This study determined the antimicrobial susceptibilities of 186 clinical isolates of Nocardia spp. isolated in Gipuzkoa, northern Spain, between 1998 and 2009. Most isolates were recovered from respiratory samples, Nocardia nova, N. farcinica, N. cyriacigeorgica, N. abscessus, and N. carnea being the species most frequently isolated. Linezolid and amikacin were the only two antimicrobials to which all isolates were susceptible. The majority of N. flavorosea, N. carnea, and N. farcinica isolates were trimethoprim-sulfamethoxazole resistant.

Scedosporium prolificans infection was analyzed in 18 patients from whom the fungus was isolated during the period 1990-1999. Of these 18 patients, 12 had some predisposing factor and either unconfirmed infection or colonization, and 6 patients had confirmed disseminated infection: 4 patients with leukemia died, 1 patient with breast cancer who underwent autologous bone marrow transplantation survived, and 1 patient with advanced acquired immunodeficiency syndrome died, although the fungal infection did not seem to affect his clinical symptoms.

The aim of this study was to evaluate the sensitivity of as well as the time to detection of mycobacteria by three procedures: solid media with traditional reading, microscopy on solid media, and liquid culture using the automated nonradiometric Bactec MGIT 960 system. A total of 2832 respiratory specimens were tested, 315 of which were positive for mycobacteria. The most frequently isolated species was Mycobacterium tuberculosis (201 isolates). One hundred twenty mycobacteria other than tuberculosis were isolated, 72 of which were Mycobacterium xenopi strains. Sensitivity of each of the different media compared to all media combined for growth of Mycobacterium tuberculosis was 93%, 76.1%, 79.6%, and 75.1% for Bactec MGIT 960, Middlebrook 7H11 plates, Löwenstein-Jensen, and Coletsos, respectively. Sensitivity of the Bactec MGIT 960 for detection of all mycobacterial isolates was 75.1%. When this automated system was supplemented with visual inspection, the sensitivity increased to 89.4%. The sensitivity of Middlebrook 7H11 plates, Löwenstein-Jensen, and Coletsos was 50.8%, 60.7%, and 52.3%, respectively. Time to detection of Mycobacterium tuberculosis using the Bactec MGIT 960 system and Middlebrook 7H11 plates with microscopic reading was 12.7 and 13 days, respectively; using the traditional Löwenstein-Jensen and Coletsos media, time to detection was 22.8 and 22.7 days, respectively.

When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged < 65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the < 65-year group.

L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients.

The rate of recovery and time to the detection of mycobacteria in clinical specimens were measured in traditional egg-based media cultures and on Middlebrook 7H11 agar plate cultures using microcolony detection. In the 5438 specimens processed, a total of 293 (5.4%) clinically relevant mycobacterial isolates were detected (Mycobacterium tuberculosis, n = 231; Mycobacterium avium complex, n = 60; Mycobacterium kansasii, n = 2). Of these, 227 (77%) and 237 (81%) isolates were detected on Lowenstein-Jensen medium and Coletsos medium, respectively, and 265 (90%) isolates were detected on Middlebrook 7H11 plates examined microscopically. The detection time was shorter with the microcolony detection method. While the Lowenstein-Jensen and Coletsos media required an average of 23 and 25 days, respectively, for first detection of mycobacteria, microcolony detection on Middlebrook 7H11 required an average of only 12 days. For acid-fast, stain-positive specimens that were culture positive for Mycobacterium tuberculosis, the average interval to positivity was nine days for the microcolony method compared with 20 and 21 days for the Lowenstein-Jensen and Coletsos media, respectively. Microscopic detection on Middlebrook 7H11 agar plates is a rapid, accurate and inexpensive method of detecting Mycobacterium tuberculosis and other clinically important mycobacteria.

Mycoplasma genitalium causes a sexually transmitted infection that sometimes persists or recurs despite adequate antibiotic treatment. Between 2014 and 2018, molecular typing was applied to 75 M. genitalium-positive samples from 48 patients with repeated infection and/or couples/groups of other infected sexual contacts. MG191 adhesin, MG309 lipoprotein, and the rRNA operon were amplified, sequenced, and typed using phylogenetic, variable number tandem repeat, and single-nucleotide polymorphism analysis, respectively. Amplicons were obtained in 74/75 samples, and the combination of locus patterns gave 44 different genetic profiles (discriminatory index of 0.987), with 43 considering only MG191 and MG309. Interestingly, 15/17 patients who presented a first sample sensitive and a second resistant to macrolides had the same genetic variant in the samples (persistence of the same strain). In 2/17 patients, discordant variants (one mixed infection and one recurrence due to incomplete contact tracing) were detected. In 31 additional not related and randomly distributed samples, MG191 typing obtained 23 different genotypes, with no appreciable clustering over time. The typing method allowed persistent and recurrent infections to be distinguished, indicating that macrolide resistance-associated mutations mostly developed during treatment. To detect these secondary resistant strains, prevent reinfections, and improve the control of M. genitalium infections, tests of cure and contact tracing of sexual partners should be mandatory.

Background Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). Methods Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008–2012) was performed. Results A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56–76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32–54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04–1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09–.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22–.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. Conclusions OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded.