Actualización en prevención de VRS: Nirsevimab vs vacunación en embarazadas (RSVpreF) / Update on RSV prevention: Nirsevimab vs vaccination in pregnant women (RSVpreF)

El anticuerpo monoclonal Nirsevimab fue el primero que se implantó para la prevención de infección por virus respiratorio sincitial (VRS) de todos los lactantes en sus primeros meses de vida. Recientemente se ha aprobado el uso de una vacuna en la embarazada (RSVpreF) con distinta forma de inmunización pero el mismo objetivo en el lactante. De este modo, surge la necesidad de valorar una nueva estrategia de inmunización. Desarrollo. Nirsevimab demostró en ensayos clínicos buenos datos de eficacia clínica y de seguridad. Tras su inclusión en la temporada epidémica 2023-2024, la cobertura en España ha sido muy alta y los resultados preliminares parecen mantener la tendencia de los ensayos. Queda pendiente una valoración adecuada de su eficiencia. RSVpreF tiene resultados similares pero, de momento, solo en ensayos y, aunque podría tener alguna ventaja inmunológica, se desconoce si se traduciría en eficacia real. Aún así, esta nueva vacuna respaldada por organismos sanitarios y científicos sería una alternativa segura y eficaz. Por otro lado, incluso con la implementación en el calendario vacunal de RSVpreF, Nirsevimab va a continuar siendo clave en la protección de ciertos lactantes. Conclusión. La aprobación de la vacuna en la embarazada RSVpreF añade una segunda herramienta inmunológica frente a la infección por VRS en lactantes. RSVpreF y Nirsevimab pueden desarrollar un papel complementario en la prevención de estas infecciones.(AU)

Introduction: Nirsevimab was the first monoclonal antibody to be implemented in order to prevent respiratory syncytial virus (RSV) infection in all infants in their first months of life. The use of a vaccine in pregnant women (RSVpreF) using a different way of immunization but still sharing the same objective in infants has recently been approved. Thus, there is a necessity to evaluate a new immunization strategy. Development. Nirsevimab showed good clinical efficacy and safety data in medical trials. After its inclusion in the 2023-2024 epidemic season, coverage in Spain has been very high and preliminary results seem to maintain the trend shown in the trials. An adequate assessment of its efficiency is still pending. RSVpreF has similar results but, for now, only in trials and although it could have some immunological advantages, it is unknown if it would result in actual efficacy. Even so, this new vaccine, supported by health and scientific organizations, would provide a safe and effective alternative. Nonetheless, even with the implementation in the RSVpreF vaccine schedule, Nirsevimab will continue to be a key factor in the protection of certain infants. Conclusion. The approval of the RSVpreF vaccine in pregnant women adds a second immunological tool against RSV infections in infants. RSVpreF and Nirsevimab may play a complementary role in the prevention of these infections.(AU)

Experimental peri-implantitis around titanium implants with a chemically modified surface with a monolayer of multi-phosphonate molecules: a preclinical in vivo investigation.

OBJECTIVES: The purpose of this experimental in vivo investigation was to evaluate the influence of modifying the implant surface by adding a monolayer of multi-phosphonate molecules on the development of experimental peri-implantitis. MATERIAL AND METHODS: Eight beagle dogs received 5 tests and 5 control implants each following a split-mouth design 3 months after premolar and molar extraction. On the most mesial implant of each side, a 3-mm buccal dehiscence was artificially created. Experimental peri-implantitis was induced by silk ligatures over a 4-month period; after ligature removal, peri-implantitis was left to progress for another 4 months without plaque control. Clinical, histological, and radiographic outcomes were evaluated. RESULTS: Radiographically, both implant groups showed a similar bone loss (BL) at the end of the induction and progression phases. BL measured on the histological sections of the test and control groups was 3.14 ± 0.42 mm and 3.26 ± 0.28 mm, respectively; the difference was not statistically significant (p > 0.05). The remaining buccal bone to implant contact (bBIC) percentage of the test and control groups was 59.38 ± 18.62 and 47.44 ± 20.46%, respectively; the difference, however, was not statistically significant (p > 0.05). Bone loss observed at dehiscent sites compared to non-dehiscent ones showed no statistically significant difference (p > 0.05). CONCLUSIONS: Addition of a monophosphonate layer to a moderately rough implant surface did not affect development of experimental peri-implantitis. CLINICAL RELEVANCE: Influence of implant surface on peri-implantitis may condition implant selection by the clinician, especially on patients with disease risk factors. In that sense, monophosphate layer implants do not show higher peri-implantitis risk than control implants.

