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Author Correction: Identifcation of CRF89_BF, a new member of an HIV‑1 circulating BF intersubtype recombinant form family widely spread in South America. Sci Rep. 2021 Aug 3;11(1):16115. DOI: 10.1038/s41598-021-95679-z. Circulating recombinant forms (CRFs) contribute substantially to the HIV-1 pandemic. Among 105 CRFs described in the literature, 16 are BF intersubtype recombinants, most of South American origin, of which CRF12_BF is the most widely spread. A BF recombinant cluster identified in Bolivia was suggested to represent a new CRF_BF. Here we find that it belongs to a larger cluster incorporating 39 viruses collected in 7 countries from 3 continents, 22 of them in Spain, most from Bolivian or Peruvian individuals, and 12 in South America (Bolivia, Argentina, and Peru). This BF cluster comprises three major subclusters, two associated with Bolivian and one with Peruvian individuals. Near full-length genome sequence analyses of nine viruses, collected in Spain, Bolivia, and Peru, revealed coincident BF mosaic structures, with 13 breakpoints, 6 and 7 of which coincided with CRF12_BF and CRF17_BF, respectively. In a phylogenetic tree, they grouped in a clade closely related to these CRFs, and more distantly to CRF38_BF and CRF44_BF, all circulating in South America. These results allowed to identify a new HIV-1 CRF, designated CRF89_BF. Through phylodynamic analyses, CRF89_BF emergence was estimated in Bolivia around 1986. CRF89_BF is the fifth CRF member of the HIV-1 recombinant family related to CRF12_BF. This work was funded through Acción Estratégica en Salud Intramural (AESI), Instituto de Salud Carlos III, projects “Estudios sobre vigilancia epidemiológica molecular del VIH-1 en España”, PI16CIII/00033, and “Epidemiología molecular del VIH en España y su utilidad para investigaciones biológicas y en vacunas”, PI19CIII/00042; Red de Investigación en SIDA (RIS), Instituto de Salud Carlos III, Subdirección General de Evaluación y Fondo Europeo de Desarrollo Regional (FEDER), Plan Nacional I+D+I, project RD16ISCIII/0002/0004; and scientific agreement with Osakidetza-Servicio Vasco de Salud, Government of Basque Country, MVI 1001/16. Sí

The extraordinary genetic variability of human immunodeficiency virus type 1 (HIV-1) group M has led to the identification of 10 subtypes, 102 circulating recombinant forms (CRFs) and numerous unique recombinant forms. Among CRFs, 11 derived from subtypes B and C have been identified in China, Brazil, and Italy. Here we identify a new HIV-1 CRF_BC in Northern Spain. Originally, a phylogenetic cluster of 15 viruses of subtype C in protease-reverse transcriptase was identified in an HIV-1 molecular surveillance study in Spain, most of them from individuals from the Basque Country and heterosexually transmitted. Analyses of near full-length genome sequences from six viruses from three cities revealed that they were BC recombinant with coincident mosaic structures different from known CRFs. This allowed the definition of a new HIV-1 CRF designated CRF108_BC, whose genome is predominantly of subtype C, with four short subtype B fragments. Phylogenetic analyses with database sequences supported a Brazilian ancestry of the parental subtype C strain. Coalescent Bayesian analyses estimated the most recent common ancestor of CRF108_BC in the city of Vitoria, Basque Country, around 2000. CRF108_BC is the first CRF_BC identified in Spain and the second in Europe, after CRF60_BC, both phylogenetically related to Brazilian subtype C strains. This work was funded through Acción Estratégica en Salud Intramural (AESI), Instituto de Salud Carlos III, projects “Estudios sobre vigilancia epidemiológica molecular del VIH- 1 en España,” PI16CIII/00033, and “Epidemiología molecular del VIH-1 en España y su utilidad para investigaciones biológicas y en vacunas”, PI19CIII/00042; Red de Investigación en SIDA (RIS), Instituto de Salud Carlos III, Subdirección General de Evaluación y Fondo Europeo de Desarrollo Regional (FEDER), Plan Nacional I + D + I, project RD16ISCIII/0002/0004; and scientific agreement with Osakidetza-Servicio Vasco de Salud, Government of Basque Country, MVI 1001/16. JC was supported by the Social European Fund through the Youth Employment Operational Program and the Youth Employment Initiative and by the Comunidad de Madrid. Sí

