A 15 year-review of peritoneal dialysis-related peritonitis: microbiological trends and patterns of infection in a teaching hospital in Argentina.

This study reports the infectious peritonitis rates in 44 patients on peritoneal dialysis in three different systems over the last 15 years, covering clinical outcomes, exit-site infections, tunnel infections, causative microorganisms, and the history of susceptibility of organisms causing peritonitis, in order to establish our center-specific selection of empiric therapy. Two microbiological procedures were herein used: method A, where 100 ml of dialysate were centrifuged and cultured in standard media and into blood-culture bottles; and method B, where 10 ml were directly injected into blood-culture bottles. Swabs from the exit-site or tunnel were taken when purulent drainage was observed. There were 96 episodes of peritonitis during 110.43 patient-years (0.87 episodes/patient-year). Sensitivity of method A was 96.88% (93/96 episodes) versus 81.25% (78/96) of method B (p=0.001). Gram stain sensitivity was 36.46%. The etiologic agents were 64 (56.64%) gram-positive cocci, 22 (19.47%) gram-negative fermentative rods, 20 (17.7%) gram-negative non fermentative rods, 5 (4.43%) yeasts, 1 (0.88%) micelial fungus, and 1 (0.88%) anaerobic rod. Fifty-five exit-site infections were documented (0.5 episodes/patient-year). Ceftazidime and imipenem showed excellent activity on gram-negative rods. There were 92.3% of methicillin-susceptible Staphylococcus aureus but only 33.3% of methicillin-susceptible coagulase-negative staphylococci; vancomycin was active against 100% of the gram-positive cocci. The clinical outcomes of peritonitis were 73 initial cure, 19 catheter removal and four related deaths. The empiric therapy in our center should be vancomycin plus ceftazidime or imipenem. Once the etiological agent and its susceptibility pattern are known, the deescalating therapy must be applied to avoid the emergence and spread of vancomycin-resistant microorganisms.

A 15 year-review of peritoneal dialysis-related peritonitis: Microbiological trends and patterns of infection in a teaching hospital in Argentina / Peritonitis en diálisis peritoneal: características microbiológicas y patrones de infección a lo largo de 15 años en un hospital universitario en Argentina

This study reports the infectious peritonitis rates in 44 patients on peritoneal dialysis in three different systems over the last 15 years, covering clinical outcomes, exit-site infections, tunnel infections, causative microorganisms, and the history of susceptibility of organisms causing peritonitis, in order to establish our center-specific selection of empiric therapy. Two microbiological procedures were herein used: method A, where 100 ml of dialysate were centrifuged and cultured in standard media and into blood-culture bottles; and method B, where 10 ml were directly injected into blood-culture bottles. Swabs from the exit-site or tunnel were taken when purulent drainage was observed. There were 96 episodes of peritonitis during 110.43 patient-years (0.87 episodes/patient-year). Sensitivity of method A was 96.88% (93/96 episodes) versus 81.25% (78/96) of method B (p= 0.001). Gram stain sensitivity was 36.46%. The etiologic agents were 64 (56.64%) gram-positive cocci, 22 (19.47%) gram-negative fermentative rods, 20 (17.7%) gram-negative non fermentative rods, 5 (4.43%) yeasts, 1 (0.88%) micelial fungus, and 1 (0.88%) anaerobic rod. Fifty-five exit-site infections were documented (0.5 episodes/patient-year). Ceftazidime and imipenem showed excellent activity on gram-negative rods. There were 92.3% of methicillin-susceptible Staphylococcus aureus but only 33.3% of methicillin-susceptible coagulase- negative staphylococci; vancomycin was active against 100% of the gram-positive cocci. The clinical outcomes of peritonitis were 73 initial cure, 19 catheter removal and four related deaths. The empiric therapy in our center should be vancomycin plus ceftazidime or imipenem. Once the etiological agent and its susceptibility pattern are known, the deescalating therapy must be applied to avoid the emergence and spread of vancomycin-resistant microorganisms.