Alveolar crest contour changes after guided bone regeneration using different biomaterials: an experimental in vivo investigation.

OBJECTIVE: To evaluate the changes in alveolar contour after guided bone regeneration (GBR) with two different combinations of biomaterials in dehiscence defects around implants. MATERIAL AND METHODS: Chronic alveolar ridge defects were created bilaterally in the mandible of eight Beagle dogs. Once implants were placed, three treatment groups were randomly allocated to each peri-implant dehiscence defect: (i) test group received a bone substitute composed of hydroxyapatite (HA) and ß-tricalcium phosphate (ß-TCP) covered by a cross-linked collagen membrane, (ii) positive control group with placement of deproteinized bovine bone mineral (DBBM) plus a porcine natural collagen membrane, and (iii) a negative control with no treatment. Two healing periods (8 and 16 weeks) were evaluated. Dental casts were optically scanned, the obtained files were uploaded into an image analysis software and superimposed to evaluate the linear changes. RESULTS: In both healing periods, the gains in linear contours were higher in the test group and at the intermediate level (3 mm below the gingival margin). While at 8 weeks, no significant differences were found between the groups; at 16 weeks, the test and positive control groups demonstrated significant gains in contour compared with negative control. CONCLUSIONS: GBR using different biomaterials significantly increased the buccal contours of the alveolar crest when used at dehiscence defects around dental implants. CLINICAL RELEVANCE: Particulate highly porous synthetic bone substitute and a cross-linked collagen membrane demonstrated similar outcomes in terms of contour augmentation when compared to bovine xenograft (DBBM) and a collagen membrane.

Evidencia microbiana de la periimplantitis, factores de riesgo coadyuvantes, diagnóstico y tratamiento según los protocolos científicos / Microbiological evidence of peri-implantitis, enhancing risk factors. Diagnosis and treatment according to the scientific protocols

Se presenta un trabajo de revisión sobre periimplantitis, comenzando con el desarrollo de los conceptos básicos de la anatomía periimplantar y los criterios de osteointegración, se hace un estudio sobre la evidencia microbiológica de la patología periimplantaria y la patogenia de la misma, conjuntamente con los factores de riesgo que afectan al proceso inflamatorio y destructivo de los tejidos periimplantarios. Continúa el trabajo exponiendo los parámetros clínicos que muestra la enfermedad, como desarrollar el diagnóstico y qué posibilidades terapéuticas y de mantenimiento basadas en los protocolos científicos se pueden aplicar (AU)

In this review article of periimplantitis an overview of the anatomical basic concepts are present followed by the osseointegration criteria, a study of the microbiological evidence, pathogenia, and risk factors, wich affect to the inflamatory and destructive periimplantar process. This paper continues by explaining the clinical parameters of the diseases, how to develop a diagnosis and the therapeutic and maintinance possibilities based on the scientific protocols (AU)

In vitro activity of fosfomycin trometamol against pathogens from urinary tract infections: a Spanish multicenter study.

