The updated Charlson comorbidity index is a useful predictor of mortality in patients with Staphylococcus aureus bacteraemia.

The objective was to compare the performance of the updated Charlson comorbidity index (uCCI) and classical CCI (cCCI) in predicting 30-day mortality in patients with Staphylococcus aureus bacteraemia (SAB). All cases of SAB in patients aged ⩾14 years identified at the Microbiology Unit were included prospectively and followed. Comorbidity was evaluated using the cCCI and uCCI. Relevant variables associated with SAB-related mortality, along with cCCI or uCCI scores, were entered into multivariate logistic regression models. Global model fit, model calibration and predictive validity of each model were evaluated and compared. In total, 257 episodes of SAB in 239 patients were included (mean age 74 years; 65% were male). The mean cCCI and uCCI scores were 3.6 (standard deviation, 2.4) and 2.9 (2.3), respectively; 161 (63%) cases had cCCI score ⩾3 and 89 (35%) cases had uCCI score ⩾4. Sixty-five (25%) patients died within 30 days. The cCCI score was not related to mortality in any model, but uCCI score ⩾4 was an independent factor of 30-day mortality (odds ratio, 1.98; 95% confidence interval, 1.05-3.74). The uCCI is a more up-to-date, refined and parsimonious prognostic mortality score than the cCCI; it may thus serve better than the latter in the identification of patients with SAB with worse prognoses.

[Clinical implications of the genus Mycoplasma]. / Implicaciones clínicas de las especies del género Mycoplasma.

Within Mycoplasma genus, M. pneumoniae, M. genitalium, M. hominis or U. urealyticum are the main species that have been traditionally linked to infectious processes. However, there are many other species involved in these conditions and that are, frequently, unfamiliar to healthcare professionals. The aim of this review is to identify all Mycoplasma genus species that have been isolated in human beings and to determine their involvement in infectious pathology.

[Simulation of an outbreak of Acinetobacter baumannii in hospitals]. / Simulación de la propagación de un brote por Acinetobacter baumannii en entornos hospitalarios.

OBJECTIVE: Acinetobacter baumannii infections have increased over time becoming a significant issue. Consequently, those applications that allow to predict the evolution of an outbreak and the relevance of the different control methods, are very important. The design of mathematical models plays a central role in this topic. METHODS: Development of a deterministic mathematical model based on ordinary differential equations whose variables and parameters are defined upon the basis of knowledge of the epidemiology and characteristics of A. baumannii. This model is analyzed from a qualitative point of view and, also, its computational implementation is derived. RESULTS: Several simulations were obtained developed from different initial conditions. The qualitative analysis of these simulations provides formal evidence of most effective control measures. CONCLUSIONS: The implementation of the computational model is an extremely useful tool in terms of managing A. baumannii outbreaks. There is mathematical proof of the fact that the observance of efficient hygiene and screening rules reduces the number of infected patients.

Antibacterial agents in the cinema.

Numerous procedures used as antibacterial therapy are present in many films and include strategies ranging from different antimicrobial drugs to surgery and supporting measures. Films also explore the correct use and misuse of antimicrobial agents. Side effects and other aspects related to antibacterial therapy have also been reflected in some films. This article refers to the presence of antibacterial agents in different popular movies. There are movies in which antibacterial agents form part of the central plot, while in others it is merely an important part of the plot. In still others, its presence is isolated, and in these it plays an ambient or anecdotal role.

The clinical microbiologist before the taxonomic changes in the genus Clostridium.

The various species included in the genus Clostridium are very heterogeneous, both from a phenotypic and a phylogenetic point of view. The advances in polyphasic taxonomy, particularly in phylogeny, are allowing to resolve this dysfunction reclassifying several species in other genres, although there is still work to be done. Changes in generic denominations are quite normal in taxonomy, but can turn into a problem when they affect species with strong clinical impact and that have been recognised for a long time, as in the case of some traditional Clostridium species. After knowing these changes clinical microbiologists, in whose work taxonomy is an essential tool, should evaluate what matters most, if the communication with other health professionals or the phylogeny, and think about the possibility of combining both things. This paper reviews some of the taxonomic changes that have took place in well-known Clostridium species that can be clinically interesting and evaluates, as far as possible, their significance in the scientific and medical communication.

