RESUMEN
Arthrographis kalrae is a rare isolate in clinical specimens. Only ten cases of infection with this species have been described so far. To our knowledge, we report the first case of a pulmonary infection caused by A. kalrae in a patient with a past history of stage IIA Hodgkin's lymphoma and demonstrate that this organism can act as an opportunistic human pathogen.
Asunto(s)
Ascomicetos/aislamiento & purificación , Enfermedades Pulmonares Fúngicas/microbiología , Infecciones Oportunistas/microbiología , Antifúngicos/uso terapéutico , Humanos , Itraconazol/uso terapéutico , Enfermedades Pulmonares Fúngicas/terapia , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/terapia , ToracotomíaRESUMEN
The treatment of choice of H. pylori infections is a 7-day triple-therapy with a proton pump inhibitor (PPI) plus amoxicillin and either clarithromycin or metronidazole, depending on local antibiotic resistance rates. The data on efficacy of eradication therapy in a group of rheumatology patients on long-term NSAID therapy are reported here. This study was part of a nationwide, multicenter RCT that took place in 2000-2002 in the Netherlands. Patients who tested positive for H. pylori IgG antibodies were included and randomly assigned to either eradication PPI-triple therapy or placebo. After completion, follow-up at 3 months was done by endoscopy and biopsies were sent for culture and histology. In the eradication group 13% (20/152, 95% CI 9-20%) and in the placebo group 79% (123/155, 95% CI 72-85%) of the patients were H. pylori positive by histology or culture. H. pylori was successfully eradicated in 91% of the patients who were fully compliant to therapy, compared to 50% of those who were not (difference of 41%; 95% CI 18-63%). Resistance percentages found in isolates of the placebo group were: 4% to clarithromycin, 19% to metronidazole, 1% to amoxicillin and 2% to tetracycline.
Asunto(s)
Antibacterianos/administración & dosificación , Infecciones por Helicobacter/tratamiento farmacológico , Inhibidores de la Bomba de Protones/administración & dosificación , Enfermedades Reumáticas/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antibacterianos/sangre , Biopsia , Endoscopía Gastrointestinal , Femenino , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/aislamiento & purificación , Histocitoquímica , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Países Bajos , Placebos/administración & dosificación , Serología/métodos , Resultado del TratamientoRESUMEN
During recent years, a rising incidence of invasive pulmonary aspergillosis (IPA) in non-neutropenic critically ill patients has been reported. Critically ill patients are prone to develop disturbances in immunoregulation during their stay in the ICU, which render them more vulnerable for fungal infections. Risk factors such as chronic obstructive pulmonary disease (COPD), prolonged use of steroids, advanced liver disease, chronic renal replacement therapy, near-drowning and diabetes mellitus have been described. Diagnosis of IPA may be difficult and obtaining histo- or cytopathological demonstration of the fungus in order to meet the gold standard for IPA is not always feasible in these patients. Laboratory markers used as a non-invasive diagnostic tool, such as the galactomannan antigen test (GM), 1,3-beta-glucan, and Aspergillus PCR, show varying results. Antifungal therapy might be considered in patients with persistent pulmonary infection who exhibit risk factors together with positive cultures or sequentially positive GM and Aspergillus PCR in serum, in whom voriconazole is the drug of choice. The benefit of combination antifungal therapy lacks sufficient evidence so far, but this treatment might be considered in patients with breakthrough infections or refractory disease.
Asunto(s)
Aspergilosis/diagnóstico , Aspergilosis/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Antifúngicos/uso terapéutico , Antígenos Fúngicos/sangre , Aspergilosis/microbiología , Aspergillus/genética , Aspergillus/aislamiento & purificación , Enfermedad Crítica , ADN de Hongos/análisis , Quimioterapia Combinada , Galactosa/análogos & derivados , Humanos , Unidades de Cuidados Intensivos , Enfermedades Pulmonares Fúngicas/microbiología , Mananos/sangre , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Reacción en Cadena de la Polimerasa , Factores de Riesgo , beta-Glucanos/sangreRESUMEN
Three hundred sixty Enterobacteriaceae and nonfermenting gram-negative bacilli, isolated during one week in May 2004 at five hospitals in Amsterdam, The Netherlands, were evaluated for the presence of extended-spectrum beta-lactamases (ESBLs). A prevalence of 7.8% was found, in contrast to the 1% observed in 1997. CTX-M ESBLs dominated, and four types were identified in 18 isolates.
Asunto(s)
Proteínas Bacterianas/análisis , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/enzimología , beta-Lactamasas/análisis , Antibacterianos/farmacología , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/aislamiento & purificación , Hospitales , Humanos , Pruebas de Sensibilidad Microbiana , Países BajosAsunto(s)
Acetamidas/uso terapéutico , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/microbiología , Resistencia a la Meticilina , Oxazolidinonas/uso terapéutico , Rifampin/uso terapéutico , Staphylococcus epidermidis , Vancomicina/uso terapéutico , Antibacterianos/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Linezolid , Persona de Mediana Edad , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus epidermidis/efectos de los fármacos , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the prevalence of carriers of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and gentamicin-resistant Gram-negative bacilli (GGNB) in patients repatriated from foreign hospitals to The Netherlands. DESIGN: Determination of prevalence. METHOD: In the period May 1998-August 2001, 1167 patients were repatriated. Swab specimens, demographic data and clinical data were obtained during the transfer. RESULTS: The prevalence of carriers of resistant microorganisms was 18.2%. MRSA was carried by 2.7% of the total repatriated group and by 4.7% of patients transferred to a Dutch hospital. Risk factors were antimicrobial treatment (odds ratio (OR): 3.4; 95% CI: 1.2-9.7), length of stay in a foreign hospital > or = 14 days (OR: 5.4; 95% CI: 2.3-12) and artificial ventilation (OR: 8.5; 95% CI: 1.8-41). VRE and GGNB were isolated from 2.7% and 14.1% of patients, respectively. Transfer from Asia or southern, south-eastern and eastern Europe were risk factors for carrying GGNB. CONCLUSION: Carriership of resistant microorganisms was high among repatriated patients. The highest risk of GGNB was more closely associated with the country from which the patient was transferred than the antimicrobial treatment received in the foreign hospital.
Asunto(s)
Portador Sano/epidemiología , Infección Hospitalaria/epidemiología , Farmacorresistencia Bacteriana , Enterococcus/efectos de los fármacos , Bacterias Gramnegativas/efectos de los fármacos , Staphylococcus aureus/efectos de los fármacos , Portador Sano/microbiología , Infección Hospitalaria/microbiología , Reservorios de Enfermedades , Femenino , Gentamicinas/farmacología , Hospitalización , Humanos , Tiempo de Internación , Masculino , Resistencia a la Meticilina , Países Bajos/epidemiología , Prevalencia , Factores de Riesgo , Resistencia a la VancomicinaRESUMEN
Two patients, a 34-year old man-to-woman transsexual and a 32-year-old man, with aids presented with pulmonary symptoms, fever, serious weight loss and an oral ulcer. A third patient, a 16-year-old boy, had signs of transverse myelitis and meningitis without immunodeficiency. All were South American citizens and had disseminated histoplasmosis. After antifungal treatment they recovered, although the third patient remained a wheelchair user. If pulmonary or miliary tuberculosis is suspected in a patient originating from South America, histoplasmosis should be considered. Oral ulcers and skin lesions can be diagnostic clues. Specific stainings of direct preparations and longer-lasting cultures of various materials, especially of biopsy samples, then provide the diagnosis.
