Posts filed under ‘Infecciones emergentes’

Rapid and Accurate Molecular Identification of the Emerging Multidrug-Resistant Pathogen Candida auris

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2445-2452

Milena Kordalewska, Yanan Zhao, Shawn R. Lockhart, Anuradha Chowdhary, Indira Berrio, and David S. Perlin

aPublic Health Research Institute, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA

bMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

cDepartment of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

dClínica El Rosario, Medellín, Colombia

eMedical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia

fHospital General de Medellin Luz Castro de Gutiérrez ESE, Medellín, Colombia

Candida auris is an emerging multidrug-resistant fungal pathogen causing nosocomial and invasive infections associated with high mortality. C. auris is commonly misidentified as several different yeast species by commercially available phenotypic identification platforms. Thus, there is an urgent need for a reliable diagnostic method. In this paper, we present fast, robust, easy-to-perform and interpret PCR and real-time PCR assays to identify C. auris and related species: Candida duobushaemulonii, Candida haemulonii, and Candida lusitaniae. Targeting rDNA region nucleotide sequences, primers specific for C. auris only or C. auris and related species were designed. A panel of 140 clinical fungal isolates was used in both PCR and real-time PCR assays followed by electrophoresis or melting temperature analysis, respectively. The identification results from the assays were 100% concordant with DNA sequencing results. These molecular assays overcome the deficiencies of existing phenotypic tests to identify C. auris and related species.


July 26, 2017 at 9:29 am

Is This the Carbapenemase Test We’ve Been Waiting for? A Multicenter Evaluation of the Modified Carbapenem Inactivation Method

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2309-2312

Susan M. Butler-Wu and April N. Abbott

aDepartment of Pathology and Laboratory Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

bDepartment of Pathology, Deaconess Health System, Evansville, Indiana, USA


A plethora of phenotypic methods exist for the detection of carbapenemases; however, clinical laboratories have struggled for years with accurate, objective phenotypic detection of carbapenemase activity in Enterobacteriaceae. In this issue of the Journal of Clinical Microbiology, V. M. Pierce et al. (J Clin Microbiol 55:2321–2333, 2017, report on a multicenter evaluation of the modified carbapenem inactivation method (mCIM). The high sensitivity, specificity, reproducibility, and ease of interpretation associated with the mCIM for Enterobacteriaceae will likely lead to its adoption by clinical laboratories.



Journal of Clinical Microbiology August 2017 V.55 N.8 P.2321-2333

Modified Carbapenem Inactivation Method for Phenotypic Detection of Carbapenemase Production among Enterobacteriaceae

Virginia M. Pierce, Patricia J. Simner, David R. Lonsway, Darcie E. Roe-Carpenter, J. Kristie Johnson, William B. Brasso, April M. Bobenchik, Zabrina C. Lockett, Angella Charnot-Katsikas, Mary Jane Ferraro, Richard B. Thomson Jr., Stephen G. Jenkins, Brandi M. Limbago, and Sanchita Das

aDepartment of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA

bDepartment of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

cDivision of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

dBeckman Coulter Diagnostics, Inc., West Sacramento, California, USA

eDepartment of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA

fBD Life Sciences–Diagnostic Systems, Sparks, Maryland, USA

gDepartment of Pathology and Laboratory Medicine, Lifespan Academic Medical Center, Providence, Rhode Island, USA

hDepartment of Pathology, University of Chicago Medical Center, Chicago, Illinois, USA

iDepartment of Pathology, NorthShore University HealthSystem, Evanston, Illinois, USA

jDepartment of Pathology and Laboratory Medicine, Weill-Cornell Medical College, New York, New York, USA

