Prevalence of and risk factors for biliary carriage of bacteria showing worrisome and unexpected resistance traits.

Data on biliary carriage of bacteria and, specifically, of bacteria with worrisome and unexpected resistance traits (URB) are lacking. A prospective study (April 2010 to December 2011) was performed that included all patients admitted for <48 h for elective laparoscopic cholecystectomy in a Spanish hospital. Bile samples were cultured and epidemiological/clinical data recorded. Logistic regression models (stepwise) were performed using bactobilia or bactobilia by URB as dependent variables. Models (P < 0.001) showing the highest R(2) values were considered. A total of 198 patients (40.4% males; age, 55.3 ± 17.3 years) were included. Bactobilia was found in 44 of them (22.2%). The presence of bactobilia was associated (R(2) Cox, 0.30) with previous biliary endoscopic retrograde cholangiopancreatography (ERCP) (odds ratio [OR], 8.95; 95% confidence interval [CI], 2.96 to 27.06; P < 0.001), previous admission (OR, 2.82; 95% CI, 1.10 to 7.24; P = 0.031), and age (OR, 1.09 per year; 95% CI, 1.05 to 1.12; P < 0.001). Ten out of the 44 (22.7%) patients with bactobilia carried URB: 1 Escherichia coli isolate (CTX-M), 1 Klebsiella pneumoniae isolate (OXA-48), 3 high-level gentamicin-resistant enterococci, 1 vancomycin-resistant Enterococcus isolate, 3 Enterobacter cloacae strains, and 1 imipenem-resistant Pseudomonas aeruginosa strain. Bactobilia by URB (versus those by non-URB) was only associated (R(2) Cox, 0.19) with previous ERCP (OR, 11.11; 95% CI, 1.98 to 62.47; P = 0.006). For analyses of patients with bactobilia by URB versus the remaining patients, previous ERCP (OR, 35.284; 95% CI, 5.320 to 234.016; P < 0.001), previous intake of antibiotics (OR, 7.200; 95% CI, 0.962 to 53.906; P = 0.050), and age (OR, 1.113 per year of age; 95% CI, 1.028 to 1.206; P = 0.009) were associated with bactobilia by URB (R(2) Cox, 0.19; P < 0.001). Previous antibiotic exposure (in addition to age and previous ERCP) was a risk driver for bactobilia by URB. This may have implications in prophylactic/therapeutic measures.

Campylobacter fetus peritonitis and bacteremia in a patient undergoing continuous ambulatory peritoneal dialysis.

We report a case of Campylobacter fetus peritonitis and bacteremia in a patient undergoing continuous ambulatory peritoneal dialysis.

Influence of recent antibiotic therapy on antimicrobial resistance of Streptococcus pneumoniae in children with acute otitis media in Spain.

BACKGROUND: Despite the high prevalence of penicillin resistance among Streptococcus pneumoniae strains in Spain (40 to 60% with MIC > or = 0.1 microg/ml), the data on acute otitis media (AOM) isolates are scarce. We conducted a prospective, longitudinal study to determine the rates of antimicrobial resistance of S. pneumoniae isolates from children with AOM in our country and to analyze the effect of previous antibiotic therapy on these rates. METHODS: Tympanocentesis was performed on 169 children diagnosed with AOM (age range, 1 month to 14 years). Two groups were considered: Group A, 113 patients with non-antibiotic-treated AOM, subdivided into Group A1 (collected from 1989 to 1992) and Group A2 (1992 to 1996); Group B, 56 patients from the period 1992 to 1996, with AOM clinical failure, defined as worsening or persistent symptoms after at least 2 days of appropriate antibiotic therapy. Amoxicillin-clavulanate was the most frequent antibiotic used (68%), followed by azithromycin (21%), cefaclor and cefixime (11%). RESULTS: A total of 63 S. pneumoniae isolates were recovered, 42 in Group A and 21 in Group B. Resistance to penicillin (MIC > or = 0.1 microg/ml) was found in 38% of strains in Group A (32% in A1 and 50% in A2), but in Group B the rate of resistance reached 90% (P = 0.0002). Erythromycin resistance was also increased from 35% (Group A2) to 62% (Group B), and trimethoprim-sulfamethoxazole resistance rose from 64% to 81%. CONCLUSIONS: Resistance to penicillin among S. pneumoniae AOM isolates is frequent and is increasing in Spain. After failure of standard antibiotic therapy, the rates of penicillin resistance reached 90% of the isolates.

Maternal colonization by group B streptococci and puerperal infection; analysis of intrapartum chemoprophylaxis.

