Infecciones por Clostridioides difficile en pediatría. La visión del laboratorio a partir del diagnóstico microbiológico / Clostridioides difficile infections in pediatrics. The view of the laboratory based on microbiological diagnosis

La infección por Clostridioides difficile (ICD) es la principal responsable de diarreas nosocomiales en adultos. En los últimos años se registró un aumento en la incidencia de la ICD en la población adulta que, en cambio, no fue bien caracterizado en pediatría. El objetivo de este trabajo es analizar los datos resultantes del diagnóstico microbiológico de ICD en el Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". Materiales y métodos: se realizó un estudio retrospectivo observacional descriptivo que abarcó desde el 01/01/2018 hasta el 31/12/2021. El diagnóstico se realizó mediante enzimoinmunoensayo para glutamato deshidrogenasa (GDH) y toxinas en materia fecal (MF). Cuando sólo se detectó GDH, se realizó un cultivo toxigénico (CT) de la MF para la detección de toxinas in vitro. Se registraron: edad, sexo y procedencia de los pacientes y recurrencias de las ICD. Se efectuaron estudios de sensibilidad de 387 cepas de C. difficile a metronidazol (MTZ) y vancomicina (VAN). Resultados: en 6632 muestras (1764 pacientes) se registraron 649 estudios positivos (9,8%) (139 pacientes), la mayoría correspondieron a pacientes internados en áreas no críticas. Edad promedio: 7 años (7 ± 4,7). Sexo: 55% masculino. Recurrencias: 62 (45%). Positivos detectados mediante CT: 43%. Sensibilidad antibiótica: 100% a MTZ y 99,7% a VAN. Conclusión: Nuestra población presenta un bajo porcentaje de positividad. Se destaca el rendimiento del CT que permitió el diagnóstico de más de un tercio de los casos. MTZ y VANCO tuvieron excelente actividad in vitro frente a C. difficile (AU)

Clostridioides difficile infection (CDI) is the main cause of nosocomial diarrhea in adults. In recent years there has been an increase in the incidence of CDI in the adult population; however, CDI has not been well characterized in pediatrics. The aim of this study was to analyze the data resulting from the microbiological diagnosis of CDI at Hospital de Pediatría Prof. Dr. Juan P. Garrahan. Materials and methods: a retrospective, observational and descriptive study was conducted from 01/01/2018 to 12/31/2021. Diagnosis was made using enzyme immunoassay for glutamate dehydrogenase (GDH) and toxins in stools. When only GDH was detected, toxigenic culture (TC) of stools was performed for in vitro toxin detection. The age, sex and origin of patients and CDI recurrences were recorded. Sensitivity studies of 387 strains of C. difficile to metronidazole (MTZ) and vancomycin (VAN) were performed. Results: In 6,632 samples (1,764 patients), 649 positive results (9.8%) were recorded (139 patients), most of which corresponded to patients hospitalized in noncritical areas. Mean age: 7 years (7 ± 4.7). Sex: 55% male. Recurrences: 62 (45%). TC-positive results: 43%. Antibiotic sensitivity: 100% to MTZ and 99.7% to VAN. Conclusion: A low percentage of positivity was found in our population. The performance of TC was outstanding, allowing for the diagnosis of more than one third of the cases. MTZ and VANCO had excellent in vitro activity against C. difficile (AU)

(-)-Epicatechin and NADPH oxidase inhibitors prevent bile acid-induced Caco-2 monolayer permeabilization through ERK1/2 modulation.

