[Comparative study of treatment with quinupristin-dalfopristin alone or in combination with gentamicin, teicoplanin, imipenem or levofloxacin in experimental endocarditis due to a multidrug-resistant Enterococcus faecium]. / Comparacion de la eficacia de quinupristina-dalfopristina en monoterapia y combinada con gentamicina, teicoplanina, imipenem o levofloxacino en un modelo experimental de endocarditis por Enterococcus faecium multirresistente.

The incidence of multidrug-resistant Enterococcus faecium is increasing despite advances in antibacterial therapy. Thus, new antibiotics are required to treat hospital- or community-acquired infections caused by these multidrug-resistant organisms. The aim of this study was to compare the therapeutic efficacy of quinupristin-dalfopristin (QD) alone, or in combination with gentamicin (G), teicoplanin (T), imipenem (I) or levofloxacin (L) against a strain of multidrug-resistant E. faecium in an experimental model of aortic valve endocarditis in rabbits. The study group consisted of 28 control animals. Eighty-two animals were treated with one of the following antibiotic regimens: G1: 18 animals QD (30 mg/kg/8 h); G2: 18 animals QD+G (6 mg/kg/12 h); G3: 16 animals QD+T (20 mg/kg/12 h); G4: 14 animals QD+I (60 mg/kg/8 h); and G5: 16 animals QD+L (20 mg/kg/12 h). The response to therapy was determined by the comparison of the number of CFU/g of E. faecium in each vegetation. In vitro, time-kill studies looking for synergy for the combinations that showed better efficacy in vivo were done. The sensitivity of the strain was intermediate to QD, resistant to T and I, and sensitive to L. There was no high-level resistance to G. QD alone revealed a significant decrease (p <0.001) in the CFU/g in the control group (9.49 vs. 7.31). There were no differences in the average of CFU/g between the QD alone (G1), QD+G (G2) and QD+T (G3) groups. These three groups revealed a significant difference in decrease of CFU/g respect of the group control (p <0.001). There were no differences in the average of CFU/g between QD+I (G4) and QD+T (G5). These two groups revealed the greatest decrease in average CFU/g (G4: 4.38 and G5: 4.04) with differences respect of the group control (p <0.0001) and respect of the groups G1, G2 and G3 (p <0.001). We did not detect any alteration of MIC from QD in the course of the treatment for either of the final isolations. Only the time kill corresponding to concentrations of I 32 mg/l (0.25 x MIC) and QD 1 mg/l (0.25 x MIC presents a descending slope in the curve at 4 and 8 h, suggesting an early synergy phenomenon, which was lost after 8 h. In light of these results, the combination QD with I and L may be considered suitable alternatives for the treatment of multiresistant E. faecium.

Comparación de la eficacia de quinupristina-dalfopristina en monoterapia y combinada con gentamicina, teicoplanina, imipenem o levofloxacino en un modelo experimental de endocarditis por Enterococcus faecium multirresistente / Comparative study of treatment with quinupristin-dalfopristin alone or in combination with gentamicin, teicoplanin, imipenem or levofloxacin in experimental endocarditis due to a multidrug-resistant Enterococcus faecium

La incidencia de infecciones por Enterococcus faecium multirresistentes va aumentando a pesar de los avances que se han producido en antibioticoterapia.Por ello, se necesitan nuevos antibióticos para tratar las infecciones nosocomiales o comunitarias causadas por este microorganismo.El objetivo principal del presente estudio fue comparar la eficacia de quinupristina-dalfopristina (QD), sola o combinada con gentamicina(G), teicoplanina (T), imipenem (I) o levofloxacino (L), en un modelo de endocarditis experimental en conejos por E. faecium multirresistente.Se utilizaron 110 animales, 28 como grupo control y 82 como grupos terapéuticos, que fueron G1: 18 animales con QD (30mg/kg/8 h); G2: 18 con QD+G (6 mg/kg/12 h); G3: 16 con QD+T (20 mg/kg/12 h); G4: 14 con QD+I (60 mg/kg/8 h); y G5: 16 con QD+L(20 mg/kg/12 h). Se valoró la respuesta terapéutica comparando la concentración de E. faecium en las vegetaciones cardiacas expresada comolog10 de las unidades formadoras de colonias por gramo de tejido (UFC/g). Se realizaron pruebas de cinética de letalidad bacteriana paralas asociaciones que mostraron mejor comportamiento in vivo: QD + I y QD + L. El patrón de sensibilidad de la cepa utilizada fue: sensiblepara L, intermedia para QD, resistente para T e I, y sin resistencia de alto grado para G. El tratamiento con QD logró una reducción significativa(p <0.001) en las UFC/g respecto al grupo control (9,49 frente a 7,31). No hubo diferencias significativas entre los grupos G1 (QDsola), G2 (QD + G) y G3 (QD + T), consiguiendo estos tres grupos una redución significativa respecto del grupo control (p <0.001). No hubodiferencias entre G4 (QD + I) y G5 (QD + L). Estos dos grupos se mostraron como los más eficaces en reducir la media de UFC/g en lasvegetaciones cardiacas (G4: 4,38 y G5: 4,04), con p <0.0001 respecto al grupo control y p <0.001 respecto a G1, G2 y G3. No se detectóningún cambio en la CMI de QD durante el tratamiento. Sólo la curva de letalidad correspondiente a la concentración de I de 32 mg/l (0,25x CMI) con QD 1 mg/l (0,25 x CMI) presentó una curva descendente a las 4 y 8 horas, sugiriendo una sinergia precoz que se perdió a las 8 horas.A la vista de estos resultados, la combinación de QD con I o L podría considerarse como alternativa terapéutica en la endocarditis porE. faecium multirresistente

