Alteraciones clínicas y paraclínicas en recién nacidos con pH arterial de cordón umbilical menor o igual a 7, 18 Hospital de San José Diciembre 2009 a Marzo 2012 / Clinical and laboratory alterations in newborns with a cord arterial pH less or equal to 7.18 Hospital de San José December 2009 to March 2012

La depresión neonatal moderada y la asfixia perinatal son poco frecuentes en nuestro medio (2% en la unidad neonatal). El pH arterial del cordón umbilical <7.00 implica mayor riesgo de compromiso multiorgánico, aunque no es claro el pronóstico entre 7.00 y 7.18. El objetivo es describir la frecuencia de alteraciones clínicas y paraclínicas en los neonatos con Apgar <6 al primer minuto, cuyos gases arteriales de cordón cursaron con pH <7.18 en el período diciembre 2009 a marzo 2012 en el Hospital San José de Bogotá DC. Metodología: estudio descriptivo prospectivo relativo a la frecuencia de alteraciones por sistemas en los neonatos que cumplieron criterios de inclusión. También se registraron los fallecimientos. Resultados: se incluyeron 52 pacientes, 45 con pH entre 7,11 y 7,18. La alteración más frecuente fue hepática, la dishidrogenia láctica estuvo elevada (100%) en quienes se realizó la medición, dos casos desarrollaron encefalopatía (pH 6,96 y 7,13), y no se registró enterocolitis necrosante en dos hubo compromiso renal (oliguria). Cinco fallecieron durante el estudio con pH < 7.00. Conclusiones: aunque el pH < 7.00 se considera la mejor evidencia de asfixia perinatal y es predictor de morbimortalidad, los pacientes entre pH 7.00 y 7.18 requieren evaluación y vigilancia clínica porque presentan alteraciones multisistémicas de gravedad variable e incluso muerte.

Moderate neonatal respiratory depression and perinatal asphyxia are uncommon in our setting (2% at the neonatal unit). Arterial cord pH <7.00 infers a higher risk of multisystem complications, although prognosis is still not clear for pH values between 7.00 and 7.18. Objective: to describe clinical and laboratory alterations in neonates with a score <6 on the one-minute Apgar assessment and cord arterial pH <7.18, between December 2009 and March 2012 at Hospital San José de Bogotá DC. Methodology: a descriptive prospective study on the frequency of multisystem involvement in neonates who met the inclusion criteria. Deaths were also recorded. Results: 52 patients were included, 45 had a pH between 7.11 and 7.18. Liver disorders and elevated lactate dehydrogenase (100%), when measured, were the most common manifestations. Two cases developed encephalopathy (pH 6.96 and 7.13), two presented renal failure (oliguria). Necrotizing enterocolitis was not evidenced. Five babies with a cord pH< 7.00 died during the trial. Conclusions: although a cord pH < 7.00 is considered the best evidence of perinatal asphyxia and constitutes a morbidity and mortality predictor, patients with a pH value between 7.00 and 7.18 require evaluation and monitoring, for they present with multisystem involvement of varied severity including death.

Nosocomial outbreak of methicillin- and linezolid-resistant Staphylococcus epidermidis associated with catheter-related infections in intensive care unit patients.

A total of 128 isolates associated with catheter-related infections was recovered from 101 intensive care unit patients in a Spanish hospital during March 2008 to August 2009, and 27 of these isolates (from 21 patients) were typed as methicillin- and linezolid-resistant Staphylococcus epidermidis. Thirteen of these 21 patients (62%) had received linezolid during the 3 months preceding S. epidermidis recovery. Two closely related pulsotypes (P1a and P1b) were identified among the 27 studied isolates that belonged to the sequence type ST2 and harboured the mecA gene and the SCCmecIII type. The strains recovered from patients 1-4 (pulsotype P1a) showed the nucleotide mutation G2474T inside the amplified fragment of the 23S rRNA region and carried the aac(6')-Ie-aph(2″)-Ia, ant(4'), and catA genes, whereas the strains from patients 5-21 (pulsotype P1b) showed the mutation G2603T and carried the aac(6')-Ie-aph(2″)-Ia gene. None of the strains amplified the cfr gene. The ica gene and the IS256 element were detected in all strains. The emergence of 2 closely related methicillin- and linezolid-resistant S. epidermidis strains with 2 different mutations in the 23S rRNA region (G2474T and G2603T) is reported in this study as a cause of a nosocomial outbreak. The presence of G2474T or G2603T point mutations suggests that there are multiple potential sites within domain V of the 23S rRNA region at which mutations could confer resistance to linezolid in the clinical isolates. To our knowledge, this is the first report in which the G2474T mutation has been detected in domain V of the 23S rRNA gene of clinical S. epidermidis.

