The Meropenem Yearly Susceptibility Test Information Collection antimicrobial susceptibility program in Spain: a 5-year analysis.

The Meropenem Yearly Susceptibility Test Information Collection program is a global study providing in vitro surveillance data on antimicrobial susceptibility in centers prescribing meropenem. This study summarizes data on the activity of meropenem and 5 comparators against 4022 clinical isolates from 7 centers in Spain (1999-2003). Those bacteria intrinsically resistant to meropenem were excluded. Among Enterobacteriaceae, 100% of Enterobacter spp., Citrobacter spp., and Serratia spp. were susceptible to meropenem. Escherichia coli and Klebsiella pneumoniae susceptibilities to carbapenems were 100% and > or =98%, respectively. Extended-spectrum beta-lactamase-producing Enterobacteriaceae were 3.8% of isolates, and all of them were susceptible to meropenem. Ciprofloxacin resistance in E. coli was around 20%. Meropenem and piperacillin/tazobactam were the most active agents against Pseudomonas aeruginosa. Acinetobacter baumannii were 61-90% susceptible to carbapenems, but only 6-21% susceptible to ciprofloxacin. In this period, around 100% of oxacillin-susceptible staphylococci were susceptible to meropenem. There was no significant decrease in susceptibility to the carbapenems throughout the 5-year period. The clinical use of meropenem in 7 Spanish centers did not increase bacterial resistance to this agent in the microorganisms evaluated.

Modelo multivariable para la planificación del entrenamiento en fútbol profesional / Multivariable Training Planning Model in Professional Soccer

El objetivo de este estudio fue describir un modelo multivariable de planificación del entrenamiento para la monitorización semanal y su periodización en relación con el perfil dinámico competitivo. Veintidós futbolistas profesionales participaron este estudio. Se analizaron 30 microciclos competitivos donde se registró individualmente todas las sesiones de entrenamiento y partidos de competición mediante GPS. Los resultados mostraron una fase de carga con valores cercanos a los alcanzados en competición, pero con estímulos diferenciados en días consecutivos, y otra fase de reducción de la carga en forma de tapering previa a la competición. La carga acumulada semanalmente mostró poca variabilidad entre los microciclos, observándose un promedio de 0.6%. La gestión dinámica de la carga presentó una ratio A:C que osciló entre 0.89-1.13. El modelo multivariable para la planificación del entrenamiento semanal es un método eficaz para monitorizar la carga del entrenamiento en relación con el perfil de rendimiento. (AU)

The aim of this study was to describe a multivariable training planning model for weekly monitoring and its periodization in relation to the dynamic competitive profile. Twenty-two professional soccer players participated in this study. Thirty competitive microcycles were analyzed. Thirty competitive microcycles were recorded individually in all training sessions and competition matches through a GPS device. The results showed a loading phase with values close to those achieved in competition, but with differentiated stimuli on consecutive days, and another phase of load reduction in the form of tapering prior to competition. The weekly accumulated load showed little variability between the microcycles; an average of 0.6% was observed. Dynamic load management presented an A: C ratio that ranged from 0.89-1.13. It can be concluded that the multivariate model for planning weekly training is an effective method to monitor training load in relation to performance profile. (AU)

Prevalence of gastro-oesophageal reflux disease in Spain and associated factors.

BACKGROUND: The prevalence of gastro-oesophageal reflux disease (GERD), has not been characterized in Spain. Aim To measure the prevalence of GERD in Spain, and the factors associated with it, by means of a primary care-based study. METHODS: An epidemiological, multicentre, cross-sectional, population-based study. A self-administered questionnaire was sent out to randomly selected patients. Data were statistically analysed to provide the prevalence of GERD and to compare it with that of gastro-oesophageal reflux symptoms. Factors associated with GERD were studied using logistic regression models. RESULTS: The response rate was 45%. The prevalence of GERD was 15% (95% CI: 13.2-16.2). When compared with gastro-oesophageal reflux symptoms patients, those with GERD experienced more intense symptoms (moderate-severe: 35% vs. 8%, P < 0.001) and suffered heartburn more frequently both at day and night (48% vs. 25%, P < 0.001) and for longer period of times (69% vs. 62%, P = 0.057). A body mass index of >25% (odds ratio: 1.07; 95% CI: 1.03-1.11) was the only independent variable associated with GERD. The risk of suffering GERD increases by 7% for each kg/m(2) that the body mass index increases. CONCLUSIONS: The prevalence of GERD among the Spanish population is 15%. Body mass index is the only risk factor significantly associated with GERD.

