Microbiota biliar en pacientes colecistectomizados: revisión de la antibioterapia empírica / Biliary microbiote in cholecystectomized PATIENTS: review of empirical antibiotherapy

INTRODUCCIÓN: La colecistitis constituye una importante causa de ingreso hospitalario. En colecistitis moderada o severa, el retraso en el tratamiento puede acarrear complicaciones graves. Nuestro objetivo es analizar los microorganismos aislados en bilis de pacientes colecistectomizados y su patrón de sensibilidad para evaluar el tratamiento empírico en aquellos casos en que la extirpación quirúrgica de la vesícula deba demorarse. PACIENTES Y MÉTODOS: Estudio descriptivo prospectivo de los cultivos biliares de pacientes sometidos a colecistectomía desde mayo de 2013 hasta febrero de 2015, en el Servicio de Cirugía del Hospital General Universitario de Castellón. RESULTADOS: Se estudiaron 196 pacientes, 83 mujeres (42,3%) y 113 hombres (57,7%), con una media de edad de 61,5 años. Los antibióticos más utilizados como tratamiento empírico fueron piperacilina/tazobactam (77,8%) y amoxicilina/clavulánico (14,8%). En el 46,4% de los pacientes (91/196) los cultivos de bilis fueron positivos. Se aislaron un total de 165 microorganismos. La mayoría eran bacilos gramnegativos (60,5%), principalmente Enterobacterales (91/54,5%), siendo Escherichia coli el microorganismo más frecuente (24%) seguido de Klebsiella spp. (12,5%). Se aislaron 3 E. coli productoras de betalactamasa de espectro extendido (BLEE) y 1 Klebsiella pneumoniae BLEE. No se aislaron microorganismos productores de carbapenemasa ni Staphylococcus aureus resistente a meticilina. CONCLUSIÓN: La microbiota biliar, con predominio de Enterobacterales, es similar a la encontrada en estudios europeos

INTRODUCTION: Cholecystitis is an important cause of hospital admission. In moderate or severe cholecystitis, the delay in treatment can lead to serious complications. Our objective is to analyze the microorganisms isolated in bile from cholecystectomized patients and their sensitivity pattern, to evaluate the empirical treatment in those cases in which the surgical removal of the gallbladder should be delayed. PATIENTS AND METHODS: Prospective descriptive study of biliary cultures of patients undergoing cholecystectomy from May 2013 to February 2015, in the Surgery Department of the Hospital General Universitari de Castelló. RESULTS: We studied 196 patients, 83 women (42.3%) and 113 men (57.7%), with an average age of 61.5 years. The most used antibiotics as empiric treatment were piperacillin/tazobactam (77.8%) and amoxicillin/clavulanic (14.8%). In 46.4% of patients (91/196) bile cultures were positive.165 microorganisms were isolated. The majority were Gram-negative bacilli (60.5%), mainly of the Enterobacterales order (91/54.5%), with Escherichia coli being the most frequent microorganism (24%) followed by Klebsiella spp. (12.5%).3 E. coli with extended-spectrum beta-lactamase (ESBL) and 1 K. pneumoniae with ESBL were isolated. Microorganisms producing carbapenemase and methicillin-resistant Staphylococcus aureus were not isolated. CONCLUSION: The bile microbiota, with a predominance of Enterobacterales is similar to that found in european studies

[Epidemiological surveillance of vertically-transmitted Chagas disease at three maternity hospitals in the Valencian Community]. / Vigilancia epidemiológica de la transmisión vertical de la enfermedad de Chagas en tres maternidades de la Comunidad Valenciana.

INTRODUCTION AND AIM: Immigration to Spain of Latin Americans with Chagas disease in its indeterminate phase could result in vertical transmission of the disease or transmission by transfusion or organ transplantation. To ascertain the magnitude of this problem, we investigated the prevalence of bearers among women who gave birth in 3 state maternity hospitals in the Valencian Community and the incidence of vertical transmission. PATIENTS AND METHODS: An immunoprecipitation test to detect anti-Trypanosoma cruzi antibodies was carried out on 624 pregnant Latin American women. In positive cases, indirect immunofluorescence and PCR analysis were performed on mothers. In addition, a microhematocrit and PCR analysis were performed on the newborns of these mothers, and immune precipitation was carried out from age 7 months. Chagas-positive mothers were referred for outpatient care at the hospital internal medicine departments. Percentage of positive serology was calculated for the total number of patients and by country of origin. RESULTS: A total of 29 women (4.8%; 95% CI, 3.1-6.3) were Chagas-positive; all were asymptomatic and PCR-negative. None of their children were positive to the tests performed. Bolivian women were the most frequently affected: 24 out of 137 (17.5%; 95% CI, 11.2-23.9) DISCUSSION: The high prevalence of Chagas disease in the Latin American immigrant population has raised awareness of this disease among professionals involved in the study and treatment of this illness. Further epidemiological studies are needed to establish the feasibility of universal detection programs in this population.