Se comunican las tasas de peritonitis infecciosa de 44 pacientes en tres sistemas diferentes de diálisis peritoneal durante los últimos 15 años. Se evaluaron evolución clínica, infecciones del sitio de salida y del túnel, y los microorganismos causales y su sensibilidad, a fin de seleccionar la mejor terapia empírica para nuestro centro. Se realizaron dos procedimientos microbiológicos, método A: 100 ml del dializado fueron centrifugados y cultivados por métodos convencionales y en frascos para hemocultivo; método B: 10 ml fueron directamente inoculados en frascos para hemocultivo. Los hisopados del sitio de salida y del túnel fueron realizados cuando se observó supuración. Se registraron 96 episodios de peritonitis en 110,43 paciente-años (0,87 episodios/paciente-año). La sensibilidad del método A fue 96,88% versus 81,25% del método B (p = 0,001). La sensibilidad de la coloración de Gram fue 36,46%. La distribución de los agentes etiológicos fue la siguiente: 64 (56,64%) cocos gram-positivos, 22 (19,47%) bacilos gram-negativos fermentadores, 20 (17,7%) bacilos gram-negativos no fermentadores, 5 (4,43%) levaduras, 1 (0,88%) hongo micelial, 1 (0,88%) bacilo anaerobio. Fueron documentadas 55 infecciones del sitio de salida (0,5 episodios/paciente-año). La ceftazidima y el imipenem mostraron una excelente actividad sobre los bacilos gram-negativos. La sensibilidad a meticilina fue de 92,3% para Staphylococcus aureus y 33,3% para estafilococos coagulasa negativos; la vancomicina fue activa frente al 100% de los cocos gram-positivos. La evolución clínica de las peritonitis fue: 73 curas, 19 remociones de catéter y cuatro muertes relacionadas. La terapia empírica en nuestro centro debería ser vancomicina más ceftazidima o imipenem. Una vez conocidos el agente etiológico y su sensibilidad, se debería aplicar la terapia de desescalonamiento para evitar la emergencia y diseminación de microorganismos resistentes a la vancomicina.

Fungal peritonitis in patients on peritoneal dialysis: Twenty five years of experience in a teaching hospital in Argentina / Peritonitis fúngica en pacientes en diálisis peritoneal: la experiencia de 25 años en un hospital universitario de la Argentina

Fungal peritonitis is a rare but serious complication of peritoneal dialysis. The aim of this study was to analyze peritonitis rates, associated factors, clinical course, microbiological aspects, therapeutic regimens, and outcome of patients with fungal peritonitis in the dialysis center of a teaching hospital over the last 25 years. A hundred and eighty three episodes of peritonitis were detected and microbiologically documented in 57 patients. Fungi were identified in eight episodes (4.37%) occurring in seven female patients. The fungal peritonitis rate was 0.06 episodes/patient-year. Gram and Giemsa stains were positive in five out of eight dialysate fluids. The causative microorganisms were: Candida albicans in five episodes, and Candida parapsilosis, Candida glabrata, and Neosartorya hiratsukae in the remaining three. Antibiotics were administered to all but one patient, within 3 months before fungal peritonitis was detected. All patients required hospitalization, and antifungal therapy was administered in all episodes. The Tenckhoff catheter was removed in seven out of eight fungal peritonitis. All patients recovered from the fungal episodes. In the group of patients studied, it is concluded that recent exposure to antibiotics and female sex, were strongly associated with the development of fungal peritonitis by yeasts. The peritonitis caused by the environmental filamentous fungus did not require antibiotic pressure. Direct microscopy of the dialysate pellet was extremely useful for the prompt management of the fungal episode. Fungal peritonitis preceded by multiple episodes of bacterial peritonitis always determined the definitive dropout of the patient from the peritoneal dialysis program. Patients with de novo yeastrelated peritonitis could continue on the program.

