Comparative Study on Nosocomial Biliary Tract Infection Rate Between Biliary Stent Loaded with Radioactive 125 I Seeds and Conventional Biliary Stent in the Treatment of Distal Malignant Biliary Obstruction.

BACKGROUND: The purpose of this prospective randomized study was to compare the nosocomial biliary tract infection rate of biliary stent implantation with a biliary stent loaded with radioactive 125 I seeds (radioactive biliary stent, RBS) and conventional biliary stent (CBS); additionally, to preliminary discuss the causes of postoperative cholangitis. Moreover, the results will provide clinical evidence for the prevention of postoperative biliary tract infection. MATERIALS AND METHODS: We prospectively analyzed the nosocomial infection rate of the distal malignant biliary obstruction (MBO) treatment by stent implantation with RBS and CBS. All MBO patients who initially visited our tertiary hospital between July 2015 and December 2019 (n= 196) were evaluated, enrolled, and randomly divided into 2 groups, RBS (n=97) and CBS (n=99) group. χ 2 test was used to evaluate the categorical data, and t test was used to evaluate the numerical data. RESULTS: Our analysis of the study showed the incidence of postoperative infections of a biliary tract of the RBS group (23.7%) was significantly higher than the CBS group (11.1%). The difference was statistically significant (χ 2 =5.425, P =0.020). Our study also showed the most common pathogenic bacteria after surgery was Escherichia coli (26.5%). CONCLUSION: Treatment for distal MBO with biliary stent loaded with radioactive 125 I seeds had a higher nosocomial infection rate, and the most common pathogenic bacteria was E coli. , Supplemental Digital Content 1, http://links.lww.com/sle/A350.

Resistência antimicrobiana na infecção urinária em unidade de terapia intensiva / Antimicrobial resistance in urinary tract infection in the intensive care unit / Resistencia a los antimicrobianos en la infección del tracto urinario en la unidad de cuidados intensivos

A infecção do trato urinário (ITU) nada mais é do que o acometimento das vias urinárias por microrganismo. Entre as infecções hospitalares de maior incidência está a infecção do trato urinário, acometendo mais mulheres do que homens. Uma das possíveis causas dessa infecção, em pacientes na unidade de terapia intensiva (UTI), é o uso de cateter vesical. Seu tratamento inadequado pode ocasionar uma pielonefrite, podendo adentrar à circulação sanguínea, gerando uma infecção sistêmica e levar o paciente a óbito. A resistência antimicrobiana é uma das principais dificuldades encontrada em UTI sendo considerado um problema de saúde pública. O objetivo deste trabalho foi realizar um breve relato, baseado na literatura, sobre a resistência antimicrobiana na infecção urinária em unidade de terapia intensiva adulta. Em ambientes hospitalares o principal microrganismo causador de ITU é Escherichia coli, sendo 55,5% das culturas positivas estão associadas a procedimentos invasivos, como as sondas vesicais de demora, como consequência este é o microrganismo que mais apresenta resistência aos antimicrobianos utilizados como a ampicilina, trimetoprima e ciprofloxacino. O uso indiscriminado de antibióticos deixa em evidência a necessidade de análise criteriosa da real necessidade de qual antimicrobianos usar, tempo de uso e forma correta de administração. Portanto é necessária a ação dos profissionais de saúde frente a atenção ao paciente, desde a higiene das mãos, uso do cateter, quando necessário observar a real necessidade do uso do antimicrobianos e que esse seja feito após cultura e antibiograma.

Urinary tract infection (UTI) is nothing more than the involvement of the urinary tract by a microorganism. Among the hospital infections with the highest incidence is urinary tract infections, affecting more women than men. One of the possible causes of this infection in patients in the intensive care unit (ICU) is the use of a bladder catheter. Its inadequate treatment can cause pyelonephritis, which can enter the bloodstream, generating a systemic infection and leading the patient to death. Antimicrobial resistance is one of the main difficulties encountered in ICUs and is considered a public health problem. The objective of this study was to present a brief report, based on the literature, on antimicrobial resistance in urinary tract infections in an adult intensive care unit. In hospital environments, the main microorganism that causes UTI is Escherichia coli, and 55.5% of positive cultures are associated with invasive procedures, such as indwelling urinary catheters, as a consequence, this is the microorganism that is most resistant to antimicrobials used, such as ampicillin, trimethoprim and ciprofloxacin. The indiscriminate use of antibiotics highlights the need for a careful analysis of the real need for which antimicrobials to use, time of use, and correct form of administration. Therefore, it is necessary for the action of health professionals in the care of the patient, from the hygiene of the professional to, the use of the catheter, when necessary to observe the real need for the use of antimicrobials and that this is done after culture and antibiogram.