Secondary bile acids promote gastrointestinal (GI) tract permeabilization both in vivo and in vitro. Consumption of high fat diets increases bile acid levels in the GI tract which can contribute to intestinal permeabilization and consequent local and systemic inflammation. This work investigated the mechanisms involved in bile acid (deoxycholic acid (DCA))-induced intestinal epithelial cell monolayer permeabilization and the preventive capacity of (-)-epicatechin (EC). While EC prevented high fat diet-induced intestinal permeabilization in mice, it did not mitigate the associated increase in fecal/cecal total and individual bile acids. In vitro, using differentiated Caco-2 cells as a model of epithelial barrier, EC and other NADPH oxidase inhibitors (VAS-2870 and apocynin) mitigated DCA-induced Caco-2 monolayer permeabilization. While EC inhibited DCA-mediated increase in cell oxidants, it did not prevent DCA-induced mitochondrial oxidant production. Prevention of DCA-induced ERK1/2 activation with EC, VAS-2870, apocynin and the MEK inhibitor U0126, also prevented monolayer permeabilization, stressing the key involvement of ERK1/2 in this process and its redox regulation. Downstream, DCA promoted myosin light chain (MLC) phosphorylation which was related to MLC phosphatase (MLCP) inhibition by ERK1/2. DCA also decreased the levels of the tight junction proteins ZO-1 and occludin, which can be related to MMP-2 activation and consequent ZO-1 and occludin degradation. Both events were prevented by EC, NADPH oxidase and ERK1/2 inhibitors. Thus, DCA-induced Caco-2 monolayer permeabilization occurs mainly secondary to a redox-regulated ERK1/2 activation and downstream disruption of TJ structure and dynamic. EC's capacity to mitigate in vivo the gastrointestinal permeabilization caused by consumption of high-fat diets can be in part related to its capacity to inhibit bile-induced NADPH oxidase and ERK1/2 activation.

Aspectos clínicos y bacteriológicos de las mastoiditis agudas como complicación de otitis media aguda y crónica en pediatría, Experiencia en 10 años / Clinical and bacteriological features of acute mastoiditis as a complication of acute and chronic otitis media in pediatrics. A 10-years experience

Antecedentes. Cualquier paciente pediátrico o adulto que presente otitis media aguda (OMA) u otitis media crónica (OMC), particularmente colesteatomatosa, puede desarrollar complicaciones intratemporales y endocraneales, especialmente mastoiditis aguda (MA). Objetivo. Describir las características clínicas y bacteriología de los pacientes asistidos por MA como complicación de OMA y OMC. Lugar de aplicación: Servicio de Otorrinolaringología. Hospital de Pediatría Juan P. Garrahan. Diseño. Descriptivo, retrospectivo, transversal y observacional. Población. Pacientes con mastoiditis aguda por OMA y por OMC asistidos en el Servicio de ORL durante 10 años. Material y métodos. Revisión de historias clínicas de todos los pacientes tratados entre enero de 1999 y diciembre de 2008. Resultados. Se estudiaron 57 pacientes con MA, 40/57 por OMA y 17/57 por OMC. Hubo 40 niños hospitalizados con signos y síntomas de MA por OMA. Se diagnosticó complicación endocraneal en el 12,5% (5/40) de los casos. Los aislamientos bacterianos más frecuentes fueron Streptococcus pyogenes, Streptococcus pneumoniae, H. influenzae y Turicella otitidis. Se registraron 17 casos de niños hospitalizados con diagnóstico de MA y OMC. Ocurrieron complicaciones supurativas intracraneales en el 35,3% (6/17) de los casos. Los aislamientos bacterianos más frecuentes fueron las enterobacterias, P. aeruginosa y los gérmenes anaerobios. Conclusión. El diagnóstico de tipo y estadio de otitis media previa o coexistente a la complicación es fundamental para encarar el tratamiento antimicrobiano empírico inicial, sospechar complicaciones endocraneales asociadas y proponer procedimientos quirúrgicos menores, medianos o mayores oportunamente (AU)

