Bacterial Patterns and Empiric Antibiotic Use in COPD Patients With Community-Acquired Pneumonia

Introduction: Chronic obstructive pulmonary disease (COPD) is strongly associated with the development of community-acquired pneumonia (CAP). Limited data are available on risk factors for difficult to manage bacteria such as Pseudomonas aeruginosa in COPD patients with CAP. Our objective was to assess the microbiological patterns associated with risk factors that determine empiric antibiotic therapy in hospitalized COPD patients with CAP. Methods: We performed a secondary data analysis of an international, multicenter, observational, point-prevalence study involving hospitalized COPD patients with CAP from March to June 2015. After identifying the risk factors associated with different microorganisms, we developed a scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy in this population. Results: We enrolled 689 hospitalized COPD patients with CAP with documented microbiological testing. The most frequent microorganisms isolated were Streptococcus pneumoniae (8%) and Gram-negative bacteria (8%), P. aeruginosa (7%) and Haemophilus influenzae (3%). We developed a scoring system incorporating the variables independently associated with P. aeruginosa that include a previous P. aeruginosa isolation or infection (OR 14.2 [95%CI 5.7–35.2]), hospitalization in the past 12 months (OR 3.7 [1.5–9.2]), and bronchiectasis (OR 3.2 [1.4–7.2]). Empiric anti-pseudomonal antibiotics were overutilized in COPD patients with CAP. The new scoring system has the potential to reduce empiric anti-pseudomonal antibiotic use from 54.1% to 6.2%. Conclusions: COPD patients with CAP present different microbiological profiles associated with unique risk factors. Anti-pseudomonal treatment is a critical decision when selecting empiric antibiotic therapy. We developed a COPD scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy. (AU)

Insecticidal features displayed by the beneficial rhizobacterium Pseudomonas chlororaphis PCL1606 / Características insecticidas mostradas por la rhizobacterium beneficiosa Pseudomonas chlororaphis PCL1606

The biocontrol rhizobacterium Pseudomonas chlororaphis is one of the bacterial species of the P. fluorescens group where insecticide fit genes have been found. Fit toxin, supported with other antimicrobial compounds, gives the bacterial the ability to repel and to fight against eukaryotic organisms, such as nematodes and insect larvae, thus protecting the plant host and itself. Pseudomonas chlororaphis PCL1606 is an antagonistic rhizobacterium isolated from avocado roots and show efficient biocontrol against fungal soil-borne disease. The main antimicrobial compound produced by P. chlororaphis PCL606 is 2-hexyl-5-propyl resorcinol (HPR), which plays a crucial role in effective biocontrol against fungal pathogens. Further analysis of the P. chlororaphis PCL1606 genome showed the presence of hydrogen cyanide (HCN), pyrrolnitrin (PRN), and homologous fit genes. To test the insecticidal activity and to determine the bases for such activity, single and double mutants on the biosynthetic genes of these four compounds were tested in a Galleria mellonella larval model using inoculation by injection. The results revealed that Fit toxin and HPR in combination are involved in the insecticide phenotype of P. chlororaphis PCL1606, and additional compounds such as HCN and PRN could be considered supporting compounds.(AU)

Infecciones respiratorias de repetición en una paciente con Síndrome de Kartagener / Repeated respiratory infections in a patient with Kartagener's Syndrome

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Pseudomonas aeruginosa nosocomial meningitis in neurosurgical patients with intraventricular catheters: Therapeutic approach and review of the literature / Meningitis nosocomial por Pseudomonas aeruginosa en pacientes portadores de catéteres intraventriculares: aproximación terapéutica y revisión de la literatura

BACKGROUND: Pseudomonas aeruginosa neurosurgical meningitis is a rare entity, usually related with intraventricular catheters and associated with high mortality rates. We describe the clinical characteristics, treatment and outcomes of a series of neurosurgical meningitis caused by P. aeruginosa along 1990-2016. METHODS: Descriptive, retrospective study of all postsurgical meningitis due to P. aeruginosa related to intraventricular catheters in Hospital Universitario Central de Asturias, between 1990 and 2016. Clinical features, therapeutic approaches and prognostic factors were analyzed statistically. A binary logistic regression analysis was performed to determine the factors influencing the infection mortality. RESULT: 51 episodes from 51 different patients with CSF culture positive for P. aeruginosa were reviewed. Seventeen patients (33.3%) died as a direct consequence of the infection. Univariate analysis showed that mortality was higher in the group of patients treated with ceftazidime (12 vs. 15, p = 0.068, OR 3.040 [0.877-10.544]) and lower in patients whom had received intrathecal therapy (2 vs. 13, p = 0.050, OR 4.64 [0.80-34.93]), without differences observed between those patients treated with aminoglycosides or with colistin. Any patient treated with colistin died (0 vs. 6, p = 0.067, OR: not defined). In the multivariate analysis mortality was only significant higher for patients without catheter withdrawal (p = 0.014) and lower for those patients who received intrathecal therapy (p = 0.05) or adequate empirical treatment (p = 0.006). CONCLUSIONS: The mortality of P. aeruginosa meningitis is high especially in infections without catheter withdrawal and in patients for whom the intrathecal route of administration was not used. Catheter withdrawal was an independent factor of good outcome in our series

ANTECEDENTES: La meningitis nosocomial por Pseudomonas aeruginosa es una entidad poco frecuente, generalmente relacionada con catéteres intraventriculares y asociada con altas tasas de mortalidad. Se describen las características clínicas, con especial hincapié en su tratamiento, de una serie de meningitis neuroquirúrgicas por P. aeruginosa entre 1990 y 2016. MÉTODOS: Estudio descriptivo, retrospectivo, de todas las meningitis posquirúrgicas por P. aeruginosa relacionadas con catéteres intraventriculares en el Hospital Universitario Central de Asturias entre 1990 y 2016, con especial hincapié en los enfoques terapéuticos y factores pronósticos. Los factores asociados con mortalidad se analizaron mediante regresión logística binaria. RESULTADOS: Se revisaron 51 episodios de 51 pacientes diferentes con cultivos de LCR positivos para P. aeruginosa. Diecisiete pacientes (33,3%) murieron como consecuencia directa de la infección. La mortalidad fue mayor en el grupo de pacientes tratados con ceftazidima (12 vs. 15, p = 0,068, OR 3,040 [0,877-10,544]) y menor en los pacientes que habían recibido terapia intratecal (2 vs. 13, p = 0,050, OR 4,64 [0,80-34,93]), sin diferencias en estos últimos entre los tratados con aminoglucósidos o con colistina. Ningún paciente tratado con colistina falleció (0 vs. 6, p = 0,067, OR no definida). El análisis multivariable únicamente confirmó la asociación con la ausencia de terapia intratecal (p = 0,05) o tratamiento empírico adecuado (p = 0,006). CONCLUSIONES: La mortalidad de la meningitis por P. aeruginosa es elevada, especialmente en pacientes en quienes no se utilizó la vía de administración intratecal. La retirada del catéter fue un factor independiente de buena evolución en nuestra serie

Broncoscopia en un caso de síndrome de Mounier-Kühn / Bronchoscopy in a Case of Mounier-Kühn Syndrome

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Inusual endocarditis infecciosa sobre válvula protésica por Pseudomonas monteilii y Acinetobacter nosocomialis con fatal desenlace / Unusual infective prosthetic valve endocarditis due to Pseudomonas monteilii and Acinetobacter nosocomialis with a fatal result

Presentamos el caso de una endocarditis por Pseudomonas monteilii y Acinetobacter nosocomialis con un fatal desenlace. El paciente tenía una historia reciente de reemplazo valvular aórtico. La ecografía transesofágica y la tomografía computarizada confirmaron la presencia de vegetación en la válvula protésica y un seudoaneurisma aórtico con un absceso en la raíz aórtica. El cultivo de la válvula demostró P.monteilii y A.nosocomialis. El paciente fue tratado con cirugía y antibióticos, pero sufrió un deterioro y murió 44días tras la cirugía. En nuestro conocimiento este es el primer caso de endocarditis producida por P.monteilii y A.nosocomialis publicado en la literatura. Estas bacterias han sido descritas como contaminantes ambientales; sin embargo, deben ser consideradas como potenciales patógenos, en especial en pacientes con válvulas protésicas

We report a case of Pseudomonas monteilii and Acinetobacter nosocomialis endocarditis with a fatal outcome in a patient with a recent history of prosthetic aortic valve replacement. Transesophageal echocardiography and computed tomography confirmed the presence of vegetation on the prosthetic valve and aortic pseudoaneurism with an aortic root abscess. Valve cultures yielded P.monteilii and A.nosocomialis. The patient underwent surgery and received antibiotics, but his condition deteriorated and he died 44days after surgery. To our knowledge, this is the first case of P.monteilii and A.nosocomialis endocarditis reported in the literature. These organisms have been described as environmental contaminants; however, they must be considered potential pathogens, particularly in patients with prosthetic valves

Evaluation of the commercial combined disk test and minimum inhibitory concentration (MIC) determination for detection of carbapenemase producers among Gram-negative bacilli isolated in a region with high prevalence of blaOXA-48 and blaNDM

Carbapenem-resistant Gram-negative bacilli (GNB) are a concern in the Middle East and worldwide. Simple screening methods have been sought to detect carbapenemase producers to determine appropriate therapeutic measures and implement infection control interventions. In this study, we evaluated the efficiency of agar disc diffusion, commercial combined disc test (Rosco), and carbapenem MIC determination in comparison to molecular detection of carbapenemase genes among 82 carbapenem non-susceptible Enterobacteriaceae (CNSE) and 37 Acinetobacter/Pseudomonas isolates. The blaOXA-48, blaNDM, blaNDM/OXA-48, and blaIMP were detected in 68 out of 82 CNSE isolates. All of the Acinetobacter baumannii isolates were positive for the blaOXA-51 (n=23), of those some were positive for blaOXA-48 (n=13) and blaNDM (n=3). Sensitivities and specificities of combined disc test for detection of blaNDM and blaOXA-48 carrying Enterobacteriaceae isolates were 92.5% and 100%, and 58.5% and 100%, respectively, while those for Acinetobacter/Pseudomonas isolates were 100%, 81.8% and 96.2%, 89%, respectively. While carbapenem MIC values had excellent concordance with phenotypic combined disc test for detection of blaOXA-48 producers (area under curve >90%), only ertapenem MIC's could precisely detect blaOXA-48 PCR-positive Enterobacteriaceae isolates (AUC 70%, sensitivity 70%, specificity 50%). The phenotypic commercial test showed excellent sensitivity for detection of blaNDM producers, but had poor sensitivity for blaOXA-48-producing Enterobacteriaceae. Ertapenem MIC values had low sensitivity and specificity for detection of the blaOXA-48-carrying Enterobacteriaceae. This is the first report of A. baumannii isolates co-harbored the blaOXA-48/blaNDM carbapenemases from Iran

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Impact of motility and chemotaxis features of the rhizobacterium Pseudomonas chlororaphis PCL1606 on its biocontrol of avocado white root rot

The biocontrol rhizobacterium Pseudomonas chlororaphis PCL1606 has the ability to protect avocado plants against white root rot produced by the phytopathogenic fungus Rosellinia necatrix. Moreover, PCL1606 displayed direct interactions with avocado roots and the pathogenic fungus. Thus, nonmotile (flgK mutant) and non-chemotactic (cheA mutant) derivatives of PCL1606 were constructed to emphasize the importance of motility and chemotaxis in the biological behaviour of PCL1606 during the biocontrol interaction. Plate chemotaxis assay showed that PCL1606 was attracted to the single compounds tested, such as glucose, glutamate, succinate, aspartate and malate, but no chemotaxis was observed to avocado or R. necatrix exudates. Using the more sensitive capillary assay, it was reported that smaller concentrations (1 mM) of single compounds elicited high chemotactic responses, and strong attraction was confirmed to avocado and R. necatrix exudates. Finally, biocontrol experiments revealed that the cheA and fglK derivative mutants reduced root protection against R. necatrix, suggesting an important role for these biological traits in biocontrol by P. chlororaphis PCL1606 (AU)

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Lavado quirúrgico de manos. Fricción alcohólica o frotado jabonoso / Surgical hand washing: handscrubbing or handrubbing

La importancia de los protocolos para la antisepsia prequirúrgica de las manos viene dada por el riesgo de transferencia de bacterias presentes en las manos del equipo quirúrgico al paciente durante la intervención y su relación con la infección de la herida quirúrgica (SSI). Un cuidadoso lavado quirúrgico reduce el número de bacterias en la piel, aunque no las elimina completamente, pues algunos microorganismos transitorios permanecen en las manos después del lavado quirúrgico. Por este motivo, en caso de micropunciones en los guantes quirúrgicos, la correcta preparación prequirúrgica de las manos y el doble enguantado será fundamental para reducir el riesgo de transmisión de bacterias a los pacientes. Los protocolos para la antisepsia quirúrgica de las manos son dos: • Lavado quirúrgico con jabón antiséptico. • Lavado quirúrgico por fricción alcohólica. La antisepsia de las manos por fricción con una solución alcohólica ha demostrado ser significativamente más eficaz, frente a las soluciones jabonosas. Esto es debido a que en la antisepsia de las manos con jabón se requiere su enjuague con agua, y a menudo en las llaves y grifos de los hospitales se encuentran colonias de las pseudomonas spp., en particular la P. aeruginosa. Los dos métodos son adecuados para la prevención de las infecciones de la herida quirúrgica (SSI. Sin embargo, los jabones antisépticos se han utilizado y se siguen utilizando por muchos equipos quirúrgicos en todo el mundo para la preparación prequirúrgica de las manos, es importante señalar que la eficacia antibacteriana de los productos que contienen las formulaciones alcohólicas es superior a la que cualquier jabón antiséptico disponible en la actualidad. Por lo tanto, el objetivo principal de este artículo es difundir estos conocimientos, que, pese a toda la literatura escrita [1-7,13], aún requieren más difusión (AU)

The importance of protocols for preoperative antisepsis of the hands is given by the risk of transferring bacteria from the hands of the surgical team to the patient during surgery and it is relationship with infection of surgical wound site (SSI). Careful surgical scrub reduces the number of bacteria on the skin, but does not eliminate them completely, remaining transient microorganisms on hands after the surgical scrub. Therefore if micropuncture in surgical gloves occurs, the correct preoperative preparation of hands and double gloving will be essential to reduce the risk of bacterial transmission to patients. The protocols for surgical hand antisepsis are two: • Surgical scrub with antiseptic soap (handscrubbing). • Surgical scrub by rubbing alcohol (handrubbing). The hand antisepsis by rubbing with an alcohol solution has proved to be significantly more effective compared to soap solutions. We must also see that in surgical hand antisepsis with soap, you must rinse them with water. And often hospitals’ taps and keys are contaminated by Pseudomonas spp., including P. aeruginosa. Both methods are suitable for the prevention of surgical site infections (SSI). However, antiseptic soaps have been and are still used by many surgical teams around the world to the preoperative preparation of hands. Importantly, the antibacterial efficacy of products containing alcoholic formulations is higher than any currently available antibacterial soap. Therefore, the main objective of this article is to spread these knowledges, that, despite all the literature written [1-7,13], still require further spreanding (AU)

Effect of propionic acid on Campylobacter jejuni attached to chicken skin during refrigerated storage

The ability of propionic acid to reduce Campylobacter jejuni on chicken legs was evaluated. Chicken legs were inoculated with Campylobacter jejuni. After dipping legs in either water (control), 1% or 2% propionic acid solution (vol/vol), they were stored at 4ºC for 8 days. Changes in C. jejuni, psychrotrophs and Pseudomonas counts were evaluated. Washing in 2% propionic acid significantly reduced (P < 0.05) C. jejuni counts compared to control legs, with a decrease of about 1.62 log units after treatment. Treatment of chicken legs with 1 or 2% propionic acid significantly reduced (P < 0.05) numbers of psychrotrophs 1.01 and 1.08 log units and Pseudomonas counts 0.75 and 0.96 log units, respectively, compared to control legs. The reduction in psychrotrophs and Pseudomonas increased throughout storage. The highest reductions obtained for psychrotrophs and Pseudomonas counts in treated legs were reached at the end of storage, day 8, being 3.3 and 2.93 log units, respectively, compared to control legs. Propionic acid treatment was effective in reducing psychrotrophs and Pseudomonas counts on chicken legs throughout storage. It is concluded that propionic acid is effective for reducing (AU)

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Increasing antibiotic resistance in preservative-tolerant bacterial strains isolated from cosmetic products

To ensure the microbiological quality, consumer safety and organoleptic properties of cosmetic products, manufacturers need to comply with defined standards using several preservatives and disinfectants. A drawback regarding the use of these preservatives is the possibility of generating cross-insusceptibility to other disinfectants or preservatives, as well as cross resistance to antibiotics. Therefore, the objective of this study was to understand the adaptive mechanisms of Enterobacter gergoviae, Pseudomonas putida and Burkholderia cepacia that are involved in recurrent contamination in cosmetic products containing preservatives. Diminished susceptibility to formaldehyde-donors was detected in isolates but not to other preservatives commonly used in the cosmetics industry, although increasing resistance to different antibiotics (β-lactams, quinolones, rifampicin, and tetracycline) was demonstrated in these strains when compared with the wild-type strain. The outer membrane protein modifications and efflux mechanism activities responsible for the resistance trait were evaluated. The development of antibiotic-resistant microorganisms due to the selective pressure from preservatives included in cosmetic products could be a risk for the emergence and spread of bacterial resistance in the environment. Nevertheless, the large contribution of disinfection and preservation cannot be denied in cosmetic products (AU)

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Meningitis por Pseudomonas oryzihabitans / Pseudomonas oryzihabitans meningitis

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Dosificación de antibióticos antipseudomónicos en pacientes con disfunción renal aguda sometidos a técnicas continuas de depuración extrarenal / Dosage of antipseudomonal antibiotics in patients with acute kidney injury subjected to continuous renal replacement therapies

Pseudomonas es un patógeno frecuente en las unidades de pacientes críticos y puede ser causa de shock séptico y de fallo renal. Es fundamental en estos pacientes instaurar un tratamiento antibiótico precoz y a dosis adecuadas. La disfunción renal aguda es también habitual en pacientes críticos. En aquellos que necesitan depuración extrarenal, las técnicas continuas de depuración extrarenal (TCDE) son una alternativa a la hemodiálisis intermitente y es necesario tener en cuenta que muchos antibióticos se eliminan de forma sustancial por las TCDE. El objetivo de esta revisión es analizar la evidencia clínica disponible sobre el comportamiento farmacocinético y las recomendaciones posológicas de los principales grupos de antibióticos empleados en el tratamiento de infecciones por Pseudomonas spp. en pacientes críticos sometidos a técnicas continuas de depuración extrarenal (AU)

Critically ill patients are often affected by infections produced by Pseudomonas, which can be a cause of sepsis and renal failure. Early and adequate antibiotic treatment at correct dosage levels is crucial. Acute kidney injury is also frequent in critically ill patients. In those patients who require renal replacement therapy, continuous techniques are gaining relevance as filtering alternatives to intermittent hemodialysis. It must be taken into account that many antibiotics are largely cleared by continuous renal replacement therapies (CRRT).The aim of this review is to assess the clinical evidence on the pharmacokinetics and dosage recommendations of the main antibiotic groups used to treat Pseudomonas spp. infections in critically ill patients subjected to CRRT (AU)

Selection of a biocontrol agent based on apotential mechanism of action: degradation of nicotinic acid, a growth factor essential for Erwinia amylovora

This work describes a medium-based screening method for selecting microbial biocontrol agents against Erwinia amylovora based on the degradation of a specific growth factor. Erwinia amylovora, the causal agent of the devastating fire blight disease, requires nicotinic acid or nicotinamide as an essential growth factor. Potential biocontrol agents are either selected for antimicrobial production in plate or directly on immature pears or apple blossoms. In this work, we have attempted to streamline the selection of a new potential biocontrol agent with a lower risk of non-target effects by isolation based on the ability to degrade nicotinic acid in vitro, using therefore few plant materials. A total of 735 bacteria and 1237 yeast were isolated from apple blossoms and pre-screened for nicotinic acid-degradation. Pseudomonas rhizosphaerae strain JAN was able to degrade both nicotinic acid and nicotinamide. Mutants deficient in this ability were constructed. JAN, but not the mutants, controlled E. amylovora on pear slices. On detached apple blossoms, JAN colonized apple hypanthia and strongly suppressed E. amylovora growth. Under greenhouse conditions, JAN was more effective in controlling blossom blight than P. fluorescens A506, a commercial biocontrol agent of fire blight unable to degrade nicotinic acid and nicotinamide (AU)

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Carbapenemasas en especies del género Pseudomonas / Carbapenemases in Pseudomonas spp

Pseudomonas aeruginosa es uno de los patógenos nosocomiales más relevantes, así como una de las principales causas de infección respiratoria crónica en pacientes con enfermedades de base, como la fibrosis quística o la enfermedad pulmonar obstructiva crónica. Su elevado nivel de resistencia intrínseca a los antibióticos, unido a su extraordinaria capacidad para desarrollar resistencias adicionales por mutaciones cromosómicas, hacen de este patógeno uno de los más difíciles de tratar. Aún es más preocupante, si cabe, la creciente detección en este microorganismo de múltiples determinantes de resistencia, frecuentemente localizados en integrones, adquiridos por transferencia horizontal a través de plásmidos o transposones. Entre estos mecanismos destacan las carbapenemasas, por el abanico de antibióticos afectados (pues en conjunto hidrolizan a prácticamente todos los betalactámicos), variedad y capacidad de dispersión. En el presente trabajo se revisa la epidemiología, el impacto y la detección de las carbapenemasas descritas hasta la fecha en el género Pseudomonas, que pertenecen principalmente a la clase B (metalo-β-lactamasas [MBL]: IMP, VIM, SPM, GIM, AIM o DIM]), pero también, en menor medida, a las clases A (GES y KPC) y D (OXA). La presencia de estas carbapenemasas transferibles no sólo es importante en P. aeruginosa, sino también en otras especies clínicamente menos relevantes dentro del género, pero que pueden actuar como reservorio y vector de dispersión de estos determinantes de resistencia. La frecuencia creciente de cepas clínicas portadoras de carbapenemasas apremia a la puesta a punto de estrategias que faciliten su detección y reduzcan la expansión de estas cepas multirresistentes y de los mecanismos transferibles implicados

Pseudomonas aeruginosa is one of the most relevant nosocomial pathogens, as well as one of the main causes of chronic respiratory infections in patients with underlying diseases such as cystic fibrosis or chronic obstructive pulmonary disease. The high intrinsic antibiotic resistance of this pathogen, together with its extraordinary capacity for acquiring additional resistances through chromosomal mutations, determines a major threat for antimicrobial therapy in hospitals worldwide. Even more concerning is the increasing detection of multiple antimicrobial resistance determinants in this microorganism, frequently located on integrons, acquired by horizontal transfer through plasmids and/or transposons. Among these mechanisms, the carbapenemases are particularly relevant, due to the wide spectrum of antibiotics affected. This work reviews the epidemiology, impact, and detection of the carbapenemases described so far in the Pseudomonas spp., that mainly include class B enzymes (metallo-β-lactamases [MBL]: IMP, VIM, SPM, GIM, AIM, or DIM), but also, to a lower extent, class A (GES y KPC) and D (OXA) beta-lactamases. The presence of transferable carbapenemases is not only important in P. aeruginosa, but also in other less clinically-relevant species of the genus, since they can act as reservoires and dispersion vectors of these resistance determinants. The growing prevalence of carbapenemase-producing clinical isolates calls for the implementation of multidisciplinary strategies to optimize the detection and minimize the dissemination of these multidrug resistant strains and the involved transferable genetic elements

Gangrena de Fournier. Análisis descriptivo de 20 casos y revisión de la bibliografía científica / Fournier’s gangrene. Descriptive analysis of 20 cases and literature review

Introducción: La gangrena de Fournier es una fascitis necrosante que afecta habitualmente a la zona genital externa y perineal, con eventual extensión al abdomen, los miembros inferiores e incluso el tórax, con alta letalidad, que debe tratarse de manera agresiva en las primeras horas tras el diagnóstico. Se considera que enfermedades debilitantes como la diabetes mellitus u la obesidad favorecen su aparición. El factor desencadenante más frecuente es el absceso perianal. Objetivo: Realizar un profundo análisis descriptivo sobre los factores de riesgo y las afecciones predisponentes de la gangrena de Fournier durante toda la historia de nuestro centro, durante los últimos 12 años, así como revelar la tasa de mortalidad de éstos y el número medio de reintervenciones realizadas. Material y métodos: El estudio realizado analiza, de manera observacional y retrospectiva, a 20 pacientes diagnosticados de gangrena de Fournier, según criterios de inclusión clínicos, en el Hospital General Universitario J.M. Morales Meseguer entre 1997 y 2008. Resultados: La gran mayoría de los pacientes revisados eran varones, con una edad media de 61 años. Todos tenían una importante afección orgánica de base; destacaba la diabetes mellitus. La estancia media hospitalaria fue de 25,7 días. Fallecieron 2 pacientes y la mortalidad global fue del 10%. Conclusiones: La gangrena de Fournier es una entidad que puede ser letal, que está favorecida por distintos factores debilitantes, cuya causa desencadenante es una enfermedad perirrectal o urogenital que no ha sido tratada correctamente. Debido a su pronóstico grave, un diagnóstico temprano y una intervención multidisciplinaria adecuada, temprana y agresiva son esenciales para una buena evolución (AU)

Background: Fournier’s gangrene is a necrotising fasciitis that usually affects the external genitalia and perineal area and may extend to the abdomen, lower limbs and chest. It has a high fatality rate and must be treated aggressively within a few hours of being diagnosed. It is believed that debilitating diseases such as diabetes mellitus or obesity are conducive to its appearance. A perianal abscess is the most common trigger. Objective: To conduct a thorough descriptive analysis of risk factors and predisposing conditions for Fournier’s gangrene based on our institution’s experience over the past 12 years and reveal the mortality rate for those factors as well as the average number of reoperations performed. Material and methods: This observational retrospective study examines 20 patients, according to clinical inclusion criteria, who were diagnosed with Fournier’s gangrene, and treated in J.M. Morales Meseguer Hospital between 1997 and 2008. Results: The vast majority of patients reviewed were males, with an average age of 61 years. All patients had a significant history of organic pathology, particularly diabetes mellitus. The average hospital stay was 25.7 days. 2 patients died, and the overall mortality rate was 10%.Conclusions: Fournier’s gangrene is an entity that can be lethal and it is favoured by several debilitating factors. It is triggered by a urogenital or perirectal disease that has not been treated properly. Because of its poor prognosis, early diagnosis and an appropriate early and aggressive multidisciplinary intervention are essential for proper recovery (AU)

Síndrome hemofagocítico. Estudio de 16 casos / Hemophagocytic syndrome. Study of 16 cases

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Piercing oral: una amenaza para la salud periodontal / Oral piercing: a threat for periodontal health

La colocación de piercing oral es hoy en día muy frecuente en la población por una cuestión de moda. Las complicaciones que puede ocasionar esta práctica son numerosas y cada vez más frecuentes debido principalmente a que se lleva a cabo por personal no sanitario, el cual carece de conocimientos médicos y anatómicos, y a que el portador del piercing no es informado adecuadamente sobre las complicaciones y los posibles riesgos que puede acarrear esta práctica en la salud oral (AU)

Nowadays oral piercings are commonplace due to their rise in fashion. Complications that can arise from this practice are numerous and increasingly more frequent, principally due to the fact that they are carried out by non-healthcare workers who lack medical and anatomy training. Due to this, the wearer is not adequately informed about the complications and possible risks to their oral health (AU)

Analysis of s-triazine-degrading microbial communities in soils using most-probable-number enumeration and tetrazolium-salt detection

A simple and sensitive method for the detection and enumeration of microbial s-triazine-degrading microorganisms in soil was designed. The procedure is based on the ability of some microbes to use s-triazines, such as simazine, atrazine, and cyanuric acid, as sole nitrogen source. It employs the respiration indicator 2,3,5-triphenyl-2H-tetrazolium chloride (TTC) to detect metabolic activity and the most-probable-number (MPN) enumeration in microtiter plates. The method was used to identify simazine- and cyanuric acid-degrading activities in agricultural soils treated with the herbicide simazine. The MPN-TTC method showed that the number of simazine- and cyanuric acid-degrading microorganisms increased four weeks after the herbicide simazine had been applied (AU)

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