La infección del tracto urinario (ITU) no es más que la afectación de las vías urinarias por un microorganismo. Entre las infecciones hospitalarias con mayor incidencia se encuentra la infección del tracto urinario, que afecta más a mujeres que a hombres. Una de las posibles causas de esta infección en pacientes en la unidad de cuidados intensivos (UCI) es el uso de una sonda vesical. Su tratamiento inadecuado puede causar pielonefritis, la cual puede ingresar al torrente sanguíneo, generando una infección sistémica y llevando al paciente a la muerte. La resistencia a los antimicrobianos es una de las principales dificultades encontradas en las UCI y se considera un problema de salud pública. El objetivo de este estudio fue presentar un breve informe, basado en la literatura, sobre la resistencia antimicrobiana en infecciones del tracto urinario en una unidad de cuidados intensivos de adultos. En ambientes hospitalarios, el principal microorganismo causante de ITU es Escherichia coli, y el 55,5% de los cultivos positivos están asociados a procedimientos invasivos, como sondas vesicales permanentes, por lo que este es el microorganismo más resistente a los antimicrobianos utilizados, como la ampicilina. ., trimetoprima y ciprofloxacino. El uso indiscriminado de antibióticos pone de relieve la necesidad de un análisis cuidadoso de la necesidad real de qué antimicrobianos utilizar, el momento de uso y la forma correcta de administración. Por lo tanto, es necesaria la actuación de los profesionales de la salud en el cuidado del paciente, desde la higiene del profesional, uso del catéter, cuando sea necesario observar la necesidad real del uso de antimicrobianos y que este se realice previo cultivo y antibiograma.

[Appreciating COVID-19 as a child and adolescent psychiatrist on the move]. / Appréhender le COVID-19 au fil de l'eau en tant que psychiatre d'enfant et d'adolescent.

COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.

Association of bacterial genotypes and epidemiological features with treatment failure in hemodialysis patients with methicillin-resistant Staphylococcus aureus bacteremia.

OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) infections in the hemodialysis (HD) population are epidemiologically classified as healthcare-associated infections. The data about the clinical impact and bacterial characteristics of hospital-onset (HO)- and community-onset (CO)-MRSA in HD patients are scarce. The current study analyzed the difference in the clinical and molecular characteristics of HO-MRSA and CO-MRSA. METHODS: We performed a retrospective review and molecular analysis of clinical isolates from 106 HD patients with MRSA bacteremia from 2009 to 2014. CA genotypes were defined as isolates carrying the SCCmec type IV or V, and HA genotypes were defined as isolates harboring SCCmec type I, II, or III. RESULTS: CO-MRSA infections occurred in 76 patients, and 30 patients had HO-MRSA infections. There was no significant difference in the treatment failure rates between patients with CO-MRSA infections and those with HO-MRSA infections. CA genotypes were associated with less treatment failure (odds ratio [OR]: 0.18; 95% confidence interval [95% CI], 0.07-0.49; p = 0.001). For isolates with a vancomycin minimum inhibitory concentration (MIC) < 1.5 mg/L, the multivariate analysis revealed that HA genotypes and cuffed tunneled catheter use were associated with treatment failure. For isolates with a vancomycin MIC ≥1.5 mg/L, the only risk factor for treatment failure was a higher Pitt score (OR: 1.76; 95% CI, 1.02-3.05; p = 0.043). CONCLUSION: CA genotypes, but not the epidemiological classification of CO-MRSA, impacted the clinical outcome of MRSA bacteremia in the HD population.