Background. Any pediatric or adult patient presenting with acute otitis media (AOM) or chronic otitis media (COM), especially cholesteatomatous, may develop intratemporal and intracranial complications, mainly acute mastoiditis (AM). Objective. To describe the clinical and bacteriological features of patients seen for AM as a complication of AOM and COM. Setting: Department of Otolaryngology, Hospital de Pediatría Juan P. Garrahan. Design. A descriptive, retrospective, cross-sectional, observational study. Population. Patients with AM because of AOM and COM seen at the Department of Otolaryngology over a 10-year period. Material and methods. Review of the clinical charts of all patients treated between January 1999 and December 2008. Results. 57 Patients with AM, 40/57 due to AOM and 17/57 due to COM, were evaluated. Forty children were admitted to hospital with signs and symptoms of AOM-related AM. Intracranial complications were observed in 12.5% (5/40) of the patients. The most frequently isolated pathogens were Streptococcus pyogenes, Streptococcus pneumoniae, H. influenzae, and Turicella Otitidis. Seventeen children were hospitalized because of COM-related AM. Suppurative intracranial complications occurred in 35.3% (6/17) of the cases. The most frequently isolated pathogens were Enterobacteriaceae, P. aeruginosa, and anaerobic bacteria. Conclusion. The diagnosis of type and stage of otitis media prior to or coexisting with the complication is essential to address the initial empirical antimicrobial treatment, associated intracranial complications should be suspected and minor, intermediate, or major surgical procedures should be proposed at the appropriate time (AU)

Bacterias causantes de otitis media aguda antes y después de la aplicación de la vacuna antineumococica 13-valente / Acute otitis media-causing bacteria before and after the application of the 13-valent pneumococcal conjugate vaccine

Los microorganismos más frecuentemente responsables de la otitis media aguda (OMA) (Streptococcus pneumoniae y Haemophilus influenzae) son los mismos en los países en vías de desarrollo que en los desarrollados. En los países que administraron la vacuna antineumocócica conjugada, los neumococos disminuyeron como causa de OMA, pero con el tiempo comenzaron a resurgir, sobre todo a expensas de cepas pertenecientes a serotipos no incluidos en la vacuna. El objetivo de este trabajo fue documentar el cambio generado en la bacteriología de la OMA a partir de la incorporación en el calendario oficial argentino de la vacuna conjugada antineumocócica 13-valente en el año 2012. Se realizaron dos estudios prospectivos, descriptivos, transversales, uno previo a la incorporación de la vacuna al calendario nacional (mayo 2009-agosto 2010) donde la población estudiada no se encontraba cubierta para S. pneumoniae y otro posterior, donde la mayoría de los pacientes se encontraban inmunizados (enero-diciembre 2016). Se obtuvieron 433 muestras de 324 pacientes en el primer período y 461 de 246 pacientes en el segundo. Se aisló un total de 326 bacterias en el primer período y 388 en el segundo. Los microorganismos respectivamente aislados en ambos períodos fueron S. pneumoniae (39,5-21,1%), H. influenzae (37,4-44,6%), Moraxella catarrhalis (6,1-7,5%), Staphylococcus aureus (8,6-9,8%), Streptococcus pyogenes (3,0-5,9%), Turicella otitidis (1,8-2,1%), Pseudomonas aeruginosa (0,9-4,1%) y otros (2,4-4,9%). Los neumococos pertenecientes a serotipos vacunales sufrieron una disminución significativa, especialmente el 6A, 9V, 14, 18C, 19A, mientras que los serotipos no vacunales aumentaron significativamente, en particular el 15B, el 11A, el 7C, el 16F y el 22F (AU)

Organisms most frequently responsible for acute otitis media (AOM) (Streptococcus pneumoniae and Haemophilus influenzae) are the same in developing countries as in developed ones. In countries that administered the pneumococcal conjugate vaccine, pneumococci decreased as a cause of AOM, but over time began to re-emerge, especially due to strains belonging to serotypes not included in the vaccine. The objective of this work was to document the change generated in the bacteriology of the OMA from the incorporation of the 13-valent pneumococcal conjugate vaccine in 2012 in the official Argentinean calendar. Two prospective, descriptive, cross-sectional studies were carried out prior to the incorporation of the vaccine into the national calendar (May 2009-August 2010), where the population studied was not covered for S. pneumoniae and a subsequent one, where most of the patients were immunized (January 2016-December 2016). We obtained 433 samples from 324 patients in the first period and 461 from 246 patients in the second. A total of 326 bacteria were isolated in the first period and 388 in the second. The microorganisms respectively isolated in both periods were S.pneumoniae (39.5-21.1%), H.influenzae (37.4-44.6%), Moraxella catarrhalis (6.1-7.5%), Staphylococcus aureus (8.6-9.8%), Streptococcus pyogenes (3.0-5.9%), Turicella otitidis (1.8-2.1%), Pseudomonas aeruginosa (0.9-4.1%) and others (2.4-4.9%). Pneumococci belonging to vaccine serotypes suffered a significant decrease, especially 6A, 9V, 14, 18C, 19A, while nonvaccine serotypes increased significantly, particularly 15B, 11A, 7C, 16F, and 22F (AU)