La peritonitis fúngica es una complicación infrecuente pero grave de la diálisis peritoneal. Los objetivos de este trabajo fueron el análisis de las tasas de peritonitis, factores asociados, aspectos clínicos y microbiológicos, esquemas terapéuticos y evolución de los pacientes afectados. Se detectaron y documentaron microbiológicamente 183 episodios de peritonitis en 57 pacientes. Se identificaron hongos en ocho episodios (4,37%) en siete pacientes, todos ellos de sexo femenino. La tasa de peritonitis fúngica fue 0,06 episodios/paciente-año. Las coloraciones de Gram y Giemsa revelaron la presencia de microorganismos en cinco de los ocho líquidos de diálisis evaluados. Los microorganismos causales fueron Candida albicans en cinco episodios y Candida parapsilosis, Candida glabrata y Neosartorya hiratsukae en los otros tres. Todos estos pacientes, excepto uno, habían recibido antibióticos en los tres meses previos al episodio de peritonitis fúngica. El catéter de Tenckhoff fue extraído en siete de los ocho episodios. Todos los pacientes evolucionaron favorablemente. Concluimos que en la población estudiada el sexo femenino y la administración reciente de antibióticos estuvieron estrechamente relacionados con el desarrollo de peritonitis fúngicas por levaduras. Sin embargo, la peritonitis causada por el hongo filamentoso ambiental no requirió de la presión antibiótica. La microscopía del sedimento del líquido de diálisis fue útil en el manejo precoz del episodio. La peritonitis fúngica precedida por múltiples episodios de peritonitis bacteriana determinó siempre la exclusión definitiva del paciente del programa de diálisis peritoneal. Los pacientes con peritonitis de novo por levaduras, en cambio, pudieron continuar en él.

Fungal peritonitis in patients on peritoneal dialysis: twenty five years of experience in a teaching hospital in Argentina.

Fungal peritonitis is a rare but serious complication of peritoneal dialysis. The aim of this study was to analyze peritonitis rates, associated factors, clinical course, microbiological aspects, therapeutic regimens, and outcome of patients with fungal peritonitis in the dialysis center of a teaching hospital over the last 25 years. A hundred and eighty three episodes of peritonitis were detected and microbiologically documented in 57 patients. Fungi were identified in eight episodes (4.37%) occurring in seven female patients. The fungal peritonitis rate was 0.06 episodes/patient-year. Gram and Giemsa stains were positive in five out of eight dialysate fluids. The causative microorganisms were: Candida albicans in five episodes, and Candida parapsilosis, Candida glabrata, and Neosartorya hiratsukae in the remaining three. Antibiotics were administered to all but one patient, within 3 months before fungal peritonitis was detected. All patients required hospitalization, and antifungal therapy was administered in all episodes. The Tenckhoff catheter was removed in seven out of eight fungal peritonitis. All patients recovered from the fungal episodes. In the group of patients studied, it is concluded that recent exposure to antibiotics and female sex, were strongly associated with the development of fungal peritonitis by yeasts. The peritonitis caused by the environmental filamentous fungus did not require antibiotic pressure. Direct microscopy of the dialysate pellet was extremely useful for the prompt management of the fungal episode. Fungal peritonitis preceded by multiple episodes of bacterial peritonitis always determined the definitive dropout of the patient from the peritoneal dialysis program. Patients with de novo yeast-related peritonitis could continue on the program.

Assessment in the diagnosis of male chronic genital tract infection.

Different methodologies have been proposed to interpret the microbiological findings associated with contaminating, indigenous microbiota of the anterior urethra. In order to solve the controversy related to the diagnosis of chronic seminal infections in asymptomatic young adults, the results applying Stamey and Meares' criteria were compared with those obtained when semen cultures were studied for significant bacteriospermia. A total of 218 consecutive asymptomatic male partners of infertile couples were evaluated by the four-specimen technique described by Stamey and Meares' with the addition of semen (SM). Infection was detected in 46% by SM, while semen cultures (SC) showed a prevalence of infection of 41%; 73 patients were positive by both criteria and 102 negative; 27 patients were positive by SM technique in prostate fluid while their semen cultures were negative; 16 patients had positive semen cultures and were considered negative by SM. The kappa statistic indicated a good degree of agreement between both methodologies (kappa = 0.61, z = 8.68, p < 0.001). The estimated risk of being considered negative attributable to the semen culture (27 patients) was 25% (attributable risk = gamma ac- = 0.2550), and of being considered positive attributable to the semen culture (16 patients) was 26% (gamma ac+ = 0.2579). The 95% confidence limits were estimated in 12 to 39%, and in 13 to 31%, respectively. In view of these results, to establish the diagnosis of chronic prostatitis, the addition of prostatic fluid or voided urine cultures after prostatic massage, must be performed. Semen culture confronted with first-voided urine avoid overestimating seminal infection.

Assessment in the diagnosis of male chronic genital tract infection.