Nocardiosis linfocutánea por Nocardia brasiliensis en un paciente inmunocompetente / Primary lynphocutaneus nocardiosis by Nocardia brasiliensis in an immunocompetent patient

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In vitro activity of cefditoren and other antimicrobial agents against 288 Streptococcus pneumoniae and 220 Haemophilus influenzae clinical strains isolated in Zaragoza, Spain.

In vitro cefditoren antimicrobial activity was tested against 288 Streptococcus pneumoniae and 220 Haemophilus influenzae clinical strains isolated in our hospital from January 2005 to May 2006 by agar dilution and broth microdilution method, respectively. MICs were also determined for 13 and 10 comparison drugs, respectively. The pneumococci tested comprised 113 (39.2%) penicillin susceptible, 91 (31.6%) penicillin intermediate, and 84 (29.2%) penicillin resistant. Cefditoren was the most active drug on the basis of the MICs (MIC(90)=0.5 microg/mL), followed by ceftriaxone and levofloxacin (MIC(90)=1 microg/mL). Cefditoren MICs ranged from 0.25 to 1 microg/mL for ceftriaxone-resistant isolates, with a modal MIC of 0.5 microg/mL and an MIC(90) of 1.0 microg/mL. No S. pneumoniae isolates evaluated in this study showed MICs to cefditoren higher than 1 microg/mL (MIC range, 4 microg/mL). Against H. influenzae (Hi beta+), the rank order of intrinsic activity (MIC(90), microg/mL) was cefditoren (0.03) < cefixime (0.06)8.0).

[Susceptibility to betalactam antibiotics, glycopeptides and aminoglycosides in commensal strains of erythromycin-resistant alpha-hemolytic streptococci and Gemella spp]. / Sensibilidad a antibióticos betalactámicos, glucopéptidos y aminoglucósidos en cepas comensales de estreptococos alfahemolíticos y Gemella spp. resistentes a eritromicina.

OBJECTIVE: Susceptibility to seven betalactam antibiotics, glycopeptides and aminoglycosides was investigated in 190 erythromycin-resistant alpha-hemolytic streptococci and 30 Gemella spp, mainly from normal flora. MATERIAL AND METHODS: Antimicrobial susceptibility testing was performed by a standard agar diffusion test and a standard agar dilution method according to NCCLS/CLSI criteria. RESULTS: 62.6% of alfahemolytic streptococci and 53.3% of Gemella spp. were not susceptible to penicillin (MIC50: 0,5 microg/mL). Cefuroxime was the least active cephalosporin (MIC50: 1 microg/mL and 0.5 microg/mL, in streptococci and Gemella spp., respectively), whereas cefotaxime, ceftriaxone (MIC50: 0.25 microg/mL) and cefepime (MIC50: 0.5 microg/mL) were more active than penicillin. All isolates were susceptible to vancomycin, teicoplanin and gentamicin. Four alfahemolytic streptococcal strains showed high-level resistance to streptomycin, and three strains to kanamycin. There were no significant differences in resistance rates to the antibiotics studied between strains with different macrolide resistance phenotypes. Resistance to penicillin and other betalactam antibiotics (73.8%) was prevalent in M phenotype strains and resistance to penicillin and other classes of antibiotics predominated in constitutive (cMLS(B)) strains (71.4%). CONCLUSIONS: Resistance to penicillin in erythromycin-resistant strains was notably high in this study. This fact has important clinical implications because of the endogenous character of alpha-hemolytic streptococcal and Gemella spp. infections. The lower cefuroxime activity suggests that use of this agent against other pathogens would be effective in preserving the oropharyngeal microflora analyzed.