This study was conducted to develop a rapid, simple and reproducible method for the quantification of ceftaroline in plasma samples by high-performance liquid chromatography with ultraviolet detection (HPLC-UV). Sample processing consisted of methanol precipitation and then, after centrifugation, the supernatant was injected into the HPLC system, working in isocratic mode. Ceftaroline was detected at 238 nm at a short acquisition time (less than 5 min). The calibration curve was linear over the concentration range from 0.25 to 40 µg/mL, and the method appeared to be selective, precise and accurate. Ceftaroline in plasma samples was stable at −80 °C for at least 3 months. The method was successfully applied to characterize the pharmacokinetic profile of ceftaroline in two critically ill patients and to evaluate whether the pharmacokinetic/pharmacodynamic (PK/PD) target was reached or not with the dose regimen administered. This research was funded by Department of Education of the Basque Government (PIBA 2019-57) and by the University of the Basque Country UPV/EHU (GIU 17/32).

Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality, which varies depending on the source of infection. Nevertheless, the global molecular epidemiology of SAB and its possible association with specific virulence factors remains unclear. Using DNA microarrays, a total of 833 S. aureus strains (785 SAB and 48 colonizing strains) collected in Spain over a period of 15 years (2002-2017) were characterized to determine clonal complex (CC), agr type and repertoire of resistance and virulence genes in order to provide an epidemiological overview of CCs causing bloodstream infection, and to analyze possible associations between virulence genes and the most common sources of bacteremia. The results were also analyzed by acquisition (healthcare-associated [HA] and community-acquired [CA]), methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) strains, and patient age (adults vs. children). Our results revealed high clonal diversity among SAB strains with up to 28 different CCs. The most prevalent CCs were CC5 (30.8%), CC30 (20.3%), CC45 (8.3%), CC8 (8.4%), CC15 (7.5%), and CC22 (5.9%), which together accounted for 80% of all cases. A higher proportion of CC5 was found among HA strains than CA strains (35.6 vs. 20.2%, p < 0.001). CC5 was associated with methicillin resistance (14.7 vs. 79.4%, p < 0.001), whereas CC30, CC45, and CC15 were correlated with MSSA strains (p < 0.001). Pathogen-related molecular markers significantly associated with a specific source of bacteremia included the presence of sea, undisrupted hlb and isaB genes with catheter-related bacteremia; sed, splE, and fib genes with endocarditis; undisrupted hlb with skin and soft tissue infections; and finally, CC5, msrA resistance gene and hla gene with osteoarticular source. Our study suggests an association between S. aureus genotype and place of acquisition, methicillin resistance and sources of bloodstream infection, and provides a valuable starting point for further research insights into intrinsic pathogenic mechanisms involved in the development of SAB., This work was supported by the Health Research Fund, Department of Health, Spain; Agency for Health Technology Assessment and Research (PI15/02013 and PI15/02125) and Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016-0002; 0003; 0004) and cofunded by the European Regional Development Fund (FEDER).

Fundamento y Objetivo: La investigación cualitativa complementa su visión de la realidad mediante la triangulación. La regresión logística binaria es un instrumento de predicción de riesgo en epidemiología analítica. Nuestro objetivo ha sido triangular una investigación cualitativa de tipo pedagógico con modelos de regresión logística. Material y Método: Sobre la información recogida por un grupo focal, organizamos los datos en tres variables: Aforismo / Frase corta (variable dependiente), Profesor y Tipo (variables predictoras) y construimos dos modelos con regresión logística binaria. El error alfa fue del 5 y del 10%. El tamaño muestral venía impuesto por el grupo focal anterior (saturación cualitativa). Se diseñaron rutinas para trabajar con los datos en el programa R. Resultados: Con 127 elementos (44 aforismos y 83 frases cortas) se obtuvieron significaciones crudas del 10% para dos de los diez profesores con información relevante para el grupo focal (odds ratios de 0.42 y 2.33 respectivamente; índice de Brier escalado = 0.06 y área bajo curva ROC = 0.63) y significaciones menores del 5% para cuatro de los cinco epígrafes en que habíamos dividido la variable tipo (epidemiológicos, epistemológicos, estadísticos y pragmáticos o heurísticos). El epígrafe “Estadístico” fue significativo con respecto a “Epistemológico” (OR=5,00; IC al 95% = 14.431-1.743) y con respecto a “Pragmático” (OR=4.80; IC al 95%=14.602-1.577). El epígrafe “Difusión Científica” no resultó significativo. Conclusiones: En un entorno de investigación cualitativo-pedagógica sobre aforismos y frases cortas, la regresión logística binaria se ha mostrado eficaz, dentro de una estrategia de triangulación, para identificar docentes originales para el grupo focal (p