The incidence of multidrug-resistant Enterococcus faecium is increasing despite advances in antibacterial therapy. Thus, new antibiotics arerequired to treat hospital- or community-acquired infections caused by these multidrug-resistant organisms. The aim of this study was tocompare the therapeutic efficacy of quinupristin-dalfopristin (QD) alone, or in combination with gentamicin (G), teicoplanin (T), imipenem(I) or levofloxacin (L) against a strain of multidrug-resistant E. faecium in an experimental model of aortic valve endocarditis in rabbits. Thestudy group consisted of 28 control animals. Eighty-two animals were treated with one of the following antibiotic regimens: G1: 18 animalsQD (30 mg/kg/8 h); G2: 18 animals QD+G (6 mg/kg/12 h); G3: 16 animals QD+T (20 mg/kg/12 h); G4: 14 animals QD+I (60 mg/kg/8 h);and G5: 16 animals QD+L (20 mg/kg/12 h). The response to therapy was determined by the comparison of the number of CFU/g of E. faeciumin each vegetation. In vitro, time-kill studies looking for synergy for the combinations that showed better efficacy in vivo were done.The sensitivity of the strain was intermediate to QD, resistant to T and I, and sensitive to L. There was no high-level resistance to G. QD alonerevealed a significant decrease (p <0.001) in the CFU/g in the control group (9.49 vs. 7.31). There were no differences in the average of CFU/gbetween the QD alone (G1), QD+G (G2) and QD+T (G3) groups. These three groups revealed a significant difference in decrease of CFU/grespect of the group control (p <0.001). There were no differences in the average of CFU/g between QD+I (G4) and QD+T (G5). These twogroups revealed the greatest decrease in average CFU/g (G4: 4.38 and G5: 4.04) with differences respect of the group control (p <0.0001)and respect of the groups G1, G2 and G3 (p <0.001). We did not detect any alteration of MIC from QD in the course of the treatment for eitherof the final isolations. Only the time kill corresponding to concentrations of I 32 mg/l (0.25 x MIC) and QD 1 mg/l (0.25 x MIC presents adescending slope in the curve at 4 and 8 h, suggesting an early synergy phenomenon, which was lost after 8 h. In light of these results, thecombination QD with I and L may be considered suitable alternatives for the treatment of multiresistant E. faecium

Comparative study of treatment with penicillin, ceftriaxone, trovafloxacin, quinupristin-dalfopristin and vancomycin in experimental endocarditis due to penicillin- and ceftriaxone-resistant Streptococcus pneumoniae.