Sensibilidad a antibióticos betalactámicos, glucopéptidos y aminoglucósidos en cepas comensales de estreptococos alfahemolíticos y Gemella spp. resistentes a eritromicina / Susceptibility to betalactam antibiotics, glycopeptides and aminoglycosides in commensal strains of erythromycin resistant alfahemolytic streptococci and Gemella spp

Objetivo. Se investigó la sensibilidad de 190 estreptococos alfahemolíticos y 30 Gemella spp., en su mayoría comensales y resistentes a eritromicina, frente a 7 antibióticos betalactámicos, glucopépticos y aminoglucósidos. Material y métodos. Para determinar la sensibilidad a los antimicrobianos se utilizaron las técnicas de dilución y difusión en agar, según las normas del National Committee for Clinical Laboratory Standards/Clinical and Laboratory Standards Institute (NCCLS/CLSI). Resultados. El 62,6% de los estreptococos alfahemolíticos y el 53,3% de Gemella spp. no fueron sensibles a penicilina (concentración inhibitoria mínima al 50% [CIM50]: 0,5 mg/ml). Cefuroxima fue la cefalosporina que presentó menor actividad (CIM50: 1 mg/ml y 0,5 mg/ml, en estreptococos y Gemella spp.), mientras que cefotaxima, ceftriaxona (CIM50: 0,25 mg/ml) y cefepima (CIM50: 0,5 mg/ml) presentaron una actividad superior a penicilina. El 100% de los aislamientos fueron sensibles a vancomicina, teicoplanina y gentamicina. Cuatro cepas de estreptococos alfahemolíticos presentaron resistencia de alto nivel a estreptomicina y tres a kanamicina. No hubo diferencia significativa en el comportamiento de los antibióticos estudiados frente a las cepas con diferente fenotipo de resistencia a macrólidos. Tanto en los aislamientos con fenotipo M como en aquéllos con fenotipo constitutivo (MLSBc) predominó la resistencia a penicilina y a otros antibióticos betalactámicos frente al patrón de resistencia, que incluye sólo penicilina o bien penicilina, otros antibióticos betalactámicos y aminoglucósidos. Conclusiones. Las tasas de resistencia a penicilina en las cepas comensales resistentes a eritromicina son particularmente elevadas, hecho que tiene una importante implicación clínica por el carácter endógeno de las infecciones causadas por estas bacterias. La menor actividad de cefuroxima podría sugerir que su utilización frente a otros patógenos preservaría en mayor grado a la microbiota orofaríngea estudiada (AU)

Objective. Susceptibility to seven betalactam antibiotics, glycopeptides and aminoglycosides was investigated in 190 erythromycin-resistant alfahemolytic streptococci and 30 Gemella spp, mainly from normal flora. Material and methods. Antimicrobial susceptibility testing was performed by a standard agar diffusion test and a standard agar dilution method according to NCCLS/CLSI criteria. Results. 62.6% of alfahemolytic streptococci and 53.3% of Gemella spp. were not susceptible to penicillin (MIC50: 0,5 mg/mL). Cefuroxime was the least active cephalosporin (MIC50: 1 mg/mL and 0.5 mg/mL, in streptococci and Gemella spp., respectively), whereas cefotaxime, ceftriaxone (MIC50: 0.25 mg/mL) and cefepime (MIC50: 0.5 mg/mL) were more active than penicillin. All isolates were susceptible to vancomycin, teicoplanin and gentamicin. Four alfahemolytic streptococcal strains showed high-level resistance to streptomycin, and three strains to kanamycin. There were no significant differences in resistance rates to the antibiotics studied between strains with different macrolide resistance phenotypes. Resistance to penicillin and other betalactam antibiotics (73.8%) was prevalent in M phenotype strains and resistance to penicillin and other classes of antibiotics predominated in constitutive (cMLSB) strains (71.4%). Conclusions. Resistance to penicillin in erythromycin-resistant strains was notably high in this study. This fact has important clinical implications because of the endogenous character of alfahemolytic streptococcal and Gemella spp. infections. The lower cefuroxime activity suggests that use of this agent against other pathogens would be effective in preserving the oropharyngeal microflora analyzed (AU)

Enterococci spp. isolated from Cuba: species frequency of occurrence and antimicrobial susceptibility profile.

