The management of Mycoplasma genitalium sexually transmitted infection (STI) is hindered by increasing resistance to the recommended antibiotics, macrolides and quinolones, worldwide. In Gipuzkoa (Basque Country, Spain), macrolide and quinolone resistance rates in 2014–2018 were reported as <20% and <10%, respectively. The aims of this study were to compare these rates with those in 2019–2021 and analyse the genetic and epidemiological features of the strains and cases associated with striking changes in the resistance trends. Resistance to macrolides (n = 1019) and quinolones (n = 958) was studied, analysing mutations in 23S rRNA and parC/gyrA genes, respectively. The rate of macrolide resistance increased from 17.3% in 2014–2018 to 32.1% in 2019–2021, as much in the more prevalent A2058/2059G mutations (16.6–27.8%) as in the emergent A2058T mutations (0.5–4.1%) but with differences in the odds ratios and the relative risk increase between A2058T and A2058/2059G mutations. MG191 adhesin and MG309 lipoprotein of the 27 emergent strains detected with A2058T mutations were amplified, sequenced, and typed using phylogenetic and variable number tandem repeat analysis, respectively. Genetic clonal spread was ruled out, but most of the A2058T cases were men who had sex with men (24/27) with a history of STI and antibiotic treatments (19/27). No changes were observed in quinolone resistance trends, but the rate of resistance to both antibiotics rose from 2.9% to 8.3%, especially in cases with A2058T mutations. The genetic characterisation of strains and epidemiological surveillance of cases are needed to detect populations at increased risk of treatment failure in this infection.

Cyclospora cayetanensis is an emerging cause of prolonged diarrhoea that remains underdiagnosed in Europe because routine laboratory testing is uncommon and conventional diagnostic methods have limited sensitivity. We retrospectively reviewed laboratory-confirmed cases of cyclosporiasis diagnosed following the implementation of routine multiplex GI PCR panel at a tertiary-care hospital in northern Spain between 2016 and 2025. Among 97,116 stool specimens screened, 52 infections were identified. Most patients had recently travelled to endemic regions, predominantly Mexico, whereas nine had no recent travel history. One of these patients reported habitual consumption of imported food, although exposure during the relevant period could not be established. Routine multiplex PCR improves the detection of cyclosporiasis in non-endemic settings and enables the identification of infections beyond the classical travel-associated pattern, supporting the inclusion of C. cayetanensis in routine gastrointestinal molecular diagnostic panels, not only for travel-associated diarrhoea but also for sporadic infections without recent travel.

Background: Streptococcus pneumoniae is currently the leading cause of acute bacterial meningitis. This study assessed the impact of pneumococcal conjugate vaccines (PCVs) on pneumococcal meningitis in Gipuzkoa, north of Spain, between 1993 and 2023. Methods: All cases were serotyped and tested for antimicrobial susceptibility, with medical records reviewed since 2013. Overall, 193 patients were diagnosed (178 patients), averaging 6.2 cases annually. Results: Pneumococcal meningitis annual incidence decreased significantly after PCVs introduction, from 1.99 cases per 100,000 inhabitants in 1993–2001 (before PCV7) to 1.64 in 2002–2010 (PCV7 period) and further to 1.13 in 2011–2023 (PCV13 period). This decline was observed in all age groups except for adults aged ≥65 years, in whom the reduction was observed only after PCV13 introduction. The greatest reduction was observed in children under five. The incidence of meningitis caused by vaccine serotypes decreased following the progressive introduction of PCVs, but non-PCV serotypes increased from 0.70 to 0.95 cases per 100,000 between 1993–2001 and 2011–2023. Otitis media was the most common source of infection, followed by CSF fistula. Most cases (85%) required ICU admission; 67.5% showed sequels at discharge, mainly sensorineural hearing loss, and the 30-day mortality rate was 11.1%. Recurrent pneumococcal meningitis represented 7.8% of cases, associated with head trauma, with favorable outcomes and no mortality. Between 1993–2001 and 2002–2010, penicillin and cefotaxime resistance decreased from 25.4% to 13.3% (47.6% reduction) and from 19.7% to 5% (74.6% reduction), respectively. In 2011–2023, cefotaxime resistance stabilized, but penicillin resistance rose to 32.3%, mainly due to non-PCV13 serotypes. Conclusions: The use of PCV reduced the incidence of pneumococcal meningitis in the region, but penicillin resistance has increased in recent years, due to the rise in non-PCV13 serotypes.