Traqueobronquitis y neumonía asociada a ventilación mecánica por Chryseobacterium indologenes / Tracheo-bronchitis and pneumonia associated with mechanical ventilation by Chryseobacterium indologenes

El desarrollo de infecciones nosocomiales por gérmenes intrínsecamente resistentes a carbapenemes aumenta la mortalidad y provoca un aumento del gasto sanitario. El conocimiento y estudio de estas infecciones es importante a la hora de mejorar protocolos de actuación epidemiológicos y terapéuticos. Presentamos un estudio descriptivo, de 8 casos clínicos de pacientes con diagnóstico de traqueobronquitis y neumonía asociada a ventilación mecánica (NAVM) por Chryseobacterium indologenes (CBI), durante un periodo de 5 años. En esta serie de casos el aislamiento del CBI se produjo a los 11 días de media (rango 7-18) de permanecer los enfermos conectados a ventilación mecánica. La duración media de los pacientes en ventilación mecánica fue de 36 días (rango 10-140). La estancia media en UCI fue de 49 días (rango 14-180). Únicamente en un paciente no se aisló copatógeno concurrente a la traqueobronquitis o la NAVM por CBI. La mortalidad intrahospitalaria fue del 25%. La infección respiratoria nosocomial secundaria a CBI en pacientes con ventilación mecánica ha aumentado en los últimos años, por lo que se debería incluir en el diangóstico diferencial de la NAMV (AU)

The development of nosocomial infections by germs resistant to carbapenems inherently increases mortality, and causes an increase in health spending. The knowledge and study of these infections is important in improving epidemiological and therapeutic performance protocols. We present a descriptive study of eight patients diagnosed with tracheobronchitis (TAVM) and pneumonia (NAVM) associated with mechanical ventilation Chryseobacterium indologenes (CBI), over a period of five years. CBI isolation occurred at 11 days on average (rank 7-18) of remaining patients connected to mechanical ventilation. The average length of patients on mechanical ventilation was 36 days (range 10-140). The average ICU stay was 49 days (range 14-180). There was no death at 28 days, but the intra-hospital mortality was 2 cases (25%). Nosocomial respiratory infection secondary to CBI in mechanically ventilated patients has increased in recent years, so that should be included in the differential diagnostic of NAMV (AU)

Antibiotic Treatment of Hospitalized Patients with Pneumonia Complicated by Clostridium Difficile Infection.

Clostridium difficile infection (CDI) is one of the most common gastrointestinal complication after antimicrobial treatment. It is estimated that CDI after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. The aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia CDI. We addressed the issue by examining retrospectively the records of 217 patients who met the diagnostic criteria of CDI. Ninety four of those patients (43.3 %) came down with CDI infection after pneumonia treatment. Fifty of the 94 patients went through severe or severe and complicated CDI. The distribution of antecedent antibiotic treatment of pneumonia in these 50 patients was as follows: ceftriaxone in 14 (28 %) cases, amoxicillin with clavulanate in 9 (18 %), ciprofloxacin in 8 (16.0 %), clarithromycin in 7 (14 %), and cefuroxime and imipenem in 6 (12 %) each. The findings revealed a borderline enhancement in the proportion of deaths due to CDI in the ceftriaxone group compared with the ciprofloxacin, cefuroxime, and imipenem groups. The corollary is that ceftriaxone should be shunned in pneumonia treatment. The study demonstrates an association between the use of a specific antibiotic for pneumonia treatment and post-pneumonia mortality in patients who developed CDI.

Vitamin D status and severity of Clostridium difficile infections: a prospective cohort study in hospitalized adults.

BACKGROUND: Clostridium difficile is the most common cause of nosocomial diarrhea, affecting up to 10% of hospitalized patients. Preliminary studies suggest an association between vitamin D status and C difficile infections (CDIs). Our goal was to investigate whether serum 25-hydroxyvitamin D (25(OH)D) levels are associated with CDI severity. METHODS: We prospectively enrolled patients diagnosed with CDI and divided them into 2 severity groups: group A (positive toxin A/B enzyme immunoassay only) and group B (positive toxin A/B enzyme immunoassay with abdominal computed tomography scan findings consistent with colitis). Serum 25(OH)D levels (25(OH)D3, 25(OH)D2, and total 25(OH)D) were measured on all patients after diagnosis of CDI. We performed multivariable logistic regression analyses to investigate the association between 25(OH)D levels and CDI severity, while adjusting for age, Deyo-Charlson Comorbidity Index, recent hospitalization, and vitamin D supplementation. RESULTS: One hundred patients were enrolled between July 2011 and February 2013. The mean (standard deviation) cohort age and Deyo-Charlson Comorbidity Index were 62 (19) years and 4 (3), respectively; 54% of patients were male. Mean serum total 25(OH)D level was 22 (10) ng/mL. Mean 25(OH)D3 level was significantly higher in group A (n = 71) than in group B (n = 29): 21 (1) vs 15 (2) ng/mL, respectively (P = .005). There was no observed difference in mean 25(OH)D2 levels and total 25(OH)D levels between the 2 groups. Multivariable logistic regression analysis demonstrated an association between 25(OH)D3 levels and CDI severity (adjusted odds ratio, 0.92; 95% confidence interval, 0.87-0.98). CONCLUSIONS: We found a significant inverse association between 25(OH)D3 levels and CDI severity. Further studies are needed to determine whether vitamin D supplementation can improve outcomes in patients with CDI.

[Monitoring and antibiotic resistance profile of tracheal aspirate microbiota in ICU children with severe craniocerebral trauma].

Nosocomial infections and their rational antibiotic treatment represent a major challenge for the healthcare nowadays. In this context, gramnegative bacteria including Pseudomonas aeruginosa, Acinetobacter baumanii and Enterobacteriaceae spp. are etiologically important and characterized by a significant level of antibiotic resistance. To examine dynamics of the respiratory tract colonization by hospital flora, tracheal aspirates obtained at three time points from 69 children with severe craniocerebral trauma during their stay in ICU were analysed. Colonization was observed on the 4th day of the ICU stay with predomination of K. pneumoniae (45%) and A. baumanii (27-37%). P. aeruginosa was detected after the 8th day of the ICU stay with the isolation rate of 33%. Substantial proportions of P. aeruginosa (61%), A. baumanii (78%) and K. pneumoniae (25%) were resistant to carbapenems. In 65 carbapemen resistant isolates, the presence of carbapenemases was examined using PCRs. OXA-48 carbapenemase was detected in 11 out of 14 (78%) K. pneumoniae isolates. Among the A. baumanii isolates, 30/31 (97%) carried OXA-40 and 1/31 (3%) had OXA-23 carbapenemases. None of the examined A. baumanii and K. pneumoniae isolates produced metallo-betalactamases (MBL). In contrast, all 20 carbapenem resistant P. aeruginosa isolates produced a MBL, and in 12 out of 20 (60%) of theme VIM-2 was detected. Thus, gramnegative nosocomial microflora rapidly colonizes ICU patients and has a high level of resistance to antibiotics, including carbapenems.

Potential benefits of vitamin D supplementation in critically ill patients.

AIM: To review potential benefits of vitamin D supplementation in critically ill patients. METHODS: The data were collected by searching Scopus, PubMed/Medline, ScienceDirect, Clinical trials and Cochrane database systematic reviews. The keywords used as search terms were 'vitamin D', 'critically ill patients', 'ICU' and 'sepsis'. RESULTS & CONCLUSION: Vitamin D deficiency is common in patients admitted to emergency departments, medical and surgical intensive care units. Positive effects of vitamin D on the immune system through decreasing inflammatory cytokines and increasing natural anti-infective molecules have been reported. Patients with low serum vitamin D concentrations experienced longer hospital stay and were more prone to nosocomial infections, including blood stream and respiratory infections. However, a correlation between vitamin D serum level and patients' mortality is not fully described. Limited studies have assessed effects of vitamin D supplementation on morbidity and mortality in critically ill patients. In the future, well-designed randomized clinical trials should describe the best dose, route and duration of vitamin D supplementation in critically ill patients.

[Nosocomial infectious complications after transplantation of allogenic kidneys from the related donor].

The comprehensive evaluation of infectious complications after kidney transplantation from the living related donor was performed. Microbes predominantly encountered in urinary tract infection (P. aeruginosa, K. pneumoniae, E. coli, E. cloacae, S. epidermidis, E. faecalis) were studied. Prevention patterns and dosing regimens for the antibacterial therapy were developed considering data from the retrospective analysis of the isolated flora and its resistance. This resulted in the reduced rate of infectious complications.

[Adequate empiric therapy of nosocomial fungal infections in oncologic patients of intensive care units].

The results of a 3-year experience with voriconasole in oncologic practice are presented. Rational schemes for the use of caspofungin and mycofungin in the treatment of oncologic inpatients and the criteria of their use in the therapy of fungal nosocomial infections were developmed. Good clinical and microbiological efficacy of caspofungin and mycofungin against Candida non-albicans was shown.

