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José Gutiérrez-Fernández,1 Juan de Dios Luna del Castillo,2 Sara Mañanes-González,1 José Antonio Carrillo-Ávila,1 Blanca Gutiérrez,3 Jorge A Cervilla,3 Antonio Sorlózano-Puerto1 1Department of Microbiology, 2Department of Statistics and Operation Research, 3Department of Psychiatry, Institute of Neurosciences and CIBERSAM, School of Medicine and Biohealth Research Institute (Instituto de Investigación Biosanitaria) IBS-Granada, University of Granada, Granada, Spain Abstract: In the present study we have performed both a meta-analysis and an analytical study exploring the presence of Chlamydia pneumoniae, herpes simplex virus type 1, human herpes virus 6, and Toxoplasma gondii antibodies in a sample of 143 schizophrenic patients and 143 control subjects. The meta-analysis was performed on papers published up to April 2014. The presence of serum immunoglobulin G and immunoglobulin A was performed by enzyme-linked immunosorbent assay test. The detection of microbial DNA in total peripheral blood was performed by nested polymerase chain reaction. The meta-analysis showed that: 1) C. pneumoniae DNA in blood and brain are more common in schizophrenic patients; 2) there is association with parasitism by T. gondii, despite the existence of publication bias; and 3) herpes viruses were not more common in schizophrenic patients. In our sample only anti-Toxoplasma immunoglobulin G was more prevalent and may be a risk factor related to schizophrenia, with potential value for prevention. Keywords: meta-analysis, analytical study, Chlamydia pneumoniae, herpes simplex virus type 1, human herpes virus 6, Toxoplasma gondii, schizophrenia

Abstract Purpose The aim of this study was to assess the risk factors for colistin-resistant carbapenemase-producing Enterobacterales (CR-CPE), and describe the mortality associated with this organism, in a low-income country. Methods A descriptive, observational, and prospective multicenter study was carried out in Guayaquil, Ecuador. All patients with carbapenem-resistant Enterobacterales admitted between December 2021 and May 2022 were enrolled. Infection definitions were established according to the Centers for Disease Control and Prevention (CDC) protocols. The presence of carbapenemase-producing Enterobacterales was confirmed with a multiplex PCR for bla KPC, bla NDM, bla OXA-48, bla VIM, and bla IMP genes. MCR-1 production was studied molecularly, and MLST assays were carried out. Results Out of 114 patients enrolled in the study, 32 (28.07%) had at least one positive sample for CR-CPE. Klebsiella pneumoniae ST512-KPC-3 was the most frequent microorganism isolated. Parenteral feeding, β-lactamase inhibitor use, recent hemodialysis, and renal failure were all considered independent risk factors for carrying CR-CPE. A mortality of 41.22% was detected, but we could not find any difference between colistin-resistant and colistin-susceptible CPE. MCR-1 production was not detected in any of the isolates studied. Conclusion A significant burden for CR-CPE was found in a South American country that was mainly caused by the high-risk clone K. pneumoniae ST512-KPC-3 and not mediated by mcr-1 production. Its acquisition involved parenteral feeding, β-lactamase inhibitor use, recent hemodialysis, and renal failure as independent risk factors, demonstrating the critical need for infection prevention and stewardship programs to avoid dissemination to other countries in the region.

Teresa del Rosal,1,2 Ana Méndez-Echevarría,1,2 Cesar Garcia-Vera,3 Luis Escosa-Garcia,1,2 Martin Agud,1 Fernando Chaves,4 Federico Román,5 José Gutierrez-Fernandez,6 Enrique Ruiz de Gopegui,7 Guillermo Ruiz-Carrascoso,8 Maria del Carmen Ruiz-Gallego,9 Albert Bernet,10 Sara Maria Quevedo,11 Ana Maria Fernández-Verdugo,12 Jesús Díez-Sebastian,13 Cristina Calvo1,2 On behalf of the COSACO Study Group1Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain; 2Translational Research Network in Pediatric Infectious Diseases (RITIP), Institute for Health Research IdiPAZ, Madrid, Spain; 3“José Ramón Muñoz Fernández” Health Care Center, Aragón Health Service, Zaragoza, Spain; 4Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain; 5Laboratory of Nosocomial Infections, Department of Bacteriology, CNM, Instituto de Salud Carlos III, Madrid, Spain; 6Department of Microbiology, Hospital Virgen de las Nieves, Granada, Spain; 7Department of Clinical Microbiology, Hospital Universitari Son Espases. Servicio de Microbiología, Palma de Mallorca, Spain; 8Department of Clinical Microbiology, Hospital Universitario La Paz, Madrid, Spain; 9Department of Microbiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain; 10Section of Microbiology, Arnau de Vilanova University Hospital, Lleida, Spain; 11Department of Microbiology, Hospital Universitario Severo Ochoa, Leganes, Spain; 12Department of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain; 13Department of Preventive Medicine, Hospital Universitario La Paz, Madrid, SpainCorrespondence: Ana Méndez-Echevarría Pediatric Infectious and Tropical Diseases Department. Hospital La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046, SpainTel/Fax +34-917277479Email amendezes@yahoo.esObjective: To assess the prevalence and risk factors for S. aureus and methicillin-resistant S. aureus (MRSA) nasal colonization in Spanish children.Methods: Cross-sectional study of patients < 14 years from primary care centers all over Spain. Clinical data and nasal aspirates were collected from March to July 2018.Results: A total of 1876 patients were enrolled. Prevalence of S. aureus and MRSA colonization were 33% (95% CI 30.9– 35.1) and 1.44% (95% CI 0.9– 2), respectively. Thirty-three percent of the children (633/1876) presented chronic conditions, mainly atopic dermatitis, asthma and/or allergy (524/633). Factors associated with S. aureus colonization were age ≥ 5 years (OR 1.10, 95% CI 1.07– 1.12), male sex (OR 1.43, 95% CI 1.17– 1.76), urban setting (OR 1.46, 95% CI 1.08– 1.97) and the presence of asthma, atopic dermatitis or allergies (OR 1.25; 95% CI: 1.093– 1.43). Rural residence was the only factor associated with MRSA colonization (OR 3.62, 95% CI 1.57– 8.36). MRSA was more frequently resistant than methicillin-susceptible S. aureus to ciprofloxacin [41.2% vs 2.6%; p< 0.0001], clindamycin [26% vs 16.9%; p=0.39], and mupirocin [14.3% vs 6.7%; p=0.18]. None of the MRSA strains was resistant to tetracycline, fosfomycin, vancomycin or daptomycin.Conclusions: The main risk factors for S. aureus colonization in Spanish children are being above five years of age, male gender, atopic dermatitis, asthma or allergy, and residence in urban areas. MRSA colonization is low, but higher than in other European countries and is associated with rural settings.Keywords: S. aureus, MRSA, child, colonization