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Objective: To describe the epidemiology of Enterobacterales producing carbapenemases (EPC) in a tertiary hospital., Methods: A retrospective observational study, all patients with a positive sample for EPC treated in hospitalization or in the Emergency Department were included, between January 1, 2014 and December 31, 2016., Results: A total of 272 patients (316 samples) were included: 155 (57%) male. Mean age of 70.4 years (95% CI 68.2 -72.7). Mean Charlson index was 3.6 (95% CI 3.4-3.8). In 63.2% the acquisition was nosocomial, in 35.3% it was health-care associated (HA). 55.1% presented infection, the most frequent infection was urinary tract infection (UTI) (58.7%). The most frequent species were Klebsiella pneumoniae (62.7%) and Enterobacter cloacae (10.1%). The most frequent types of carbapenemase were OXA-48 (53.8%) and VIM (43%). The nosocomial acquisition was associated with the male gender, transplantation, immunosuppression, admission to the Intensive Care Unit (ICU) or surgical service, prior antibiotic treatment, Enterobacter, VIM, respiratory and intra-abdominal infections. The HA acquisition was associated with age and comorbidity, nursery home origin, bladder catheterization, greater number of outpatient procedures, previous hospital admission, K. pneumoniae and E. coli, OXA-48, coproduction of extended spectrum betalactamases, UTI and sepsis., Conclusions: Patients who acquire EPC in nursery homes frequently have an infection. Patients with nosocomial acqui-sition are colonized by EPC in the ICU, in relation to invasive procedures and transplantation. This population has a higher mortality due to developing respiratory infections by EPC., (©The Author 2020. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Chronic granulomatous disease is an uncommon primary immunodeficiency due to a defect of the killing activity of phagocytes, caused by mutations in any of the genes encoding subunits of the superoxide-generating phagocyte NADPH oxidase system. The incidence is 1 in 250 000 live births. It can occur from infancy to adulthood, usually in children under 2 years. Bacterial and fungal infections in association with granuloma lesions are the most common manifestations of the disease. Aspergillus species, Staphylococcus aureus, Serratia marcescens, Nocardia species are the most common microorganisms isolated. We describe here a case of a 1-year-old boy with chronic granulomatous disease and invasive pulmonary aspergillosis, Serratia marcescens osteomyelitis and Enterobacter cloacae cervical granuloma., (Sociedad Argentina de Pediatría.)

Introduction: A description is presented on the molecular epidemiology of carbapenemase-producing enterobacteriaceae infection in a tertiary hospital., Material and Methods: A study was made on all the carbapenemase-producing enterobacteriaceae isolations obtained between February 2015 and March 2016 in the Hospital Universitario 12 de Octubre (Madrid). Phenotypic and molecular methods were used., Results: A total of 7 bacterial species were identified, with the majority being Klebsiella pneumoniae (K. pneumoniae) (78.9%) and Enterobacter cloacae (E. cloacae) (16.4%). The resistance of K. pneumoniae and E. cloacae for carbapenems was 88.7 and 88.6% for ertapenem, 21.4 and 54.3% for imipenem, and 20.8 and 34.3% for meropenem, respectively. The most frequent carbapenemase type was OXA-48 (91.1%) and VIM (71.4%) in E. cloacae. A total of 9K. pneumoniae clonal types were identified, including a majority pertaining to the sequence type ST11. In E. cloacae, 16 clonal types were identified., Conclusions: The current increase in carbapenemase-producing enterobacteriaceae is mainly due to the spread of OXA-48-producing K. pneumoniae., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Introduction: Standard management of infected mesh advocates its removal, but this often results in a larger hernia than at the time of original repair. In this article we describe a novel approach to manage conservatively an infected prosthetic mesh., Patient and Methods: Mesh infection rate at our institution was 1%. We describe 3 cases (inguinal, ventral and parastomal hernias) that presented prosthetic mesh infections. All the cases were satisfactorily managed with a conservative approach, consisting in wound opening and pressurized wound irrigation with gentamicin (80mg/8hours) and intravenous infusion of Amoxicilin/Clavulanic acid (875mg+125mg/8hours) during 7 days, achieving sterile cultures of the mesh surface in all the cases. A 3rd intention closure of the wound was performed. There is no clinical evidence of recurrent infection in any case., Conclusion: Conservative management of mesh infection, including drainage, antibiotic irrigation and wound closure, is a potential alternative to mesh removal.