Vigilancia epidemiológica de la transmisión vertical de la enfermedad de Chagas en tres maternidades de la Comunidad Valenciana / Epidemiological surveillance of vertically-transmitted Chagas disease at three maternity hospitals in the Valencian Community

INTRODUCCIÓN Y OBJETIVO. La inmigración a nuestro país de poblaciones latinoamericanas afectadas de enfermedad de Chagas en fase indeterminada abre la posibilidad de transmisión vertical y por transfusión o trasplante de órganos afectados por esta enfermedad. Para averiguar la magnitud del problema, hemos investigado la prevalencia de portadoras entre las mujeres que dan a luz en tres maternidades públicas de la Comunidad Valenciana y la tasa de transmisión vertical. PACIENTES Y MÉTODOS. A un total de 624 mujeres latinoamericanas embarazadas se les practicó una prueba de inmunoprecipitación para detectar anticuerposanti-Trypanosoma cruzi. A las madres positivas se les realizó inmunofluorescencia indirecta y reacción en cadena de la polimerasa (PCR), y a sus hijos, microhematocrito yPCR en el período neonatal e inmunoprecipitación a partir de los 7 meses de vida. Se remitieron las madres seropositivas a la consulta de medicina interna. Se calculó el porcentaje de serología positiva total y por países. RESULTADOS. Un total de 29 mujeres (4,8 %; intervalo dec onfianza [IC] del 95 %: 3,1-6,3) eran seropositivas, todas asintomáticas y con PCR negativa. Ninguno de sus hijosresultó positivo en las pruebas realizadas. Las mujeres bolivianas fueron las más frecuentemente afectadas:24 de 137 (17,5 %; IC 95 %: 11,2 a 23,9).DISCUSIÓN. La elevada prevalencia de enfermedad de Chagas en la población inmigrante latinoamericana obliga a sensibilizar a los profesionales implicados en el conocimiento de esta enfermedad. Se necesitan más estudios epidemiológicos para poder establecer la conveniencia de programas de detección universal para este colectivo (AU)

INTRODUCTION AND AIM. Immigration to Spain of Latin Americans with Chagas disease in its indeterminate phase could result in vertical transmission of the disease or transmission by transfusion or organ transplantation. To ascertain the magnitude of this problem, we investigated the prevalence of bearers among women who gave birth in 3 state maternity hospitals in the Valencian Communityand the incidence of vertical transmission. PATIENTS AND METHODS. An immunoprecipitation test to detect anti-Trypanosoma cruzi antibodies was carried out on 624 pregnant Latin American women. In positive cases, indirect immunofluorescence and PCR analysis were performed on mothers. In addition, a microhematocrit and PCR analysis were performed on the new-borns of these mothers, and immune precipitation was carried out from age 7 months. Chagas-positive mothers were referred for outpatient care at the hospital internal medicine departments. Percentage of positive serology was calculated for the total number of patients and by country of origin. RESULTS. A total of 29 women (4.8 %; 95 % CI, 3.1-6.3)were Chagas-positive; all were asymptomatic and PCR-negative. None of their children were positive to the tests performed. Bolivian women were the most frequently affected: 24 out of 137 (17.5 %;95 % CI, 11.2-23.9)DISCUSSION. The high prevalence of Chagas disease in the Latin American immigrant population has raised awareness of this disease among professionals involved in the study and treatment of this illness. Further epidemiological studies are needed to establish the feasibility of universal detection programs in this population (AU)

Estrongiloidiasis: epidemiología, manifestaciones clínicas y diagnóstico. Experiencia en una zona endémica: la comarca de La Safor (Valencia) / Strongyloidiasis: epidemiology, clinical manifestations and diagnosis. Experience in an endemic area: the region of La Safor (Valencia, Spain)

