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Objectives: The study aimed to characterize the clonal spread of resistant bacteria and dissemination of resistance plasmids among carbapenem-resistant Enterobacterales at a tertiary hospital in Catalonia, Spain.Methods: Isolates were recovered from surveillance rectal swabs and diagnostic samples. Species identification was by matrix-assisted laser desorption ionization-time time of flight mass spectrometry (MALDI-TOF MS). Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Antimicrobial susceptibility was assessed by gradient-diffusion and carriage of bla genes was detected by PCR. Plasmid typing, conjugation assays, S1-PFGE studies and long-read sequencing were used to characterize resistance plasmids.Results: From July 2018 to February 2019, 125 Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales were recovered from 101 inpatients from surveillance (74.4%) or clinical samples (25.6%), in a tertiary hospital in Barcelona. Clonality studies identified a major clone of Klebsiella pneumoniae belonging to sequence type ST15 and additional isolates of K. pneumoniae, Escherichia coli and Enterobacter sp. from different STs. All isolates but one carried the blaKPC–2 allelic variant. The blaKPC–2 gene was located in an IncFIIk plasmid of circa 106 Kb in a non-classical Tn4401 element designated NTEKPC-pMC-2-1. Whole-genome sequencing revealed different rearrangements of the 106 Kb plasmid while the NTEKPC-pMC-2-1 module was highly conserved.Conclusion: We report a hospital outbreak caused by the clonal dissemination of KPC-producing ST15 K. pneumoniae but also the intra- and inter-species transmission of the blaKPC–2 gene associated with plasmid conjugation and/or transposon dissemination. To our knowledge, this is the first report of an outbreak caused by KPC-producing Enterobacterales isolated from human patients in Catalonia and highlights the relevance of surveillance studies in the early detection and control of antibiotic resistant high-risk clones.

Resumen Objetivo Describir las caracteristicas clinicas y respiratorias de una cohorte de 43 pacientes con COVID-19 tras 28 dias de evolucion. Diseno Prospectivo, observacional en un solo centro. Ambito Medicina intensiva. Pacientes Pacientes ingresados por COVID-19 e insuficiencia respiratoria. Intervenciones Ninguna. Variables Se obtuvieron de forma automatica variables demograficas, de gravedad, de laboratorio, de asistencia ventilatoria recibida (oxigenoterapia alto flujo [OAF] y ventilacion mecanica invasiva [VMI]), de oxigenacion (PaO2, PaO2/FiO2) y de complicaciones. Los pacientes se dividieron en 3 grupos: supervivientes (G1), fallecidos (G2) y aquellos que continuaban ingresados (G3). Se utilizo la prueba de Chi-cuadrado o de Fisher (variables categoricas) y la U de Mann-Whitney o Wilcoxon para analizar la diferencia entre medianas. Se considero significativo un valor de p Resultados Se incluyeron 43 pacientes (G1 = 28 [65,1%]; G2 = 10 [23,3%] y G3 = 5 [11,6%]), edad 65 (52-72) anos, 62% varones, APACHE II 18 (15-24), SOFA 6 (4-7), hipertension arterial (30,2%) y obesidad (25,6%) fueron las comorbilidades mas frecuentes. La OAF fue usada en el 62,7% de pacientes, el 85% fracaso. El 95% de los pacientes necesito VMI y el 85% ventilacion en prono. En la poblacion general, la PaO2/FiO2 inicial mejoro a los 7 dias (165 [125-210] vs. 194 [153-285]; p = 0,02), al igual que en el G1 (164 [125-197] vs. 207 [160-294]; p = 0,07), pero no en el G2 (163 [95-197] vs. 135 [85-177]). No se observo co-infeccion bacteriana. El desarrollo de neumonia asociada a la VMI fue elevado (13 episodios/1.000 dias de VMI). Conclusiones Los pacientes con COVID-19 requieren VMI precoz, elevada frecuencia de ventilacion en prono y presentan alta prevalencia de fracaso a la OAF. La falta de mejoria de la PaO2/FiO2 a los 7 dias podria ser un marcador de pronostico.