Airway pressure release ventilation: an alternative ventilation mode for pediatric acute hypoxemic respiratory failure.

Airway pressure release ventilation (APRV) is a relatively new mode of mechanical ventilation. The use of this model of ventilation in pediatrics has been limited. The authors describe their experience with this mode of ventilation in a series of pediatric hypoxemic respiratory failure patients. Three patients with acute hypoxemic respiratory failure (AHRF) were treated with APRV, when oxygenation did not improve with pressure control ventilation (PCV). The mean age of the patients was 5.8 ± 1.3 months. Fractional oxygen concentration decreased from 0.97 ± 0.02 for PCV to 0.68 ± 0.12 for APRV, peak airway pressure fell from 36.6 ± 11.5 cm H2O for PCV to 33.3 ± 5.7 cm H2O for APRV, mean airway pressure increased from 17.9 ± 5.9 cmH2O for PCV to 27 ± 2.6 cm H2O for APRV and release tidal volume increased from 8.3 ± 1.5 mL/kg for PCV to 13.2 ± 1.1 mL/kg for APRV after 1 h. APRV may improve oxygenation in pediatric AHRF when conventional mechanical ventilation fails. The APRV modality may provide better oxygenation with lower peak airway pressure.

Empiric therapy for gram-negative pathogens in nosocomial and health care-associated pneumonia: starting with the end in mind.

Nosocomial pneumonia is a major cause of morbidity and mortality for hospitalized patients. Antimicrobial resistance is increasing, creating a strain between ensuring the provision of adequate empiric therapy and slowing the development of antimicrobial resistance. Excessive antimicrobial therapy places patients are at greater risk of drug interactions, adverse events, and superinfections. Ways to maximize adequate empiric therapy include (1) categorizing each patient's risk of being infected with a multidrug-resistant pathogen and knowledge of local susceptibility patterns, (2) de-escalating antimicrobial therapy to decrease the rates of superinfections such as Clostridium difficile, and (3) limiting the duration of therapy to decrease the likelihood of adverse events, drug interactions, and antimicrobial resistance. Pharmacodynamically enhanced dosing regimens also have the potential to improve clinical outcomes and slow the development of antimicrobial resistance. Drugs whose killing is optimized by the percentage time above the minimum inhibitory concentration (MIC), such as beta-lactams, can be given by continuous or extended infusion to provide superior pharmacodynamic (PD) target attainment rates compared with traditional regimens. Drugs whose killing is optimized with a high-peak plasma concentration to MIC ratio (eg, aminoglycosides) should be administered once daily to maximize the likelihood of achieve optimal target attainment rates. Drugs whose killing is optimized by the ratio of the area under the curve (AUC) to MIC ratio (eg, fluoroquinolones) depend on the total daily dose as opposed to the dosing schedule or infusion time. Determining the optimal drug dosing schedules for obese patients remains critical because these patients have may have significantly increased volumes of distribution and clearance rates compared to normal weight patients. Optimizing the use of current antimicrobials is paramount to ensure quality treatment options are available, given the lack of gram-negative antimicrobials in the pipeline.

[Analysis of 62 cases of nosocomial staphylococcal meningitis admitted to the Iasi Hospital of Infectious Diseases over a period of 21 years]. / Analiza asupra a 62 de cazuri de meningita stafilococica nosocomiala internate în Spitalul de Boli Infectioase Iasi într-o perioada de 21 de ani.

AIM: To analyze the clinical features, evolution and treatment of nosocomial staphylococcal meningitis admitted to Hospital of Infectious Diseases Iasi between 1988 and 2007. MATERIAL AND METHOD: The data were gathered from the archive of Hospital of Infectious Diseases Iasi. We studied the clinical and laboratory features of 62 cases of nosocomial staphylococcal meningitis admitted in the study period. RESULTS: The development of nosocomial meningitis was subsequent to interventions on the central nervous system for haematoma, ventriculo-peritoneal shunts, tumors, spinal anesthesia. The symptoms were fever, headache, stiff neck and vomiting. The etiological agents were: Staphylococcus aureus 37 in cases and coagulase negative staphylococci in 25 cases. The treatment was according to their susceptibility rates, using systemic quinolones and ceftazidime or colymicin. The evolution was favorable in 52 patients and unfavorable in another 10. CONCLUSION: Nosocomial staphylococcal meningitis remains a serious condition due to the fact that the etiological agents are resistant to the classical antistaphylococcal antibiotics and increasingly resistant to methicillin.