The ability of clinical microbiology laboratories to reliably detect carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is an important element of the effort to prevent and contain the spread of these pathogens and an integral part of antimicrobial stewardship. All existing methods have limitations. A new, straightforward, inexpensive, and specific phenotypic method for the detection of carbapenemase production, the carbapenem inactivation method (CIM), was recently described. Here we describe a two-stage evaluation of a modified carbapenem inactivation method (mCIM), in which tryptic soy broth was substituted for water during the inactivation step and the length of this incubation was extended. A validation study was performed in a single clinical laboratory to determine the accuracy of the mCIM, followed by a nine-laboratory study to verify the reproducibility of these results and define the zone size cutoff that best discriminated between CP-CRE and members of the family Enterobacteriaceae that do not produce carbapenemases. Bacterial isolates previously characterized through whole-genome sequencing or targeted PCR as to the presence or absence of carbapenemase genes were tested for carbapenemase production using the mCIM; isolates with Ambler class A, B, and D carbapenemases, non-CP-CRE isolates, and carbapenem-susceptible isolates were included. The sensitivity of the mCIM observed in the validation study was 99% (95% confidence interval [95% CI], 93% to 100%), and the specificity was 100% (95% CI, 82% to 100%). In the second stage of the study, the range of sensitivities observed across nine laboratories was 93% to 100%, with a mean of 97%; the range of specificities was 97% to 100%, with a mean of 99%. The mCIM was easy to perform and interpret for Enterobacteriaceae, with results in less than 24 h and excellent reproducibility across laboratories.



July 26, 2017 at 9:25 am

Amoxicillin and Ceftriaxone as Treatment Alternatives to Penicillin for Maternal Syphilis.

Emerging Infectious Diseases. May 2017 V.23 N.5 P.827-829.

Katanami Y, Hashimoto T, Takaya S, Yamamoto K, Kutsuna S, Takeshita N, Hayakawa K, Kanagawa S, Ohmagari N.


There is no proven alternative to penicillin for treatment of maternal syphilis. We report 2 case-patients with maternal syphilis who were successfully treated without penicillin.

We used amoxicillin and probenecid for the first case-patient and amoxicillin, probenecid, and ceftriaxone for the second case-patient.


July 12, 2017 at 3:26 pm

Surveillance and outbreak report LEGIONNAIRES’ DISEASE IN EUROPE, 2011 TO 2015

Eurosurveillance July 06, 2017 V.22 N.27

J Beauté 1 2 , on behalf of the European Legionnaires’ Disease Surveillance Network 3

  1. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
  2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  3. The members of the network are listed at the end of the article

Under the coordination of the European Centre for Disease Prevention and Control (ECDC), the European Legionnaires’ disease Surveillance Network (ELDSNet) conducts surveillance of Legionnaires’ disease (LD) in Europe. Between 2011 and 2015, 29 countries reported 30,532 LD cases to ECDC (28,188 (92.3%) confirmed and 2,344 (7.7%) probable). Four countries (France, Germany, Italy and Spain) accounted for 70.3% of all reported cases, although their combined populations represented only 49.9% of the study population. The age-standardised rate of all cases increased from 0.97 cases/100,000 population in 2011 to 1.30 cases/100,000 population in 2015, corresponding to an annual average increase of 0.09 cases/100,000 population (95%CI 0.02–0.14; p = 0.02). Demographics and infection setting remained unchanged with ca 70% of cases being community-acquired and 80% occurring in people aged 50 years and older. Clinical outcome was known for 23,164 cases, of whom 2,161 (9.3%) died. The overall case fatality ratio decreased steadily from 10.5% in 2011 to 8.1% in 2015, probably reflecting improved reporting completeness. Five countries (Austria, Czech Republic, Germany, Italy, and Norway) had increasing age-standardised LD notification rates over the 2011−15 period, but there was no increase in notification rates in countries where the 2011 rate was below 0.5/100,000 population….



