Distribución de los patrones de sensibilidad de Escherichia coli intrahospitalario y extrahospitalario y los fenotipos de resistencia asociados durante el año 2005 / Distribution of patterns of sensitivity and associated phenotypes of resistance in nosocomial and community acquired Escherichia coli during 2005

Introducción. El aumento de las resistencias de Escherichiacoli en los últimos años hace imprescindible el conocimientode los patrones de sensibilidad en un área determinadapara poder orientar un tratamiento empírico adecuado.Métodos. Estudio longitudinal prospectivo a partir delos aislamientos de E. coli durante el año 2005 en el HospitalUniversitario Virgen de la Victoria. La identificación y el estudiode sensibilidad se realizaron según protocolos normalizadosde trabajo de laboratorio.Resultados. Se aislaron 2.612 cepas de E. coli pertenecientesa 2.098 pacientes con una edad media de 52 añosque presentaban como cuadro clínico más frecuente una infecciónurinaria. La sensibilidad de E. coli fue: ampicilina(AMP) (35,4 %), trimetoprim-sulfametoxazol (SXT) (63,4 %),quinolonas (QUIN) (67,3 %), amoxicilina-clavulánico (89%)y fosfomicina (97,2%). El porcentaje de E. coli productoresde betalactamasas de espectro extendido (BLEE) fue del8,2 %. En general, los aislamientos nosocomiales presentaronuna resistencia mayor, que era significativa para cefalosporinasde tercera generación, gentamicina y piperacilina-tazobactam (p < 0,005). La resistencia en hombres fuemayor que en mujeres, al igual que en los adultos frente a losniños, con diferencias significativas para ciprofloxacino y gentamicina(p<0,005). El 27,5% de los aislamientos presentaronmultirresistencia y el fenotipo más frecuente era resistente aAMP/SXT (11,9%), seguido de AMP/QUIN/SXT (10,9%).Conclusiones. Las resistencias en E. coli son muy elevadasen nuestro medio, sobre todo en QUIN, y aparece inclusoen niños, de tal forma que hasta la mitad de los fenotiposmultirresistentes incluyen ciprofloxacino. Paralelamente enlos últimos años se ha producido en nuestro medio un incrementoen los aislamientos de E. coli productores de BLEE (AU)

Introduction. The increase of resistances to Escherichiacoli over recent years has made it necessary toknow the patterns of sensitivity in a certain area in orderto be able to orient adequate empirical treatment withthis knowledge.Method. Prospective longitudinal study using E. coliisolations obtained during year 2005 in the UniversityHospital Virgen de la Victoria was performed. Sensitivityidentification and study were made according to standardizedlaboratory protocols.Results. A total of 2,612 strains of E. coli were isolatedfrom 2,098 patients with an average age of 52 years whohad urinary infection as the most frequent sign. E. coli sensitivitywas: ampicillin (AMP) (35.4%), ciprofloxacin (QUIN)(67.3 %), trimethoprim-sulfametoxazole (SXT) (63.4 %),phosphomycin (97.2 %) and amoxicillin-clavulanic acid (89%). The percentage of E. coli extended-spectrum â-lactamase(ESBL) producers was 8.2%. In general, nosocomial isolations were more resistant, this difference being significant for third generation cephalosporins, gentamicin and piperacillin/tazobactam (p < 0.005). Resistance in men was greater than in women and also in adults compared to children, with significant differences to ciprofloxacin and gentamicin(p < 0.005). A total of 27.5% of the strains were multiresistant, the most frequent phenotype being the oneto AMP/SXT (11.9%), followed by AMP/QUIN/SXT (10.9%).Conclusions. Resistances to E. coli are very elevated in out setting, above all, in quinolones, that even appear in children, so that up to half of the multiresistant phenotypes present resistance to this family. Furthermore, during the last year, an increase in the isolations of E. coli ESBL producers has been observed (AU)

Time-kill evaluation of antimicrobial regimens against clinical isolates of penicillin-resistant Streptococcus pneumoniae.

The rate of penicillin-resistant Streptococcus pneumoniae isolates in Spain is high. At present, penicillin and ceftriaxone are two drugs chosen for treating serious infections. In this study the bactericidal activity of four antimicrobial regimens against ten clinical isolates of S. pneumoniae (five with an intermediate resistance to penicillin and five highly resistant ones), was determined by means of kill kinetics studies using either penicillin, or ceftriaxone, in combination with vancomycin, or fosfomycin. The concentrations of the antimicrobial regimens (MICs 4x, 1x and 1/4x) were within possible physiological levels. While the combinations of penicillin, or ceftriaxone, plus vancomycin showed a significant increase in bactericidal activity, the bacterial reductions obtained in combination with fosfomycin were greater, achieving synergistic effects. These results suggest that in vivo trials with a regimen composed of ceftriaxone and fosfomycin would be worthwhile.

