A randomized trial comparing transanal irrigation and percutaneous tibial nerve stimulation in the management of low anterior resection syndrome.

AIM: To assess the effectiveness of transanal irrigation (TAI) compared with posterior tibial nerve stimulation (PTNS) in severe and chronic low anterior resection syndrome (LARS). METHOD: A two-group parallel, open-label randomized controlled trial carried out in a single university hospital. The study population included patients with a LARS scale score of more than 29 points who had undergone rectal surgery more than 1 year previously. These were randomly allocated, with a central randomization system, following a 1:1 sequence to TAI or PTNS. The main study outcome was to achieve a reduction of at least one LARS grade in at least 50% of the patients, for each intervention. RESULTS: A total of 27 patients (TAI = 13, PTNS = 14) were randomized. Both groups were similar with regard to confounding factors. Four patients were excluded because of intercurrent disease or early dropout, leaving 23 (TAI, n = 10; PTNS, n = 13) for analysis. Eight out of 10 and 4 out of 13 patients were downgraded with TAI and PTNS, respectively. The median LARS score decreased from 35 [interquartile range (IQR) 32-39] to 12 (IQR 12-26) (P = 0.021) for the TAI group and from 35 (IQR 34-37) to 30 (IQR 25-33) (P = 0.045) for the PTNS group. The Vaizey score fell from 15 (IQR 11-18) to 6 (IQR 4-7) (P = 0.037) and from 14 (IQR 13-17) to 9 (IQR 7-10) (P = 0.007) with TAI and PTNS, respectively, with 80% and 38% of patients, respectively, showing decreases of more than 50%. Improvement in quality of life was observed in both groups. CONCLUSION: Both treatments improved the LARS score in this study but this was only significant in the TAI group.

Outbreak of infection with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a Mexican hospital.

Thirty-one strains of Klebsiella pneumoniae (including 10 duplicates) from 21 septicemic pediatric patients (age, <2 months) were studied during a 4-month period (June to October 1996) in which the fatality rate was 62% (13 of 21). These isolates identified by the API 20E system yielded the same biotype. Pulsed-field gel electrophoresis experiments revealed the same clone in 31 strains. The isolates were multidrug-resistant but were still susceptible to ciprofloxacin, imipenem, and cefoxitin. A 135-kb plasmid was harbored in all of the isolates. No transconjugants were obtained that were resistant to ampicillin, cefotaxime, tetracycline, or gentamicin. Isoelectric focusing for beta-lactamases was performed on all strains, and three bands with pIs of 5.4, 7.6, and 8.2 were obtained. Of these, the pI 8.2 beta-lactamase had an extended-spectrum beta-lactamase phenotype. PCR amplification of both TEM- and SHV-type genes was obtained. The sequence analysis of the SHV PCR product indicated a mutation corresponding to the SHV-5 beta-lactamase.

Antibiotic resistance in Streptococcus pneumoniae in six Latin American countries: 1993-1999 surveillance.

The impact of invasive pneumococcal invasive disease is increased by the emergence of antibiotic resistance. We report regional and temporal variations in antibiotic resistance for 4,105 invasive Streptococcus pneumoniae isolates collected from Latin American children <5 years, between 1993 and 1999. Reduced susceptibility to penicillin was detected in 1,182 isolates (28.8%); 36% of these were resistant (> or = 2 microg/ml), including 12.6% with MIC > or = 4 microg/ml, occurring primarily in serotypes 14 and 23F. Reduced susceptibility to third-generation cephalosporins was detected in 12.1% of the collection. Mexico had the highest proportion of reduced susceptibility to penicillin (51.6%) and to third-generation cephalosporins (22%), whereas Brazil had the lowest at 20.9% and 0.7%, respectively. Isolates cultured from patients with pneumonia were more likely to have reduced susceptibility to third-generation cephalosporins than isolates from patients with meningitis (p < 0.0001). Susceptibility to trimethoprim-sulfamethoxazole, chloramphenicol, erythromycin, and vancomycin was tested by disk diffusion for 2.899 isolates. Reduced susceptibility was observed for 45.6%, 11.5%, 6.9%, and 0%, respectively. Thirty-one percent of the strains were resistant to > or = 2 drugs. High levels of antibiotic resistance in Latin America emphasize the need for the development of and adherence to rational antibiotic use guidelines. On-going surveillance will monitor the impact of these programs.

[Impact of Streptococcus pneumoniae on pneumonia in Latin American children. SIREVA-Vigía Group]. / Impacto de Streptococcus pneumoniae en las neumonías del niño latinoamericano. Grupo SIREVA-Vigía.

Community-acquired pneumonia is one of the leading causes of infant morbidity and mortality. Studies conducted in developing countries indicate that the most serious symptoms of pneumonia are associated with bacterial causes, mainly Streptococcus pneumoniae, followed by Haemophilus influenzae type b. Managing those infections in children under two years of age is hindered by the lack of appropriate vaccines and by the decreased susceptibility of S. pneumoniae to penicillin and other antibiotics. In 1993, at the initiative of the Regional System for Vaccines of the Pan American Health Organization, and with funding from the Canadian International Development Agency, a study was designed to identify the S. pneumoniae capsular types that cause invasive disease in Latin American children under 5 years of age. The objective of the study was to determine the ideal composition of a conjugate vaccine that could be used in Latin America, and the penicillin susceptibility of the S. pneumoniae isolates. The initiative was undertaken in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. This report analyzes the information that the participating countries generated on pneumococcal pneumonia. A total of 3,393 children were found with systemic S. pneumoniae infections, of which 1,578 corresponded to pneumonias. The analysis focused on 1,409 cases of pneumonia in Argentina, Brazil, Colombia, Mexico, and Uruguay. Of the children, 63.8% of them were under two years of age. Twelve prevalent capsular types were identified, of which serotypes 14, 5, and 1 were the three most common in the majority of the countries. At the beginning of the study the highest level of penicillin resistance was found in Mexico (47.0%), and the lowest in Colombia (12.1%). Over the 1993-1998 period, resistance to penicillin increased in the five countries. Penicillin resistance was associated with a small number of capsular serotypes, mainly 14 and 23F. The first of those serotypes was resistant to penicillin and to trimethoprim-sulfamethoxazole, and the second was multiresistant. The frequency of resistance to trimethoprim-sulfamethoxazole was high in all of the countries; Argentina had the highest level, 58.0%. A decrease in susceptibility to chloramphenicol was uncommon, except in Colombia, where there was a resistance level of 23.4%. Resistance to erythromycin was low in all the countries, and all the isolates were susceptible to vancomycin.

