Bacteriemia por Staphylococcus aureus resistente a meticilina de origen respiratorio / Meticillin resistant Staphylococcus aureus bacteremia of respiratory origin

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[Study of antibiotic multiresistance of Escherichia coli from urine cultures]. / Estudio de multirresistencia antibiótica de Escherichia coli en urocultivos.

BACKGROUND AND OBJECTIVE: The appearance of resistance in urinary tract infections caused by Escherichia coli constitutes an important therapeutic problem that requires the study of its evolution throughout time in order to establish a suitable empirical treatment. Our objective was to test the antimicrobial sensitivity of E. coli isolations in urine cultures performed in our area. MATERIAL AND METHOD: 5,247 isolates of E. coli from hospital and ambulatory urine cultures of patients in the area of Segovia were retrospectively analyzed. The antibiotic sensitivity of these isolations was studied for 4 years (2000-2005). Moreover, 6 phenotype patterns of resistance to betalactams were analyzed: natural, penicillinase, increased penicillinase, IRT, increased AMPc and BLEE and the difference in sensitivity between BLEE producing and non-producing stocks regarding nitrofurantoin, phosphomicin, ciprofloxacin, gentamicin, and trimetoprim-sulfametoxazol. RESULTS: 57% of isolates were resistant to ampicillin, 23% to ciprofloxacin and 31% to trimetroprim-sulfametoxazol. 48% were penicillinase producer, 6.6% increased penicillinase producer, 1.2% IRT producer, 1.1% AMPc producer and 2.2% were BLEE producer. As far as the origin of the sample is concerned, significant differences were not found. The percentages of co-resistance to ciprofloxacin and trimetoprim-sulfametoxazol were greater in BLEE producer stocks than in non-producers ones. We observed a gradual increase in the expression of this resistance mechanism throughout the studied period. CONCLUSIONS: Ampicillin, ciprofloxacin and trimetoprim-sulfametoxazol are not suitable for the empirical treatment of uncomplicated urinary infections. Research on sensitivity is essential in order to establish correct empirical treatments.

Estudio de multirresistencia antibiótica de Escherichia coli en urocultivos / Study of antibiotic multiresistance of Escherichia coli from urine cultures

Fundamento y objetivo: La aparición de resistencias en las infecciones del tracto urinario causadas por Escherichia coli constituye un importante problema terapéutico que requiere estudiar su evolución en el tiempo para instaurar un tratamiento empírico adecuado. Nuestro objetivo fue conocer la sensibilidad antimicrobiana de los aislamientos de E. coli en urocultivos en nuestra área. Material y método: Se analizaron retrospectivamente 5.247 aislamientos de E. coli procedentes de urocultivos de pacientes hospitalarios y extrahospitalarios en la provincia de Segovia. Se estudió la sensibilidad antibiótica de los aislamientos realizados en 2000-2005 y se analizaron 6 patrones fenotípicos de resistencia a betalactámicos: salvaje, producción de penicilinasa, hiperproducción de penicilinasa, productor de IRT (inhibitor resistant TEM mutants), hiperproducción de adenosinmonofosfato cíclico (AMPc) y betalactamasas de espectro extendido (BLEE), así como la diferencia de sensibilidad entre cepas productoras y no productoras de BLEE a la nitrofurantoína, la fosfomicina, el ciprofloxacino, la gentamicina y la trimetoprima-sulfametoxazol. Resultados: Un 57% fue resistente a ampicilina; un 23%, a ciprofloxacino y un 31%, a trimetoprima-sulfametoxazol. Un 48% fue productor de penicilinasa; un 6,6%, de penicilinasa incrementada; un 1,2%, de IRT; un 1,1%, de AMPc hiperproducido y un 2,2%, de BLEE, sin diferencias estadísticamente significativas en cuanto a la procedencia de la muestra. Se encontraron porcentajes de resistencia combinada a ciprofloxacino y trimetoprima-sulfametoxazol muy superiores en cepas productoras de BLEE, y se observó un incremento paulatino en la expresión de este mecanismo de resistencia durante el período estudiado. Conclusiones: Ampicilina, ciprofloxacino y trimetoprima-sulfametoxazol no son recomendables en el tratamiento empírico de las infecciones urinarias no complicadas en nuestra área. Los estudios de sensibilidad son esenciales con el fin de instaurar tratamientos empíricos correctos

Background and objective: The appearance of resistance in urinary tract infections caused by Escherichia coli constitutes an important therapeutic problem that requires the study of its evolution throughout time in order to establish a suitable empirical treatment. Our objective was to test the antimicrobial sensitivity of E. coli isolations in urine cultures performed in our area. Material and method: 5,247 isolates of E. coli from hospital and ambulatory urine cultures of patients in the area of Segovia were retrospectively analyzed. The antibiotic sensitivity of these isolations was studied for 4 years (2000-2005). Moreover, 6 phenotype patterns of resistance to betalactams were analyzed: natural, penicillinase, increased penicillinase, IRT, increased AMPc and BLEE and the difference in sensitivity between BLEE producing and non-producing stocks regarding nitrofurantoin, phosphomicin, ciprofloxacin, gentamicin, and trimetoprim-sulfametoxazol. Results: 57% of isolates were resistant to ampicillin, 23% to ciprofloxacin and 31% to trimetroprim-sulfametoxazol. 48% were penicillinase producer, 6.6% increased penicillinase producer, 1.2% IRT producer, 1.1% AMPc producer and 2.2% were BLEE producer. As far as the origin of the sample is concerned, significant differences were not found. The percentages of co-resistance to ciprofloxacin and trimetoprim-sulfametoxazol were greater in BLEE producer stocks than in non-producers ones. We observed a gradual increase in the expression of this resistance mechanism throughout the studied period. Conclusions: Ampicillin, ciprofloxacin and trimetoprim-sulfametoxazol are not suitable for the empirical treatment of uncomplicated urinary infections. Research on sensitivity is essential in order to establish correct empirical treatments

Endocarditis por Granulicatella adiacens en un paciente anciano / Endocarditis due to Granulicatella adiacens in an old patient

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Dermatitis estreptocócica perianal / Perianal streptococcal dermatitis

Presentamos diez casos de dermatitis perianal estreptocócica en seis niños y cuatro niñas. El cuadro clínico incluía eritema perianal, exudación y hematoquecia, con prurito anal y dolor con la defecación como síntomas más frecuentes. En un niño se acompañó de psoriasis en gotas. El cultivo bacteriológico fue positivo para el estreptococo betahemolítico del grupo A en todos los casos y también todos ellos respondieron a tratamiento antibiótico general y/o local. El diagnóstico diferencial con otros procesos de esa localización es fácil si se conoce este cuadro clínico. (AU)