A computer program for application in epidemiological analysis.

The importance of computer science as a working tool for the health sector is an unquestionable fact in any modern society. EPIDEMO, developed by the authors, can be defined as a set of programs whose main characteristic is its ability to process a given series of data in a totally integrated way, with an epidemiological and statistical approach. EPIDEMO is a program with a good relational database, which allows preliminary statistical analyses of data that can easily be expanded with more specific statistical options, and is compatible with other programs available on the market. It is a useful, accurate and versatile tool that meets the needs of health professionals in the field of epidemiological research.

[Molecular epidemiology of Salmonella enterica poisoning: correlation of the serotype and protein profile and plasmid DNA analysis]. / Epidemiología molecular de toxiinfecciones producidas por Salmonella enterica: correlación del serotipo y del perfil proteico y análisis del ADN plasmídico.

Food-borne diseases nosocomial outbreaks due to Salmonella enterica strains have a high incidence nowadays. We describe here an outbreak that occurred in July 1990 in the Malaga University Hospital, that only involves one shift of health care workers. Salmonella enterica was detected in stool samples from HCW and a first analysis revealed the presence of two different antibiotic susceptibility patterns (resistotypes) among isolated strains. Two months after the outbreak started, the CNVIS (Majadahonda, Spain) confirmed the presence of two different serotypes (bovismorbificans and enteritidis). The delayed availability of the results (due to the lack of specific sera needed in most of the clinical Laboratories) was responsible for finishing only a partial and restricted epidemiologic study in terms of source identification for one particular serotype as well as for the antimicrobial resistance studies. The molecular identification techniques, particularly the electrophoretic protein profile could overcome these problems.

[Contributions of the epidemiologic method to the rational study of juvenile delinquency]. / Aportaciones del método epidemiológico al estudio racional de la delincuencia juvenil.

In this study we analyze some of the contributions of the epidemiological method to the study of juvenile delinquency. We used 68,583 complaints to the Police during 1983-1986 to do so; furthermore, we asked the opinion of the citizens by means of an opinion poll of a representative sample of the population on the subject of public safety. The application of the techniques of Multivariant Analysis (Analysis of the Principal Components) allowed us to reduce the dimensions of the study and fix our attention on 8 specific crimes. We have attempted to design a system, using Predictive Epidemiology, for the evaluation of preventive measures applied to the rational fight against delinquency. Special emphasis is made on the presentation of a system of analysis for the calculation of the real rate of delinquency in a given community.

[Socioeconomic effects of human brucellosis]. / Repercusión socioeconómica de la brucelosis humana.

The socio-economic cost of human brucellosis is analyzed. One hundred and seven patients are included in this study, 75 males (70.09%) and 32 females (29.91), diagnosed of brucellosis in the Internal Medicine Department of the Regional Hospital "Carlos Haya" in Málaga from the 1st of October 1984 to the 31st of December 1986. Thirty seven patients (34.57%) presented some kind of complication. Seventy eight cases (72.89%) were admitted to the hospital resulting in a total of 1.005 hospital admissions with a mean hospital stay of 12.88 days. The total economic cost was 30.724.962 pesetas with a mean patient cost of 287.149 pesetas. The total number of work absence days was 5.291 with a mean 101.7 days per patient and with an accumulated cost in this respect of 49.053.151 pesetas. The total money loss was 84.307.488 pesetas with a mean of 787.920 pesetas per patient. This high cost, together with the high incidence of the disease throughout most of our national territory, clearly justify the need for aggressive preventive measures.

[Tobacco and cancer of the lung. A case-control study]. / Tabaco y cáncer pulmonar. Estudio caso-control.

The relationship between cigarette smoking and risk of lung cancer has been analyzed in a case control study of 98 cancer patients and 108 age matched healthy controls. This relationship has been studied based on age when smoking started, number of cigarettes per day and minimum number of cigarettes smoked, and smoke inhalation. The excess rate (ER) of lung cancer amongst those who started smoking before age 20 was 3.47 (C.I. 95% 1.33 + 9.05) above those who started smoking later. There is a progressive increase in ER as the mean daily number of cigarettes and the minimum number of cigarettes smoked increase. The ER in those who inhale smoke was 2.4 (C.I. 95% 1.6 - 5.05) when compared to those who did not inhale smoke. It is essential to quantify the magnitude of the smoking habit as well as its duration since these variables are going to determine the risk of acquiring the disease. Case control smoking-lung cancer study.