The in-vitro susceptibilities of a total of 1371 urinary tract pathogens to fosfomycin trometamol were determined. According to the NCCLS breakpoints, Enterobacteriaceae and gram-positive microorganisms were, in general, very sensitive to this antimicrobial. More than 90.0% of the Escherichia coli and Citrobacter spp. and more than 70.0% of the Klebsiella pneumoniae, K. oxytoca, Enterobacter spp., Proteus mirabilis, Staphylococcus aureus, coagulase-negative staphylococci and Enterococcus spp. strains tested were susceptible to fosfomycin trometamol. However, Pseudomonas aeruginosa and Acinetobacter spp. strains were more resistant. In general, recent clinical isolates from urinary tract infections (UTIs) in both community and hospital were also very sensitive (> 80.0%) to fosfomycin, its activity being higher than that of the rest of the antimicrobials commonly used for therapy of uncomplicated UTIs. More than 75.0% of the most frequently isolated pathogens from UTIs, except for P. aeruginosa (31.8%) and Acinetobacter spp. (11.1%), were susceptible to fosfomycin trometamol. The results obtained in this study, together with the infrequency of side effects and its pharmacokinetic properties, indicate that fosfomycin trometamol may be a useful alternative for single-dose therapy of uncomplicated UTIs.

Treatment with various antibiotics of experimental endocarditis caused by penicillin-resistant Streptococcus sanguis.

BACKGROUND: Streptococcus sanguis currently accounts for one-half of viridans streptococci. Treatment has become complicated due to the increase in resistance to penicillin and cephalosporins. The aim of the study was to assess the efficacy of various antibiotics as monotherapy and in association with gentamicin, in a experimental model of infective endocarditis in rabbits. The effects were compared with a control group and a group given classical penicillin-gentamicin treatment. MATERIAL AND METHODS: Infective endocarditis was induced in 180 rabbits with a clinical isolate of Streptococcus sanguis. Treatment was started 48 h after infection, and lasted 5 days. The animals were divided into nine groups of 20 rabbits: G1, untreated controls; G2, penicillin-gentamicin; G3, clindamycin-gentamicin; G4, imipenem; G5, imipenem-gentamicin; G6, teicoplanin; G7, teicoplanin-gentamicin; G8, vancomycin and G9, vancomycin-gentamicin. Response to therapy was evaluated by mortality curves, as negative blood cultures, concentration of S. sanguis in aortic vegetations and rate of sterilization of vegetations. RESULTS: Vegetation weight was significantly lower in treated groups than in controls; lower weights were found in G5, 6, and 9. G9 sterilized 75% of the vegetations. Death occurred in 25% of the control group and in 4.76% of G6 and 7. Blood cultures became negative most rapidly in G9. CONCLUSIONS: Combined treatment with vancomycin-gentamicin may be highly efficacious in patients with endocarditis caused by penicillin-resistant Streptococcus sanguis. Other combinations, such as imipenem-gentamicin and teicoplanin-gentamicin, may be also advantageous.

[Evaluation of Mycobacterium fortuitum acyltrehaloses in the serologic diagnosis of pulmonary tuberculosis]. / Evaluación de aciltrehalosas de Mycobacterium fortuitum en el diagnóstico serológico de tuberculosis pulmonar.

BACKGROUND: Several glycolipids of Mycobacterium tuberculosis are antigenic and their use in the serodiagnosis of pulmonary tuberculosis has been postulated. Acyltrehaloses (SL-IV) are among the strongest antigenic glycolipids of M. tuberculosis; similar compounds have been found in M. fortuitum. The aim of the present study was to evaluate the usefulness of the acyltrehaloses of M. fortuitum in the serodiagnosis of pulmonary tuberculosis. METHODS: Two glycolipids, identified as triacyl- (TAT-MF) and diacyl- (DAT-MF) trehaloses, were studied by an ELISA method. Two independent analyses were carried out. In the first one, IgG and IgM were determined in sera from patients with pulmonary tuberculosis (84-24 bacteriologically not confirmed--), healthy individuals (46) and patients with respiratory pathologies other than pulmonary tuberculosis (38), using TAT-MF. In the second one, IgG was determined in sera from pulmonary tuberculosis patients (34) and from healthy individuals (20), using DAT-MF. RESULTS: The sensitivity of the IgG ELISA using TAT-MF varied, according to the cut-off point, between 79.8 and 39.3%; the specificity values ranged between 83.3 and 98.8%. In sera from bacteriologically not confirmed pulmonary tuberculosis patients the sensitivity was 87.5-45.8%. The sensitivity for IgM was very low using TAM-MF (10.7-2.3%), with specificity values ranging from 77.4 to 100%. The sensitivity and specificity values of IgG using DAT-MF were, respectively, 34.3-9.3% and 90-100%. CONCLUSIONS: The IgG ELISA using TAT-MF has similar values of sensitivity and specificity to those reported for the acyltrehaloses of M. tuberculosis, although this antigen, by itself, can not be used in the serodiagnosis of pulmonary tuberculosis. DAT-MF has no value in the serodiagnosis of pulmonary tuberculosis.

