title: [Application of restriction fragment length polymorphism-polymerase chain reaction-flaA and resistotype to identify potential undiagnosed outbreaks of campylobacteriosis in Spain].
abstract: BACKGROUND
  Outbreaks of campylobacteriosis are infrequent and usually involve a low number of patients, although it is estimated that many more remain undiagnosed. The most successful techniques for outbreak investigation in Campylobacter spp. (PFGE, MLST) have the drawback of being laborious and not available in many laboratories.
  
  
  METHODS
  During the year 2008, 352 isolates of C. jejuni and C. coli from 16 hospitals were received in our laboratory. All strains were genotyped by RFLP-PCR-flaA (flaA type) and phenotyped with their resistotype. It was established that the strains of the same species from the same hospital, isolated over a period of up to 11 days, with MIC values of±1 dilution with the same flaA type could belong to an outbreak. Strains that met these criteria would be later subtyped by KpnI-PFGE and MLST.
  
  
  RESULTS
  A total of 23 out of 352 isolates, distributed in 10 groups, met the criteria for being associated with putative undiagnosed outbreaks. The similarity of the PFGE-profiles in 8 groups was greater than 95% among the isolates from each group. In 7 of the groups, the sequence types (MLST) were coincident.
  
  
  CONCLUSIONS
  The use of 2 easy markers (resistotype and RFLP-PCR-flaA) may detect isolates probably belonging to an undiagnosed outbreak of campylobacteriosis. Accurate diagnosis requires other molecular markers and epidemiological data of each isolate. The study suggests that, as in other countries, the number of outbreaks of campylobacteriosis in Spain is probably underestimated.
authors.affiliation: Unidad de Enterobacterias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España. Electronic address: dperez@externos.msssi.es.
authors.forename: David
authors.initials: D
authors.lastname: Pérez-Boto
authors.affiliation: Unidad de Enterobacterias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: López-Portolés
authors.affiliation: Unidad de Enterobacterias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Simón
authors.affiliation: Unidad de Enterobacterias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España.
authors.forename: María Aurora
authors.initials: MA
authors.lastname: Echeita
mesh_terms: D002169:Campylobacter Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D016123:Campylobacter jejuni / Q000145:classification* / Q000235:genetics*; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005408:Flagellin / Q000235:genetics*; D006801:Humans; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D013030:Spain / Q000453:epidemiology
chemical_list: D005408:Flagellin; C067138:flaA protein, bacteria
keywords: Brotes no diagnosticados; Campylobacter; Electroforesis en campo pulsante; Multi-locus sequence typing; Pulse field gel electrophoresis; Secuenciación de múltiples locus de genes constitutivos; Undiagnosed outbreaks; flaA