Asunto(s)
Histoplasmosis/complicaciones , Histoplasmosis/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adolescente , Adulto , Antifúngicos/uso terapéutico , Diagnóstico Diferencial , Femenino , Histoplasmosis/tratamiento farmacológico , Histoplasmosis/etnología , Humanos , Masculino , Meningitis/microbiología , Mielitis Transversa/microbiología , Neumonía/microbiología , América del Sur/etnología , Estomatitis Aftosa/microbiología , Resultado del Tratamiento , Tuberculosis/diagnósticoAsunto(s)
Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico , Cerebelo/microbiología , Histoplasmosis/diagnóstico , Bulbo Raquídeo/microbiología , Meninges/microbiología , Adolescente , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Cerebelo/patología , Histoplasma/aislamiento & purificación , Histoplasmosis/microbiología , Humanos , Imagen por Resonancia Magnética , Masculino , Bulbo Raquídeo/patología , Meninges/patologíaRESUMEN
We found that NCTC11637, the type strain of Helicobacter pylori, the causative agent of peptic ulcer disease and an early risk factor for gastric cancer, is metronidazole resistant. DNA transformation, PCR-based restriction analysis, and DNA sequencing collectively showed that the metronidazole resistance of this strain was due to mutation in rdxA (gene HP0954 in the full genome sequence of H. pylori 26695) and that resistance did not depend on mutation in any of the other genes that had previously been suggested: catalase (katA), ferredoxin (fdx), flavodoxin (fldA), pyruvate:flavodoxin oxidoreductase (porgammadeltaalphabeta), RecA (recA), or superoxide dismutase (sodB). This is in accord with another recent study that attributed metronidazole resistance to point mutations in rdxA. However, the mechanism of rdxA inactivation that we found in NCTC11637 is itself also novel: insertion of mini-IS605, one of the endogenous transposable elements of H. pylori, and deletion of adjacent DNA sequences including 462 bp of the 851-bp-long rdxA gene.
Asunto(s)
Proteínas Bacterianas/genética , Eliminación de Gen , Helicobacter pylori/efectos de los fármacos , Helicobacter pylori/genética , Proteínas de la Membrana/genética , Metronidazol/farmacología , Mutación/fisiología , Nitrorreductasas/genética , Secuencia de Aminoácidos , Secuencia de Bases , Farmacorresistencia Microbiana , Datos de Secuencia Molecular , Mutación/genética , Sondas de Oligonucleótidos , Polimorfismo de Longitud del Fragmento de RestricciónRESUMEN
A PCR-based reverse hybridization system (research prototype kit INNO-LiPA for H. pylori resistance) was developed and evaluated for simultaneous detection of 23S ribosomal DNA point mutations, associated with macrolide resistance in Helicobacter pylori. Fifty-seven H. pylori strains (51 natural, 6 laboratory-derived artificial, 52 resistant, and 5 susceptible strains) were tested by PCR-LiPA (detecting mutations A2115-->G, G2141-->A, A2142-->G, A2142-->C, A2143-->G, A2143-->C, and A2143-->T), DNA sequencing, restriction fragment length polymorphism, and/or hybridization to oligonucleotide probes. Results were highly concordant, but PCR-LiPA appears to be more sensitive for the simultaneous detection of multiple mutants.
Asunto(s)
Antibacterianos/farmacología , Helicobacter pylori/efectos de los fármacos , Mutación , Reacción en Cadena de la Polimerasa/métodos , ARN Ribosómico 23S/genética , Farmacorresistencia Microbiana , Helicobacter pylori/genética , Macrólidos , Hibridación de Ácido Nucleico , Polimorfismo de Longitud del Fragmento de RestricciónRESUMEN
Successful treatment of Helicobacter pylori infection is becoming compromised by emerging resistance. We report the prevalence rates of H. pylori resistance to metronidazole, clarithromycin, amoxycillin, tetracycline and trovafloxacin in The Netherlands. A total of 231 H. pylori clinical isolates were collected throughout the country over a period of 6 months during 1997-1998. The MICs of the above-mentioned antibiotics were determined in a single laboratory. The overall percentage of resistance for clarithromycin and metronidazole was 1.7% and 21.2%, respectively. None of the strains was resistant to amoxycillin or tetracycline. The primary resistance rate of trovafloxacin was as high as 4.7%. Since trovafloxacin has not yet been introduced on to the Dutch market, the resistance is probably induced by the use of other quinolones. Our data indicate that treatment outcome would benefit from susceptibility testing before starting therapy, especially when prescribing metronidazole.
