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Scientific letter
Enteroinvasive bacteria. Local study in specialized clinical care
Bacterias enteroinvasivas. Estudio local en atención clínica especializada
María del Mar Martín-Rodrígueza, Jaime Borrego-Jiménezb, Enrique Rodríguez-Guerrerob, José Gutiérrez-Fernándezb,c,
Corresponding author
josegf@go.ugr.es

Corresponding author.
a Unidad de Gestión Clínica de Digestivo, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-IBS-Granada, Granada, Spain
b Unidad de Gestión Clínica de Microbiología Clínica, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-IBS-Granada, Granada, Spain
c Departamento de Microbiología, Universidad de Granada-Instituto de Investigación BioSanitaria-IBS-Granada, Granada, Spain
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The geographical area was the province of Granada and the population in scope was the Hospital Universitario Virgen de las Nieves catchment area&#44; with a basic reference population of 330&#44;486&#44; but which provides tertiary healthcare&#46; The population treated came from specialised care &#40;including hospital in-patients&#44; outpatient clinics and the Accident and Emergency department&#41;&#46; Express information on symptoms was lacking&#46; Non-solid faeces were transported and processed following a strict working protocol&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The MicroScan system &#40;Beckman Coulter&#44; Barcelona&#44; Spain&#41; was used to determine the sensitivity of rapidly growing microorganisms&#46; The minimum inhibitory concentration &#40;MIC&#41; of azithromycin and fosfomycin was determined by diffusion gradient &#40;MIC Test Strip&#44; Liofilchem&#174;&#44; Italy&#41;&#46; When there was a breakpoint&#44; results were interpreted following the guidelines of the European Committee on Antimicrobial Susceptibility Testing &#40;2020&#41; &#40;<a href="https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_10.0_Breakpoint_Tables.pdf">https&#58;&#47;&#47;www&#46;eucast&#46;org&#47;fileadmin&#47;src&#47;media&#47;PDFs&#47;EUCAST&#95;files&#47;Breakpoint&#95;tables&#47;v&#95;10&#46;0&#95;Breakpoint&#95;Tables&#46;pdf</a>&#41;&#46; Absolute and relative frequencies were calculated for the categorical variables&#44; and measures of central tendency and dispersion for the numerical variables&#46; We used the &#967;<span class="elsevierStyleSup">2</span> test for the statistical analysis of categorical variables and Student&#39;s <span class="elsevierStyleItalic">t</span>-test to analyse the numerical variables&#44; such as age&#46; The data were analysed with the IBM&#174; SPSS&#174; Statistics program&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">For this study&#44; 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and <span class="elsevierStyleItalic">Aeromonas</span> remained stable &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;52&#41;&#46; <span class="elsevierStyleItalic">Campylobacter</span> and <span class="elsevierStyleItalic">Salmonella</span> were more common in summer and autumn &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;002 and <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#44; respectively&#41;&#46; There were more isolates in the child population than in adults &#40;60&#46;2&#37; vs 39&#46;8&#37;&#41;&#44; despite there being more adult samples &#40;69&#46;3&#37; vs 30&#46;7&#37;&#41;&#44; so the yield of stool culture is higher in the child population &#40;15&#37; vs 4&#37;&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#46; Overall&#44; 64&#46;8&#37; of <span class="elsevierStyleItalic">Campylobacter</span> &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#44; 54&#37; of <span class="elsevierStyleItalic">Salmonella</span> &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;009&#41; and 61&#46;1&#37; of <span class="elsevierStyleItalic">Aeromonas</span> were detected in the child population &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;002&#41;&#46; In patients under a year old&#44; <span class="elsevierStyleItalic">Campylobacter</span> was the most isolated species&#44; followed by <span class="elsevierStyleItalic">Aeromonas</span>&#46; In the adult population&#44; the most commonly isolated pathogens were the same as in the paediatric population &#40;additional Table 