In a population of 1011 puerperal women, the significance of rectovaginal colonization by group B streptococci during pregnancy with respect to infective puerperal morbidity was analyzed. Patients who were found to be carriers during pregnancy (121) were randomly divided into two groups: women who received ampicillin during delivery (500 mg i.v./6 h) and patients without chemoprophylaxis. Compared with the non-carriers, the carrier patients without prophylaxis had a significant increase in the mild puerperal infective morbidity, when defined as the proportion of women with an index fever greater than or equal to 10 (10.6% vs. 25%). However, the increased incidence among the carrier women of premature rupture of the membranes and of other possible morbidity factors made it impossible to identify the role of group B streptococci. Mild puerperal infective morbidity in the carrier women who received prophylaxis was lower than in those without prophylaxis and very similar to that of non-carrier women. It is concluded that the use of chemoprophylaxis to prevent neonatal sepsis would probably be followed by a reduction in infectious puerperal morbidity.

Intrapartum chemoprophylaxis of early-onset group B streptococcal disease.

A randomized study in 121 pregnant women carrier of group B streptococci is undertaken in order to assess the administration of 500 mg of intrapartum ampicillin intravenously to interrupt mother-to-fetus group B streptococcal transmission. In the prophylaxis group there was a significant reduction in neonatal colonization (3.7 vs. 42.9%) and in severe neonatal colonization (0 vs. 25%). There was no case of group B streptococcal sepsis in the prophylaxis group compared to 4.6% (3 cases) in the control group (P greater than 0.05). Clinically infected newborns represented 3.3% in the prophylaxis group vs. 13.8% in the control group. When the organism was isolated during delivery in the vagina or amniotic fluid, prophylaxis was quickly followed by second negative cultures. Ampicillin levels in the amniotic fluid were detected early, and they increased significantly till the third hour. Bactericidal levels in the umbilical cord were detected in 60% of newborns. All these findings support the usefulness of ampicillin prophylaxis in the prevention of early-onset group B streptococcal sepsis.

Natural transmission of group B Streptococcus during delivery.

This is a study of group B Streptococcus during labor of 121 patients in whom group B Streptococcus was isolated in the vagina and/or rectum before delivery. The intrapartum vaginal culture was positive in 55.2% of the antepartum carriers (32/58). When the vaginal culture during delivery was positive, the group B Streptococcus was isolated in the amniotic fluid 2 h after the rupture of membranes in 81% of the cases. The newborns of antepartum carriers, when the labor developed naturally, were colonized by group B Streptococcus in 69.2% of cases when the intrapartum vaginal and/or amniotic fluid cultures were positive (9/13), while only 5.6% of the newborns of antepartum carriers but with negative cultures during delivery were colonized by group B Streptococcus (1/18). The most frequent positive neonatal culture was in the umbilicus (83.3%) followed by the external ear (62.5%).

[Weight status, dietary habits and physical activity among 6-12 year-old children in Castile-La Mancha]. / Situación ponderal, hábitos alimentarios y deportivos en población castellano-manchega de 6 a 12 años.

INTRODUCTION: Childhood obesity is a multifactorial disease, in which unhealthy dietary patterns and sedentary lifestyles play a decisive role. The aim of this study was to assess the weight status, dietary habits and physical activity in Castile-La Mancha children. SUBJECTS AND METHODS: A cross-sectional study was conducted on 3061 children 6-12 years-old who were participating in the programme, "Alimenta su salud". Anthropometric measurements, food consumption frequency, dietary habits and physical activity were assessed by a questionnaire, including gender, age and geographical influences. RESULTS: The prevalence of subjects with excess weight-for-height was 24.0% and obesity was 14.3%, with geographical differences. Girls more often have mid-morning snacks, consume more supplements, and reported to be less active than boys. Special diets and sports activities were lower in children aged 6-9 years as compared to the 10-12 years old group. The intake of vegetables and fruit is low, while there is overconsumption of sausages, pastries, salted snacks, sweets and fast food, with some differences by age group. CONCLUSIONS: One out of four children is overweight or obese in this population. Children do not meet recommendations for fruit and vegetables and there is a high consumption of foods associated with obesity risk. Physical inactivity was more prevalent during the weekends, and among girls.

Penicillin-susceptible and erythromycin-resistant Streptococcus pneumoniae in children with acute mastoiditis.

Resistance to erythromycin is usually associated with resistance to penicillin in Streptococcus pneumoniae isolates. Over the last few years, however, an increase has been detected in the number of Streptococcus pneumoniae isolates obtained from children with acute otitis media complicated by acute mastoiditis. These isolates are characterized by a penicillin-susceptible and erythromycin-resistant antibiotic profile. This observation prompted a review of the microbiology database and analysis of all Streptococcus pneumoniae isolates with this peculiar antibiotic profile at a university hospital in Madrid, Spain.