[Changes in the epidemiology of Clostridium difficile infection during 2005-2014 in Salamanca, Spain]. / Cambios en la epidemiología de la infección por Clostridium difficile durante 2005-2014 en Salamanca, España.

OBJECTIVE: To know the most relevant epidemiological features of Clostridium difficile infection (CDI) between 2005- 2014 in the province of Salamanca (Spain). METHODS: Descriptive cross-sectional study carried out through review of the clinical microbiologic records at Complejo Asistencial Universitario de Salamanca. Detection was performed according to standard methodology. RESULTS: 2.6% of stool samples analyzed for detection of C. difficile toxins (9,103) were positive. The average prevalence was 6.8 cases per 100,000 people per year. The mean age was 65 ± 21.4 years and the median 70 years. 59% of cases occurred in patients over 64 years, with an average prevalence of 16.5 (4 times higher than the 15-64 group). Most cases (86.4%) occurred in hospitalized patients, and the group of over 64 had the highest percentage of hospital CDI, with 55%. CONCLUSIONS: A significant increase in the number of requests and in the prevalence of CDI over the decade studied is observed, and prevalence rates were significantly lower than those of other studies. The percentage of CDI increased significantly in both inpatient and community. Age and hospitaliza-tion were risk factors for developing CDI. After the introduc-ion of a molecular detection technique in 2014, the prevalence increased, being 2.5 times higher than 2013.

Review of pulmonary brucellosis: a case report on brucellar pulmonary empyema.

In certain geographic areas, among which most South European countries are included, brucellosis continues to be an important health problem. Despite the disease's continued high prevalence, the advances made in its diagnosis and treatment have contributed to the rarity of different focal locations, such as the lung. Formerly, these occurrences were much more frequent. The present work offers a review of the literature on pulmonary brucellar affection and describes a case report of brucellar pulmonary empyema with isolation of Brucella melitensis from the pleural exudate. This constitutes an exceptional circumstance even in areas considered hyperendemic, such as a large part of Spain.

Current status of bacterial resistance to third-generation cephalosporins.

A review of the evolution of bacterial resistance to third-generation cephalosporins is presented, focusing mainly on the prototypical member of this group-cefotaxime. Third-generation cephalosporins generally remain highly active against most Enterobacteriaceae, staphylococci, streptococci, Haemophilus, and Neisseriaceae. Only enterobacteria with a high frequency of mutant derepressed strains that hyperproduce chromosomally mediated beta-lactamase, Pseudomonas spp., and some glucose nonfermenter Gram-negative bacilli have demonstrated increased levels of resistance. The significance of derepressed strains and of the recently described extended-spectrum, plasmid-mediated beta-lactamases to the usefulness of the third-generation cephalosporins is discussed.

Antibiotic susceptibility profile of Xanthomonas maltophilia. In vitro activity of beta-lactam/beta-lactamase inhibitor combinations.

The susceptibility of 42 strains of Xanthomonas (Pseudomonas) maltophilia to 37 antibiotics (mainly beta-lactams, aminoglycosides, and fluorinated quinolones) was tested. Xanthomonas maltophilia was resistant to most beta-lactams, with ceftazidime, moxalactam, and ICI-194008 being the most active ones. Aminoglycosides had a very modest activity, with quinolones showing only moderate activity against this species. Trimethoprim/sufamethoxazole was effective against all strains tested. We also tested the synergy of several beta-lactam/beta-lactamase inhibitors against X. maltophilia. Only aztreonam/clavulanic acid at 3:1, 1:1 and, mainly, 2:1 combinations had synergistic activity, decreasing the rate of resistance from 92.8% for aztreonam alone to 32.4% for aztreonam-clavulanic acid at 1:1 and 0% for aztreonam-clavulanic acid at 2:1.