Different methodologies have been proposed to interpret the microbiological findings associated with contaminating, indigenous microbiota of the anterior urethra. In order to solve the controversy related to the diagnosis of chronic seminal infections in asymptomatic young adults, the results applying Stamey and Meares criteria were compared with those obtained when semen cultures were studied for significant bacteriospermia. A total of 218 consecutive asymptomatic male partners of infertile couples were evaluated by the four-specimen technique described by Stamey and Meares with the addition of semen (SM). Infection was detected in 46

by SM, while semen cultures (SC) showed a prevalence of infection of 41

; 73 patients were positive by both criteria and 102 negative; 27 patients were positive by SM technique in prostate fluid while their semen cultures were negative; 16 patients had positive semen cultures and were considered negative by SM. The kappa statistic indicated a good degree of agreement between both methodologies (kappa = 0.61, z = 8.68, p < 0.001). The estimated risk of being considered negative attributable to the semen culture (27 patients) was 25

(attributable risk = gamma ac- = 0.2550), and of being considered positive attributable to the semen culture (16 patients) was 26

(gamma ac+ = 0.2579). The 95

confidence limits were estimated in 12 to 39

, and in 13 to 31

, respectively. In view of these results, to establish the diagnosis of chronic prostatitis, the addition of prostatic fluid or voided urine cultures after prostatic massage, must be performed. Semen culture confronted with first-voided urine avoid overestimating seminal infection.

Improvement of semen quality in infected asymptomatic infertile male after bacteriological cure.

Bacteriological etiology was investigated in 29 infected asymptomatic infertile males. The localization of the infection and the effect of a long term antibiotic therapy on semen parameters were evaluated. The most frequent etiological agent isolated was Enterococcus faecalis. Positive bacteriological culture was obtained in prostatic fluid in 16 patients and in semen in 13. Bacteriological cure was achieved in 24 cases and it was associated with improved seminal parameters: sperm concentration, viability and total motile sperm per ejaculate. In 5 patients without bacteriological cure there was no change in semen analysis after antibiotic therapy. In 45% of the infected patients there were less than 0.5 x 10(6)/ml seminal polymorphonuclear leukocytes. In view of these findings granulocyte concentration seems to be a poor marker to predict infection.

Susceptibility of Enterococcus faecalis to twelve antibiotics, time-kill assays, and high-level aminoglycoside resistance in a university hospital in Argentina.

A total of 201 Enterococcus faecalis strains isolated from different body sites were tested to (i) establish their antibiotic susceptibility pattern; (ii) determine the percentage of strains highly resistant (MIC greater than 2,000 micrograms/ml) to five aminoglycosides and (iii) know if the combination of penicillin or ampicillin plus an aminoglycoside is reliably synergistic for the strains with low-level resistance (MICs ranged from the break point of susceptibility for each aminoglycoside to 2,000 micrograms/ml). Erythromycin exhibited very poor activity with MIC90 greater than 128 micrograms/ml. Pefloxacin and norfloxacin had intermediate activity, inhibiting 50% of isolates at 4 micrograms/ml and 90% at 8 micrograms/ml. Trimethoprim-sulfamethoxazole (1:20) inhibited 94% of isolates at less than or equal to 2 micrograms/ml and 87.6% at less than or equal to 0.5 microgram/ml. Ampicillin, penicillin and piperacillin were the most potent agents studied. Ninety percent of strains were inhibited at 1 microgram/ml of ampicillin and 4 micrograms/ml of penicillin and piperacillin. The E. faecalis isolates were relatively or totally resistant to the aminoglycosides. Ninety six (47.8%) were highly resistant at least to one of them. High level resistance to streptomycin was found in 47.3% of all strains and was the most frequent resistance encountered; amikacin highly resistant strains were the less common and accounted for 4.5%. Low-level resistance to the aminoglycosides ranged from 50.2% (for streptomycin) to 94.5% (for amikacin). Thirty one E. faecalis isolates were selected for 24-time kill-assays. There was a good correlation between resistance to penicillin or ampicillin aminoglycoside synergy in all but 3 strains which were highly resistant. Among the strains with low-level resistance to the aminoglycosides, there was no synergy in 37 (63.8%) of 58 killing assays with each of the aminoglycosides combined with penicillin. These results demonstrate that the susceptibility to 2,000 micrograms/ml of the aminoglycoside does not assure the penicillin or ampicillin aminoglycoside synergism.

Susceptibility of Enterococcus faecalis to twelve antibiotics, time-kill assays, and high-level aminoglycoside resistance in a university hospital in Argentina.