Recto-vaginal colonization and urinary tract infection by group B Streptococcus in the pregnant diabetic patient.

The influence of maternal diabetes on Group B Streptococcus (GBS) colonization and GBS urinary infection was investigated. The population under study comprised 1,050 pregnant women (70 of them diabetics, the remaining 980 non-diabetics). A higher prevalence of GBS colonization was found among diabetics (20% versus 10.9%) (p less than 0.05). The rate of colonization was not correlated to the severity of the diabetes condition. Urinary infection was diagnosed on 8.6% of diabetic patients, versus 7.1% of non-diabetics (p greater than 0.05). Urinary infection by GBS occurred with similar frequency in both groups (0% in diabetics and 1% in non-diabetics). The possible etiological implications are commented on, and vaginal and rectal cultures are recommended for GBS screening in the pregnant diabetic patient.

Clinical significance of exit-site infections due to Xanthomonas in CAPD patients: a comparison with Pseudomonas infection.

We have assessed the clinical significance of exit-site infections secondary to Xanthomonas maltophilia in continuous ambulatory peritoneal dialysis (CAPD) patients, and compared them with episodes due to Pseudomonas. The study was a retrospective survey of all episodes of Xanthomonas and Pseudomonas-related exit-site infections (ESI) in all patients treated in our unit between 1984 and 1992. Thirteen episodes of Xanthomonas-related ESI were observed in eight patients and 17 episodes of Pseudomonas-related ESI were seen in 15 patients. Xanthomonas-related ESI was frequently associated with other microorganisms, while Pseudomonas-related ESI was not (66% versus 5%, P < 0.02). Only one episode of Xanthomonas-related ESI resulted in peritonitis and subsequent catheter removal, after 15 months of resistant colonization. Another case was considered to be chronic and indolent, as the Xanthomonas-related ESI continued after 23 months of local treatment. The other 11 episodes were resolved either without treatment or with an antibiotic cream after 7-120 days. However, all but two episodes of Pseudomonas-related ESI required intravenous antibiotics (usually ceftazidime); seven patients developed peritonitis, and 11 required surgical catheter manipulation (five external cuff extrusion, and six catheter removal) (1/13 Xanthomonas-related versus 11/17 Pseudomonas-related ESI, P < 0.03). Most Xanthomonas-related ESI do not lead to peritonitis, and constitute a mild condition, easily treatable without parenteral antibiotics or catheter replacement. The appearance of other associated organisms and the favourable evolution with local treatment suggest a saprophytic behaviour for Xanthomonas in our CAPD patients. On the contrary, Pseudomonas-related ESI is usually severe, requires parenteral antibiotics, frequently leads to peritonitis, and requires catheter replacement.

[Acute otitis media in childhood. Clinical and microbiological study of 50 cases]. / Otitis media aguda en la infancia. Estudio clínico y microbiológico de 50 casos.

Fifty cases of acute otitis media effusion (AOME) in children less than 14 years of age are reported. The largest age group consisted of children less than 22 months of age (22 cases). Otolgia or irritability (80%) and fever (66%) were the most common symptoms. Tympanocentesis of the middle-ear effusion was performed in all of the cases. Haemophilus influenzae was recovered in 13 patients (26%), S. pneumoniae in 12 (24%), S. pyogenes in 4 (8%), P. aeruginosa in 2 (4%), anaerobic bacteria in 2 (4%) and mixed cultures in 4 children; 2 cases of H. influenzae and S. pneumoniae, 1 case of S. pneumoniae and E. coli, and 1 case of E. coli and P. aeruginosa. There were no cases of M. catarrhalis or S. aureus. We conclude that H. influenzae and S. pneumoniae are the most frequent pathogens (60% of all patients and 81% of the positive cultures).

Group B streptococcus and premature rupture of membranes and preterm delivery.

In a population of 1,050 pregnant women the effect of maternal colonization by group B Streptococcus on premature rupture of membranes (PROM), preterm delivery, and low weight was analyzed. A significant increment was found of the prevalence of PROM for patients colonized in the vagina and/or the rectum (26.4%) versus noncarrier patients (17.8%). In vaginal and/or rectal group B Streptococcus carriers, in whom group B Streptococcus was also isolated from the cervical culture, the rate of PROM was higher (41.7%), while when the cervical culture was negative, the PROM was similar to noncarriers. THere were no significant differences with respect to colonization conditions regarding the incidence of preterm delivery or the different preterm delivery indicators analyzed.