Evolution of antimicrobial susceptibility patterns of aerobic and facultative gram-negative bacilli causing intra-abdominal infections: results from the SMART studies 2003-2007.

Study for Monitoring Antimicrobial Resistance Trends (SMART) is an ongoing global antimicrobial surveillance program focused on clinical isolates from intra-abdominal infections (IAI). The objective of this subanalysis was to assess the evolution of the antimicrobial susceptibility patterns among aerobic and facultative gram-negative bacilli (GNB) recovered over a 5-year period at our institution. We tested the in vitro activity of the antimicrobials, commonly used to treat IAI, against consecutive unique isolates from IAI using microdilution techniques according to the CLSI guidelines for MIC testing. All isolates were screened phenotypically for extended-spectrum beta-lactamase (ESBL) production. Isolates recovered within 48 h of hospitalization were considered community-acquired (CA). Over the study period a total of 572 aerobic and facultative gram-negative bacilli were recovered from 510 patients, of which 258 (45%) were CA. Enterobacteriaceae composed 91% of the total isolates. Escherichia coli was the most common isolated species (52%). Susceptibility rates of Enterobacteriaceae ranged from 96.5 %-100 % to ertapenem, 96.5 %-100 % to imipenem, 87.7%-94.3% to piperacillin-tazobactam, 85.1%-94.3% to cefotaxime, 89.5%-100% to cefepime, 76.3%-84.8% to ciprofloxacin, and 93.8%-100% to amikacin. ESBL were detected in 6.3% of E. coli, 5.7% of Klebsiella spp. and 2.7% of Enterobacter spp. ESBL producers generally had a more antibiotic- resistant profile than non-ESBL producers and 16% of them were CA. Susceptibility rates to ertapenem, imipenem, piperacillin-tazobactam, ceftazidime, cefepime, ciprofloxacin and amikacin were, respectively, for P. aeruginosa: 28.2 %, 58.9%, 82%, 84.6 %, 76.9 %, 71.8% and 82%; for Acinetobacter baumannii: 33.3 %, 100 %, 66.6 %, 66.6 %, 66.6%, 66.6% y 66.6%, and for Stenotrophomonas maltophilia: 0%, 0%, 0%, 28.6%, 0%, 42.9% and 14.3%. Over the 5 year-study period we have not observed significant increases in resistance of aerobic and facultative GNB causing IAI to commonly used beta-lactam antimicrobial drugs. A minority of ESBL-producing Enterobacteriaceae were CA. Carbapenems, including group I agents like ertapenem, were the most reliably active drugs in vitro against isolates producing IAI.

High rates of antimicrobial co-resistance among Enterobacteriaceae: comparative analysis between clinical isolates resistant and susceptible to third-generation cephalosporins.

We compared the antimicrobial co-resistance of 3,402 clinical isolates of Enterobacteriaceae resistant to third-generation cephalosporins (2,569 ESBL-producing and 833 AmpC overproducing) with that of 16,220 susceptible isolates, in order to determine the impact of resistance to third-generation cephalosporins on the likelihood of resistance to other antimicrobial classes. Enterobacteriaceae resistant to third-generation cephalosporins, independently of their mechanism of resistance, were significantly more resistant to other classes of antimicrobials than susceptible isolates (p <0.001). Percentages of co-resistance to ciprofloxacin, gentamicin, tobramycin and trimethoprim-sulfamethoxazole of resistant isolates were: 51%, 39%, 53% and 51%, respectively. However, among the susceptible isolates, percentages were 17%, 7%, 6% and 19%, respectively. Fosfomycin exhibited excellent in vitro activity against urinary isolates (92%), mainly against ESBL-producing organisms (90%), and is a good alternative treatment of infections caused by multidrug resistant Enterobacteriaceae. Amikacin and imipenem were the most active antimicrobials against all species tested.

[Having diabetes without knowing it]. / Tener diabetes y no saberlo. Cribaje de diabetes desconocida en una muestra oportunista de población residente en Cataluña.

As part of the activities on the World Day for Diabetes in 2002, nine professors, one nurse who teaches about diabetes and 126 nursing students at University Schools of Nursing in Barcelona, Lleida, Tarragona, Tortosa and Girona, in collaboration with the Association of Diabetics in Catalonia and with the help of the Advisory Council for Diabetes in Catalonia participated in a diabetes screening campaign on the population residing in Catalonia. This campaign studied the prevalence of type two diabetes in a random sample of the Catalan population. This campaign also proposed to raise the awareness among the general population and among nursing students about the important health consequences diabetes has and to increase investigation and social support measures by nurses related to diabetes. This study checked 4083 persons and discovered 77 cases of altered blood-sugar levels among people who did not know they had diabetes. This finding means that there is a 2.2% prevalence of altered blood-sugar levels in the population who are not diagnosed diabetics. Professors and student participants all gave this experience positive marks and the students' degree of satisfaction was very high.

Effect of long-term antihypertensive therapy with angiotensin converting enzyme inhibitors on red cell sodium transport.