Frecuencia de neumococos del serotipo 19A en otitis media aguda en niños inmunocompetentes antes de la aplicación masiva de la vacuna conjugada / Incidence of 19A pneumococci in acute otitis media in immunocompetent children before the massive administration of the conjugated vaccine

La aplicación de la vacuna PCV7 en algunos países ha determinado un aumento significativo de neumococos del serotipo 19A y este hecho ha llevado a una atenuación del impacto inicial logrado en términos de prevención de enfermedades neumocócicas invasivas. Los objetivos de este trabajo fueron: (a) describir la frecuencia de los neumococos 19A, antes de la vacunación antineumocócica masiva, en niños con OMA desde la óptica parcial de un solo hospital de la ciudad de Buenos Aires, (b) estudiar su vinculación a casos de recurrencias y (c) su sensibilidad a los antimicrobianos. Se aislaron 133 neumococos, 126 de los cuales resultaron viables para poder realizar su identificación a nivel de tipo y los estudios correspondientes de sensibilidad a los antibióticos. Los serotipos más prevalentes fueron el 14 (14,3%) y el 19A (11,9%). Ocho de los 15 aislados de S. pneumoniae 19A presentaron sensibilidad disminuida a la penicilina, lo que representó el 22,2% de los neumococos no sensibles provenientes de OMA. El serotipo 19A estuvo involucrado en 3 de los 12 casos de recurrencias por S. pneumoniae. Probablemente la nueva vacuna 13-valente, la única conjugada que contiene antígenos contra el neumococo 19A, pueda impedir su incremento tanto en OMA como en enfermedades invasivas.

In several countries administration of PCV7vaccine has cau-sed a significant increase in 19A serotype pneumococci.This effect has diminished the initial impact on invasive pneumococcal infection prevention. The aims of the present study were: (a) to describe the incidence of 19A pneumococci in children with acute otitis media (AOM), beforethe massive administration of pneumococcal vaccines, fromthe scope of a single pediatric hospital in the city of Buenos Aires, (b) to study their relation to recurrences, and (c) their antimicrobial susceptibility. One hundred and thirty-three pneumococci were isolated from children with AOM; 126 of these were viable to further identify pneumococcal serotypes and determine antimicrobial susceptibility. The most prevalent serotypes were 14 (14.3%) and 19A (11.9%). Eightout of the 15 19A serotype pneumococcal isolates showed diminished susceptibility to penicillin, accounting for 22.2% of non-susceptible pneumococci from AOM. Serotype 19A was involved in 3 out of 12 cases of recurrent AOM due to S. pneumoniae. The new 13-valent vaccine, containing antibodies against 19A pneumococci, may prevent its increasing incidence rate both in AOM and in other invasive infections.

Lipopolysaccharide (LPS) induction of nitric oxide synthase-2 and cyclooxygenase-2 is impaired in fructose overloaded rats.