Resumen Objetivos Describir las caracteristicas de la colonizacion por Staphylococcus aureus meticilin resistente (SARM) detectada en la Unidad de Hemodialisis (UHD) del Complejo Hospitalario de Caceres ante la deteccion de infecciones asociadas a cateter. Ademas, tratamos de evaluar la eficacia de las estrategias preventivas implementadas. Metodos Se realizaron frotis nasales para deteccion de colonizacion por SARM en pacientes y profesionales desde agosto de 2008 a enero de 2009, segun Consenso GEIH-SEIMC Y SEMPSPH. Se realizo vigilancia activa con tratamiento y seguimiento de portadores hasta negativizacion. Se elaboro documento de consenso en UHD con medidas preventivas protocolizadas y se revisaron procedimientos de trabajo. Se calcula prevalencia, incidencia acumulada, presion de colonizacion (ratio de portadores-dia/total pacientes o profesionales-dia).Test chi-cuadrado y prueba Z de comparacion de proporciones. Resultados Frotis nasal a 54 pacientes agudos y cronicos en hemodialisis con prevalencia inicial de portadores del 29,6%; incidencia acumulada en pacientes 42,6%. Frotis nasal en 48 profesionales con incidencia acumulada de 39,5%. Descenso paralelo de presion de colonizacion en pacientes y profesionales. A los 5 meses se realiza frotis nasal en 40 pacientes y 26 profesionales, con cero portadores en pacientes y uno en profesionales. Conclusiones Se detecto un numero elevado de portadores de SARM tanto entre pacientes como entre el personal sanitario de la Unidad de Hemodialisis. Las medidas de cribado y tratamiento fueron eficaces para la descolonizacion de esta poblacion. Es importante la adopcion de estrategias de vigilancia activa, mantenidas en el tiempo para la deteccion rapida de situaciones de alerta.

We conducted a retrospective study of 99 patients with methicillin-suseptible Staphylococcus aureus catheter-related bacteremia in which vancomycin MIC was determined by Etest. High vancomycin MIC (>1.5 ug/mL) was the only independent risk factor for development of complicated bacteremia caused by methicillin-susceptible S. aureus (odds ratio 22.9, 95% confidence interval 6.7-78.1).

Most Staphylococcus aureus small-colony variants (SCVs) are auxotrophs for menadione, hemin, or thymidine but rarely for CO 2 . We conducted a prospective investigation of all clinical cases of CO 2 -dependent S. aureus during a 3-year period. We found 14 CO 2 -dependent isolates of S. aureus from 14 patients that fulfilled all requirements to be considered SCVs, 9 of which were methicillin resistant. The clinical presentations included four cases of catheter-related bacteremia, one complicated by endocarditis; two deep infections (mediastinitis and spondylodiscitis); four wound infections; two respiratory infections; and two cases of nasal colonization. Pulsed-field gel electrophoresis typing showed that the 14 isolates were distributed into 4 types corresponding to sequence types ST125- agr group II ( agr II), ST30- agr III, ST34- agr III, and ST45- agr I. An array hybridization technique performed on the 14 CO 2 -dependent isolates and 20 S. aureus isolates with normal phenotype and representing the same sequence types showed that all possessed the enterotoxin gene cluster egc , as well as the genes for α-hemolysin and δ-hemolysin; biofilm genes icaA , icaC , and icaD ; several microbial surface components recognizing adhesive matrix molecules (MSCRAMM) genes ( clfA , clfB , ebh , eno , fib , ebpS , sdrC , and vw ); and the isaB gene. Our study confirms the importance of CO 2 -dependent SCVs of S. aureus as significant pathogens. Clinical microbiologists should be aware of this kind of auxotrophy because recovery and identification are challenging and not routine. Further studies are necessary to determine the incidence of CO 2 auxotrophs of S. aureus , the factors that select these strains in the host, and the genetic basis of this type of auxotrophy.

Resumen Introduccion Staphylococcus aureus es una causa importante de infecciones neonatales de inicio en la comunidad. En los ultimos anos se ha notificado en Estados Unidos la emergencia de infecciones por cepas resistentes a la meticilina en este grupo de edad, aunque existen pocos estudios en Espana. El objetivo de este estudio es describir las caracteristicas epidemiologicas, clinicas y microbiologicas de las infecciones por S. aureus de inicio en la comunidad en neonatos. Metodos Estudio prospectivo de las infecciones neonatales por S. aureus de inicio en la comunidad realizado durante 3 anos (2007-2009) en el Servicio de Urgencias Pediatricas del Hospital 12 de Octubre de Madrid (Espana). Resultados Se registraron 30 casos de los que solo un aislado (3,3%) fue resistente a la meticilina y 2 (6,7%) fueron LPV(+). Conclusiones A pesar de la emergencia de SARM y/o productor de LPV fuera del ambiente hospitalario en poblacion pediatrica en Espana, dichas infecciones son todavia poco frecuentes en neonatos.

