Search

Introduction and Objectives: Infective endocarditis (IE) caused by oral streptococci is considered to be a 'more benign' IE than those caused by other microorganisms. Our aim is to analyse the changes in its incidence and its differential characteristics in our setting., Methods: Observational, single-centre, prospective cohort study including all cases of IE diagnosed in our centre between 1987 and 2023. IE caused by oral streptococci were identified and their characteristicsand mortality were compared with those of other IE., Results: Of 569 cases of IE, 104 (18.5%) were oral streptococcal IE, decreasing from 29.5% in 1987-1999 to 12.2% in 2000-2023 (p<0.001). The incidence of serious complications was lower in oral IE (65.3 vs. 78.9%; p=0.003), as was in-hospital mortality (14.4 vs. 29.9%; p=0.001)., Conclusions: Oral streptococcal IEs account for almost 20% of all IEs in our setting. They have a better prognostic clinical profile, with a lower incidence of serious complications, and their mortality is significantly lower than that of other IE. Their incidence seems to be decreasing in recent years., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

The purpose of this study was to characterize the antibiotic resistance, virulence, and genetic diversity among invasive and non-invasive Streptococcus dysgalactiae subsp. equisimilis (SDSE) isolates. SDSE were isolated from clinical samples of outpatients and inpatients cares in La Rioja region (Spain) during 2012-2015. The analyses performed were susceptibility testing by disc diffusion, resistance and virulence genes by PCR, emm typing by PCR and sequencing, and other molecular typing by SmaI-PFGE and MLST. Forty-two SDSE isolates were recovered (64.3% non-invasive, 35.7% invasive) that were grouped in 31 PFGE patterns, 17 ST, and 14 emm types, being stC1400, stG6792, and stG62647 the most frequent, and stC74a and stC5345 exclusive in invasive SDSE. Twenty-one SDSE were resistant to at least one antibiotic. The erm(TR) and erm(B) genes were linked with resistance to macrolides; tet(M) and tet(T) to tetracycline; dfrF to trimethoprim; ant(6)-Ia and aph(3')-IIIa to aminoglycosides; and the substitutions Asp80Ala in GyrA and Ser79Phe in ParC with resistance to levofloxacin. The sagA, slo, scpA, and ska virulence genes were amplified in 93% SDSE. Streptococcal superantigenic speG dys gene was identified in 80% of invasive and 63% of non-invasive SDSE and correlated with certain emm types (e.g., stG62647 or stG6792). SDSE invasive infections were most frequent in elderly patients, and half of our SDSE were resistant to at least one antibiotic tested. This work is the first detection of tet(T), dfrF, and new substitution in GyrA protein in SDSE. A high diversity of circulating genetic lineages was found among our SDSE.