AIMS: Fructose (F) overload in rats induces metabolic dysfunctions that resemble the human metabolic syndrome. In this paper, we aimed to investigate the response of F overload rats to lipopolysaccharide (LPS) challenge in terms of nitric oxide (NO) production and prostanoids (PR) release. MAIN METHODS: NO blood steady-state concentration was monitored through the detection of nitrosyl-hemoglobin complexes (NO-Hb) by electronic spin resonance. Production of 6-keto PGF(1)α, PGE(2), PGF(2)α and TXB(2) was measured in aorta and mesenteric beds by HPLC. Western blot analysis was used to examine the changes in the expression levels of NOS-2 and COX-2 in aorta. KEY FINDINGS: Our results showed that increases in NO circulating steady-state concentration and PR production by aorta and mesenteric beds 6h after LPS administration were significantly attenuated in F overload rats with respect to control animals. Oxidative stress parameters were equally affected in the presence or absence of the F treatment. Aorta protein levels of NOS-2 and COX-2, two enzymes inducible by LPS, were significantly lower in F overload rats with respect to control rats at the end of the treatment (-39% and -61% for NOS-2 and COX-2 respectively). SIGNIFICANCE: These results suggest that the metabolic alterations established by 15 weeks of F overload should affect the response to LPS challenge due to an attenuation in the induction of NOS-2 and COX-2. This effect would be one of the components contributing to abnormalities in the course of the inflammatory response in other conditions associated to insulin resistance, such as diabetes.

Susceptibility trends of Bacteroides fragilis group isolates from Buenos Aires, Argentina.

The aim of this study was to analyze the susceptibility trends to seven antibiotics of Bacteroides fragilis group isolates based on three survey studies performed by the Committee of Anaerobic Bacteria between 1989 and 2002. Fifty three, 82 and 65 B. fragilis group isolates were collected during each period. The antimicrobial agents included were: ampicillin, ampicillin-sulbactam (2:1), cefoxitin, piperacillin, imipenem, clindamycin, and metronidazole. Minimal inhibitory concentrations (MICs) were determined according to the reference agar dilution method described by the Clinical and Laboratory Standards Institute (CLSI, formerly NCCLS). The most active antibiotics for B. fragilis and non-B. fragilis species throughout the three periods were: imipenem with 99.1 and 100% of activity, respectively, and metronidazole with 100% of activity. The susceptibility to ampicillin-sulbactam showed a decrease, from 100% to 90.3% and to 82.4 % in the last period, for both B. fragilis and non-B. fragilis species, respectively. The overall susceptibility rates for cefoxitin, piperacillin, and clindamycin were significantly different between B. fragilis and non-B. fragilis species (84.2% vs. 56.5%; 85.9% vs. 66.7% and 88.8% vs. 64.7%, respectively, p < 0.05). Cefoxitin was the antibiotic that showed more variations as regards periods and species. The susceptibility rates for clindamycin were low, about 60%, for non-B. fragilis species during the last two periods. The variations observed in the susceptibility patterns of the B. fragilis group isolates emphasize the need to continue monitoring the emergence of resistance in order to guide the election of the most appropriate antibiotic therapy scheme for anaerobic infections.

["In vitro" activity of ten antimicrobial agents against anaerobic bacteria. A collaborative study, 1999-2002]. / Actividad "in vitro" de 10 antimicrobianos frente a bacterias anaerobias. Estudio multicéntrico, 1999-2002.

The antimicrobial activity of ampicillin, ampicillin-sulbactam, cefoxitin, ceftriaxone, imipenem, piperacillin, piperacillin-tazobactam, clindamycin, metronidazole, and azitromycin was assesed against 166 strains of anaerobic bacteria recovered from eight hospitals in Buenos Aires. The strains studied were Bacteroides fragilis group (65), Fusobacterium spp. (26), Prevotella spp. (21), Porphyromonas spp. (10), Clostridium difficile (10), other clostridia (12), and gram-positive cocci (22). The MICs were determined by the agar dilution method according to NCCLS document M11-A5. Metronidazole and piperacillin-tazobactam were the most active antimicrobial agents tested and exhibited MIC90 values of < or = 2 microg/ml and < or = 4 microg/ml against gram-negative organisms, and < or = 2 microg/ml, and < or = 8 microg/ml against gram-positive organisms, respectively. Among beta-lactams the activity against gram-negative rods was in the following order: imipenem > piperacillin > cefoxitin > ceftriaxone > ampicillin. Among the gram-positive bacteria the decreased activity was: piperacillin > imipenem > cefoxitin > ceftriaxone > ampicillin. The majority of the species studied showed different degrees of resistance to clindamycin and azitromycin. Nevertheless, 90% of Fusobacterium nucleatum and Porphyromonas spp. isolates were inhibited by 0.125 mg/ml of clindamycin and azitromycin, respectively.

