[Community-acquired, methicillin-resistant Staphylococcus aureus acute osteomyelitis and pneumonia]. / Osteomielitis aguda y neumonía comunitaria por Staphylococcus aureus resistente a meticilina.

The appearance of a community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a increasingly important problem. We describe the case of a child suffering a CA-MRSA osteomyelitis complicated with a non-necrotizing pneumonia. The fast resolution of the pulmonary infection contrasts with the poor evolution of the septic bone. We emphasise the importance of correct surgical drainage to clear the infection. We review the literature on this emergent pathogen.

Immunocytochemical investigation of normal and chronic lymphocytic leukaemia lymphocytes reveals unexpectedly frequent reactivity with some myelomonocytic associated antibodies.

Information about the expression of some myelomonocytic markers in lymphocytes of patients with B-CLL is scarce. We studied the CD13, CD14, CD11c and CD68 surface antigens in 42 controls and in 38 patients with B-CLL to detect their possible reactivity. Eighty-nine percent of B-CLL expressed very strongly the CD14 antigen; on the contrary, the other myelomonocytic antigens tested were very weakly expressed. Forty-one of 42 controls showed a few CD14-positive lymphocytes with a statistical difference between normal and CLL lymphocytes. No statistical difference was recorded either between CD14 expression and Rai's staging system or Binet's stages, nor between CD14 and bone marrow involvement and doubling time or between CD14 and heavy or light chain expression. A minor B lymphocytic subset in humans coexpresses the CD14 and CD5 antigens, it being increasingly speculated that B chronic lymphocyte leukaemias originate precisely from this B CD5- and CD14-positive cells. Just as the CD5 antigen is regarded as an excellent B-CLL marker, it seems to us that a strong expression of the CD14 antigen might have the same diagnostic relevance.

[Pseudohemopathy caused by rhabdomyosarcoma]. / Seudohemopatía por rabdomiosarcoma.

A 26-year-old male with a primary rhabdomyosarcoma of maxillary sinus is reported. The tumor was initially mistaken for an anaplastic Ki-1 positive anaplastic lymphoma in the histological preparation, owing to its high indifferentiation degree. After a smear study it was categorized as IEA, and chemotherapy of CHOP type was started; after two courses, local telecobalt therapy was given. After this was completed, the disease showed a progression, involving the bone marrow and resulting in clinical and cytological features consistent with acute leukemia. At that time we saw the patient for the first time. He is presently in complete remission after having started polychemotherapy of CVADIC type. After a commentary on the major study steps that led to the diagnosis, the crucial role of electron microscopy and, particularly, immunocytology for the correct identification of anaplastic tumors is emphasized.

[Changes in the sensitivity of Escherichia coli to 6 antimicrobial agents during the last 12 years. Group of Microbiologists of County Hospitals of Catalonia]. / Evolución de la sensibilidad de Escherichia coli a 6 antimicrobianos durante los últimos 12 años. Grupo de Microbiológos de Hospitales Comarcales de Catalunya.

OBJECTIVE: To study the current state and development in the sensitivity of Escherichia coli during 12 years, in order to find the use of 6 antimicrobials. DESIGN: A descriptive study of the annual sensitivity percentages of E. coli strains isolated from clinical samples between 1984 and 1995. SETTING: Microbiology Laboratories in 15 County Hospitals in the province of Barcelona. PATIENTS AND PARTICIPANTS: E. coli strains, isolated from clinically significant samples, were studied for sensitivity against antimicrobials. MEASUREMENTS AND MAIN RESULTS: Cefuroxime and Gentamicin had in vitro sensibility above 94%. Current sensitivity of E. coli to Norfloxacin was 85%. Amoxicillin-Clavulanic acid maintained its sensitivity at about 80% with few variations. Ampicillin and Co-trimoxazole had steady sensitivity figures, always below 50 and 70%, respectively. CONCLUSIONS: Progressive decrease in the sensitivity of E. coli strains to Norfloxacin was observed. There was excellent sensitivity to Cefuroxime and Gentamicin.

[Enterococci: high level of resistance to aminoglycosides in strains isolated by different laboratories in Catalonia]. / Enterococos: alto nivel de resistencia a aminoglucósidos en cepas aisladas por distintos laboratorios de Cataluña.

We study 583 strains of enterococci isolates by 19 laboratories from Catalonia: 546 E. faecalis (93.5%), 34 E. faecium (6%) and 3 E. durans (0.5%). We inoculated all the strains in Müeller-Hinton agar with 2,000 mg/l of one of the following aminoglycoside: gentamicin, tobramycin, amikacin, streptomycin and kanamycin. Global incidence of high-level resistance was 9.4% to gentamicin, 7.3% to tobramycin, 0.2% to amikacin, 30.3% to streptomycin and 37.7% to kanamycin, with important changes in regard of procedence.

[Enterococci: high level of resistance to aminoglycosides]. / Enterococos: alto nivel de resistencia a aminoglucósidos.

According to different authors, the emergence of enterococci with high-level aminoglycoside-resistance reaches values of 4.5-55%. The objective of this work is to determine the frequency of these strains in our hospital. We have studied 274 strains of enterococci isolated in our centre, of which 235 were E. faecalis and 39 E. faecium. Strains were obtained from haemocultures (75), urine cultures (100) and other samples (99). The detection of high-level resistance was performed on Mueller-Hinton agar, containing concentrations of 2,000 mg/l of streptomycin, kanamycin, gentamicin, tobramycin or amikacin. MICs and MBCs were determined for several antibiotics by microdilution. We detected the presence of high-level resistance to streptomycin, kanamycin, gentamicin, tobramycin and amikacin in 29.1%, 52.9%, 31.0%, 26.6%, and 1.8% respectively. The more active antibiotics against the strains with high-level resistance to gentamicin were: mezlocillin (MIC90 = 1.0 mg/l), piperacillin and vancomycin (MIC90 = 2.0 mg/l), and ampicillin and imipenem (MIC90 = 4.0 mg/l).