Evaluation of API Coryne system for identifying coryneform bacteria.

AIM: To identify rapidly and accurately coryneform bacteria, using a commercial strip system. METHODS: Ninety eight strains of Corynebacterium species and 62 additional strains belonging to genera Erysipelothrix, Oerskovia, Rhodococcus, Actinomyces, Archanobacterium, Gardnerella and Listeria were studied. Bacteria were identified using conventional biochemical tests and a commercial system (API-Coryne, BioMèrieux, France). Fresh rabbit serum was added to fermentation tubes for Gardnerella vaginalis isolates. RESULTS: One hundred and five out of the 160 (65.7%) organisms studied were correctly and completely identified by the API Coryne system. Thirty five (21.8%) more were correctly identified with additional tests. Seventeen (10.6%) organisms were not identified by the system and three (1.9%) were misidentified. CONCLUSIONS: The system was a good alternative for identification of coryneform organisms. When occasionally performed with some additional tests, this method permits reliable and rapid identification of coryneform organisms compared with conventional methods.

Problems in minimum inhibitory concentration determinations in coryneform organisms. Comparison of an agar dilution and the Etest.

The antimicrobial susceptibility of 159 coryneform organisms was determined by an agar dilution and Etest methods. Overall, the correlation between minimum inhibitory concentrations obtained by both techniques was good (> or = 0.09) for most antibiotics and organisms although the essential agreement ranged from 59% to 88.3%. Most organisms were equally categorized (sensitive, intermediate, or resistant) by both methods with only 0.2%, 0.4%, and 3.5% of very major, major or minor discrepancies, respectively. Such percentages dropped significantly when discrepant strains were retested. The correlation was specially good for Corynebacterium jeikeium and Corynebacterium urealyticum.

Evaluation of a new selective medium for the isolation of Corynebacterium urealyticum.

A new selective medium (CBU agar) was compared with blood agar (BA) medium for primary isolation of Corynebacterium urealyticum from urine and skin samples of hospitalised patients. Overall, the CBU agar detected C. urealyticum in 14 (4.6%) of 302 urine samples and the BA medium detected the organism in four (1.3%), but most cultures which were positive only on CBU agar had < 10(4) cfu/ml. Six strains of C. urealyticum were isolated from 60 skin samples with CBU agar, whereas none was detected with BA. Although most skin samples had heavy inocula, the selective agar facilitated the recognition of low colony counts (< or = 10 cfu/plate) of C. urealyticum by reducing the growth of competing flora. Challenge of the selective medium with reference and clinical strains showed that CBU agar was inhibitory for gram-negative bacteria and reduced the gram-positive flora, allowing the growth of C. urealyticum strains. The new selective medium appears to be a useful epidemiological tool to study urinary and skin colonisation by C. urealyticum.

[Burden of gastroesophageal reflux disease. Evidence from a recent methodological study in Spain]. / Repercusión de la enfermedad en pacientes con reflujo gastroesofágico. Evidencia de un estudio metodológico reciente en España.