Actividad “in vitro” de 10 antimicrobianos frente a bacterias anaerobias: Estudio multicéntrico, 1999-2002 / “In vitro” activity of ten antimicrobial agents against anaerobic bacteria. A collaborative study, 1999-2002

Se evaluó la actividad de ampicilina, ampicilina-sulbactama, cefoxitina, ceftriaxona, imipenem, piperacilina, piperacilina-tazobactama, clindamicina, metronidazol y azitromicina frente a 166 cepas de bacterias anaerobias aisladas en 8 hospitales de Buenos Aires. Se estudiaron: Bacteroides grupo fragilis (65), Fusobacterium spp. (26), Prevotella spp. (21), Porphyromonas spp. (10), Clostridium difficile (10), otros clostridios (12) y cocos gram-positivos (22). Las CIMs se determinaron usando el método patrón de dilución en agar recomendado por el NCCLS, documento M11-A5. Los antibióticos más activos fueron metronidazol y piperacilina-tazobactama que exhibieron valores de CIM90£ 2 µg/ml y £ 4 µg/ml frente a los microorganismos gram-negativos y £ 2 µg/ml y £ 8 µg/ml frente a los microorganismos gram-positivos, respectivamente. Entre los b-lactámicos el orden de actividad frente a bacilos gram-negativos fue: imipenem > piperacilina > cefoxitina > ceftriaxona > ampicilina. En gram-positivos la actividad decreciente fue: piperacilina> imipenem > cefoxitina > ceftriaxona > ampicilina. La mayoría de las especies estudiadas mostraron distintos niveles de resistencia con clindamicina y azitromicina. Sin embargo, el 90% de las cepas de Fusobacterium nucleatum y Por-phyromonas spp. fue inhibido por una concentración de 0,125 µg/ml de clindamicina y azitromicina, respectivamente.

The antimicrobial activity of ampicillin, ampicillin-sulbactam, cefoxitin, ceftriaxone, imipenem, piperacillin, piperacillin-tazobactam, clindamycin, metronidazole, and azitromycin was assesed against 166 strains of anaerobic bacteria recovered from eight hospitals in Buenos Aires. The strains studied were Bacteroidesfragilis group (65), Fusobacterium spp. (26), Prevotella spp. (21), Porphyromonas spp. (10), Clostridium difficile (10), other clostridia (12), and gram-positive cocci (22). The MICs were determined by the agar dilution method according to NCCLS document M11-A5. Metronidazole and piperacillin-tazobactam were the most active antimicrobial agents tested and exhibited MIC90values of £ 2 µg/ml and £ 4 µg/ml against gram-negative organisms, and £ 2 µg/ml, and £ 8 µg/ml against gram-positive organisms, respectively. Among b-lactams the activity against gram-negative rods was in the following order: imipenem> piperacillin > cefoxitin > ceftriaxone > ampicillin. Among the gram-positive bacteria the decreased activity was: piperacillin> imipenem> cefoxitin > ceftriaxone > ampicillin. The majority of the species studied showed different degrees of resistance to clindamycin and azitromycin. Nevertheless, 90% of Fusobacterium nucleatum and Porphyromonas spp. isolates were inhibited by 0.125 mg/ml of clindamycin and azitromycin, respectively.

Actividad [quot ]in vitro[quot ] de 10 antimicrobianos frente a bacterias anaerobias. Estudio multicéntrico, 1999-2002 / [[quot ]In vitro[quot ] activity of ten antimicrobial agents against anaerobic bacteria. A collaborative study, 1999-2002]