Several sodium transport abnormalities have been reported in erythrocytes from essential hypertensive patients. The possible modification of these parameters under antihypertensive treatment remains controversial. We have measured the maximal rates of the Na+/K+ pump, Na+/K+/Cl- cotransport, and Na+/Li+ countertransport and the rate constant of Na+ leak in erythrocytes from 22 essential hypertensive patient responders to angiotensin converting enzyme inhibitors quinapril or captopril, and from 17 patient nonresponders to these drugs. In the former group, sodium transport measurements were performed at the baseline placebo period and after 6 months of active treatment. The maximal rate of Na+/Li+ countertransport decreased significantly after 6 months of treatment, without differences between both groups of treatment. Angiotensin converting enzyme inhibitors did not significantly modify other sodium transport parameters. The basal activity of erythrocyte sodium transport was not different between patients who responded or not to antihypertensive treatment with those drugs, excluding a predictive value of these measurements concerning the response to angiotensin converting enzyme inhibitors.

[Insulin resistance and metabolic syndrome in first-degree relatives of patients with NIDDM]. / Resistencia a la insulina y síndrome metabólico en familiares de primer grado de pacientes con diabetes mellitus tipo 2.

BACKGROUND: Relatives of type 2 diabetes mellitus (DM2) patients present or can develop the plurimetabolic syndrome (MS). Insulin sensitivity determination could be useful to detect relatives with higher risk. PATIENTS AND METHODS: Insulin sensitivity (IS) and MS in 106 first degree relatives of DM2 and 52 control subjects, matched for age, sex and body mass index (BMI). Insulin sensitivity was evaluated by the HOMA method. Insulin sensitivity was classified as high, middle or low according to the percentiles 33 and 66 observed in the control group. MS was diagnosed if hyperglycemia, hypertension, hypertriglyceridemia and overweight (two or more) were present. RESULTS: Insulin sensitivity was lower in relatives (36.3 vs 51.8%; p = 0.0001). Relatives with lower insulin sensitivity (n = 56) have higher BMI (29.2 vs 25.6 kg/m2), higher systolic (128 vs 116 mmHg) and diastolic (80 vs 74) blood pressure, hyperglycemia (5.7 vs 5.1 mmol/l), hyperinsulinemia (116 vs 59 pmol/l) and hypertriglyceridemia (1.4 vs 1.0 mmol/l) when compared with the remainder relatives (n = 50). Age, sex, waist/hip ratio and cholesterol level were similar in both groups. 23 relatives have MS (20 of them with low insulin sensitivity, relative risk = 8.7; 95% confidence interval 2.4-31.6). In multiple logistic regression analysis, only age and IS have a significant value to predict the presence of MS. CONCLUSIONS: Relatives of DM2 are insulin-resistant and present a high prevalence of MS. Both insulin sensitivity and MS are highly correlated. Insulin sensitivity evaluation using a simple methodology like HOMA can be useful in the selection of relatives at higher risk of MS.

[Comparative study of nicardipine versus placebo in the prevention of cognitive deterioration in patients with transient ischemic attack]. / Estudio comparativo de nicardipina frente a placebo en la prevención del deterioro cognitivo en los pacientes con accidentes isquémicos transitorios.

The neuropsychological follow up of transient ischemic attacks can provide a model for evaluating the efficiency of a drug in vascular dementia. A double blind study has been conducted using nicardipine, a calcium-antagonist, as opposed to a placebo in 40 patients with transient ischemic attacks, over a six month period. The patients were evaluated according to a Wechsler's intelligence scale, and their memory was also tested before and after this period. Although no alterations were registered on either scale, some differences did appear in certain sub-tests, especially as regards the verbal coefficient. This pilot study has provided information concerning the possible beneficial effect of the drug, which should be proven by means of a larger-scale study.

Comparison of human insulin and insulin analogues on hypoglycaemia and metabolic variability in type 1 diabetes using standardized measurements (HYPO score and Lability Index).

To evaluate whether treatment with insulin analogues is associated with a lower risk of hypoglycaemia (HYPO score) and less glycaemic variability (Lability Index) than treatment with human insulin in patients with type 1 diabetes. In a 6-month prospective, open-labelled trial, we randomized 47 patients treated with human insulin to receive treatment with human insulin (n = 21) or insulin analogues (n = 26). HYPO score, Lability Index (LI), and hypoglycaemic episode characteristics were assessed at baseline and at the end of follow-up. A 72-h, continuous glucose monitoring was performed at the end in a subgroup of patients. Groups were compared with nonparametric tests. Significance was defined as P < 0.05. HYPO score (71.5 [36.0-162] vs. 260 [52.0-676], P < 0.05), nocturnal hypoglycaemia (0.4 vs. 1.4 events/patient/4-week, P < 0.05), and <2.5 mmol/l hypoglycaemic events were lower in insulin analogue group after 6 months. There was a trend towards a lower LI in insulin analogue group (74.3 [51.3-133] vs. 123 [76.4-171] mmol/l(2)/h week(-1), P = 0.064). HbA1c and insulin dose were comparable between groups. In type 1 diabetes, insulin analogues were associated with a lower hypoglycaemic risk and a trend towards reduced glycaemic variability compared with human insulin. These effects occurred despite comparable metabolic control.