INTRODUCTION: The clinical and socioeconomic burden of gastroesophageal reflux disease (GERD) is considerable. AIM: The aim of this study was to describe the impact of heartburn on patients' health-related quality of life (HRQL) in Spain, using validated generic and disease-specific instruments to measure patient-reported outcomes. PATIENTS AND METHODS: Patients with symptoms of heartburn completed the Spanish versions of the Gastrointestinal Symptom Rating Scale (GSRS), the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), the Short Form-36 (SF-36) and the Hospital Anxiety and Depression (HAD) scale. The frequency and severity of heartburn in the previous 7 days were also recorded. RESULTS: One hundred fifty-eight patients completed the assessments (mean age: 51 years, SD = 16; 58% female). Sixty-one percent of the patients had moderate symptoms and 73% had symptoms on three or more days in the previous week. Patients were most bothered by symptoms of reflux (mean GSRS score of 3.8 on a scale of 1 [not bothered] to 7 [very bothered]), abdominal pain (3.1) and indigestion (3.1). As a result of their symptoms, patients experienced problems with food and drink (mean QOLRAD score of 4.5 on a scale of 1 to 7, where 1 represents the most severe impact on daily functioning), impaired vitality (4.7) and emotional distress (4.8). This led to impaired overall HRQL across all domains (mean SF-36 score of this heartburn population compared with a general population in Spain). The HAD scale showed that 28% of patients were anxious and 13% were depressed. CONCLUSION: There is consistent evidence that GERD substantially impairs all aspects of HRQL.

[Psychometric validation of translation to Spanish of the gastrointestinal symptoms rating scale (GSRS) and quality of life in reflux and dyspepsia (QOLRAD) in patients with gastroesophageal reflux disease]. / Validación psicométrica de la traducción al español de la escala de evaluación de síntomas gastrointestinales (GSRS) y del cuestionario de calidad de vida de reflujo y dispepsia (QOLRAD) en los pacientes con enfermedad por reflujo gastroesofágico.

INTRODUCTION: Pyrosis symptoms and their impact on the quality of life related with health (QLRH) are frequently evaluated in clinical trials. When a questionnaire is translated into a language other than the original, it is necessary to have a linguistic validation, although this is not sufficient unless the psychometric characteristics have been verified. This study aims to document the psychometric characteristics of the translation to Spanish of the gastrointestinal symptoms rating scale (GSRS) and quality of life in reflux and dyspepsia (QOLRAD). MATERIAL AND METHOD: One hundred fifty eight patients with pyrosis symptoms (age: 51.0; SD: 16.3 years; men: 42.4%) completed the translation to Spanish of the GSRS, the pyrosis version of the QOLRAD, the Short-Form-36 (SF-36) and the hospital of anxiety and depression (HAD) scale. Seventy six patients were given an appointment for a second visit after one week, to fill out the GSRS and QOLRAD again. RESULTS: The reliability of the internal consistence of the GSRS was 0.59-0.83 and that of the QOLRAD: 0.87-0.95, and test-retest reliability of the GSRS was 0.44-0.63 and QOLRAD: 0.77-0.85. Score of the important domains of the GSRS "reflux", "abdominal pain" and "indigestion" and above all those of the QOLRAD correlated significantly. The domain "abdominal pain" of the GSRS had a strong correlation (negative) with the relevant domains of the SF-36. The QOLRAD domains significantly correlated with all the related domains of the SF-36. CONCLUSIONS: The psychometric characteristics of the translation to Spanish of the GSRS and QOLRAD were good, with satisfactory reliability and validity. However, the test-retest reliability of the "reflux" domain of the GSRS was not optimum.

Antimicrobial susceptibilities of Corynebacterium species and other non-spore-forming gram-positive bacilli to 18 antimicrobial agents.

The susceptibilities of 265 strains of Corynebacterium species and other non-spore-forming gram-positive bacilli to 18 antimicrobial agents were tested. Most strains were susceptible to vancomycin, doxycycline, and fusidic acid. Corynebacterium jeikeium and Corynebacterium urealyticum were the most resistant organisms tested. Resistance to beta-lactams, clindamycin, erythromycin, azythromycin, ciprofloxacin and gentamicin was common among strains of Corynebacterium xerosis and Corynebacterium minutissimum. Ampicillin resistance among Listeria monocytogenes was more prevalent than previously reported. Optochin, fosfomycin, and nitrofurantoin showed very little activity against most organisms tested, but the use of nitrofurantoin as a selective agent in culture medium may prevent the recovery of some isolates. Except for the unvarying activity of vancomycin against Corynebacterium species, the antimicrobial susceptibilities of the latter to other antibiotics are usually unpredictable, such that susceptibility tests are necessary for selecting the best antimicrobial treatment.