The antimicrobial activity of ampicillin, ampicillin-sulbactam, cefoxitin, ceftriaxone, imipenem, piperacillin, piperacillin-tazobactam, clindamycin, metronidazole, and azitromycin was assesed against 166 strains of anaerobic bacteria recovered from eight hospitals in Buenos Aires. The strains studied were Bacteroides fragilis group (65), Fusobacterium spp. (26), Prevotella spp. (21), Porphyromonas spp. (10), Clostridium difficile (10), other clostridia (12), and gram-positive cocci (22). The MICs were determined by the agar dilution method according to NCCLS document M11-A5. Metronidazole and piperacillin-tazobactam were the most active antimicrobial agents tested and exhibited MIC90 values of piperacillin > cefoxitin > ceftriaxone > ampicillin. Among the gram-positive bacteria the decreased activity was: piperacillin > imipenem > cefoxitin > ceftriaxone > ampicillin. The majority of the species studied showed different degrees of resistance to clindamycin and azitromycin. Nevertheless, 90

of Fusobacterium nucleatum and Porphyromonas spp. isolates were inhibited by 0.125 mg/ml of clindamycin and azitromycin, respectively.

Lemierre's syndrome: case report in a pediatric patient.

Lemierre's syndrome was described in 1936 as a severe oropharyngeal infection followed by septic thrombophlebitis of the internal jugular vein and disseminated metastatic infections. Cases occur typically in previously healthy young adults and children. Fusobacterium necrophorum is the main anaerobic bacterium implicated. We present a septic 2-month-old infant with mastoiditis, multiple sites of osteoarthritis and multiple subcutaneous abscesses. No underlying anatomic or immunologic abnormalities were identified. Fusobacterium necrophorum was recovered from blood and bone samples obtained intraoperatively. Treatment included anaerobic coverage and drainage of septic foci. The patient was discharged home on 35th hospital day with oral amoxicillin-clavulanic acid and he recovered without sequelae. This was the first case of Lemierre's syndrome in our hospital. We want to highlight the absence of jugular vein thrombophlebitis, the presence of mastoiditis as previous infection and the surprising appearance of this infection in an edentulous 2-month-old infant.

Actividad [quot ]in vitro[quot ] de 10 antimicrobianos frente a bacterias anaerobias. Estudio multicéntrico, 1999-2002. / [[quot ]In vitro[quot ] activity of ten antimicrobial agents against anaerobic bacteria. A collaborative study, 1999-2002]

The antimicrobial activity of ampicillin, ampicillin-sulbactam, cefoxitin, ceftriaxone, imipenem, piperacillin, piperacillin-tazobactam, clindamycin, metronidazole, and azitromycin was assesed against 166 strains of anaerobic bacteria recovered from eight hospitals in Buenos Aires. The strains studied were Bacteroides fragilis group (65), Fusobacterium spp. (26), Prevotella spp. (21), Porphyromonas spp. (10), Clostridium difficile (10), other clostridia (12), and gram-positive cocci (22). The MICs were determined by the agar dilution method according to NCCLS document M11-A5. Metronidazole and piperacillin-tazobactam were the most active antimicrobial agents tested and exhibited MIC90 values of < or = 2 microg/ml and < or = 4 microg/ml against gram-negative organisms, and < or = 2 microg/ml, and < or = 8 microg/ml against gram-positive organisms, respectively. Among beta-lactams the activity against gram-negative rods was in the following order: imipenem > piperacillin > cefoxitin > ceftriaxone > ampicillin. Among the gram-positive bacteria the decreased activity was: piperacillin > imipenem > cefoxitin > ceftriaxone > ampicillin. The majority of the species studied showed different degrees of resistance to clindamycin and azitromycin. Nevertheless, 90

of Fusobacterium nucleatum and Porphyromonas spp. isolates were inhibited by 0.125 mg/ml of clindamycin and azitromycin, respectively.

Broth disk elution method for anaerobic bacteria: a collaborative study to assess its reliability for clinical purposes.