Multiple sclerosis in Spain: an epidemiological study of the Alcoy health region, Valencia.

Alcoy is a defined health region in eastern Spain, at 3 degrees E-38 degrees N, with a single neurology department and includes 33 towns with a total population of 133,915 inhabitants. We have evaluated the prevalence and incidence of multiple sclerosis (MS) by analysing this region. Six new cases have been detected (2.24/100,000/year) and the prevalence rate was 17.17/100,000, the highest in Spain at the moment. However, we found an irregular distribution in the different towns in so far that 15 of our 23 patients lived in a particular subregion, which means a prevalence of 44.59/100,000. Our study shows that the area of Alcoy is a medium MS risk region according to the thesis of Kurzke, although high MS areas may be found, thus confirming that MS distribution in southern Europe is not uniform.

Ischemic stroke in young adults. II. Analysis of risk factors in the etiological subgroups.

A prospective study on 386 consecutive patients affected of ischemic stroke (IS) has been analysed in relation to etiologies, comparing them with a control group of 100 people. The atherotrombotic etiology subgroups are associated with family history of stroke, risk factors, atheromatosis, occlusive peripheral arteriopathy, previous of stroke, high levels of hematocrit and hemoglobin, impaired lipid fractions and high levels of uric acid. The cardiac embolism etiology subgroups are associated with the presence of personal history of stroke, just as the mitral valva prolapse (MVP) patients group. The migraine group is significantly related with the intake of oral contraceptives.

Cardiovascular reflexes in patients with malignant disease.

Although some authors have reported clinical features of autonomic dysfunction in patients with malignant disease only a few systematic studies have been carried out. We have investigated the autonomic function of 48 patients with carcinoma or lymphoma by testing their cardiovascular reflexes, and compared their results with those of 62 healthy volunteers. Our patients showed a smaller increase in heart rate and a greater fall in blood pressure on standing up, as well as a smaller rise in blood pressure in response to contralateral handgrip. The study group showed a higher percentage of established sympathetic lesion (54.2% vs 27.4%, p: 0.008) and of atypical pattern of global autonomic function impairment (50% vs 24.2%, p: 0.03) than the control group. Our data suggest that patients with malignant disease suffer from a definite autonomic dysfunction.

Ischemic stroke in young adults. I. Analysis of the etiological subgroups.

An ischemic stroke (IS) group including 386 patients under 50 years old is analysed taking into account different etiological subgroups and comparing risk factors against a control group of 100 people. The series points out the presence of 66.1% patients included in the inconclusive-atherothrombosis group, of which 22.7% had defined criteria of atheromatosis, while 11.6% were diagnosed of lacunar infarct. 13.5% of cases were considered as cardiac origin embolisms, and 14.1% were affected of mitral valve prolapse. The migraine group includes 4.9% of the patients while 17.6% belong to the miscellaneous group. The comparison of each of these groups with the control group showed significant differences for family history of stroke, personal history of peripheral arteriopathy, tobacco, arterial hypertension and previous IS.

[Normalization of cognitive and functional assessment instruments for dementia (NORMACODEM) (I): objectives, content and population]. / Normalización de instrumentos cognitivos y funcionales para la evaluación de la demencia (NORMACODEM) (I): objectivos, contenidos y población.

UNLABELLED: To adequately evaluate patients with 4 neuropsychological deficits a project for norming cognitive and functional instruments that assess dementia (NORMACODEM) was designed. Four hundred fifty-one subjects in three groups: 254 controls, 86 patients with minor memory/cognitive deficits without dementia (DWD) and 111 patients with probable Alzheimer-type dementia (ATD) according to the NINCDS/ADRDA criteria. Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale (ADAS), Abbreviated Barcelona Test (ABT), Global Dementia Staging (GDS), Functional Assessment Staging (FAST), Clinical Dementia Rating (CDR), Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), Interview for Deterioration in Daily life in Dementia (IDDD), Geriatric Evaluation by Relatives Rating Instrument (GERRI), Geriatric Depression Scale (GDS), Zung Self-Rating Anxiety Scale (ZSRAS). Descriptive statistics and analysis of variance. The characteristics of the sample were as follows. CONTROLS: 99 men, 155 women. Mean (SD) age: 64.6 (10.9) years. Mean (SD) educational level: 9.1 (4.9) years. DWD: 42 men, 44 women. Mean (SD) age: 65.8 (8.7) years. Men (SD) educational level: 8.4 (4.4) years. ATD: 48 mean, 63 women. Mean (SD) age: 68.3 (8.0) years. Mean (SD) educational level: 6.2 (4.3) years. The ATD patients were significantly older than the controls. Mean educational level was significantly lower in the ATD group than in the other two.