Asunto(s)
Antibacterianos/farmacología , Fluoroquinolonas , Infecciones por Helicobacter/microbiología , Helicobacter pylori/efectos de los fármacos , Amoxicilina/farmacología , Claritromicina/farmacología , Farmacorresistencia Microbiana , Resistencia a Múltiples Medicamentos , Utilización de Medicamentos , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/crecimiento & desarrollo , Helicobacter pylori/aislamiento & purificación , Humanos , Metronidazol/farmacología , Pruebas de Sensibilidad Microbiana , Naftiridinas/farmacología , Países Bajos , Tetraciclina/farmacologíaRESUMEN
The prevalence of ESBL was determined among isolates of Escherichia coli (n = 571) and Klebsiella spp. (n = 196) collected during a 1-week study period in 8 university and 3 large regional laboratories all over the Netherlands. 18 isolates were positive for at least one of the screening tests used, i.e., VITEK-ESBL, E-test ESBL and MIC ratio of ceftazidime/ceftazidime-clavulanic acid, cefotaxime/cefotaxime-clavulanic acid. In 5 of these 18 putative ESBLs no betalactamase production was detectable. A TEM type was found in three E. coli and two Klebsiella spp. An SHV type was present in five Klebsiella spp. In one E. coli and one Klebsiella pneumoniae both enzymes were present. In one Klebsiella oxytoca neither of the two enzymes was present. Using PCR for both ESBL TEM and ESBL SHV, an SHV ESBL was found in one E. coli and four Klebsiella isolates. The mutations at position 238 and 240 were already described. In one E. coli isolate a TEM ESBL was found with three mutations, at position 21, 164 and 265. These mutations were already described in other ESBLs but not in this combination suggesting a new TEM ESBL. The overall prevalence of ESBL producing E. coli and Klebsiella spp. was less than 1% (6 out of 767).
Asunto(s)
Escherichia coli/enzimología , Klebsiella/enzimología , beta-Lactamasas/metabolismo , Antibacterianos/farmacología , Secuencia de Bases , Escherichia coli/efectos de los fármacos , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Genes Bacterianos/genética , Humanos , Focalización Isoeléctrica , Klebsiella/efectos de los fármacos , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/microbiología , Pruebas de Sensibilidad Microbiana , Datos de Secuencia Molecular , Mutación , Países Bajos , Reacción en Cadena de la Polimerasa , beta-Lactamasas/análisis , beta-Lactamasas/genéticaRESUMEN
A single point mutation in the 23S rRNA gene of Helicobacter pylori is known to confer resistance to clarithromycin. Most prevalent among clarithromycin-resistant clinical H. pylori isolates are the mutations from A-2142 to G and A-2143 to G in the 23S rRNA gene. The bias in the 23S rRNA gene mutations conferring clarithromycin resistance may result from the higher MIC, stability of resistance, and growth rate found for the strains with the above-mentioned mutations.