Resultados del tratamiento quirúrgico de las roturas del tendón distal del bíceps braquial con técnicas de una y dos incisiones / Results of surgical treatment of ruptures of the distal biceps brachii tendon by means of one and two-incision techniques

Objetivo: Comparar los resultados de las técnicas de una y dos incisiones para la reinserción ósea del tendón distal del bíceps. Material y métodos: Serie de 59 sujetos diagnosticados de rotura aguda del tendón distal del bíceps braquial durante 14 años (desde 1990 hasta 2004). El 100% eran varones y su edad media era de 46 años; en la mayoría, la rotura se había producido por flexión forzada contra resistencia asociada a supinación. Se intervino quirúrgicamente a 57 sujetos, en los que se encontraron 50 desinserciones óseas, en 5 sujetos se encontró rotura completa a 1 o 2 cm de la inserción, y en 2 sujetos se encontró rotura parcial. En 36 casos se utilizó la vía anterior de Henry y en 21 casos se utilizó la doble vía de Boyd y Anderson. El uso de los anclajes instrumentados facilitó la reinserción. Los resultados se valoraron según la escala para codo de Broberg y Morrey. Resultados: Las complicaciones más frecuentes fueron las lesiones del nervio radial, las dehiscencias de la herida y los síndromes de dolor regional complejo tipo i. No se encontraron diferencias significativas entre los 2 abordajes en cuanto a la incidencia de complicaciones. El tiempo promedio para la reincorporación laboral fue de 21 semanas. Ningún caso derivó a incapacidad laboral. Se valoró el resultado final como excelente en 54 sujetos y como bueno en 3 sujetos. Conclusión: El tratamiento quirúrgico consigue buenos resultados en la rotura distal del tendón del bíceps braquial, aunque no está exento de complicaciones (AU)

Purpose: To compare the results achieved by one- and two-incision techniques in the reattachment of the distal biceps tendon. Materials and methods: Review of 59 patients with an acute rupture of the distal biceps brachii tendon diagnosed over a 14-year period (1990¿2004). All patients were male, of a mean age of 46 years. In most cases the rupture had been brought about by a forceful flexion of the elbow in combination with resisted supination. Fifty-seven patients were subjected to surgery: tendon detachment was found in 50 cases, a fully ruptured tendon at 1¿2cm of the attachment site in 5 cases and a partial rupture in 2. Henry's anterior approach was used in 36 cases and Boyd and Anderson's combined approach in 21. The use of suture anchors facilitates reattachment. Results were assessed by means of Broberg and Morrey's scale. Results: The most usual complications were radial nerve lesions, wound dehiscences and complex regional pain syndrome type 1. No significant differences were found between the two approaches in terms of complications. Mean time to work resumption was 21 weeks. None of the cases resulted in occupational disability. The final result was rated as excellent in 54 patients and good in 3. Conclusion: Surgical treatment affords good results in ruptures of distal biceps brachii, although it is not exempt from complications (AU)

Actividad in vitro de terapia combinada con colistina frente a Pseudomonas aeruginosa aisladas en Unidad de Cuidados Intensivos / In vitro activities of colistin combinations against Pseudomonas aeruginosa isolated from the intensive care unit