A case of colonization of a prosthetic mitral valve in a 73-year-old Spanish male by the fungus Acremonium strictum W. Gams is described. The valve was replaced due to paravalvular leak and severe insufficiency and the patient died of multiorgan failure. The identity of the fungus was determined by morphological studies and it was confirmed by the analysis of the ITS region sequence analysis. Molecular studies seem to demonstrate that A. strictum is a species complex. The case emphasizes the potential high risk of fungal infection for patients with prosthetic valves.

Panton-Valentine leukocidin (PVL) is a toxin associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) worldwide and also occurs in community-associated methicillin-susceptible S aureus (CA-MSSA) strains. The aims of the study were to determine the prevalence of PVL in community-onset S aureus skin and soft-tissue infections (SSTIs) and to analyse the influence of methicillin resistance and PVL presence on the clinical characteristics of these infections.We prospectively enrolled all children with S aureus community-onset SSTIs attending the emergency department of a tertiary hospital between 2007 and 2009. Results A total of 142 S aureus SSTIs were identified, 46 (32%) were PVL positive. The proportion of subjects in each group was: 89 (63%) PVL-MSSA, 33 (23%) PVL+MSSA, 13 (9%) PVL+MRSA and 7 (5%) PVL-MRSA. PVL+infections were more frequently abscesses (63% vs 39%, p0.01), and more often required incision and drainage (p0.01) and hospital admission (46% vs 26%, p=0.02). MRSA infections were also more frequently associated with abscesses but in a multivariable analysis only PVL remained independently related (OR 2.33; 95% CI 1.10 to 4.90).Our study found a high prevalence of PVL presence in community-onset S aureus SSTIs in children in Spain. This toxin is associated with more abscess formation, regardless of methicillin resistance.

Staphylococcus aureus is a major cause of neonatal community-onset infections. The emergence of methicillin-resistant S. aureus infections in this age group has been reported in USA in the last few years; however there are no studies in Spain. The aim of this study is to describe the epidemiological, clinical and microbiological characteristics of S. aureus community-onset infections in neonates.We prospectively reviewed the S. aureus infections in neonates over a three year period (2007-2009) in the Pediatric Emergency Department of Hospital 12 de Octubre in Madrid (Spain).We recorded 30 cases of neonatal S. aureus community-onset infections. Only one isolated (3.3%) was resistant to methicillin, and two (6.7%) were PVL(+).Despite the emergence of MRSA outside the hospital in pediatric population in Spain, CA-MRSA and SA PVL(+) infections are not frequent in neonates.

To describe the dynamics of colonization by methicillin resistant Staphylococcus aureus (MRSA) detected in the Haemodialysis Unit (UHD) of the Hospital San Pedro de Alcantara of Caceres due to the detection of catheter-associated infections. Additionally, we attempt to evaluate the effectiveness of preventive strategies introduced.Nasal swab tests were performed in order to detect MRSA colonization in patients and health professionals from August 2008 to January 2009, according to the Consensus GEIH-SEIMC Y SEMPSPH Consensus. An active surveillance was performed with treatment and control of the carriers until negative results were achieved. A consensus document was drawn up in the UHD with registered preventive measures and work systems were reviewed. Prevalence, cumulative incidence, colonization pressure (carrier ratio per day/total patients or experts per day) were calculated. A chi-square test was performed, as well as a Z test for the comparison ratio.The nasal swabs of 54 acute and chronic patients on haemodialysis showed an initial carrier prevalence of 29.6%; cumulative incidence in patients of 42.6%. Nasal swabs of 48 professionals had a cumulative incidence of 39.5%. There was a parallel decrease in colonization pressure in patients and specialists. After five months A smear was performed 5 months later on 40 patients and 26 specialists, which showed no carriers among the patients, and one among the health professionals.We detected a high number of MRSA carriers among patients and Health professionals from the Haemodialysis Unit. Screening and treatment measures were effective for the decolonization of this population. It is important to adopt long-term strategies for active surveillance for the rapid detection of alert situations.

Molecular epidemiology of Staphylococcus aureus strains causing bacteremia in neonates during 2002 to 2005 revealed seven clones, with four MSSA clones responsible for 80% of the cases. Some clones persisted or reappeared throughout the study. Three bacteremic clones were found colonizing health care workers (HCWs), particularly clone C, which was harbored by at least 15% of HCWs.