A family of diacyltrehaloses isolated from Mycobacterium fortuitum.

A trehalose-containing glycolipid was detected in several strains of Mycobacterium fortuitum and characterized as 2,3-di-O-acyltrehalose (DAT) by combined NMR spectroscopy, IR spectroscopy, GLC and GLC-MS. Lipid constituents of the molecule were identified as a mixture of straight-chain (14-18 carbon atoms) and methyl-branched-chain (17-21 carbon atoms) fatty acyl groups. DAT was further fractionated by reverse phase TLC into four fractions that were designated DAT-I-DAT-IV. DAT-I contained 70-75% straight-chain acyl substituents (hexadecanoyl and octadecanoyl predominating) and 25-30% 2-methyl branched substituents (mainly 2-methyl octadecadienoyl). DAT-II was composed of a mixture in which the acyl groups were almost exclusively 2-methyl branched, with 2-methyl octadecadienoyl and 2-methyl octadecen-2-oyl predominating. DAT-III, which was the major isolated fraction, consisted of compounds in which the ratio linear to branched acyl groups varied between 0.8 to 0.9, 2-methyl octadecen-2-oyl, hexadecanoyl and octadecanoyl being the most abundant. Finally, DAT-IV comprised a mixture of DAT molecules containing mostly 2-methyl octadecadienoyl, 2-methyl octadecen-2-oyl, 2-methyl eicosadienoyl and 2-methyl eicosen-2-oyl groups.

Treatment with imipenem of experimental endocarditis caused by penicillin-resistant Streptococcus sanguis.

The efficacy of imipenem alone or in combination with gentamicin for the treatment of experimental endocarditis in rabbits caused by a penicillin resistant strain of Streptococcus sanguis was compared to that of gentamicin and penicillin G. In vitro, both beta-lactams were bactericidal in action and the combination of gentamicin and imipenem was synergistic after 4 h whereas penicillin G and gentamicin showed synergy after 8 h. Antibiotic treatment was started two days after initiating infection and groups of 20 animals were treated for 5 days with imipenem alone or in combination with gentamicin or with gentamicin and penicillin G. Two of 20 rabbits which received no therapy died whereas all other rabbits survived the treatment period. Blood cultures became negative in 19 rabbits on the second day of treatment with imipenem and gentamicin and sterilization of the vegetations was achieved in 12 animals. In contrast, eight animals given the alternative treatments remained bacteraemic and viable organisms were recovered from the vegetations in every case. However, bacterial counts and vegetation weights only differed significantly between treated animals and controls but not between the different treatment groups. Never the less, these data suggest that combined treatment with imipenem and gentamicin might provide an effective regimen for patients with endocarditis caused by penicillin resistant S. sanguis.

Treatment of experimental endocarditis caused by penicillin-resistant Streptococcus sanguis with different doses of teicoplanin.

