteroides thetaiotaomicron and Bacteroides vulgatus were the most susceptible (MIC50/MIC90s of 0.5-1/8 mg/L).
Tigecycline exhibited activity against most isolates of the B. fragilis group tested. These results indicate that tigecycline may be useful in the treatment and prophylaxis of infections involving these organisms.
Journal of Antimicrobial Chemotherapy 08/2005; 56(2):349-52. · 5.07 Impact Factor
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Journal of Antimicrobial Chemotherapy 06/2005; 55(5):809-10. · 5.07 Impact Factor
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ABSTRACT: Carbapenem resistance in clinical isolates of P. aeruginosa has risen notably in recent years. P. aeruginosa has different mechanisms for carbapenem resistance, such as decreased levels of OprD or overexpression of the MexAB-OprM efflux system. Also, the emergence of metallo-beta-lactamases (MBL)-producing bacteria is becoming a severe therapeutic problem. The aim of this study was to determine MBL presence in clinical isolates of P. aeruginosa: 133 with MIC > or =4 mg/l for imipenem and/or meropenem were selected. We studied the sensitivity to different antibiotics in these strains. Tobramycin (26.3%) and colistin (17.3%) were the most active antibiotics. To determine the presence of MBL, we used the E-test with imipenem/imipenem plus EDTA and disk-agar diffusion, also using EDTA as an MBL inhibitor. As a result of the screening test to evaluate the presence of MBL, we obtained four out of 133 strains as probable producers of metalloenzyme. These four strains were positive for the VIM-like gene as determined by a polymerase chain reaction method.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 12/2004; 17(4):336-40. · 0.81 Impact Factor
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ABSTRACT: The activity of tigecycline was tested against erythromycin-resistant streptococci (107 Streptococcus pyogenes and 98 Streptococcus agalactiae strains). The presence of erythromycin and tetracycline resistance genes was determined by PCR. Among S. pyogenes strains the most prevalent gene was mef(A) (91.6%). The erm(B) gene was the most prevalent (65.3%) among S. agalactiae strains. Tigecycline proved to be very active against all the isolates tested (MIC at which 90% of the isolates tested were inhibited, 0.06 micro g/ml), including those resistant to tetracycline.
Antimicrobial Agents and Chemotherapy 02/2004; 48(1):323-5. · 4.84 Impact Factor
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Clinical Microbiology and Infection 01/2004; 9(12):1261-3. · 4.54 Impact Factor
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ABSTRACT: This study aimed to identify therapeutic approaches and the tendencies of Gram-positive infections in Spanish hospitals in terms of prevalence, origin, location and etiology, as well as the characteristics of patients with these infections, their underlying illnesses, the severity and predisposing factors. We used statistical analysis to compare the results of two multicenter prevalence studies, the first from 1994-1995, and the second in 1998. We found a statistically significant decrease in the percentage of infected patients (45.8% vs. 32.8%; p <0.001), but an increase in infections by Gram-positive microorganisms (14.4% vs. 20.6%; p <0.001), which was reflected in the increased use of glycopeptides (17.1% vs. 31.2%; p = 0.002). The use of quinolones also increased. The most common underlying illnesses were heart disease and diabetes mellitus, and there was a reduction in the number of patients infected by HIV and in users of parenteral medication. The decrease in outpatient infections indicated that nosocomial infection was more frequent in the second study, in which the number of predisposing factors increased (52.3% vs. 79.2%; p <0.001), the most common of which were peripheral line, immobilization and a bladder catheter. Bacteremia was the most frequent infection, and there was a reduction in lower respiratory tract infections and an increase in skin and soft tissue infections. Staphylococcus aureus was the most frequently found microorganism and showed a significant increase in incidence (27.2% vs. 47.9%; p <0.001), whereas pneumococcus showed a decrease (15.0% vs. 5.2%; p = 0.012). It was concluded that despite the decrease in the percentage of infected patients and severely ill patients, there is an increase in Gram-positive infections, especially bacteremia, and in the use of more aggressive treatments. This may reflect the increase in resistant isolates.
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 12/2003; 16(4):428-35. · 0.81 Impact Factor
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ABSTRACT: The rates of resistance to erythromycin and clindamycin among Streptococcus agalactiae strains isolated in our hospital increased from 4.2 and 0.8% in 1993 to 17.4 and 12.1%, respectively, in 2001. Erythromycin resistance was mainly due to the presence of an Erm(B) methylase, while the M phenotype was detected in 3.8% of the strains. Telithromycin was very active against erythromycin-resistant strains, irrespective of their mechanisms of macrolide resistance.
Antimicrobial Agents and Chemotherapy 04/2003; 47(3):1112-4. · 4.84 Impact Factor
