Scientific Letter
In vitro activity of azithromycin in faecal isolates of Aeromonas hydrophila
Actividad in vitro de azitromicina en aislados fecales de Aeromonas hydrophila
Jorge Jover-García, Virginia Pérez-Doñate, Javier Colomina-Rodríguez
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Servicio de Microbiología, Hospital Universitario de la Ribera, Alzira, Valencia, Spain
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Numerous species have been described, the most frequent of which are <span class="elsevierStyleItalic">A. caviae</span>, <span class="elsevierStyleItalic">A. veronii</span> and, above all, <span class="elsevierStyleItalic">A. hydrophila</span>. These bacteria are transmitted through contaminated fresh and salt waters. In humans, they are most commonly involved in wound infections, systemic disease (usually in patients with underlying conditions) and especially acute gastroenteritis (AGE).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> In Spain, <span class="elsevierStyleItalic">Aeromonas</span> is considered the third most frequent enteropathogenic bacterium identified in patients with AGE, following <span class="elsevierStyleItalic">Campylobacter</span> and <span class="elsevierStyleItalic">Salmonella</span>, accounting for 6–7% of cases<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a>; in the Valencian metropolitan area, the incidence of AGE due to Aeromonas is of 20 cases per 1,000,000 inhabitants.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Recently, the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and the European Society for Paediatric Infectious Diseases (ESPID) have recommended oral azithromycin for the treatment of moderate to severe gastroenteritis based on the bacterial enteropathogens that are most commonly involved.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> However, due to the lack of data on <span class="elsevierStyleItalic">Aeromonas</span> species, we do not have any evidence of the actual usefulness of this antimicrobial. The aim of our study was to assess the <span class="elsevierStyleItalic">in vitro</span> activity of azithromycin against clinical isolates of <span class="elsevierStyleItalic">Aeromonas</span>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We conducted a prospective descriptive study of clinical isolates of <span class="elsevierStyleItalic">A. hydrophila</span> from patients with AGE during 2015. We isolated the bacterial strains by culturing stool samples in selective CIN agar (Becton-Dickinson). Bacterial identification and antibiotic susceptibility testing were performed by means of standardised and widely used techniques, specifically with NC70 panels of the commercially available MicroScan WalkAway<span class="elsevierStyleSup">®</span> system (Siemens). Furthermore, we used Etest<span class="elsevierStyleSup">®</span> strips (bioMérieux) to determine the minimum inhibitory concentration (MIC) in a McFarland 0.5 bacterial suspension; and interpreted the results applying the epidemiological cut-off values established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) for <span class="elsevierStyleItalic">Shigella</span> and <span class="elsevierStyleItalic">Salmonella</span> (sensitivity: MIC<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>16<span class="elsevierStyleHsp" style=""></span>mg/L). We analysed the cases by on time, age and sex as well as the microbiological characteristics of the isolated strains.</p><p id="par0015" class="elsevierStylePara elsevierViewall">During the period under study, <span class="elsevierStyleItalic">A. hydrophila</span> was isolated from a total of 50 clinical samples. The median age of the patients was 8 years (range, 0–89 years). Fifty-four percent were children (78% aged less than 4 years) and 32% elderly. Fifty-two percent were male. All isolates came from patients in primary care, and no patients reported having been hospitalised. The isolates did not exhibit a significant seasonal pattern, although 58% of detections occurred in summer or spring. The percentage of isolates that showed <span class="elsevierStyleItalic">in vitro</span> sensitivity to antibiotics commonly used to treat AGE were: 0% for ampicillin, 10% for amoxicillin/clavulanic acid, 92% for cefuroxime, 100% for cefotaxime, 100% for ciprofloxacin, 100% for gentamicin and 96% for cotrimoxazol. All isolates were considered sensitive to azithromycin; the determined MICs ranged between 0.5 and 8.0<span class="elsevierStyleHsp" style=""></span>mg/L, and the MIC50 (concentration required to inhibit 50% of bacterial strains) and the MIC90 (for inhibition of 90% of strains) were 3.0–6.0<span class="elsevierStyleHsp" style=""></span>mg/L, respectively.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Antibiotic treatment is not always indicated for AGE caused by <span class="elsevierStyleItalic">Aeromonas</span>, so the use and choice of antimicrobials should be based on the symptoms and age of the patient, the site of infection (intestinal or extraintestinal), the immune status of the patient and the local prevalence of different pathogens and patterns of drug resistance. The antibiotic sensitivity of <span class="elsevierStyleItalic">Aeromonas</span> has been studied mainly in environmental bacterial strains,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> but few studies have analysed clinical isolates and the use of azithromycin. In our experience, <span class="elsevierStyleItalic">A. hydrophila</span> showed a high sensitivity to azithromycin <span class="elsevierStyleItalic">in