Efficacy of daptomycin in the treatment of enterococcal endocarditis: a 5 year comparison with conventional therapy.

OBJECTIVES: Enterococcus spp. account for 10% of infective endocarditis (IE). Although daptomycin is a bactericidal drug with in vitro activity against Enterococcus, there is little experience of its use in IE. We analysed the effectiveness of daptomycin in the treatment of enterococcal IE (EIE). METHODS: This was a retrospective descriptive study comparing the efficacy of daptomycin versus ampicillin/ceftriaxone versus conventional antibiotic regimens (ampicillin or vancomycin ±â€Šgentamicin) in EIE. RESULTS: From January 2007 to December 2011, 6 patients with EIE treated with daptomycin monotherapy were compared with 21 patients treated with ampicillin/ceftriaxone and 5 patients treated with ampicillin or vancomycin ±â€Šgentamicin. The three groups had similar epidemiological and clinical characteristics. Daptomycin indications were allergy to ß-lactams (n = 3), therapy simplification (n = 2), renal failure (n = 2) and Enterococcus faecium resistant to ampicillin/gentamicin (n = 1). Daptomycin MICs ranged from 1 to 2 mg/L and the doses were 6-10 mg/kg/day intravenously. Daptomycin patients had longer duration of bacteraemia (6 versus 1 day, P < 0.01) and greater need of therapy switch due to complications (66.7% versus 0%, P < 0.01). There were no differences regarding duration of hospital stay or mortality. CONCLUSIONS: Daptomycin-treated patients more frequently required a therapeutic change due to worse microbiological and clinical response, although mortality was not increased. Our findings do not support the use of daptomycin as single therapy in the treatment of EIE. Its role in combined strategies should be further investigated.

A review of difficult-to-treat post-traumatic osteomyelitis: Role of Clostridium celerecrescens. / Osteomielitis postraumática difícil de tratar: papel del Clostridium celerecrescens.

PURPOSE: We reviewed the clinical features of post-traumatic infections produced by Clostridium celerecrescens reported in the literature. C. celerecrescens is an emerging pathogen involved in traumatic wound infection that progresses to deep infection and osteomyelitis. METHODS: We found only 4 cases reported in the literature with enough data to be analysed and we added our own case and experience with this type of infection. The identification was performed by matrix-assisted desorption ionization-time of flight mass spectrometry (MALDI TOF) or API gallery, and 16S rRNA gene sequencing were performed to confirm identification in all cases. RESULTS: Identification of the bacteria is discrepant according to the method used due to the genetic and phenotypic similarities of other species of the genus. Identification through MALDI-TOF and API gallery is not suitable for determining the specie, confirmation by 16S rRNA sequencing being necessary. Treatment of the infection included complex antibiotic combinations and surgical treatment together with skin and soft tissue dressings due to the persistence of the pathogen over time. CONCLUSION: This report supports the pathogenic role of C. celerecrescens in post-traumatic infections and the need to improve the management of these difficult-to-treat infections.

Antimicrobial activity of ceftolozane-tazobactam against multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa clinical isolates from a Spanish hospital.

OBJECTIVE: Our objective was to evaluate the in vitro activity of ceftolozane-tazobactam against multidrug resistant (MDR) and extensively drug-resistant (XDR) non metallo-ß-lactamase producing Pseudomonas aeruginosa clinical isolates at Hospital Universitario Miguel Servet (Zaragoza, Spain) from February 2016 to October 2017. METHODS: We evaluated the in vitro activity of ceftolozane-tazobactam and other antipseudomonal antibiotics against 12 MDR and 117 XDR non metallo-ß-lactamase producing P. aeruginosa isolates. Ceftolozane-tazobactam minimal inhibitory concentrations (MICs) were determined by MIC gradient diffusion test strip. RESULTS: Among the 129 MDR/XDR isolates included, 119 (92.2%) were susceptible to ceftolozane-tazobactam, and ten (7.8%) were resistant. MIC50 was 2 mg/L, and MIC90 4 mg/L. Ceftolozane-tazobactam was the second most active antibiotic after colistin, overtaking amikacin. CONCLUSIONS: Ceftolozane-tazobactam is a valuable treatment option for MDR and XDR P. aeruginosa infections in our setting.

Osteomielitis postraumática difícil de tratar: papel del Clostridium celerecrescens / A review of difficult-to-treat post-traumatic osteomyelitis: Role of Clostridium celerecrescens

OBJETIVO: Se ha realizado una revisión sobre las infecciones producidas por Clostridium celerecrescens que aparecen recogidas en la literatura. C. celerecrescens es un patógeno emergente relacionado con infecciones de heridas traumáticas que progresan a infecciones profundas y osteomielitis. MÉTODOS: En la literatura solo se han encontrado 4 casos con suficientes datos para ser analizados; nosotros añadimos un nuevo caso y experiencia en el manejo de la infección. La identificación se realizó mediante espectrometría desorción/ionización láser asistida por matriz acoplada a un detector de tiempo de vuelo (MALDI-TOF) o mediante galería API. Se realizó secuenciación del ARNr 16S en todos los casos. RESULTADOS: La identificación de la bacteria fue discrepante según el método utilizado debido a las similitud fenotípica y genética con otras especies del mismo género. La identificación mediante MALDI-TOF y galerías API no resulta adecuada para la determinación a nivel de especie, siendo necesaria la secuenciación del ARNr 16S. El tratamiento de la infección incluye combinaciones de antibióticos complejas y tratamiento quirúrgico junto con curas de piel y partes blandas debido a la persistencia de la bacteria a lo largo del tiempo. CONCLUSIÓN: El presente estudio manifiesta el potencial patogénico de C. celerecrescens en infecciones postraumáticas y la necesidad de mejorar el tratamiento de estas infecciones

PURPOSE: We reviewed the clinical features of post-traumatic infections produced by Clostridium celerecrescens reported in the literature. C. celerecrescens is an emerging pathogen involved in traumatic wound infection that progresses to deep infection and osteomyelitis. METHODS: We found only 4 cases reported in the literature with enough data to be analysed and we added our own case and experience with this type of infection. The identification was performed by matrix-assisted desorption ionization-time of flight mass spectrometry (MALDI TOF) or API gallery, and 16S rRNA gene sequencing were performed to confirm identification in all cases. RESULTS: Identification of the bacteria is discrepant according to the method used due to the genetic and phenotypic similarities of other species of the genus. Identification through MALDI-TOF and API gallery is not suitable for determining the specie, confirmation by 16S rRNA sequencing being necessary. Treatment of the infection included complex antibiotic combinations and surgical treatment together with skin and soft tissue dressings due to the persistence of the pathogen over time. CONCLUSION: This report supports the pathogenic role of C. celerecrescens in post-traumatic infections and the need to improve the management of these difficult-to-treat infections

Free amino acids in the cerebrospinal fluid of children with febrile seizures.

The content of free amino acids in the cerebrospinal fluid from 52 children in different age groups with febrile seizures were determined and compared to 88 age matched children without seizures. We found that the concentrations of some amino acids in CSF in the control group decreased slowly with age, reaching the concentrations found in adults at the age of 3 to 6 years, and that the free amino acid levels were no significantly altered by temperature. The free amino acids in the CSF from patients with febrile seizures showed a different pattern of change with age. These results suggest that the same type of convulsive disorder may show a different alteration in amino acids in CSF depending on the patient's age, and that the degree of elevation of body temperature is not implicated in these changes.

Las medidas penales alternativas en Cataluña: Resultados obtenidos y retos para el futuro / No disponible

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