Streptococcus viridans continues to be the most frequent causal agent of infective endocarditis. Treatment has become more complicated due to the increase in resistance to penicillin and cephalosporins. In order to study the possible efficacy of teicoplanin at low and high doses, this antibiotic was investigated in rabbits as a monotherapy and in association with gentamicin. The effects were compared with a control group and a group given classical penicillin-gentamicin treatment. Infective endocarditis was induced in 120 rabbits with a clinical isolate of Streptococcus sanguis. Treatment was started 48 h after infection, and lasted 5 days. Animals were divided into 6 groups of 20 rabbits each: G1, untreated controls; G2, penicillin+gentamicin; G3 low-dose teicoplanin; G4, low-dose teicoplanin+gentamicin; G5, high-dose teicoplanin; and G6, high-dose teicoplanin+gentamicin. Response to therapy was evaluated with mortality curves, negativization of blood cultures, concentration of S. sanguis in aortic vegetations and rate of sterilization of vegetations. Vegetation weight was significantly lower in treated groups than in controls; lower weights were found in G4, the only treatment that sterilized 65% of vegetations. Death occurred only in the control group (10% mortality). Negativization of blood cultures was greatest and most rapid in G4, followed by G6. Concentrations of S. sanguis in aortic vegetations were significantly lower in all treated groups compared with controls, with the lowest being in groups G4 and G6. Combined treatment with teicoplanin+gentamicin may be highly efficacious in patients with endocarditis caused by penicillin-resistant Streptococcus sanguis. High-dose teicoplanin+gentamicin does not seem to be more efficacious than low-dose teicoplanin+gentamicin.

cis-Diamminedichloroplatinum(II) resistant human tumor cell lines are collaterally sensitive to PtCl4(Rh-123)2: evidence for mitochondrial involvement.

Three human tumor cell lines made resistant to cis-diamminedichloroplatinum(II) (CDDP), SCC-25/CP, MCF-7/CP, and C13, are more sensitive to rhodamine-123 [tetrachloroplatinum(II)] [(PtCl4(Rh-123)2] than are the corresponding parental cell lines. The CDDP-resistant cells have higher intracellular concentrations of PtCl4(Rh-123)2 for the same exposure than do the parent cells. Each of the CDDP-resistant cell lines has an increased level of cytochrome c oxidase activity compared with the parent cell lines, indicating that the resistant cells have greater mitochondrial mass or activity than the parent cells. In fact, there was a linear correlation between the increase in cytochrome c oxidase activity and the increased sensitivity to PtCl4(Rh-123)2 in the CDDP-resistant lines. Exposure of the cells to each of the mitochondrial effectors, chloramphenicol, FCCP, oligomycin, or antimycin prior to and during exposure to CDDP or PtCl4(Rh-123)2 had variable effects on the cytotoxicity of the platinum complexes in the parental lines. However, there was a consistent decrease in the cytotoxicity of PtCl4(Rh-123)2 in the CDDP-resistant cells in the presence of the mitochondrial effectors such that, in some cases, the CDDP-resistant lines were now less responsive to PtCl4(Rh-123)2 than were the parent cell lines. These studies indicate that mitochondrial alterations may be an important component of CDDP resistance in these cell lines and that PtCl4(Rh-123)2 may represent a prototype platinum complex useful in the treatment of CDDP resistant tumors.

[Microbiological study via occluded telescopic catheter in patients under mechanical ventilation and suspected of pneumonia. Clinico-bacteriological follow up of the cases]. / Estudio microbiológico mediante catéter telescópico ocluido en pacientes bajo ventilación mecánica y sospecha de neumonía. Seguimiento clínico-bacteriológico de los casos.

Pneumonias related to mechanical ventilation pose a serious diagnostic challenge and are responsible for elevated mortality. Conventional diagnostic methods are of little help. The introduction of invasive techniques such as bronchial catling via an occluded telescopic catheter (OTC) has proven to be an important advance in diagnosis and therapy. We have compared the bacteriological results obtained using OTC with those using conventional diagnostic methods such as tracheobronchial pumps (TBP) and hemocultures, and we have undertaken a bacteriological, clinical follow-up of the cases. Seventy-four patients under mechanical ventilation and suspected of pneumonia were under study. The study consisted to two consecutive phases of collecting bacteriological samples throughout the patient's evolution. A total of 121 fibrobronchoscopies were performed. The sensitivity obtained with OTC was 76%, and the specificity was 100%. The two techniques, OTC and TBP, coincided in 38% of the cases. According to the bacteriological results obtained with OTC, the antibiotic treatment was modified in 44.5% of the patients. The sensitivity of the OTC was significantly less in those patients were the last doses of antibiotic was administered within two hours of performing the procedure. The procedure of gathering secretions from the inferior respiratory tract with OTC possesses greater sensitivity and diagnostic specificity in patients with mechanical ventilation and pulmonary infiltrates and improves the diagnosis performed by other conventional and routine techniques such as TBA and hemocultures.