Comparative in vitro activity of the new glycopeptide SK&F 104662 against problematic gram-positive bacteria.

The in vitro activity of the new glycopeptide antibiotic SK&F 104662 against problematic gram-positive microorganisms was determined using the agar dilution technique. For comparison, ampicillin, oxacillin, vancomycin, erythromycin and gentamicin were tested. SK&F 104662 was found to have high activity against Staphylococcus aureus, coagulase-negative staphylococci (both methicillin sensitive and resistant strains), Enterococcus faecalis, Enterococcus faecium, Listeria monocytogenes, Corynebacterium jeikeium and Corynebacterium group D2. All of 254 isolates, except one vancomycin-resistant strain of Enterococcus faecium, were inhibited by 2 mg/l of SK&F 104662; this compound may thus be potentially useful in the treatment of infections with the above-mentioned gram-positive pathogens.

Non-urinary tract infections caused by multiply antibiotic-resistant Corynebacterium urealyticum.

Five patients with non-urinary tract infections caused by Corynebacterium urealyticum were seen during an 8-year period at a university hospital in Madrid. Bacteremia (one case) and wound infections (four cases) were the most relevant features of these cases. Treatment with vancomycin, surgery, and supportive measures contributed to a favorable outcome for four of the five patients.

Effect of pH and buffer system on the in-vitro activity of five antifungals against yeasts.

We have compared the effect of various media on the in-vitro activity of amphotericin B, flucytosine, fluconazole, itraconazole and ketoconazole against 93 clinical yeast isolates by a micro-broth dilution technique. The media used were: RPMI 1640 with 2% glucose, buffered with 0.165 M MOPS at pH 7.0; the same medium, but buffered at pH 7.4; and the same medium, but buffered at pH 7.4 with 0.15% sodium bicarbonate. The three media gave similar results with azole antifungals and flucytosine, but the medium buffered at pH 7.0 failed to detect different populations of yeasts with respect to amphotericin B susceptibility. In the case of the media buffered at pH 7.4, Candida krusei was significantly less susceptible to amphotericin B than Candida albicans or Torulopsis glabrata. We could not evaluate the results obtained with Candida parapsilosis and Cryptococcus neoformans since these species did not grow adequately in all three media.

Cytopathic effect mimicking virus culture due to Mycobacterium tuberculosis.

Mycobacterium tuberculosis grew, from a bronchoalveolar lavage of a patient with AIDS, on a gentamicin-supplemented cell culture monolayer, causing a focal and slowly spreading cytopathic effect resembling that of a virological isolate. The same effect was observed after inoculation of two different inocula of M. tuberculosis onto the same cell culture.

Infection caused by the nonfermentative gram-negative bacillus CDC group IV c-2: case report and literature review.

A 10-year-old girl with acute lymphocytic leukemia developed nosocomial septicemia caused by the gram-negative bacterium CDC group IV c-2. Recovery of the patient followed appropriate treatment with ceftriaxone, to which the organism was susceptible in vitro. Four other reported cases of infection caused by this organism are reviewed.

Peritonitis with CDC group IVc-2 bacteria in a patient on continuous ambulatory peritoneal dialysis.

A case of CDC group IVc-2 peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD) is described. To the authors' knowledge, this is the first case reported of CAPD peritonitis in which a member of this unusual group of bacteria was isolated as the sole microorganism. As this microorganism is usually resistant to most antibiotics commonly used to treat peritonitis in patients on CAPD, microbiological investigations with identification and antimicrobial susceptibility tests are mandatory.