Oral cephalosporins: current perspectives.

Oral cephalosporins had been, for years, a small group of compounds belonging to the first or second-generation cephalosporins, with a limited antimicrobial spectrum. New oral first-generation cephalosporins include cefprozil and loracarbef, similar to cefadroxil and cefaclor, respectively, with activity similar to cefaclor but with pharmacokinetic improvements. Second-generation oral cephalosporins are esters of already available cephalosporins, and third-generation oral cephalosporins include a number of drugs whose activity is similar to available parenteral drugs, showing pharmacokinetic advantages and, some of them, better resistance to hydrolysis mediated by extended wide-spectrum beta-lactamases. They may be a good alternative against mild to moderate ENT infections, UTIs, STDs, lower respiratory tract and skin and soft tissue infections, mainly in the outpatient setting.

In vitro activity of tigemonam against urinary tract pathogens.

Tigemonam's in vitro activity was compared with that of aztreonam, cefotaxime, gentamicin, and norfloxacin. Thirty-two strains of Pseudomonas and 960 strains of Enterobacteriaceae were studied using the agar dilution method (including Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter sp., Serratia marcescens, Proteus mirabilis, Proteus vulgaris, Morganella morganii, and Salmonella enterica). Tigemonam displayed good activity against Enterobacteriaceae. Minimum inhibitory concentrations (MICs), were as follows: MIC50S were 0.01 mg/L for P. mirabilis and 0.5 mg/L for S. marcescens, MIC90S were 0.03 mg/L for P. mirabilis and P. vulgaris and 4 mg/L for Citrobacter freundii. Tigemonam inhibited E. coli and P. mirabilis, the most common strains of urinary pathogens. Despite MIC90S of 9.5 and 4 mg/L for Enterobacter and C. freundii, respectively, resistance to tigemonam was observed. Tigemonam was found to be inactive against Pseudomonas aeruginosa, with MIC50S and MIC90S higher than 128 mg/L (range, 64 to greater than 128 mg/L). Tigemonam's activity was found to be similar to that of cefotaxime, slightly less than that of norfloxacin and aztreonam, and substantially greater than that of gentamicin. Of all the drugs tested, only norfloxacin and aztreonam possessed activity profiles against P. aeruginosa that were compatible with their clinical usefulness (MIC90, 8 mg/L for norfloxacin; MIC50, 8 mg/L and MIC90, 32 mg/L for aztreonam). Cefotaxime and gentamicin showed no activity on more than 90% of the P. aeruginosa strains tested.

Activity of BAY y 3118, a novel 4-quinolone, against Brucella melitensis.

We have tested the in-vitro activities of BAY y 3118, a new chlorofluoroquinolone, ciprofloxacin, sparfloxacin, streptomycin, tetracycline and rifampin against 59 strains of Brucella melitensis. BAY y 3118 (MIC90 0.12 mg/L) was twice as active as sparfloxacin and tetracycline (MIC90 0.25 mg/L). The activity of ciprofloxacin, rifampin and streptomycin (MIC90 0.5, 2, and 8 mg/L, respectively) was, respectively, four-, sixteen-, and more than sixty-fold lower than that of BAY y 3118.

In vitro activity of BAY y 3118, and nine other antimicrobial agents against anaerobic bacteria.

