Antimicrobial resistance of Pseudomonas aeruginosa strains isolated from surgical infections in a 7-year period at a general hospital in Venezuela.

BACKGROUND: By definition, the term "surgical infection" implies that surgery plays the major role in therapy, whereas antimicrobial chemotherapy is only supplementary. Despite this view, the efficacy of such drugs is relevant, and for this reason, drug activity surveillance is necessary, especially for opportunistic and nosocomial pathogens such as Pseudomonas aeruginosa. We evaluated bacterial isolates from patients with suspected surgical infections in a hospital of Caracas, Venezuela (West General Hospital) between 1997 and 2003. METHODS: Clinical samples were processed and identified with standard cultures and biochemical tests. The antimicrobial susceptibility of the isolates in vitro was assessed by an agar disk diffusion method using Mueller-Hinton agar, as recommended by the National Committee for Clinical Laboratory Standards (now the Clinical and Laboratory Standards Institute). Isolates were tested against 22 drugs, including piperacillin, ceftazidime, cefoperazone, amikacin, gentamicin, ciprofloxacin, meropenem, and imipenem. RESULTS: From a total of 16,287 bacterial strains isolated from surgical infections during the study period, 243 (1.5%) were P. aeruginosa. Of this total, 30.9% were resistant to gentamicin, 26.3% to tobramicin, 23.0% to cefoperazone, 22.8% to piperacillin, 22.5% to ciprofloxacin, 17.6% to amikacin, 13.6% to imipenem, and 12.9% to meropenem. The best antimicrobial activity was observed with cefepime (90.1% susceptible strains, 1.9% intermediate resistance, and 8.0% resistant strains) and aztreonam (77.7% susceptible strains, 15.2% intermediate resistance, and 7.1% resistant strains). CONCLUSIONS: In our setting, cefepime is most active against strains of P. aeruginosa. In comparison with third-generation cephalosporins, cefepime may be less likely to induce resistance. Surveillance of antimicrobial activity should be done periodically to guide therapy of surgical infections.

Hipertensión inducida por el embarazo: predicción mediante la relación calcio-creatinina / Pregnancy induced hypertension: prediction by means to calciun/creatinine relation

La hipertensión inducida por el embarazo (HIE) constituye la complicación más frecuente de la gestación, con una incidencia reportada que oscila entre 6 al 10 por ciento. Ocupa el nivel mundial los primeros lugares en las tasas de morbi-mortalidad maternofetal y perinatal. El objetivo del presente trabajo fue determinar la utilidad de la relación calcio-creatinina urinaria como predictor para el desarrollo de HIE. Se estudiaron 85 pacientes embarazadas que consultaron el servicio de prenatal del Hospital General de Oeste "Dr. José Gregorio Hernández" de Caracas, entre el 1 de Octubre de 1996y el 1 de Octubre de 1997. A cada paciente se le realizó controles prenatales sucesivos hasta el término y se les tomó una muestra parcial de orina antes de las 20 semanas de gestación, para la obtención de la relación calcio-creatinina. Sólo 64 embarazadas completaron el estudio, de las cuales 8 (12, 5 por ciento) desarrollaron HIE. Una relación calcio-creatinina, igual o menor de 0,04, demostró ser un predictor eficiente para el desarrollo de HIE, cuando se calculó entre las 24 a 34 semanas de gestación; no así durante la primera mitad del embarazo