Purpose. The genus Arcobacter includes bacteria that are considered emergent pathogens because they can produce infections in humans and animals. The most common symptoms are bloody and non-bloody persistent diarrhea but cases with abdominal cramps without diarrhea or asymptomatic cases have also been described as well as cases with bacteremia. The objective was to characterize Arcobacter clinical strains isolated from the faeces of patients from three Spanish hospitals. Methodology. We have characterized 28 clinical strains (27 of A. butzleri and one of A. cryaerophilus) isolated from faeces, analysing their epidemiological relationship using the multilocus sequence typing (MLST) approach and screening them for their antibiotic susceptibility and for the presence of virulence genes. Results/Key findings. Typing results showed that only one of the 28 identified sequence types (i.e. ST 2) was already present in the MLST database. The other 27 STs constituted new records because they included new alleles for five of the seven genes or new combinations of known alleles of the seven genes. All strains were positive for the ciaB virulence gene and sensitive to tetracycline. However, 7.4 % of the A. butzleri and A. cryaerophilus strains showed resistance to ciprofloxacin. Conclusion. The fact that epidemiological unrelated strains show the same ST indicates that other techniques with higher resolution should be developed to effectively recognize the infection source. Resistance to ciprofloxacin, one of the antibiotics recommended for the treatment of Arcobacter intestinal infections, demonstrated in 10.7 % of the strains, indicates the importance of selecting the most appropriate effective treatment.

The objective was to characterize a group of clinical isolates of fluoroquinolone-resistant Haemophilus parainfluenzae collected in Northern Spain (March-December 2014).Twelve clinical isolates of H. parainfluenzae were studied by performing antimicrobial susceptibility testing and PCR amplification and nucleotide sequencing of the QRDR (quinolone resistance-determining region) of gyrA, parC, gyrB, and parE genes. Screening for plasmid-mediated quinolone resistance (PMQR) was also studied. Pulsed-field gel electrophoresis (PFGE) was used for molecular typing.Antimicrobial susceptibility testing showed that all the isolates were resistant to the fluoroquinolones tested (ciprofloxacin, levofloxacin, norfloxacin, and moxifloxacin). Analysis of the QRDR demonstrated that all the isolates presented mutations in gyrA and parC. A Glu88Lys substitution in ParC is reported for the first time in H. parainfluenzae. No PMQR gene was detected. PFGE results showed that isolates were not clonally related.Multiple H. parainfluenzae fluoroquinolone-resistant isolates grouped in the same area in a short period of time showed diverse substitutions in QRDR of gyrA/parC and were not clonally related, indicating individual emergence. In addition, we described the first report of Glu88Lys substitution in ParC.

Introduction: The diagnosis of streptococcal infection is usually made with the use of Centor criteria, but some family doctors also rely on the determination of C-reactive protein (CRP) to guide antibiotic therapy. Methods: This was an observational study conducted in a health center. Adults with acute pharyngitis and the presence of the 4 Centor criteria (tonsillar exudates, tender cervical glands, history of fever, and absence of cough) were recruited. The patients underwent a pharyngotonsillar swab for microbiologic study and a CRP rapid test during the consultation. Results: A total of 149 patients were enrolled. The most frequent etiology was group A streptococcus, present in 83 cases (55.7%). The highest CRP concentration was observed among patients with group C streptococcus infection, with a mean of 56.3 mg/L (95% confidence interval, 25.7–86.5 mg/L). For patients with group A streptococcus infection, the mean CRP value was 34.4 (95% confidence interval, 25.6–43.3 mg/L). Conclusion: CRP concentrations are not associated with group A streptococcus infection in patients with acute pharyngitis. The use of this point of care test is therefore not useful for distinguishing patients who require antibiotic therapy.