Introducción. Ante el incremento de aislados de Pseudomonasaeruginosa multirresistentes en la Unidad de CuidadosIntensivos (UCI) del Hospital Clínico San Carlos deMadrid y para determinar la posibilidad de que se tratase deun brote epidémico causado por la diseminación de unaúnica cepa, se recogieron 12 muestras consecutivas de distintospacientes que fueron identificadas y a las que posteriormentese determinó su sensibilidad a los antibióticosutilizados habitualmente para el tratamiento de las infeccionesproducidas por este microorganismo.Métodos. Mediante la amplificación de secuencia basadaen la reacción en cadena de la polimerasa (repetitive sequence-based polymerase chain reaction, rep-PCR) se determinó larelación clonal entre los aislados utilizando los primers BOX yERIC y se estudió la actividad in vitro frente a estas cepas decolistina, rifampicina, doxiciclina y azitromicina para determinaren qué casos la combinación de colistina con alguno de losotros tres antibióticos presentaba actividad sinérgica.Resultados. Los estudios de sensibilidad apuntan a la presenciade varias cepas de P. aeruginosa como responsables delas infecciones respiratorias producidas por este microorganismoen la UCI, hecho que fue corroborado mediante los estudiosclonales realizados. En los estudios de sinergia las asociacionesde colistina con doxiciclina y con azitromicina presentaron actividadsinérgica para alguno de los aislados.Discusión. Los resultados de los estudios clonales revelanla presencia de cinco clones diferentes entre los aisladosseleccionados, por lo que podemos concluir que no se tratade un brote de P. aeruginosa en la UCI. La actividad sinérgicade la asociación de colistina con azitromicina, doxiciclinay rifampicina ha sido menor de la esperada y se observa unelevado porcentaje de resultados indiferentes (AU)

Introduction. As the number of multidrug-resistantstrains of Pseudomonas aeruginosa has risen in the intensivecare unit (ICU) of the San Carlos Clinic Hospital,12 consecutive isolates from different patients were collectedto determine the possibility of an epidemic outbreakcaused by the spread of a single strain. We determinedthe antimicrobial susceptibility to the most commonagents used in the treatment of infections caused by thisbacteria. The results of susceptibility studies suggest thatdifferent strains of P. aeruginosa are responsible for therespiratory tract infections in ICU.Methods. The clonal relationship between the isolatesusing was determined using BOX and ERIC primersby means of repetitive sequence-based polymerase chainreaction (rep-PCR). The in vitro activity of these strainsagainst colistin, rifampicin, doxicycline and azythromycinwas studied to determine in which cases the combinationof colistin with any of the other three antibioticswas synergistic.Results. Sensitivity studies point out the presence ofseveral strains of P. aeruginosa as the causal agents ofrespiratory infections produced by this microorganism inthe ICU. Combinations of colistin with doxycicline andcolistin with azithromycin were synergistic for some isolatesin the synergy studies.Discussion. Clonal studies reveal the presence of fivedifferent clones among our isolates. Therefore we canconclude that there was no outbreak of P. aeruginosa inthe ICU. Synergistic activity of combinations of colistinplus azithromycin, colistin plus doxicycline and colistinplus rifampicin was less than expected and a high percentageof indifferent results was observed (AU)

Impétigo bulloso causado por Staphylococcus aureus" resistente a meticilina / Bullous impetigo caused by methicillin-resistant Staphylococcus aureus

El impétigo es una infección cutánea superficial que ocurre sobre todo en la edad pediátrica, más frecuentemente por debajo de los 5 años de edad. SE clasifica en primario, que es el que tiene lugar sobre piel previamente sana, y secundario, que aparece en piel lesionada, principalmente tras un eccema. Existen dos tipos de impétigo: no bulloso, más frecuentemente, y bulloso. el agente causal predominante en todos los tipos de impétigo es Staphylococcus aureus. En los últimos años se ha descrito la emergencia de cepas de S. aureus resistentes a meticilina (SARM) como causantes de infecciones adquiridas en la comunidad, tanto leves como graves. Se presenta el caso de un varón de 8 años que presenta lesiones ampollosas dolorosas de una semana de evolución en la región lumbar. Se recoge cultivo de las lesiones y se identifica el crecimiento de colonias de S. aureus con resistencia a meticilina(AU)

Impetigo is a superficial skin disease that occurs in children, mainly before the age of five years. It is classified as primary if it occurs on previously healthy skin and secondary when it develops on damaged skin, usually following eczema. There are two types of impetigo: non-bullous, which is more frequent, and bullous. The predominant causative agent in both types is Staphylococcus aureus. In recent years, emergent methicillin-resistant strains (MRSA) that provoke mild to severe community-acquired lesions have been described. We report the case of an eight-year-old boy with painful, bullous skin lesions on his back that had developed one week earlier. A skin culture revealed the presence of colonies of methicillin-resistant S. aureaus(AU)

Bacteriemia por Pantoea agglomerans / Bacteremia caused by Pantoea agglomerans

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Sensibilidad microbiana de escherichia coli en bacteriurias en el área sanitaria del Bierzo en el año 2003 / Antimicrobial susceptibility of escherichia coli isolated from bacteriurias in Bierzo Health Area during 2003