This study investigated the species distribution and antimicrobial resistance among 99 enterococci isolated from hospitalized patients in 12 hospitals in Cuba from October 2000 to September 2001. Species identification was performed by WIDER Automatic System (Francisco Soria Melguizo, Madrid, Spain), and the susceptibility testing was performed by disk diffusion, agar dilution, and E-test methods. Enterococcus faecalis was the most prevalent (85%) species, followed by E. faecium (10%), E. gallinarum (2%), E. casseliflavus (2%), and E. durans-hirae (1%). A higher percentage of resistance to ampicillin (50%), fosfomycin (40%), ciprofloxacin (30%), norfloxacin (20%), and tetracycline (90%) was detected in E. faecium isolates, whereas E. faecalis strains showed higher rates of resistance to erythromycin (52.4%), chloramphenicol (34.5%), rifampicin (62.5%), moxifloxacin (3%), and nitrofurantoin (2.4%). Resistance to glycopeptide was detected in E. faecalis (1.2%) and E. faecium (10%). Thirty-one E. faecalis (37%) and 3 E. faecium (30%) showed a high-level resistance to gentamicin. The results of this work will be very helpful to guide empirical antimicrobial therapy and the implementation of infection control measures in Cuban hospitals.

Absceso primario de psoas por Salmonella enterica serogrupo Gserovar friedenau / Primary abscess of the psoas due to Salmonella enterica serogroup G, serotype friedenau

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Resistencia a penicilina y otros antimicrobianos en 301 aislamientos clínicos de Streptococcus pneumoniae / Resistance to penicillin and other antimicrobials in 301 clinical isolates of Streptococcus pneumoniae

Fundamentos: Conocer en nuestra comunidad la sensibilidad a penicilina de aislamientos de Streptococcus pneumoniae, así como analizar la asociación de resistencia a penicilina y otros antimicrobianos y la actividad de cefotaxima y cefepima en cepas de S. pneumoniae con sensibilidad disminuida a penicilina. Métodos: Se determinó la sensibilidad de 301 aislamientos de S. pneumoniae, procedentes de muestras clínicas durante los años 1995-1996, a penicilina, cefotaxima, cefepima, eritromicina, cloramfenicol, tetraciclina, cotrimoxazol y ciprofloxacino. Resultados: El 38,2 por ciento de los aislamientos fueron sensibles a penicilina, mientras que un 61,8 por ciento de las cepas de S. pneumoniae aisladas fueron resistentes a penicilina, presentando el 20,6 por ciento resistencia de alto grado a la misma. La resistencia a eritromicina, cloramfenicol, tetraciclina, cotrimoxazol y ciprofloxacino fue del 30,9, 30,2, 40,9, 66,4 y 13,3 por ciento, respectivamente, incrementándose a valores del 54,8, 54,8, 61,3 y 93,5 por ciento en las 62 cepas con resistencia de alto nivel a penicilina. La resistencia a cefotaxima y cefepima fue del 13,9 y 14,9 por ciento, respectivamente. Los valores de la concentración inhibitoria mínima (CIM)50 y CIM90 para cefotaxima y cefepima en las cepas con sensibilidad disminuida a la penicilina fueron de 0,5 y 1 µg/ml, respectivamente. Conclusiones: Un alto porcentaje de cepas de S. pneumoniae presentaron algún grado de resistencia a penicilina, lo que concuerda con los resultados de otros estudios de ámbito nacional. Asimismo, se demostró que la resistencia a penicilina se asociaba significativamente (p < 0,001) con la resistencia a todos los antimicrobianos estudiados, excepto ciprofloxacino. Las CIM50 y CIM90 han sido equiparables para cefotaxima y cefepima, observándose CIM inferiores a las de la penicilina en las cepas de S. pneumoniae con resistencia de alto grado a la misma, con las consiguientes implicaciones terapéuticas (AU)