ESßL E. coli isolated in pig's chain: Genetic analysis associated to the phenotype and biofilm synthesis evaluation.

Resistance to new generation cephalosporins is an important public health problem globally, in terms of economic and social costs, morbidity and mortality. Βeta-lactamase enzymes are mainly responsible for the antibiotic resistance of Gram negative bacteria and extended-spectrum-ß-lactamases (ESßLs) are one of the major determinants of resistance against oxymino-cephalosporins in Enterobacteriaceae. Food-producing animals represent one of the sources of antibiotic resistant bacteria, including pigs. Here we analysed the presence of E. coli resistant to III generation cephalosporins isolated from different matrices collected from intensively bred pigs. A total of 498 E. coli were isolated from faeces and carcasses of pigs at slaughterhouse as well as from pork meat and sausages. Among these, 73 were phenotypically confirmed to be ESßL producers. Genetic analysis revealed that all except two harboured at least one of the three selected genes: blaCTX-M, blaTEM, and blaSHV. Furthermore, six of the E. coli ESßL isolated from faeces and carcasses swabs, were also able to produce biofilm, highlighting the virulence potential of these strains. The presence of Multi-Drug-Resistance patterns (MDR) recorded by the 73 ESßL E. coli was significant (60% of the strains were resistant to more than six antibiotics in MIC test). Results from the present study show that the transmission of resistant bacteria is possible along the food chain, including production of pork, one the most highly consumed meats around the world. Transmission is possible through the ingestion of raw meat products, and following cross-contamination between raw and cooked foods during preparation. The potential risk for human health demonstrated here, associated with the consumption of pork contaminated with bacterial strains characterized by multidrug resistance patterns, and the ability to produce ESßL and biofilm, is cause for concern. It is imperative to study future control strategies to avoid or limit as much as possible the transmission of these highly pathogenic strains through food consumption and/or contact with the environment.

Concentraciones plasmáticas de digoxina en cuatro esquemas terapéuticos de uso común en la práctica clínica / Digoxin plasma levels in patients usign four common therapeutic schedules

Background: The different therapeutic schedules used for the prescription of digoxin have little theoretical support. Aim: To measure digoxin plasma levels in patients using four different prescription schedules. Patients and methods: Four groups of patients were studied. Group I corresponded to 56 patients taking digoxin 0.25 mg/day, from Monday to Friday. Group II corresponded to 30 patients taking digoxin 0.25 mg/day, from Monday to Saturday. Group III corresponded to 53 patients taking digoxin 0.25 mg/day continuosly. Group IV corresponded to 36 patients taking digoxin 0.125 mg/day continuosly. Plasma digoxin levels were measured in two consecutive Mondays before taking the daily dose of the drug. Serum creatinine was also measured and creatinine clearance was calculated. The therapeutic plasma concentration range was set between 0.5 and 2 ng/ml. Results: Mean plasma digoxin levels were 1.15±0.8 ng/ml in group I, 1.4±0.55 ng/ml in group II, 1.68±0.7 ng/ml in group III and 1.14±0.43 ng/ml in group IV. 93 percent of patients in group I, 80 percent of patients in group I, 80 percent of patients in group II, 75 percent of patients in group III and 94 percent of patients in group IV had therapeutic digoxin levels. A low creatinine clearance, an age over 65 and interactions with other drugs were risk factors associated with supratherapeutic levels, mostly seen in group II and group III with 20 percent and 24 percent respectively. Conclusions: Most patients using digoxin with different therapeutic schedules had plasma drug levels within the therapeutic range