Streptococcus uberis is a worldwide pathogen that causes intramammary infections in dairy cattle. Nevertheless, commercial vaccines are currently not available and measures to control S. uberis mastitis are limited to the implementation of good management practices. The aim of the present study was to evaluate the efficacy of an S. uberis subunit vaccine against bovine mastitis (Laboratorios Hipra S.A., Amer, Spain) administered precalving against an experimental intramammary challenge with a heterologous S. uberis strain in dairy cows postcalving. With this objective, 25 gestating Holstein-Friesian heifers were randomly assigned to 1 of 2 groups: group 1 (n = 13), vaccinated by intramuscular route with the vaccine, and group 2 (n = 12), vaccinated by intramuscular route with phosphate-buffered saline as a control group. Both groups were immunized 60 and 21 d before the expected parturition date (75 and 36 d before challenge). Fourteen days after calving all cows were challenged by intramammary infusion of 100 colony-forming units of a heterologous S. uberis strain in 2 quarters per cow. Then, challenged quarters were monitored for clinical signs of mastitis, bacterial count, and somatic cell count for the following 21 d. Rectal temperature and daily milk yield per cow were also assessed. Results showed that all challenged quarters developed clinical mastitis. Nevertheless, vaccination significantly reduced the clinical signs of mastitis, bacterial count, rectal temperature, and daily milk yield losses after the intramammary infection and significantly increased the number of quarters with no bacterial isolation and somatic cell count <200,000 cells/mL at the end of the study (d 19, 20, and 21 after challenge). To confirm the efficacy of this vaccine, further studies under field conditions are needed., (Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Introduction: Nebulized devices are commonly used in the treatment of respiratory infection, and other respiratory diseases. It has been reported nosocomial infections in cystic fibrosis patients as a result of the use of contaminated devices. However, little is known about nosocomial infections secondary to aerosolized therapy in COPD patients admitted for acute exacerbation., Methods: Thirty consecutive patients (13 males) were included. All of them received aerosolized medication. Each patient used their own facemask and nebulizer cup, which were stored in the room after its use. Samples from nebulizer cups were obtained on days 0, 4 and 7. In addition, sputum samples were obtained on day 0 (prior to any nebulization) and on day 7, and cultivated in enriched media., Results: Only nine nebulizer cups had positive microbiological cultures. Coagulase negative staphylococci (CoNS) were isolated in all cases. Sputum samples could be obtained in 27 patients. None grew CoNS after 7 days of aerosolized therapy. Gram-negative non-fermenting bacilli were isolated in three patients without concomitant grown in nebulizer cups., Conclusions: We did not find any nosocomial infection related to aerosolize medications in COPD patients admitted for acute exacerbation.

Streptococcosis caused by Streptococcus iniae has become one of the most serious marine and freshwater aquatic diseases in the past decade, causing large losses in farmed and wild fish worldwide. In this study, we performed an ultrastructural study of major lesions in gilthead seabream Sparus aurata and red porgy Pagrus pagrus experimentally infected with the S. iniae IUSA-1 strain, isolated in a natural outbreak in Spain in the mentioned species. The transmission electron micrographs revealed the resistance of this pathogen inside the phagosome, indicating that the macrophage may provide a significant bacterial reservoir for continuing infection, disease dissemination, and tissue injury by crossing the blood-brain barrier., (© The Author(s) 2014.)

The role of Streptococcus species as an aetiological microorganism of vertebral osteomyelitis (VO) is considered to be of little relevance. We aimed to describe a large number of cases of streptococcal vertebral osteomyelitis (SVO), to analyze the clinical features associated with different Streptococcus species, and to compare them with a cohort of patients with VO caused by Staphylococcus aureus. An incidence study and a retrospective, multicenter, observational clinical study of cases of SVO (1991-2011) were performed. Statistical comparison of SVO by different species and between them and staphylococcal VO was carried out. Over the whole period there was an increasing incidence in the number of VOs and SVOs per year (p <0.05). Among 58 cases of SVO, those caused by non-viridans streptococcus (Streptococcus pneumoniae, Streptococcus agalactiae and Streptococcus pyogenes; n = 26) mimicked VO by S. aureus, and presented with more fever, neurological symptoms and paravertebral abscesses in comparison with those caused by the viridans group (remaining species). In contrast, the latter have a sub-acute clinical picture and were associated with the presence of endocarditis (p <0.05). Among non-viridans SVOs, concomitant infection was specifically related to S. pneumoniae (p <0.05). In conclusion, SVO presents a wide range of clinical patterns. The relationship between VO and diagnosis of endocarditis was established with SVO caused by the viridans group. Whereas non-viridans SVO mimics acute characteristics of VO caused by S. aureus, cases of viridans SVO are significantly more likely to have a sub-acute clinical presentation. The increased incidence of SVO during the last decades could support a new epidemiological scenario., (© 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.)