Introduction: An increasing number of neonates require intensive care, and this population has a high risk of developing infections. The Enterobacteriaceae most commonly related to healthcare-associated infection in neonatal intensive care units (NICU) are Escherichia coli, Klebsiella spp and Enterobacter cloacae., Methods: From January 2001 to December 2005, 84 bloodstream infections caused by E. cloacae, E. coli and Klebsiella spp. were studied in 80 neonates hospitalized in the NICU and intermediate care unit. Clinical histories were reviewed to extract the most important demographic data. Identification and susceptibility patterns were carried out with GN VITEK 2 and AST&#95;N057 VITEK 2 (bioMérieux, Marcy l'Etoile, France). Molecular typing was performed by macrorestriction and pulsed-field gel electrophoresis (PFGE)., Results: Twenty-one community bloodstream infections and 63 healthcare-associated infections were diagnosed. In community bloodstream infections there were no significant differences according to birth weight or gestational age of the neonates. In healthcare-associated infection, however, there was a high percentage of neonates whose birth weight was between 1.001 and 1.500 grams and gestational age < or =36 weeks (P<0.001). On PFGE analysis, the majority of E. coli strains belonged to different clones. Among Klebsiella pneumoniae and E. cloacae isolates, some strains showed a high percentage of similarity, highlighting detection of an E. cloacae outbreak., Conclusion: The study has provided better knowledge of bloodstream infections caused by Enterobacteriaceae in the NICU of our hospital from both the epidemiological and clonal standpoints., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

Severe thrombocytosis (platelet count > 1,000,000 microL(-1)) is a rare, usually reactive, process and few perioperative cases have been reported. We describe the management of a patient who developed severe reactive thrombocytosis in the preoperative period before undergoing segmentectomy to remove a malignant nodule. A platelet count of 2,086,000 microL(-1) was observed during the first few days after surgery; we therefore started antiplatelet therapy to prevent thrombotic complications. We analyze the factors that might have contributed to the development of severe thrombocytosis in this case and discuss the different treatment options that may affect perioperative outcomes in these patients.

Objective: The aim of this research was to detect the presence of genes encoding beta-lactamases which can confer cefepime resistance on Enterobacter cloacae isolates, meaning that this antibiotic may be considered an important therapeutic alternative., Materials and Methods: 28 E. cloacae isolates collected from 4 hospitals in Bogotá during 2003 were analysed. Extended spectrum beta-lactamases and cephalosporinase production were phenotypically determined. The presence of extended spectrum beta-lactamase genes was determined by PCR amplification. Mating assays were done to determine the possible transfer of bla-genes encoding cefotaximases., Results: Microbiological tests detected 57% of extended-spectrum beta-lactamase-producing isolates. blaTEM, blasHv and blacTX-M genes were detected by PCR in 82% of the isolates. 7 out of 9 isolates carrying group 1 blacTX-M genes were in the resistant or intermediate range for cefepime. These isolates produced cefotaxime-resistant transconjugants., Conclusion: A relationship was found between resistance to cefepime and the presence of cefotaximases in E. cloacae. blacTx-M genes were present in 32% of the isolates, indicating an significant spread in the hospitals being studied. The facility of these genes' transfer between other species and Enterobacteria genera becomes an important reason for detecting them and controlling their spread in hospital settings. These results suggest a cautious use of cefepime for treating infection caused by E. cloacae strains which might produce CTX-M enzymes.

Vascular access through a venous catheter for haemodialysis is associated with increased risk of thrombosis, central venous stenosis, short access survival and inadequate dialysis. The most important catheter-related complications, which determine method survival, are infection and dysfunction. In particular, infectious episodes are in some studies the leading cause for untimely catheter removal and for catheter-related morbidity but also for morbidity in dialysis patients. Double-lumen central venous catheters used for haemodialysis, are common causes of septicaemia. Most cases are caused by staphylococci. Episodes of gram-negative bacteriemia have been traced to bacterial contamination of water and/or dialysate, errors in dialyzer reprocessing, and improper setup procedures. In this paper, we describe and outbreak of gram-negative bacteremia, firstly E. cloacae, in an outpatients haemodialysis unit, in the patients with long-term tunnelled haemodialysis catheters. We describe the epidemic investigation that we achieved to identify the source of contaminating bacteria and the route by which bacteria gained access to the bloodstream. We prove the contamination by gram-negative bacterium of the water-distribution lines and haemodialysis machines. Moreover, E. cloacae strains isolated from the lines and machines are genotypically identical to the isolated from the patients. Also, we prove that the hands of health care personnel are unintentional carriers. The outbreak was finished when decontamination of dialysis machines was enhanced and dialyzer-priming fluid was modified.

Enterobacter cloacae, Enterobacter aerogenes and Enterobacter agglomerans were identified using gas chromatography as a substitution of the traditional techniques. Their acid methyl esters profiles were determined using a gas chromatograph Hewlett Packard 5890A and a RSL-150 heliflex capillary column. A total of 120 samples were analyzed from reference strains (ATCC 13047, 13048, 27155) and environmental isolations, eleven fatty acids were included in the profiles from which cis-9, 10-methyleneoctadecanoic acid (peak 24), cis-9-hexadecenoic acid (peak 14), octadecanoic acid (peak 23) and dodecanoic acid (peak 3), were the most important for the differentiation of the three species analyzed.