[Right endocarditis caused by Staphylococcus aureus in parenteral drug addicts: evaluation of a combined therapeutic scheme for 2 weeks versus conventional treatment]. / Endocarditis derecha por Staphylococcus aureus en adictos a drogas por vía parenteral: valoración de un régimen terapéutico combinado de 2 semanas frente al tratamiento convencional.

BACKGROUND: Intravenous drug addicts (IVDA) are a group of patients in whom it is difficult to complete standard treatment of infectious endocarditis due to frequent antisocial behavior and in whom, once clinical improvement is achieved, voluntary discharge is frequently requested. This is why the evaluation of new treatment schedules tending to decrease the length of the same is of great interest. This non randomized study has the aim of knowing the efficacy of a short treatment with cloxacillin or vancomycin associated to gentamicin in right-sided endocarditis by methicillin-sensitive Staphylococcus aureus, comparing this with the standard schedule of 28 days. METHODS: This series was made up of IVDA patients diagnosed of right endocarditis by S. aureus. Inclusion criteria were the presence of intravenous drug addiction, isolation of methicillin-sensitive S. aureus in 2 or more blood cultures and achievement of the diagnostic criteria of right-sided endocarditis. Two schedules were used: a) standard: cloxacillin or vancomycin for 4 weeks, associating aminoglucoside in the first 3-5 days; b) short; cloxacillin or vancomycin associated to gentamicin for 2 weeks with no ulterior treatment. The study was not randomized and the treatment of 2 weeks was compared with historic controls treated for 4 weeks. The criteria evaluated were those of clinical cure, relapse, appearance of complications during treatment and mortality. RESULTS: Both the standard treatment and the combination of cloxacillin or vancomycin with gentamicin for 2 weeks cured 100% of the episodes of right endocarditis by S. aureus. There were no relapses and mortality was nul. Neither were there any differences between the two groups with regard to appearance of complications. CONCLUSIONS: In intravenous drug addict patients with right-sided endocarditis by methicillin S. aureus, the association of cloxacillin and gentamicin for 2 weeks is an effective alternative to long (4 week) treatments with only one antibiotic. The low number of cases treated with vancomycin does not allow conclusions to be drawn on its efficacy.

[Treatment with vancomycin of experimental endocarditis caused by Streptococcus sanguis II resistant to penicillin]. / Tratamiento de endocarditis experimental por Streptococcus sanguis II resistente a penicilina con vancomicina.

BACKGROUND: Streptococcus viridans continues to be the most frequent causal agent of infective endocarditis. Treatment has become more complicated due to the increase in resistance to penicillin and cephalosporins. In order to study the possible efficacy of vancomycin, this antibiotic was investigated in rabbits as a monotherapy and in association with gentamicin. The effects were compared with a control group and a group given classical penicillin-gentamicin treatment. MATERIAL AND METHODS: Minimum inhibitory concentration, minimum bactericidal concentration, lethality curves and synergism were determined against Streptococcus sanguis II. Infective endocarditis was induced in 80 rabbits, which were infected via catheter. Treatment was started 48 hours after infection, and lasted 5 days. The animals were divided into 4 groups of 20 rabbits each: 1, untreated controls; 2, penicillin-gentamicin; 3, vancomycin; 4, vancomycin-gentamicin. Response to therapy was evaluated with mortality curves, negativization of blood cultures, concentration of Streptococcus sanguis II in aortic vegetations, rate of sterilization of vegetations, body weight and serum bactericidal capacity. RESULTS: Vegetations weight was significantly lower in treated groups than in controls; lower weights were found in groups 2 and 4. The lowest vegetation weight was recorded in group 4, the only treatment that sterilized 75% of vegetations. Death occurred only in the control group (10%). Negativization of blood cultures was greatest and most rapid in group 4. Serum bactericidal capacity was greater after the two combined treatments, and highest in group 4. CONCLUSIONS: Combined treatment with vancomycin-gentamicin may be highly efficacious in patients with endocarditis caused by penicillin-resistant Streptococcus viridans.