Through a continuing resistance surveillance monitoring program, linezolid was shown to maintain its spectrum and potency against a collection of 8059 clinically relevant Gram-positive strains collected from patients at 79 medical centers in 33 countries and Hong Kong. Linezolid MIC90 values were 2 μg/mL for methicillin-resistant and -susceptible Staphylococcus aureus and enterococci, and the MIC90 value was 1 μg/mL for coagulase-negative staphylococci (CoNS), β-hemolytic streptococci, Streptococcus pneumoniae, and viridans group streptococci. Reference broth microdilution susceptibility testing for linezolid demonstrated a 99.83% susceptibility rate for all organisms. All S. aureus were inhibited by ≤2 μg/mL. Three (0.3%) of 928 strains of CoNS had a linezolid MIC of 4 μg/mL and contained the cfr resistance gene; 1 also had a mutation in L3. There were 14 linezolid-resistant strains detected from 7 countries (Brazil [5], France [1], Germany [2] Greece [2], Italy [2], Ireland [1], and Spain [1]) representing 5 species (E. faecium, S. capitis, S. epidermidis, S. hominis, S. lugdenensis). A mobile cfr gene was noted in 2 species having elevated linezolid MIC values; one was a S. haemolyticus isolate with a MIC at 4 μg/mL. Resistance rates were as follows for the 6 groups of organisms sampled in the 2011 ZAAPS Program: CoNS, 1.2%; enterococci, 0.39%; among S aureus, S. pneumoniae, viridans group streptococci, and β-hemolytic streptococci, no resistance was detected. As the activities of commonly used antimicrobials continue to be compromised by evolving resistance mechanisms in Gram-positive pathogens, linezolid-resistant strains remain uncommon and without increasing occurrence., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Susceptibility to erythromycin and clindamycin was determined in 860 consecutive clinical isolates of beta-haemolytic streptococci belonging to groups A (GAS, n = 134), B (GBS, n = 689), C (GCS, n = 19) and G (GGS, n = 18). Erythromycin resistance was 26.1% in GAS, 15.7% in GBS, 5.3% in GCS and 33.3% in GGS. The highest rate of clindamycin resistance (33.3%) was in GGS, followed by GBS (15.8%), GCS (15.8%) and GAS (5.2%). The M phenotype was predominant in GAS (80%), the constitutive MLS(B) phenotype was predominant in GBS (75%), and all GGS isolates showed the inducible MLS(B) phenotype. The uncommon erythromycin-susceptible and clindamycin-resistant phenotype was found in four GBS and two GCS isolates.

In more than 10 Spanish dairy cows, a bovine herpesvirus 4 (BHV4) associated postpartum metritis was confirmed by virus isolation, BHV4-glycoprotein B (gB) PCR and/or serology. In this study, 12 cows with, and, at the time of sampling, 3 cows without clinical signs of acute postpartum metritis from one large dairy herd in Spain were examined for bacterial and viral infections. Blood, placenta/caruncles and uterine contents were collected between day 1 and day 20 post-calving, and examined for the presence of bacteria and for viruses by virus isolation, BHV4 DNA by BHV4-gB PCR and/or BHV4 antibody titres. Bovine herpesvirus 4 was detected in 83% of the cases with clinical signs of acute postpartum metritis by virus isolation and/or BHV4-gB PCR. An increase of BHV4 antibodies was detected in all examined postpartum metritis cows and in the 3 cows without clinical metritis. Two of these 3 cows developed severe metritis a few dayss after collecting the first blood sample. A concurrent infections of BHV4 and bacteria, mainly Arcanobacterium pyogenes and Streptococcus sp., were detected in 73% of the examined uterine contents collected from postpartum metritis affected cows. This case-report study showed a clear association between BHV4 infections and acute postpartum metritis in dairy cows. In addition, the BHV4-associated postpartum metritis appeared to be an emerging syndrome in this Spanish herd.

With the aim of assessing the potability of drinking water, 31 different springs sited along the road to Santiago "The French Way" in Galicia (NW Spain) were studied. Twenty-one parameters, according to Spanish Legislation have been determined by Official Methods. It was observed that the parameters: pH, nitrate, ammonia, total coliforms, fecal coliforms and fecal streptococcus did not always comply with the levels established by Spanish Legislation. The bacteriological characters were the most restrictive of the sanitary quality of drinking water, only 19% of the springs were drinkable during all the study. According to the Factorial Analysis in Principal Component applied to the obtained results, it was concluded that the parameters: conductivity, hardness, dry residue, nitrate and fecal coliforms can be very indicative for assessing water sanitary quality.