The antibacterial activity of BAY y 3118, a new chlorofluoroquinolone, was determined against 257 strains of anaerobic bacteria and compared with the activities of ofloxacin, ciprofloxacin, sparfloxacin, imipenem, cefoxitin, clindamycin, chloramphenicol, metronidazole, and ornidazole. Overall, BAY y 3118 was the most active agent tested against the Bacteroides fragilis group. Its activity (MIC90, 0.5 mg/L) was 16-fold lower than that of sparfloxacin (MIC90, 8 mg/L), and more than 100-fold lower than that of ofloxacin (MIC90, 64 mg/L) and ciprofloxacin (MIC90, 128 mg/L) against the group. No strains belonging to this group were resistant to metronidazole (MICs range, 0.12-2 mg/L) and ornidazole (MICs range, 0.12-4 mg/L). BAY y 3118 was more active than those quinolones against Prevotella and Porphyromonas spp., Fusobacterium spp., Clostridium perfringens and C. difficile (MIC90, 0.12, 0.06, 0.12 and 0.25 mg/L, respectively). The activity of BAY y 3118 against Peptostreptococcus spp. (MIC90, 1 mg/L) was slightly lower than that of the other Gram-positive bacteria tested. In general, BAY y 3118 was more active than cefoxitin, and it was superior to antianaerobic chemical agents like metronidazole, ornidazole and clindamycin. Pharmacokinetic and clinical trials are required to define the role of BAY y 3118 in the treatment of anaerobic infections.

Kinetics of antimicrobial activity of amoxicillin/clavulanic acid and metronidazole against beta-lactamase-producing Bacteroides fragilis group.

Bacteroides fragilis group are the most common anaerobic bacteria isolated in clinical specimens. The use of a beta-lactam with a beta-lactamase inhibitor should result in a marked increase in the group's sensitivity to the beta-lactams. Since the activity (MIC) shown by the amoxicillin + clavulanic acid combination against Bacteroides fragilis group is good, other parameters of in vitro activity have been studied. This study was also done with metronidazole. The minimum inhibitory concentration (MIC) was determined in 26 strains of Bacteroides fragilis group (14 B. fragilis; 5 B. thetaiotaomicron; 4 B. vulgatus; 3 B. distasonis). Likewise, the minimum bactericidal concentration (MBC), the killing curve, the sub-MIC and post-antibiotic effect were determined. The MIC ranged between 0.5 and 32 mg/l. The MBC was two- to four-fold the MIC for amoxicillin/clavulanic acid, and one- to two-fold the MIC for metronidazole for most strains. The killing curve showed a continuous decrease, sloping most sharply between 0-2 hours and 6-8 hours. Amoxicillin + clavulanic acid showed a post-antibiotic effect between 2 and 4 hours. The inhibitory minimum antibiotic concentration was one-half the MIC for most strains.

In-vitro activity of meropenem, a new carbapenem, against imipenem-resistant Pseudomonas aeruginosa and Xanthomonas maltophilia.

The activity of meropenem, a new carbapenem, as well as imipenem, ceftazidime, aztreonam, tobramycin, amikacin and ciprofloxacin against 18 strains of Xanthomonas maltophilia and 23 strains of Pseudomonas aeruginosa resistant to imipenem was tested. All strains of X. maltophilia were resistant to both penems. Ceftazidime, tobramycin and ciprofloxacin were the most active antimicrobial agents against this specie. 17% of imipenem-resistant strains of P. aeruginosa were sensitive to meropenem. Ciprofloxacin, amikacin and aztreonam were the most effective agents against these strains.

In vitro activity of meropenem against ciprofloxacin-resistant enterobacteriaceae and Pseudomonas aeruginosa.

The in-vitro susceptibilities of a total of 174 ciprofloxacin-resistant Enterobacteriaceae and Pseudomonas aeruginosa were determined. According to the BSAC and NCCLS breakpoints, meropenem, aztreonam, ceftibuten, ceftazidime, imipenem and cefotaxime were the most active (> 90%) antimicrobial agents tested against Enterobacteriaceae. Susceptibility of these strains to piperacillin/tazobactam, cefpodoxime and cefixime (84.96%) was higher than that to tobramycin, gentamicin and fosfomycin (50-75%). More than 90% of P. aeruginosa were susceptible to meropenem when both interpretative susceptibility breakpoint criteria were used. Piperacillin, piperacillin/tazobactam and ceftazidime were active against 50-75% of the same strains. Meropenem was the most active antimicrobial tested against all ciprofloxacin-resistant clinical isolates assayed.

Aztreonam/clavulanic acid in the treatment of serious infections caused by Stenotrophomonas maltophilia in neutropenic patients: case reports.