The efficacy of different antibiotics was compared in an experimental model of aortic valve endocarditis in rabbits, using a serotype 19 strain of Streptococcus pneumoniae resistant to penicillin (MIC 12 mg/L) and ceftriaxone (MIC 12 mg/L). The results were compared with those of a control group, which received no treatment. One hundred and nineteen animals were treated with one of the following antibiotic regimens: im procaine penicillin G at a dosage of 300,000 U/kg weight/12 h (16 animals); iv trovafloxacin, 13.3 mg/kg/12 h (31 animals); iv ceftriaxone, 75 mg/kg/24 h (21 animals); iv vancomycin, 20 mg/kg/12 h (15 animals) and im quinupristin-dalfopristin, 30 mg/kg/8 h (20 animals). All the antibiotics used in this study proved to be efficient in reducing numbers of S. pneumoniae and in increasing the percentage of aortic vegetations that were rendered sterile compared with the control group. Penicillin at the dosage used in our study was capable of achieving serum concentrations two or three times greater than the MIC, thus demonstrating its effectiveness as an antibiotic for this endocarditis model. No significant difference was observed between the effects of vancomycin, quinupristin-dalfopristin and penicillin. Vancomycin proved to be more efficient than trovofloxacin in reducing the bacterial load and increasing the numbers sterilized. There was also a tendency for this antibiotic to be more effective than ceftriaxone in reducing the bacterial load of the vegetations. There was a statistically significant correlation between the weight of the vegetations and their bacterial load. In the light of these results, vancomycin and quinupristin-dalfopristin may be considered suitable alternatives to penicillin for the treatment of penicillin-resistant S. pneumoniae endocarditis.

Revisión y perspectivas actuales de la endocarditis por neumococo / Review and current perspectives on endocarditis due to pneumococci

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[The long-term clinical results of the implanting of intracoronary stents in current practice]. / Resultados clínicos a largo plazo del implante de stents intracoronarios en la práctica actual.

INTRODUCTION: Published Stress and Benestent studies, obtained in selected populations under technical conditions that do not reflect present practice with intercoronary stenting showed a clinical benefit of coronary stenting. OBJECTIVE: To assess clinical longterm outcome of coronary stenting in current practice and to compare coronary lesions with and without Stress/Benestent criteria. METHODS: 216 consecutive patients with successful placement of 279 stents in 256 lesions and no major in-hospital events. Mean clinical follow-up was 16.7 +/- 10.4 months. Standard technique included seven types, high pressure balloon inflation (15.6 +/- 2.2 atm) and post-stenting treatment of four weeks with aspirin and ticlopidine. RESULTS: Cumulative rates of target lesion revascularization were 9.7% at 6 months, 13.5% at 12 months and 15.1% at 18, 24 and 36 months. Cumulative rates of combined clinical end-point (death, myocardial infarction and target lesion revascularization) were 11.3%, at 6 months, 13.9% at 1 year, 19.3% at 2 years and 21.1% at 3 years. No Stress/Benestent lesions were 193; 75%, and had a higher incidence of target lesion revascularization (17.9 vs 7.5%, Log Rank = 0.015) and combined clinical end-point (22.4 vs 10%, Log Rank = 0.025), than Stress/Benestent lesions. CONCLUSION: Coronary stenting of no Stress/Benestent lesions have a less favourable clinical longterm outcome. However, clinical outcome in a nonselected population at the present time is similar to the old Stress/Benestent studies, probably because of technical improvements.

[Retrospective study of auricular fibrillation of recent onset in a hospital emergency service: frequency, clinical presentation, and predictive factors of early conversion to sinus rhythm]. / Estudio retrospectivo de la fibrilación auricular de reciente comienzo en un servicio de urgencias hospitalario: frecuencia, presentación clínica y factores predictivos de conversión precoz a ritmo sinusal.

AIM: To evaluate the proportion of emergencies due to recent-onset atrial fibrillation (AF), its clinical characteristics and in-hospital follow-up. The clinical predictors of conversion to sinus rhythm within the first 24 hours were analyzed. PATIENTS AND METHODS: 34,445 consecutive reports from patients presenting themselves at the emergency room of a community hospital during 15 months were retrospectively studied. The clinical reports of all patients (n = 186) with symptoms of recent onset AF (< 15 days) were reviewed. RESULTS: Hypertension (n = 77.41%) and lone AF (52 patients, 28%) were the most common etiologies. Forty seven patients (25%) presented with heart failure and the onset time was > 24 hours in 77 cases (41%). Conversion to sinus rhythm was observed in 71 out of 166 patients with at least 24 hours of follow-up (42.8%). Age < 60 years, the absence of cardiac disease, a NYHA functional class I, the absence of heart failure at the emergency room and the time from onset < 24 hours were significantly associated with conversion to sinus rhythm. The last two variables were selected as independent predictors by logistic regression analysis (sensitivity: 80%, specificity: 68%). CONCLUSIONS: We conclude that recent-onset AF represents 0.54% of all the hospital emergencies. The time from onset and the presence of heart failure predict the probability of conversion to sinus rhythm within the first 24 hours.