A total of 201 Enterococcus faecalis strains isolated from different body sites were tested to (i) establish their antibiotic susceptibility pattern; (ii) determine the percentage of strains highly resistant (MIC greater than 2,000 micrograms/ml) to five aminoglycosides and (iii) know if the combination of penicillin or ampicillin plus an aminoglycoside is reliably synergistic for the strains with low-level resistance (MICs ranged from the break point of susceptibility for each aminoglycoside to 2,000 micrograms/ml). Erythromycin exhibited very poor activity with MIC90 greater than 128 micrograms/ml. Pefloxacin and norfloxacin had intermediate activity, inhibiting 50

of isolates at 4 micrograms/ml and 90

at 8 micrograms/ml. Trimethoprim-sulfamethoxazole (1:20) inhibited 94

of isolates at less than or equal to 2 micrograms/ml and 87.6

at less than or equal to 0.5 microgram/ml. Ampicillin, penicillin and piperacillin were the most potent agents studied. Ninety percent of strains were inhibited at 1 microgram/ml of ampicillin and 4 micrograms/ml of penicillin and piperacillin. The E. faecalis isolates were relatively or totally resistant to the aminoglycosides. Ninety six (47.8

) were highly resistant at least to one of them. High level resistance to streptomycin was found in 47.3

of all strains and was the most frequent resistance encountered; amikacin highly resistant strains were the less common and accounted for 4.5

. Low-level resistance to the aminoglycosides ranged from 50.2

(for streptomycin) to 94.5

(for amikacin). Thirty one E. faecalis isolates were selected for 24-time kill-assays. There was a good correlation between resistance to penicillin or ampicillin aminoglycoside synergy in all but 3 strains which were highly resistant. Among the strains with low-level resistance to the aminoglycosides, there was no synergy in 37 (63.8

) of 58 killing assays with each of the aminoglycosides combined with penicillin. These results demonstrate that the susceptibility to 2,000 micrograms/ml of the aminoglycoside does not assure the penicillin or ampicillin aminoglycoside synergism.

[Peritonitis in continuous ambulatory peritoneal dialysis. Microbiological and clinical evaluation]. / Peritonitis en diálisis peritoneal contínua ambulatoria. Evaluación microbiológica y clínica.

In 1976, Popovich et al. described a technique of peritoneal dialysis using bottled dialysate. Later Oreopoulos et al. modified the technique by using plastic bags. But peritonitis still is a major and potentially serious complication of peritoneal dialysis. We have evaluated a) microbiologic diagnostic methods for infectious peritonitis, b) incidence of etiologic agents, and c) the evolution during antimicrobial treatment. Eighteen patients with chronic renal failure of diverse causes were followed from initiation of the CAPD program since January 1981 until June 1988. There were 80 episodes of infectious peritonitis during 17 patient-years of dialysis with an overall incidence of peritonitis of 4.7 episodes/patient-year. The total volume centrifuged technique and culture of sediment showed a sensibility of 85% in 73 episodes where cultures were obtained. The 59.1% of episodes of peritonitis were caused by gram negative bacilli; 11.6% were due to Acinetobacter calcoaceticus and Gram positive cocci accounted for 37.3%. These results are different from those found in other countries because most of our patients had received antimicrobial agents which probably changed their body flora, some did not have manual ability, others were of bad hygienic habits and finally, all of them had frequent contact with hospital environment. The species most frequently isolated were coagulase negative staphylococci (12.8%), probably from patients' skin flora. (ABSTRACT TRUNCATED AT 250 WORDS)

Peritonitis en diálisis peritoneal contínua ambulatoria: evaluación microbiológica y clínica / Peritonitis in continuous ambulatory peritoneal dialysis: Microbiological and clinical evaluation

La infección peritoneal continúa siendo el más común y frecuente factor de morbilidad en pacientes sometidos a DPCA, hemos realizado una evaluación de nuestra metodologia microbiológica para su diagnóstico, de la incidencia de agentes etiológicos y de la evolución a través del tratamiento antibiótico, en un estudio retrospectivo de 18 pacientes con insuficiencia renal crónica terminal en plan de episodios/paciente/año. El método de diagnóstico microbiológico por centrifuhgación de 2000 ml del liquido mostró una sensibilidad del 85% en los 73 episodios estudiados. De los agentes etiológicos aislados, los bacilos gram negativos respresentaron el 59,1% y los cocos gram positivos el 37,3%. Los gérmenes más frecuentes fueron los estafilococos coagulasa negativos (12,8%). El tratamiento empírico inicial, cefalotina 250 mg/l y gentamicina 8 mg/l i.p., resultó eficaz en el 61,1% de los episodios