Objectives: The aim of this study was to analyse the prevalence of dental treatment and oral infections related to the development of infective endocarditis (IE)., Methods: A retrospective study of 103 cases of IE diagnosed from 1997 to 1999 was conducted in Galicia, Spain., Results: According to the Duke's endocarditis criteria (1994), 87 cases (84.5%) were considered definite IE. A presumed oral portal of entry was recorded in 12 patients (13.7%). Oral infections were held responsible in six cases while the remaining six had received dental treatment in the previous three months (three tooth extractions, one scaling, one cleaning, one fillings). In eight cases of IE (66.6%) typical oral pathogenic microflora was identified, with Streptococcus viridans being the most frequent. In four patients no previous cardiac disease was recorded., Conclusions: These results suggest that prevalence and characteristics of IE cases of dental origin did not change significantly in the last decades. The need for increased oral hygiene and improved dental care should be emphasized on preventing IE of dental origin. Continued education of physicians and dentists on the importance of the knowledge of current prophylactic protocols should also be considered.

Bacteremia continues to be one of the main causes of mortality despite the existence of numerous antimicrobial agents and an increase in means of support. A variety of factors, such as the type of microorganism, age, the underlying disease and where the bacteremia was acquired, can change the prognosis of the infection. The aim of this study was to analyze the cases of community-acquired bacteremia gathered prospectively from the Basurto hospital in Bilbao, Spain. The incidence of bacteremia was estimated using preestablished protocol (SEPSIS-DATA) from January 1994 to September 2001. Information was gathered on all the cases of bacteremia at the hospital and only those which were of non-hospital origin (2886 cases) were selected for the study. In our hospital, 67.82% of the bacteremia cases were community-acquired, a figure which remained stable throughout the 8-year study period. A total of 54.64% of the patients were male, 1603 (55.54%) of whom were over age 60 years. The most common underlying diseases were diabetes (15.75%), neoplasia (14.96%) and HIV infection (12.9%). The majority of the cases (2216, 76.8%) were admitted to the general medicine ward, 335 (11.6%) to surgery, 200 (6.9%) to pediatrics and 135 (4.67%) to ICU. The origin of the bacteremia was urinary (33%), gastrointestinal (18%) or respiratory (18.26%). The most common microorganisms were E. coli (36%), S. pneumoniae (13%), S. aureus (9.46%), S. enteritidis (2.87%), P. aeruginosa (2.71%), P. mirabilis (2.65%) and N. meningitidis (2.45%). The bacteremia was polymicrobial in 6.27% of the cases. The most used antibiotics were ceftriaxone (31%), gentamicin (7.3%) and amoxicillin-clavulanic acid (6.9%). Overall mortality was 13.82%. The relative frequency of community-acquired/nosocomial infection remained stable in two-thirds of the total cases. The incidence of bacteremia decreased in the 20-40 year age group and in those with HIV infection. E. coli and S. pneumoniae increased, while S. aureus decreased. The use of imipenem and quinolones increased. E. coli resistance to quinolones increased from 3.54% in 1995 to 14.36% in 2000. Mortality decreased slightly, with no significant differences.

Background: Betahemolytic streptococci, particularly group A, are the most frequently isolated pathogen in the cases of acute pharyngotonsilitis in school-aged children. A study was carry out in school children of Las Palmas de Gran Canaria with the aim of knowing of the state of pharyngeral carriers of betahemolytic streptococci in Lancefield groups A, B and C., Methods: A total of 1,002 healthy school children (520 boys and 482 girls) with ages ranging from 4 to 15 of aged were included in the study in which a pharyngeal exudate was obtained to detect the presence of betahemolytic streptococci., Results: 69.5% of the healthy school children were not pharyngeal carriers of betahemolytic streptococci. The prevalence of streptococci group A in all the age groups studied was of 6%. The prevalence of beta streptococci groups B and C were of 11 and 13.5%, respectively., Conclusions: The results of this study are in agreement with the literature reviewed in which the rate of pharyngeal carriers of beta-hemolytic streptococci in school children of Las Palmas de Gran Canaria are more similar that studies reported from tropical and subtropical zones showed a high prevalence of groups B and C and a lower prevalence of a group A than others communities of our country and zones with temperature climate where showed a high prevalence of group A and lower prevalence of groups B and C.