A collaborative study involving seven laboratories was undertaken to evaluate the reproducibility and the reliability of the broth disk elution test against anaerobic bacteria by comparing with the reference agar dilution method. A two breakpoint broth test was also evaluated. Assays were performed using the same testing conditions (i.e. medium, temperature, atmosphere and incubation time). One hundred Gram-negative and Gram-positive clinical isolates were initially studied. Overall agreement of 98.5% and 97.5%, were found for disk elution and the two breakpoint tests, respectively. In order to assess the reliability of the disk elution test, two different lots (LOT1 and LOT2) of disks of piperacillin and clindamycin were selected, to obtain two final concentrations after dilution (10 and 60 mg/mL; 1 and 4 mg/mL, respectively). Two hundred and eighty assays were performed against one strain of both Bacteroides fragilis(piperacillin MIC, 8.0 mg/mL; clindamycin MIC, <0.5 mg/mL) and Bacteroides thetaiotaomicron(piperacillin MIC, 16.0 mg/mL; clindamycin MIC, <0.5 mg/mL). With LOT 1, considering both species and both antibiotics, the agreement among six laboratories ranged from 85% to 100% (P > 0.05) with the higher concentration. Overall agreement among all laboratories was 91%. No optimal agreement (>90%) for clindamycin-Bacteroides thetaiotaomicron using the LOT1 (77%) was found. Since this finding was not observed with LOT2 (100% agreement), discrepancies were attributed to variation between lots. Overall agreement with LOT2 was 100% for all centres. The present study indicates that the broth disk elution method proved to be a reliable and suitable alternative for routine susceptibility testing for anaerobic bacteria, as a resistance screening method for clinical purposes.

Estudio multicéntrico de la sensibilidad de bacterias anaerobias en la Argentina / Multicentric study of anaerobic bacteria susceptibility in Argentina

Se determinó la actividad de ampicilina (AMP), ampicilina-sulbactama (AMS), penicilina (PEN), piperacilina (PIP), imipenem (IMI), cefoxitina (CXT), ceftizoxima (CFZ), clindamicina (CLI), cloranfenicol (CLO) y metronidazol (MET) frente a 106 cepas de bacterias anaerobias aisladas de muestras clínicas en seis centros asistenciales del país por un método de dilución en agar. Todos los microorganismos gramnegativos fueron sensibles a AMS, CLO, IMI y MET. Se encontraron 5/7 Bacteroides spp., 2/6 bacilos gram negativos pigmentados y 1/4 Fusobacterium spp. resistentes a AMP. Los Bacteroides del grupo fragilis fueron altamente resistentes a AMP y la especie Bacteroides fragilis fue más sensible a PIP, CXT, CFZ y CLI que las otras especies del grupo (5 por ciento vs. 21 por ciento, 5 por ciento vs. 7 por ciento, 8 por ciento vs. 14 por ciento y 2,5 por ciento vs. 14 por ciento respectivamente). Entre los organismos gram positivos se encontró resistencia PEN en el 7 por ciento de Peptostreptococcus spp., a MET en 4 de 5 bacilos no esporulados y sensibilidad al resto de los antibióticos

Estudio multicéntrico de la sensibilidad de bacterias anaerobias en la Argentina / Multicentric study of anaerobic bacteria susceptibility in Argentina

Se determinó la actividad de ampicilina (AMP), ampicilina-sulbactama (AMS), penicilina (PEN), piperacilina (PIP), imipenem (IMI), cefoxitina (CXT), ceftizoxima (CFZ), clindamicina (CLI), cloranfenicol (CLO) y metronidazol (MET) frente a 106 cepas de bacterias anaerobias aisladas de muestras clínicas en seis centros asistenciales del país por un método de dilución en agar. Todos los microorganismos gramnegativos fueron sensibles a AMS, CLO, IMI y MET. Se encontraron 5/7 Bacteroides spp., 2/6 bacilos gram negativos pigmentados y 1/4 Fusobacterium spp. resistentes a AMP. Los Bacteroides del grupo fragilis fueron altamente resistentes a AMP y la especie Bacteroides fragilis fue más sensible a PIP, CXT, CFZ y CLI que las otras especies del grupo (5 por ciento vs. 21 por ciento, 5 por ciento vs. 7 por ciento, 8 por ciento vs. 14 por ciento y 2,5 por ciento vs. 14 por ciento respectivamente). Entre los organismos gram positivos se encontró resistencia PEN en el 7 por ciento de Peptostreptococcus spp., a MET en 4 de 5 bacilos no esporulados y sensibilidad al resto de los antibióticos (AU)