Asunto(s)
Antibacterianos/farmacología , Claritromicina/farmacología , Helicobacter pylori/efectos de los fármacos , Mutación Puntual , ARN Bacteriano/genética , ARN Ribosómico 23S/genética , Farmacorresistencia Microbiana , Helicobacter pylori/genética , HumanosRESUMEN
The intra- and interlaboratory reproducibilities of a commercial sandwich enzyme-linked immunosorbent assay (ELISA) for the detection of Aspergillus galactomannan in serum (Platelia Aspergillus; Sanofi Diagnostics Pasteur, Marnes-La-Coquette, France) were evaluated in six laboratories of university hospitals. Twenty serum samples were obtained from 12 neutropenic patients including 6 with invasive aspergillosis. These samples were blinded and sent to each center together with eight blinded ELISA-negative serum samples spiked with known concentrations of galactomannan. The centers were provided with ELISA microtiter plates from a single batch and a detailed protocol. Ten clinical samples showed ELISA reactivity, while 10 samples were ELISA negative. The mean coefficient of variation (CV) of the optical density values was 4.24% within a single assay and 25.6% between runs. The interassay CV of the ratios for the serum samples tested was 18.6%. Analysis of ordinal interpretation of the ELISA result (i.e., negative, gray zone, or positive) showed excellent reproducibility. Recalculation of the cutoff values for positive and negative samples suggested that the cutoff level recommended by the manufacturer could be lowered from 1.0 to 0.8 for negative samples and from 1.5 to 1.0 for positive samples. The intra- and interlaboratory reproducibilities were excellent when the ELISA results were interpreted as ordinal data, but considerable variation in optical density values and, to a lesser extent, in the ratios for the serum samples tested, was observed between runs. High assay variability was also found for serum samples spiked with known concentrations of galactomannan. Therefore, antigen titers in serum samples from a single patient, measured in different runs, should be compared with caution.
Asunto(s)
Antígenos Fúngicos/sangre , Aspergilosis/diagnóstico , Aspergillus/inmunología , Ensayo de Inmunoadsorción Enzimática , Mananos/sangre , Aspergilosis/complicaciones , Galactosa/análogos & derivados , Hospitales Universitarios , Humanos , Laboratorios de Hospital , Mananos/inmunología , Países Bajos , Neutropenia/complicaciones , Variaciones Dependientes del Observador , Control de Calidad , Reproducibilidad de los ResultadosRESUMEN
Seventy-three Helicobacter pylori-positive patients were treated with a combination of clarithromycin and ranitidine in order to eradicate the bacterium. Eradication was successful in 79.5%. In 15 patients eradication failed, and in 11 cases this was due to clarithromycin resistance. In one patient the infecting strain was resistant at the onset of treatment, while in the remaining 10 patients resistance developed during therapy. These isolates had also become resistant to various other antibiotics. Random amplified polymorphic DNA and restriction fragment end-labeling analysis of the isolates showed close genetic relatedness between pre- and post-treatment isolates, indicating that resistance was the result of selection of variants of the infecting strain rather then infection with an exogenous resistant strain. Nucleotide sequence comparisons revealed that all resistant isolates had a single base pair mutation in the 23S rRNA. Since this single point mutation results in co-resistance to various antibiotics at high frequencies, caution should be taken when using clarithromycin as a single antibiotic.
Asunto(s)
Antibacterianos/farmacología , Claritromicina/farmacología , Helicobacter pylori/efectos de los fármacos , Antibacterianos/uso terapéutico , Secuencia de Bases , Claritromicina/uso terapéutico , Cartilla de ADN/genética , ADN Bacteriano/genética , ADN Bacteriano/aislamiento & purificación , Farmacorresistencia Microbiana/genética , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/microbiología , Helicobacter pylori/genética , Helicobacter pylori/aislamiento & purificación , Humanos , Datos de Secuencia Molecular , ARN Bacteriano/genética , ARN Ribosómico 23S/genéticaRESUMEN
The susceptibility of 30 clinical isolates of Helicobacter pylori to trospectomycin, ampicillin, metronidazole, clarithromycin, azithromycin and clindamycin under varying pH conditions was evaluated. An acidic environment was shown to affect unfavourably the activity of all the antimicrobial agents tested. This pH effect was most marked for the two macrolides and for clindamycin.