Strongyloides stercoralis es un nematodo intestinal con un ciclo vital único, capaz de hacer persistir la parasitación durante décadas gracias a procesos de autoinfección. En el Servicio de Microbiología del Hospital Francesc de Borja de Gandía (Valencia) se han diagnosticado más de mil casos autóctonos en los últimos 15 años, confirmando que se trata de una zona endémica. Las estrongiloidiasis aguda y crónica suelen cursar asintomáticas, o se asocian con leves procesos gastrointestinales, cutáneos y respiratorios, pero si se producen deficiencias en el sistema inmunitario del portador, especialmente en la respuesta de tipo celular, se pueden desencadenar fenómenos acelerados de autoinfección y desembocar en un síndrome de hiperinfestación, con gravísimas complicaciones que suelen resultar fatales. El diagnóstico etiológico directo, basado en el cultivo de heces en placa de agar, ha conseguido, en nuestro laboratorio, una eficacia diagnóstica semejante al método de concentración de Baermann, considerado como referente, si bien en población autóctona la serología podría utilizarse como método de cribado, ya que no se conocen interferencias con otras parasitosis propias de nuestro medio. La mejor opción terapéutica para el tratamiento de S. stercoralis es la ivermectina, aunque los problemas de disponibilidad propician que se sustituya por el albendazol con demasiada frecuencia. Recomendamos que, en todas las personas procedentes de zonas endémicas o con antecedentes epidemiológicos de riesgo, se descarte la estrongiloidiasis antes de iniciar cualquier terapia inmunosupresora

Strongyloides stercoralis is an intestinal nematode with a singular life cycle, capable of producing persistent parasitization for decades because of an autoinfestation process. In the last 15 years, more than a thousand autochthonous cases have been diagnosed at the Hospital Francesc de Borja, Gandía (Valencia), thus confirming the endemicity of the area served by this hospital. Acute and chronic strongyloidiasis usually cause asymptomatic or mild infestations, characterized by moderate gastrointestinal, cutaneous and respiratory disturbances. However, in cases of impaired host immunity, especially cell-related immunity, accelerated autoinfection can develop that can eventually lead to a “hyperinfection syndrome”, a serious and life-threatening complication. In our laboratory, direct etiologic diagnosis based on the agar plate culture method has achieved a diagnostic efficacy similar to that of the Baermann technique, considered as the gold standard diagnostic method. However, in the autochthonous population, serologic tests might be useful for screening patients with risk factors, since crossreactions with other parasites specific to our environment have not been observed. The drug of choice for strongyloidosis is ivermectin, but because this drug is not always available, albenzole is frequently used as an alternative. We strongly recommend that all individuals from endemic areas or with epidemiological risk for strongyloidiasis be carefully screened before initiating any immunosuppressive therapy

Efficacy and safety of ivermectin and thiabendazole in the treatment of strongyloidiasis.

Treatment of strongyloidiasis has been traditionally based on thiabendazole, despite its frequent gastrointestinal side effects and failure to achieve eradication of the parasite from faeces in approximately 30% of cases. Ivermectin has been shown to be more effective for treating chronic uncomplicated strongyloidiasis. The efficacy and tolerability of these drugs in a series of patients treated from 1999 to 2002 at the Oliva Health Centre, Valencia, Spain, are reported. A total of 88 patients diagnosed of strongyloidiasis were treated using the following regimens: thiabendazole 25 mg/kg/12 h for 3 consecutive days in 31 patients; ivermectin 200 mug/kg as a single dose in 22 patients; and ivermectin 200 mug/kg for 2 consecutive days in 35 patients. The efficacy and side effects were recorded. A total of 65 patients were male, and 23 female. The mean age was 64 +/- 12 years. Of the patients, 44 had worked barefoot in rice fields. Among the 31 patients treated with thiabendazole, 25 (78%) met the criteria for cure (the absence of parasite in faeces after examination of three samples collected on alternate days), and 5 (16%) experienced side effects (asthenia, epigastralgia and disorientation). Of the 22 patients treated with ivermectin on a single day, 17 (77%) met the criteria for cure, and 2 (9%) reported side effects (dizziness, dyspepsia). Among the 35 patients treated with ivermectin on 2 consecutive days, 100% met the criteria for cure, and 0% experienced side effects. In chronic uncomplicated strongyloidiasis, a treatment regimen consisting of ivermectin 200 mug/kg for 2 consecutive days provided the best results with regard to efficacy and tolerability. When the eosinophilia continued after treatment, we observed a high percentage of not-cure rate (7 of 9 patients, 77%).