July 12, 2017 at 8:20 am

Staphylococcus haemolyticus – an emerging threat in the twilight of the antibiotics age

Microbiology (2015), 161, 2061–2068

Tomasz Czekaj, Marcin Ciszewski and Eligia M. Szewczyk

Department of Pharmaceutical Microbiology and Microbiological Diagnostics, Medical University

of Ło´dz´, Pomorska 137, 90-235 Ło´dz´, Poland

Staphylococcus haemolyticus is one of the most frequent aetiological factors of staphylococcal infections. This species seems to lack the important virulence attributes described in other staphylococci.

However, studies have shown that the presence of various enzymes, cytolysins and surface substances affects the virulence of S. haemolyticus. Nevertheless, none of them has been identified as crucial and determinative.

Despite this, S. haemolyticus is, after Staphylococcus epidermidis, the second most frequently isolated coagulase-negative staphylococcus from clinical cases, notably from blood infections, including sepsis.

This raises the question of what is the reason for the increasing clinical significance of S. haemolyticus?

The most important factor might be the ability to acquire multiresistance against available antimicrobial agents, even glycopeptides.

The unusual genome plasticity of S. haemolyticus strains manifested by a large number of insertion sequences and identified SNPs might contribute to its acquisition of antibiotic resistance.

Interspecies transfer of SCCmec cassettes suggests that S. haemolyticus might also be the reservoir of resistance genes for other staphylococci, including Staphylococcus aureus.

Taking into consideration the great adaptability and the ability to survive in the hospital environment, especially on medical devices, S. haemolyticus becomes a crucial factor in nosocomial infections caused by multiresistant staphylococci.


July 6, 2017 at 9:21 pm

Old and new antibiotics for therapy of multidrug resistant bacteria.

Rev Esp Quimioter. Sept 2016 V.29 Suppl 1 P.39-42.

[Article in Spanish]

Pintado V1.

Author information

1 Vicente Pintado, Servicio de Enfermedades Infecciosas. Hospital Ramón y Cajal. Madrid, Spain.


The lack of new antibiotics for multidrug-resistant bacteria is a matter of concern in microorganisms such as Pseudomonas aeruginosa, ESBL- and carbapenemase-producing Enterobacteriaceae, Acinetobacter baumannii, methicillin-resistant Staphylococcous aureus and vancomycin-resistant Enterococcus faecium.

This situation has conditioned the reuse of “old” antibiotics (colistin, fosfomycin), the use of more recent antibiotics with new indications or dosage regimens (tigecycline, meropenem) and the introduction of “new” antibiotics (β-lactams, lipoglycopeptides, oxazolidinones) that are the subject of this review.


July 2, 2017 at 9:33 pm

Resistance to Colistin in Klebsiella Pneumoniae: A 4.0 Strain?

Infect Dis Rep. May 31, 2017 V.9 N.2 P.7104.     

Granata G1, Petrosillo N1.

Author information

1 Clinical and Research Department, National Institute for Infectious Diseases “L. Spallanzani” – IRCCS, Rome, Italy.


The global rise of multidrug-resistant gram-negative bacteria represents an increasing threat to patient safety. From the first observation of a carbapenem-resistant gram-negative bacteria a global spread of extended-spectrum beta-lactamases and carbapenemases producing Klebsiella pneumoniae has been observed.

Treatment options for multidrug-resistant K. pneumoniae are actually limited to combination therapy with some aminoglycosides, tigecycline and to older antimicrobial agents. Unfortunately, the prevalence of colistin-resistant and tigecycline-resistant K. pneumoniae is increasing globally. Infection due to colistin-resistant K. pneumoniae represents an independent risk factor for mortality.

Resistance to colistin in K. pneumoniae may be multifactorial, as it is mediated by chromosomal genes or plasmids. The emergence of transmissible, plasmid-mediated colistin resistance is an alarming finding.

The absence of new agents effective against resistant Gram-negative pathogens means that enhanced surveillance, compliance with infection prevention procedures, and antimicrobial stewardship programs will be required to limit the spread of colistin-resistant K. pneumoniae.



July 2, 2017 at 9:29 pm

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