vitro</span>, although it would be advisable to have international committees on microbiology to establish clinical breakpoints to determine the sensitivity or resistance to azithromycin, as has been done for <span class="elsevierStyleItalic">Salmonella</span> and <span class="elsevierStyleItalic">Shigella</span>. Given its easy dosage (one dose a day), low toxicity and evidence of the high sensitivity of <span class="elsevierStyleItalic">Campylobacter</span> and also <span class="elsevierStyleItalic">Salmonella</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> to it, azithromycin has been established as the empirical treatment of choice in cases of bacterial AGE that require antibiotherapy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jover-García J, Pérez-Doñate V, Colomina-Rodríguez J. Actividad <span class="elsevierStyleItalic">in vitro</span> de azitromicina en aislados fecales de <span class="elsevierStyleItalic">Aeromonas hydrophila</span>. An Pediatr (Barc). 2017;86:226–227.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Previous presentation: This study was presented at the XX Congreso Nacional SEIMC; May 26–28, 2016; Barcelona, Spain.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The main <span class="elsevierStyleItalic">Aeromonas</span> pathogenic factors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. 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Guarino" 1 => "S. Ashkenazi" 2 => "D. Gendrel" 3 => "A. lo Vecchio" 4 => "R. Shamir" 5 => "H. Szajewska" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MPG.0000000000000375" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2014" "volumen" => "59" "paginaInicial" => "132" "paginaFinal" => "152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24739189" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and antimicrobial susceptibilities of <span class="elsevierStyleItalic">Vibrio</span>, <span class="elsevierStyleItalic">salmonella</span>, and <span class="elsevierStyleItalic">Aeromonas</span> isolates from various uncooked seafoods in Thailand" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Woodring" 1 => "A. 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Colomina-Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "2015" "volumen" => "83" "paginaInicial" => "346" "paginaFinal" => "347" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008600000004/v1_201703250056/S2341287917300200/v1_201703250056/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008600000004/v1_201703250056/S2341287917300200/v1_201703250056/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300200?idApp=UINPBA00005H" ]
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| 2024 September | 88 | 21 | 109 |
| 2024 August | 110 | 50 | 160 |
| 2024 July | 112 | 20 | 132 |
| 2024 June | 110 | 26 | 136 |
| 2024 May | 79 | 27 | 106 |
| 2024 April | 79 | 38 | 117 |
| 2024 March | 83 | 30 | 113 |
| 2024 February | 93 | 35 | 128 |
| 2024 January | 81 | 30 | 111 |
| 2023 December | 129 | 22 | 151 |
| 2023 November | 85 | 47 | 132 |
| 2023 October | 71 | 21 | 92 |
| 2023 September | 67 | 24 | 91 |
| 2023 August | 52 | 19 | 71 |
| 2023 July | 62 | 31 | 93 |
| 2023 June | 56 | 30 | 86 |
| 2023 May | 78 | 31 | 109 |
| 2023 April | 40 | 16 | 56 |
| 2023 March | 70 | 31 | 101 |
| 2023 February | 59 | 11 | 70 |
| 2023 January | 35 | 24 | 59 |
| 2022 December | 59 | 27 | 86 |
| 2022 November | 57 | 27 | 84 |
| 2022 October | 45 | 49 | 94 |
| 2022 September | 36 | 37 | 73 |
| 2022 August | 51 | 74 | 125 |
| 2022 July | 28 | 54 | 82 |
| 2022 June | 30 | 29 | 59 |
| 2022 May | 44 | 31 | 75 |
| 2022 April | 25 | 33 | 58 |
| 2022 March | 62 | 56 | 118 |
| 2022 February | 50 | 27 | 77 |
| 2022 January | 55 | 30 | 85 |
| 2021 December | 40 | 30 | 70 |
| 2021 November | 68 | 34 | 102 |
| 2021 October | 80 | 84 | 164 |
| 2021 September | 39 | 36 | 75 |
| 2021 August | 43 | 48 | 91 |
| 2021 July | 50 | 38 | 88 |
| 2021 June | 56 | 42 | 98 |
| 2021 May | 44 | 39 | 83 |
| 2021 April | 134 | 75 | 209 |
| 2021 March | 81 | 32 | 113 |
| 2021 February | 49 | 24 | 73 |
| 2021 January | 56 | 27 | 83 |
| 2020 December | 62 | 25 | 87 |
| 2020 November | 53 | 17 | 70 |
| 2020 October | 46 | 19 | 65 |
| 2020 September | 49 | 19 | 68 |
| 2020 August | 46 | 12 | 58 |
| 2020 July | 47 | 23 | 70 |
| 2020 June | 38 | 14 | 52 |
| 2020 May | 42 | 18 | 60 |
| 2020 April | 27 | 12 | 39 |
| 2020 March | 23 | 17 | 40 |
| 2020 February | 34 | 12 | 46 |
| 2020 January | 27 | 13 | 40 |
| 2019 December | 41 | 17 | 58 |
| 2019 November | 37 | 5 | 42 |
| 2019 October | 49 | 16 | 65 |
| 2019 September | 58 | 16 | 74 |
| 2019 August | 49 | 22 | 71 |
| 2019 July | 41 | 18 | 59 |
| 2019 June | 56 | 24 | 80 |
| 2019 May | 71 | 11 | 82 |
| 2019 April | 56 | 30 | 86 |
| 2019 March | 45 | 24 | 69 |
| 2019 February | 43 | 16 | 59 |
| 2019 January | 39 | 15 | 54 |
| 2018 December | 52 | 24 | 76 |
| 2018 November | 77 | 31 | 108 |
| 2018 October | 103 | 36 | 139 |
| 2018 September | 45 | 20 | 65 |
| 2018 August | 2 | 0 | 2 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 4 | 0 | 4 |
| 2018 May | 9 | 0 | 9 |
| 2018 April | 28 | 0 | 28 |
| 2018 March | 44 | 0 | 44 |
| 2018 February | 20 | 0 | 20 |
| 2018 January | 35 | 0 | 35 |
| 2017 December | 23 | 0 | 23 |
| 2017 November | 19 | 0 | 19 |
| 2017 October | 9 | 0 | 9 |
| 2017 September | 15 | 0 | 15 |
| 2017 August | 10 | 0 | 10 |
| 2017 July | 12 | 0 | 12 |
| 2017 June | 27 | 12 | 39 |
| 2017 May | 20 | 9 | 29 |
| 2017 April | 145 | 132 | 277 |
| 2017 March | 9 | 11 | 20 |
| 2017 February | 0 | 1 | 1 |
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