Two seriously neutropenic patients (a 23-year-old man with a promyelocytic acute myeloid leukemia [AML-M3] and a 77-year old male with an immature acute myeloid leukemia [AML-M1] diagnosis) with severe infections caused by Stenotrophomonas maltophilia were treated with aztreonam/clavulanic acid (2:1) combination. In the first patient the infection was caused by a multiresistant strain and in the second, by a strain with poor response to trimethoprim-sulfamethoxazole and other antimicrobial agents. After treatment with aztreonam/clavulanic acid both patients evolved favorably.

Cefdinir: in vitro activity study and effect of human serum.

The in-vitro activity of cefdinir (Cl-983, FK482), an orally absorbed aminothiazole cephalosporin, was compared with that of penicillin, ampicillin, amoxycillin, amoxycillin/clavulanic acid (2/1), cefaclor, cefuroxime, cefixime, cefotaxime, vancomycin and erythromycin against 370 clinical isolates of Gram-negative and Gram-positive bacteria. Cefdinir was highly active against Staphylococcus aureus and S. epidermidis, inhibiting 90% of the strains at doses of 0.25 and 0.5 mg/l respectively. However, cefdinir was not active against methicillin-resistant S. aureus (range 16- > 128 mg/l). The respiratory pathogens Moraxella catarrhalis, Streptococcus pneumoniae, and S. pyogenes were also susceptible (MIC90 < or = 0.5 mg/l), but against Enterococcus spp. cefdinir displayed no useful activity. The common members of the family Enterobacteriaceae were susceptible (MIC90 < or = 1 mg/l), but those possessing chromosomal beta-lactamases were more resistant (MIC90 2-8 mg/l). The presence of human serum had little effect on MICs of cefdinir. These results indicate that cefdinir exhibited a wide spectrum for an oral cephalosporin and support its possible clinical use against susceptible pathogens in infections of the skin, soft tissue, respiratory and urinary tracts.

[Clinical and analytic diagnostic evaluation of deep venous thrombosis of the lower limbs]. / Valoración diagnóstica clínica y analítica de la trombosis venosa profunda de miembros inferiores.

BACKGROUND: Diagnosis of deep-vein thrombosis (DVT) of lower limbs has changed in recent years. The objective of our study was to analyze the diagnostic accuracy of a combination of clinical and epidemiological data and the D-Dimer plasma levels in this entity. PATIENTS AND METHODS: Clinical (symptoms and signs) and epidemiological data, personal and family history, and D-dimer plasma levels or positivity were reviewed, on the admittance, in 108 patients to whom a phlebography was performed due to a suspected DVT. RESULTS: Phlebography was positive in 76 cases (70.37%). Logistic regression analysis determined a prediction model of the diagnostic of DVI including a combination of both D-dimer plasma levels or positivity and pain along the deep venous involved area. CONCLUSION: Combination of D-dimer testing and pain along the distribution of the deep venous area is useful as an initial diagnostic approach to the DVI of the lower limbs.

[Characteristics of Helicobacter (Campylobacter) pylori infection in our field]. / Características de la infección por Helicobacter (Campylobacter) pylori en nuestro medio.

The presence of helicobacter pylori in the stomach in patients with clinical signs of gastroduodenal disease and its possible relationship with several clinical, endoscopic and anatomopathologic characteristics of the illness were prospectively evaluated in 359 patients. H. pylori was isolated from 388 samples in 216 patients (60% of colonization). In patients with endoscopic and, or, anatomopathologic evidence of gastroduodenal alterations the microorganism was isolated in 67% of the instances whereas it was observed in only 7% of the patients free of such alterations (p less than 0.001). The prevalence was 100% in cases of bulboduodenitis, 77% in patients with peptic ulcer, 66% in cases of gastritis, and 20% in neoplastic patients. The colonization index for duodenal ulcer was 80% and that of gastric ulcer 70%. Among the cases with gastritis the highest index corresponde to the superficial chronic gastritis (82%). We failed to observe clinical signs that allowed to envisage the presence or absence of H. pylori in the gastric mucosa.