Susceptibility to new beta-lactams of enterobacterial extended-spectrum beta-lactamase (ESBL) producers and penicillin-resistant Streptococcus pneumoniae in Mexico.

The activities of several beta-lactam antimicrobial agents, aminoglycosides and ciprofloxacin, were determined against 62 clinical isolates of enterobacteria resistant to oxyimino cephalosporins (extended-spectrum beta-lactamase producers), collected during 1991 to 1993, and 16 penicillin-resistant invasive isolates of Streptococcus pneumoniae collected during 1994-1996. The numbers and percentages of susceptible enterobacterial strains to tested antibiotics were: imipenem 60 (97%), ciprofloxacin 57 (92%), cefepime 56 (90%), cefpirome 34 (55%), aztreonam 13 (21%), cefotaxime 7 (11%), ceftazidime 0 (0%), amikacin 11 (18%) and gentamicin 16 (26%). Despite the fact that these strains had never been exposed previously to cefepime or cefpirome, the susceptibility was 90% and 55%, respectively. No penicillin-resistant strains of S. pneumoniae were susceptible to cefotaxime, imipenem or cefepime. Only one strain was susceptible to ceftazidime and 4 (25%) were susceptible to cefpirome. Erythromycin showed the greatest activity with 12 (75%) susceptible strains.

Treatment of presumed bacterial pneumonia in ambulatory children.

In a prospective, randomized, open study, a combination of trimethoprim and rifampin (TMP/R) 20 mg/kg/day was compared with ampicillin (AMP) 150 mg/kg/day, both given orally twice daily for 10 days, for the treatment of 60 children who had mild community-acquired pneumonia. The control group comprised 112 healthy children. The overall duration of the disease was 8.5 +/- 3.6 days in the TMP/R group vs 6.0 +/- 1.1 days in the AMP group. Fever persisted for 7.0 +/- 1.8 days in the TMP/R-treated patients vs 5.2 +/- 1.0 days in the AMP-treated patients. At the end of the 10 days, nasopharyngeal cultures were negative in all patients in the AMP group and in 25 of the 30 patients in the TMP/R group. These five patients were clinical and microbiologic failures. We conclude that in infants and children with mild community-acquired pneumonia, treatment with AMP for 10 days is more effective than treatment with a combination of TMP/R for clinical cure and eradication of bacterial pathogens.

Serogroup specificity and antimicrobial susceptibilities of Neisseria gonorrhoeae isolated in Mexico City.

The serogroup pattern of 87 clinical isolates of Neisseria gonorrhoeae was determined by monoclonal coagglutination and the in-vitro activity of seven antimicrobial agents against the same strains was tested by an agar dilution method. The frequency of resistance to spectinomycin, ampicillin, penicillin, erythromycin, chloramphenicol and tetracycline was 14.9%, 33.3%, 34.4%, 30%, 40.2% and 41.3%, respectively. All strains were susceptible to cefotaxime. Out of 87 strains tested, 29.8% produced beta-lactamases and 4.5% were chromosomally resistant to penicillin. In all instances resistance to a drug was associated with serogroup 1-B except for erythromycin. The results presented here correlate with observations made worldwide.

Results of treatment of uncomplicated urogenital gonorrhoea with enoxacin compared with ceftriaxone.

The increasing incidence of penicillinase producing Neissreria gonorrhoeae (PPNG) and chromosomally-mediated resistant N. gonorrhoeae (CMRNG) has generated a need for therapy other than penicillin. PPNG constitutes about 30% of the circulating strains of gonococci in the high risk population in Mexico City. The object of the present study was to compare the safety and efficacy of single-dose treatment with either oral enoxacin (400 mg tablet) or intramuscular ceftriaxone (250 mg injection), for the treatment of acute uncomplicated gonococcal urethritis in men, caused by N. gonorrhoeae, including both PPNG and non-PPNG strains. Of the 93 men with uncomplicated gonorrhoea entered into a study, randomly assigned to receive ceftriaxone or enoxacin, 80 completed it. Infections were initially diagnosed by Gram-stained smears of urethral exudate and subsequently confirmed for isolation of N. gonorrhoeae. Chlamydia trachomatis was confirmed by direct immunofluorescence. About 30% of the strains of gonococci were PPNG and 1% were CMRNG. C. trachomatis was coexisting with N. gonorrhoeae in about 25% of the patients and remain positive after treatment. In the study presented, a single dose of either enoxacin or ceftriaxone was highly active against both PPNG or CMRNG. One single dose was enough to achieve a 100% cure rate. There was no difference between the two treatment groups. Thus either regimen has proved to be a useful alternative to the present-day treatment of uncomplicated gonococcal infections.(ABSTRACT TRUNCATED AT 250 WORDS)