3 in the <a class="elsevierStyleCrossRef" href="#sec0015">Appendix A</a>&#41;&#46; In most of the patients&#44; a single pathogen was detected&#44; in 56 patients two were isolated simultaneously&#59; of these&#44; in 96&#46;4&#37; of the episodes&#44; one of the microorganisms was <span class="elsevierStyleItalic">Aeromonas</span>&#46; The most common accompanying pathogen in co-infection with <span class="elsevierStyleItalic">Aeromonas</span> was <span class="elsevierStyleItalic">Campylobacter</span>&#46; Of the co-infections with <span class="elsevierStyleItalic">Aeromonas</span>&#44; 85&#46;2&#37; occurred in children&#44; primarily under one year of age&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The antibiotic sensitivity is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Interesting is the low sensitivity of <span class="elsevierStyleItalic">Campylobacter</span> to ciprofloxacin&#44; given that in some cases of severe acute diarrhoea empirical treatment with quinolones is started&#44; and the fact that <span class="elsevierStyleItalic">Campylobacter jejuni</span> is the most detected microorganism in stool cultures&#46; The results of the sensitivities to nalidixic acid and ciprofloxacin in <span class="elsevierStyleItalic">Salmonella</span> are shown in additional Tables 4 and 5 in the <a class="elsevierStyleCrossRef" href="#sec0015">Appendix A</a>&#46; In general&#44; susceptibility to nalidixic acid quite accurately predicted susceptibility to ciprofloxacin&#44; except in <span class="elsevierStyleItalic">Salmonella enterica</span> serogroup B&#44; possibly due to the presence of non-classic quinolone resistance phenotypes in <span class="elsevierStyleItalic">S&#46; enterica</span> serogroup B&#46; For the study of susceptibility to azithromycin&#44; 133 isolates from stool cultures were taken from 2016 to 2019 &#40;additional Tables 6-8 in the <a class="elsevierStyleCrossRef" href="#sec0015">Appendix A</a>&#41;&#46; In the fosfomycin susceptibility analysis&#44; we recovered 31 <span class="elsevierStyleItalic">Campylobacter coli</span> isolates&#44; noting that the MICs were high &#40;additional Table 9 in the <a class="elsevierStyleCrossRef" href="#sec0015">Appendix A</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; <span class="elsevierStyleItalic">Campylobacter jejuni</span> is the most commonly isolated microorganism&#44; followed by <span class="elsevierStyleItalic">Salmonella</span>&#44; which is most notable in the child population&#46; Interestingly&#44; erythromycin was the first choice antibiotic against <span class="elsevierStyleItalic">Campylobacter</span>&#46; Also striking was the high degree of resistance of <span class="elsevierStyleItalic">Salmonella</span> serogroup B to ampicillin&#46; Nalidixic acid sensitivity predicted the susceptibility of <span class="elsevierStyleItalic">Salmonella</span> to ciprofloxacin&#44; except in the case of <span class="elsevierStyleItalic">S&#46; enterica</span> serogroup B&#46; Azithromycin can be considered a good option for empirical treatment of choice&#44; or an alternative in the case of multidrug resistance to other antibiotics&#44; in severe acute enteritis caused by the main enteroinvasive bacteria&#44; apart from <span class="elsevierStyleItalic">Shigella</span>&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Open access financial support&#58; <span class="elsevierStyleGrantSponsor" id="gs0005">Universidad de Granada&#47;Consorcio de Bibliotecas Universitarias de Andaluc&#237;a &#40;CBUA&#41;</span> &#91;University of Granada&#47;Consortium of Andalusian University Libraries&#93;&#46;</p></li></ul></p></span></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The percentage of antibiotic sensitivity has been calculated based on the sensitive isolates versus the total isolates of each bacteria tested for the antibiotic&#46;</p>"
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                  \t\t\t\t">167&#47;167 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">152&#47;158 &#40;96&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Trimethoprim&#47;sulfamethoxazole</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;11 &#40;72&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3334567.png"
              ]
            ]
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos