[Prototheca Wickerhami peritonitis in patients on peritoneal dialysis]. / Peritonitis por Prototheca Wickerhamii en paciente en diálisis peritoneal.

Prototheca spp exits throughout nature but only infrequently cause infection in humans. Most of the cases of human infection have involved the skin or subcutaneous tissues, but there have been reports of rare cases of protothecosis of the urinary tract, and disseminated disease. The species most commonly isolated is Prototheca wickerhamii. Few cases of peritonitis due to P. wickerhamii in peritoneal dialysis had been reported. We report a successful treatment of Prototheca peritonitis complicating peritoneal dialysis with amphotericin, itraconazole and removal of the catheter.

[Antimicrobial susceptibility of the bloodstream infections: a study in a nonteaching hospital]. / Estudio de sensibilidad antibiótica en las bacteriemias de un hospital secundario.

BACKGROUND: To try established antimicrobial susceptibility patterns and frequency of both nosocomial and community-acquired bloodstream infections and and to try identified the prognostic factors that can be modified. MATERIAL AND METHODS: A prospective study of 310 bloodstream infections with clinical significance detected in a non teaching hospital over period from October 2000-2001. A blood culture were identified by Bact-Alert system and the confirmation was performed by MicroScan system; an antimicrobial susceptibility test was performed by reference microdilution methods as described by NCCLS. We studied sentinel antimicrobial/organism combinations with potential clinical importance. Data were computerized using SPSS. Qualitative variables were compared using the X2 test or the Fisher exact test, and quantitative variables with t Student or ANOVA. RESULTS: Gram positive and Candida were frequently recovered in nosocomial bloodstreams. The proportion of oxacillin-resistant S. aureus isolates was 24% and the penicillin resistant pneumococci was 14%. Vancomycin was universal active against gram positive. Gram negatives were often recovered in community bloodstream. The proportion of EBSL E. coli isolates was < 2% and the proportion of multiresistance Pseudomonas aeruginosa was higher among UCI isolates. An independent risk factors for death identified after multivariate analysis was the inappropriate antimicrobial therapy OR 2.6. CONCLUSIONS: Ongoing surveillance of microbial pathogens and their resistance profiles is essential on local scale and permit the selection of appropriate antibiotic therapy which would be reduce the mortality.

[Prognostic factors of bacteremia: prospective study]. / Factores pronósticos de la bacteriemia: estudio prospectivo.

BACKGROUND: To identify the epidemiology and risk factors with influence in the outcome and mortality of a series of bacteriemic patients. MATERIAL AND METHODS: A prospective study of bloodstream infections with clinical significance detected in a secondary hospital of 650 beds over period from May 1998 to May 1999. The true bacteriemia was defined in basis to the criteria both the physician and microbiologist. A total of 16 variables were defined and categorized such as clinical-epidemiologic, intrinsic risk factor, extrinsic risk factor, outcome and survival. We used SPSS statistical package: For cuantitative variables we carried out with the mean with confidence interval of 95%, for cualitative variables: number and %. Univariate analysis of the results was carried out with the X2 test and t Student, the survival was expressed with Kaplan Meyer graphics and the logistic regression model. RESULTS: A total of 320 positive blood cultures were studied but only 272 blood cultures were considered true bacteriemia in 259 patients. The calculated incidence of significant episodes of bacteriemia per 1000 admissions/year was 13. The overall mortality was 22% whereas death attributable to bacteriemia was 16%. The mean age was 66.9 years (IC 95% 65-69), 59% episodes occurred in men. The 78% episodes occurred in patients hospitalized in medical services. 52% episodes were of nosocomial infection and 48% of community acquired infection. According to the severity of the underlying disease, 15% had fatal diseases and 35% episodes occurred in patients without underlying disease. According to the univariant analysis, the variables which where significantly associated with greater risk death were: etiology (fungus), septic shock, the inadequate antibiotic therapy, presence of extrinsic factors (central intravenous catheter, performance of invasive procedures, previous antimicrobial therapy) and the hospital stay of less than 10 days. According to the multivariable analysis showed that the factors remaining independent predictors of mortality were: septic shock (p < 0.0001, OR: 8), inadequate antimicrobial therapy (p < 0.005, OR: 6.7), existence of two or more extrinsic risk factors (p < 0.04). CONCLUSIONS: The presence of septic shock was the most important variable which influenced in the mortality in our serie, together with inappropriate antimicrobian therapy and the association of various extrinsic risk factors. These variables could be modified partly, for this reason the aggressive hemodynamic control and the early and appropriate antibiotic therapy would be the support of the successful bacteriemia management.

Identification of motile Aeromonas strains with the MicroScan WalkAway system in conjunction with the combo negative type 1S panels.

This study was performed to compare the MicroScan WalkAway automated identification system in conjunction with the new MicroScan Combo Negative type 1S panels with conventional biochemical methods for identifying 85 environmental, clinical, and reference strains of eight Aeromonas species.

Evaluation of the MicroScan system for identification of staphylococci.

Conventional biochemical tests were compared with reactions in a multiple test system, MicroScan Walkaway (Dade Diagnostic Inc. MicroScan Divison, West Sacramento, California) in conjugation with the Combo Pos ID Panels (Dade Diagnostic Inc. MicroScan Divison, West Sacramento, California), in order to evaluate the accuracy for the identification of 99 clinical isolates of Staphylococcus spp. and five reference strains. False-negative or positive reactions were detected from Voges-Proskauer, urease and mannose tests. A good correlation was found among the two identification systems for the fermentation of trehalose, lactose, raffinose, as well as for arginine dyhydrolase, esculin hydrolisis and nitrate reduction. From the results of the present study, it is concluded that the MicroScan Walkaway system is a reliable method for identification of staphylococci (94.23%), although 8.2% could be identified to the species level only after use of additional test.

[Post-traumatic arterial priapism resolved using supraselective embolization]. / Priapismo arterial postraumático resuelto por embolización supraselectiva.

Presentation of a new case of high flow priapism in a patient with recent background of perineal traumatism. Diagnosis, already inferred through anamnesis, was later suspected from the results of blood gasometry in cavernous bodies, and eventually confirmed by Eco-Doppler. A revision of the related literature revealed a total of 20 patients in whom supraselective embolization has been used as the therapeutical approach, Bucrylate being used in only two of them. Finally, a few considerations are contributed on the therapeutical management of these patients and the relevance of a correct diagnosis of the two distinct groups of priapism, since they differ considerably in terms of treatment.