Streptococci other than Streptococcus pneumoniae are a rare cause of bacterial meningitis in adults. We report 29 cases of streptococcal meningitis (1977-1997). The patients comprised 19 men and 10 women, with a mean age +/- standard deviation of 47 +/- 18 years. Nine cases were secondary to neurosurgical procedures, seven to brain abscess, five to cerebrospinal fluid pericranial fistula, and three to endocarditis. Causative microorganisms included the following: viridans group streptococci, 20 cases; anaerobic streptococci, 3; Streptococcus agalactiae, 3; Streptococcus bovis, 2; and Streptococcus pyogenes, 1. Four Streptococcus mitis strains showed decreased susceptibility to penicillin (MIC, 0.5-2 microg/mL). Five patients (17%) died. The infection is increasing in the hospital setting. Streptococci resistant to penicillin should be considered in the empirical treatment of nosocomial meningitis. In cases of community-acquired infection, anaerobic streptococci or streptococci of the Streptococcus milleri group should alert the clinician to the presence of an undiagnosed brain abscess, whereas oral streptococci of the viridans group suggest the diagnosis of bacterial endocarditis.

A nationwide susceptibility surveillance study of beta-hemolytic streptococcal isolates from pharyngeal swabs obtained in 11 Spanish hospitals between May 1996 and April 1997 against 12 antibiotics was carried out. Of the isolates 86% (786 of 914 isolates) were group A and 8.4% (77 of 914 isolates) were group C. No resistance was found to beta-lactam antibiotics, but significant differences (P < 0.001) with respect to lack of susceptibility to macrolides were found between groups (27% for group A and 12% for group C) and between seasons (13.2% in summer and 31.7% in winter). Most of these isolates displayed the M phenotype (low-level resistance to erythromycin and susceptibility to clindamycin).

The objective of this study was to increase our understanding of the importance of members of the Streptococcus milleri (SM) group as respiratory pathogens, by studying the epidemiological and clinical features of thoracic infections caused by this group and comparing the epidemiology and prognosis of empyema caused by SM with cases of pneumococcal aetiology. The clinical histories and microbiology reports were reviewed in 27 cases of thoracic infection caused by SM over a period of 8 yrs. Cases of pneumococcal empyema that occurred during the same period were also analysed. Diagnoses were made of cases of empyema, including six with pneumonia and one with pulmonary abscess, three cases of pneumonia and two of mediastinitis. In 17 cases, SM was the only pathogen isolated. There was a history of instrument or surgical procedures on the digestive or respiratory tract in 59%. Secondary bacteraemia was documented in three cases. The treatment administered, a combination of antibiotics and surgery, was successful in 22 of 27 (81%) of cases. All strains were susceptible to penicillin. When the characteristics of the empyemas caused by monomicrobial SM infection were compared with those of pneumococcal aetiology from the same period of study, significant differences were found with respect to age, origin of the infection and the need for surgery. In conclusion, thoracic infections caused by Streptococcus milleri are largely pleural. They are polymicrobial in one-third of cases, commonly acquired in hospital and, in most patients, associated with major surgery and/or surgical procedures of the respiratory or digestive tract. The empyema frequently requires thoracotomy for complete resolution.