OBJETIVO: Evaluar la sensibilidad a varios antibióticos en cepas de Escherichia coli aisladas en muestras de orina de pacientes hospitalarios y extrahospitalarios. MATERIAL Y MÉTODOS: Se analizaron los urocultivos positivos para Escherichia coli obtenidos de muestras de pacientes hospitalizados y atendidos en consultas externas hospitalarias y atención primaria. Se determinó la sensibilidad de este germen a diecinueve antibióticos de uso hospitalario y/o extrahospitalario. RESULTADOS: Según el origen hospitalario, consultas externas hospitalarias y atención primaria, respectivamente, la sensibilidad in vitro ha sido la siguiente: imipenem (100%, 100% y 100%; p=NS), amikacina (100%, 100% y 99,7%; p=NS), fosfomicina (98,6%, 98,4% y 99,6%; p=NS), cefepima (96%, 96,9% y 98,3%; p=NS), piperacilina-tazobactam (96%, 95,3% y 96,6%; p=NS), aztreonam (93,5%, 94,7% y 97,7%; p<0,001), ceftazidima (93,5%, 94,3% y 97,8%; p<0,001), cefotaxima (93,1%, 95% y 97,7%; p<0,001), cefixima (92,7%, 94,6% y 96,7%; p<0,05), nitrofurantoína (92%, 94,7% y 94,7%; p=NS), cefuroxima (88,4%, 93,1% y 95%; p<0,001), amoxicilina-clavulánico (87,7%, 88,7% y 93,8%; p<0,001), tobramicina (87%, 93,7% y 93,8%; p<0,001), gentamicina (85,9%, 92,8% y 93%; p<0,001), cefazolina (84,4%, 88,7% y 91,6%; p<0,01), ciprofloxacino (63,8%, 71,4%, 78,4%; p<0,001), norfloxacino (63%, 70,8 y 78,2%; p<0,001), cotrimoxazol (65,2%, 68,6% y 74,9%; p<0,01) y ampicilina (35,5%, 42,5% y 47,8%; p<0,01). (NS= No significativo). CONCLUSIONES: El tratamiento de las infecciones del tracto urinario frecuentemente se inicia de forma empírica. Por este motivo resulta esencial conocer los patrones de sensibilidad de las bacterias potencialmente causantes del cuadro

OBJECTIVE: Sensitivity to antibiotics of Escherichia coli isolated from intrahospital and extrahospital bacteriurias is analized. MATERIAL AND METHODS: Sensitivity to nineteen antibiotics used in the clinical practise was determined in strains of Escherichia coli isolated from intrahospital and extrahospital bacteriurias. RESULTS: The prevalence of in-vitro susceptibilities to antibiotics were (hospital, state health service clinic, health center-primary-care): imipenem (100%-100%-100%; p=NS), amikacin (100%-100%-99.7%; p=NS), fosfomicyn (98.6%- 98.4%-99.6%; p=NS), cefepime (96%-96.9%-98.3%; p=NS), piperacillin-tazobactam (96%-95.3%-96.6%; p=NS), aztreonam (93.5%-94.7%-97.7%; p<0.001), ceftazidime (93.5%-94.3%-97.8%; p<0.001), cefotaxime (93.1%-95%-97.7%; p<0.001), cefixime (92.7%-94.6%-96.7%; p<0.05), nitrofurantoin (92%-94.7%-94.7%; p=NS), cefuroxime (88.4%-93.1%- 95%; p<0.001), amoxicillin-clavulanic (87.7%-88.7%-93.8%; p<0.001), tobramicyn (87%-93.7%-93.8%; p<0.001), gentamcin (85.9%-92.8%-93%; p<0.001), cefazolin (84.4%-88.7%-91.6%; p<0.01), ciprofloxacin (63.8%-71.4%-78.4%; p<0.001), norfloxacin (63%-70.8%-78.2%; p<0.001), cotrimoxazole (65.2%-68.6%-74.9%; p<0.01) and ampicillin (35.5%-42.5%-47.8%; p<0.01). (*NS= No significant differences). CONCLUSIONS: The knowledge of the sensitivity of uropathogens to antimicrobians can allow us to initiate empirical therapy of urinary tract infections