Numerical analysis of fatty and mycolic acid profiles of Corynebacterium urealyticum and other related corynebacteria.

The fatty and mycolic acid profiles of 52 strains of clinical origin belonging to Corynebacterium urealyticum were subjected to numerical analysis along with those of representative members of Corynebacterium ammoniagenes, Corynebacterium bovis, Corynebacterium glutamicum, Corynebacterium jèikeium, Corynebacterium minutissimum, Corynebacterium pseudodiphtheriticum, Corynebacterium pseudotuberculosis, Corynebacterium xerosis, Corynebacterium renale, Corynebacterium cystitidis, "Corynebacterium ulcerans" and one strain of the Corynebacterium F1 group. Strains were divided into eight clusters at an amalgamation distance of 7.4. Corynebacterium urealyticum appeared as an homogeneous cluster clearly distant from others, that included several members of the genus Corynebacterium, and it was characterized by its content on unsaturated mycolic acids of mainly 28 (28:1) and 30 (30:3) carbon atoms. On the basis of these results the taxonomic "status" of Corynebacterium urealyticum, a new species within the genus Corynebacterium "sensu stricto", is further justified.

[Resistance in Haemophilus influenzae in Spain. 2d study (1990)]. / Resistencias en Haemophilus influenzae en España. Segundo estudio (1990).

AIM: To study the resistance to strains of H. influenzae simultaneously isolated during 1990 in 10 Spanish cities with this being the second multicentric study carried out in Spain. METHODS: Three hundred eight strains of H. influenzae were consecutively isolated with less than 50% being from the respiratory tract. The sensitivity by microdilution in supplement Isosensitest was studied. RESULTS: Thirty-five percent of the strains were producers of beta-lactamase which predominate among those isolated in systemic infections and specially among those from Madrid (58.78%) and Barcelona (61.8%). The strains producing beta-lactamase were more resistant to all the antimicrobials than the non producers. Five point two percent of the strains were resistant to ampicillin by non enzymatic mechanisms. Resistance to chloramphenicol is frequent (28.6%) especially among strains producing beta-lactamase, strains of ocular origin and ORL (46%) and systemic infections (74.3%). The distribution is irregular, being more frequent in Seville (66.7%) and not detectable in Barcelona. Resistance to tetracycline is also usually linked to the production of beta-lactamase and not necessarily to that of chloramphenicol. Resistance to cotrimoxazole is the most frequent (67.5%) specially in Valladolid (87.5%). Resistance to cefaclor is of 60.7% being the most frequent among those isolated from ocular processes and ORL. Only 28 strains (9.1%) were sensitive to all the antimicrobials tested. Thirty-nine percent were multiresistant. CONCLUSIONS: The authors found a slight increase in the high resistance detected in 1986. This increase was not uniform in all of Spain being significant in Madrid with producers of beta-lactamase, in Seville to chloramphenicol, to tetracycline in Bilbao and cotrimoxazole in Valencia.

Prophylaxis in transurethral surgery: oral lomefloxacin versus intravenous cefuroxime.

A randomized study compared the efficacy of a single dose of lomefloxacin given orally vs. cefuroxime given intravenously for prophylaxis against urinary tract infection in patients who were undergoing transurethral surgery. Patient groups were demographically similar; 25 received 400 mg lomefloxacin orally 2-6 h before surgery and 26 received 1.5 g cefuroxime intravenously 30-90 min before surgery. Urine cultures were obtained prior to surgery, 24 h after surgery and 3-5 days after surgery or before hospital discharge. Treatment was considered successful if bacterial culture showed < 10(5) CFU/ml. Clinical results expressed as success/failure rates showed success in 18 patients in the lomefloxacin group (72%) and 15 patients in the cefuroxime group (57.7%). Results demonstrated that lomefloxacin is superior to cefuroxime when used as prophylaxis against urinary tract infection following transurethral surgery. In addition, lomefloxacin may be preferable because of its convenient single-dose oral administration.