Objective: To study the epidemiological and clinical characteristics of bacteremia caused by Streptococcus milleri group streptococci (SMG)., Methods: Prospective evaluation of all bacteremic episodes with clinical significance from 1990 to 1995 in two general hospitals. In this study all episodes caused by SMG were analyzed., Results: A total of 905 bacteremic episodes with clinical significance were detected; 18 (1.98%) were caused by SMG (0.16/1,000 admissions). The mean age of patients were 43 years and the male/female ratio 1.6. Seventeen patients (94.4%) had some underlying disease; nine patients had diabetes, four were parenteral drug abusers, and two had neoplasms. The most common sources of bacteremia were intraabdominal in four episodes (two liver abscesses, one subphrenic abscess and one pancreatic pseudocyst), cutaneous and/or soft tissues in four, surgical wound in two and respiratory in two; no source was identified in five episodes. Four episodes had a polymicrobial origin. In 13 isolates the identification was at species level (Streptococcus anginosus eight, Streptococcus intermedius four and Streptococcus constellatus one). All strains were susceptible to penicillin. Six patients (33.3%) required surgery. In ten episodes a favorable outcome was recorded, although four patients required surgery. The infection associated mortality rate was 31.2%. The mean age of deceased patients was higher than for cured patients (62.2 +/- 20.2 versus 35.3 +/- 20.3; p < 0.05)., Conclusions: SMB bacteremia is uncommon. It involved mainly diabetic patients or parenteral drug abusers, commonly with an intraabdominal suppurative source or in skin or soft tissues. The mortality rate was high despite surgery in one third of patients. Patients with advanced age had a poorer prognosis. All isolates investigated were susceptible to penicillin.

Saragossa city supply channel and the river Ebro (up and downstream urban sewage) were studied for the presence of coliphages and B. fragilis phages and their relationship with the bacterian faecal indicators. In the supply channel the coliphages geometric mean was of 130 ufp/100 ml, and showed no correlation with faecal and total coliforms, but it showed indirect correlation with ambient temperature. In the river Ebro the coliphages geometric mean ranged from 290 to 8,000 ufp/100 ml; the relationship with total and faecal coliforms and faecal streptococci was high, but they were temperature independent. With the methodology utilized B. fragilis phages only were recovered in samples with faecal coliforms levels > 1 x 10(4) ufc/100 ml.

We study 583 strains of enterococci isolates by 19 laboratories from Catalonia: 546 E. faecalis (93.5%), 34 E. faecium (6%) and 3 E. durans (0.5%). We inoculated all the strains in Müeller-Hinton agar with 2,000 mg/l of one of the following aminoglycoside: gentamicin, tobramycin, amikacin, streptomycin and kanamycin. Global incidence of high-level resistance was 9.4% to gentamicin, 7.3% to tobramycin, 0.2% to amikacin, 30.3% to streptomycin and 37.7% to kanamycin, with important changes in regard of procedence.

Pollution indicators in Doñana National Park show a cyclic seasonal pattern with maximum level in the autumn and minimum in the spring. While faecal streptococci proved to be the best indicator micro-organisms in this type of salty, alkaline environment, total coliforms gave an overestimation of pollution because of the presence of hydroteluric coliforms.

The Spanish legislature has announced the required microbiological standards for bottled mineral waters. These requirements were the subject of "Decree 607/13th March 1975" and they are the following: -A total absence of parasites and pathogen microorganisms. -A total account of Fungus: absence in 100 ml. -A total account of coliforms: absence in 100 ml. -E. coli: entire absence in 100 ml. -A total account of Streptococcus, absence in 100 ml. -A total account of Clostridium sulphite reducing: absence in 100 ml. -A total absence of Pseudomonas aeruginosa in 100 ml. Several technical methods which have been adopted in Spain for the microbiological investigation of mineral waters have been described. For the first time the Spanish legislation has specified the total absence of Pseudomonas aeruginosa in mineral waters and techniques wich reveal the differentiation between Pseudomonas aeruginosa and other Pseudomonas by fluorescent pigments. The confirmation of diagnosis must be to carry out by the Director of National Reference Centre of Health.

A taxonomic analysis of the malolactic microflora present in nine grape samples from different zones of Galicia, was carried out. Nineteen strains were isolated and identified as Lactobacillus plantarum (42%), L. brevis (10.6%), L. casei (5.25%), L. hilgardii (5.25%), Streptococcus cremoris (5.25%), Leuconostoc lactis (5.25%), L. oenos (10.6%), and Pediococcus acidilactici (15.8%).