Peritonitis en diálisis peritoneal contínua ambulatoria. Evaluación microbiológica y clínica. / [Peritonitis in continuous ambulatory peritoneal dialysis. Microbiological and clinical evaluation]

In 1976, Popovich et al. described a technique of peritoneal dialysis using bottled dialysate. Later Oreopoulos et al. modified the technique by using plastic bags. But peritonitis still is a major and potentially serious complication of peritoneal dialysis. We have evaluated a) microbiologic diagnostic methods for infectious peritonitis, b) incidence of etiologic agents, and c) the evolution during antimicrobial treatment. Eighteen patients with chronic renal failure of diverse causes were followed from initiation of the CAPD program since January 1981 until June 1988. There were 80 episodes of infectious peritonitis during 17 patient-years of dialysis with an overall incidence of peritonitis of 4.7 episodes/patient-year. The total volume centrifuged technique and culture of sediment showed a sensibility of 85

in 73 episodes where cultures were obtained. The 59.1

of episodes of peritonitis were caused by gram negative bacilli; 11.6

were due to Acinetobacter calcoaceticus and Gram positive cocci accounted for 37.3

. These results are different from those found in other countries because most of our patients had received antimicrobial agents which probably changed their body flora, some did not have manual ability, others were of bad hygienic habits and finally, all of them had frequent contact with hospital environment. The species most frequently isolated were coagulase negative staphylococci (12.8

), probably from patients skin flora. (ABSTRACT TRUNCATED AT 250 WORDS)

Peritonitis en diálisis peritoneal contínua ambulatoria: evaluación microbiológica y clínica / Peritonitis in continuous ambulatory peritoneal dialysis: Microbiological and clinical evaluation

La infección peritoneal continúa siendo el más común y frecuente factor de morbilidad en pacientes sometidos a DPCA, hemos realizado una evaluación de nuestra metodologia microbiológica para su diagnóstico, de la incidencia de agentes etiológicos y de la evolución a través del tratamiento antibiótico, en un estudio retrospectivo de 18 pacientes con insuficiencia renal crónica terminal en plan de episodios/paciente/año. El método de diagnóstico microbiológico por centrifuhgación de 2000 ml del liquido mostró una sensibilidad del 85% en los 73 episodios estudiados. De los agentes etiológicos aislados, los bacilos gram negativos respresentaron el 59,1% y los cocos gram positivos el 37,3%. Los gérmenes más frecuentes fueron los estafilococos coagulasa negativos (12,8%). El tratamiento empírico inicial, cefalotina 250 mg/l y gentamicina 8 mg/l i.p., resultó eficaz en el 61,1% de los episodios (AU)

[Bacteroides distasonis meningitis]. / Meningitis por Bacteroides distasonis.

A 50 year old woman while undergoing severe treatment for rheumatoid arthritis, developed anaerobic meningitis. The cerebrospinal fluid (CSF) sample was transported and cultivated aerobically and anaerobically. After 48 h at 37 degrees C the anaerobically incubated plate, the enriched fluid thioglycollate medium and the anaerobic culture medium yielded luxuriant growth of an anaerobic Gram negative bacillum. The biochemical and antimicrobial susceptibility patterns were consistent with those for Bacteroides distasonis. Most of the strains of the 5 species included in the Bacteroides fragilis group (B. fragilis, B. vulgatus, B. ovatus, B. thetaiotaomicron and B. distasonis) are resistant to penicillins, cephalosporins of first generation and aminoglycosides. Anaerobic polyresistant flora from an intraabdominal focus (chronic cholecystitis) might have been selected by treatment with gentamicin and cephalotin, and proliferated into meningeal dissemination. It is important that CSF from immunocompromised patients with acute or chronic pulmonary, intraabdominal or cranium-facial infectious processes be transported and cultured in aerobic and anaerobic conditions. These patients must be treated with an initial therapeutic scheme that includes an effective antibiotic for the anaerobic microorganism that may be involved.

Meningitis por bacteroides distasonis / Bacteroides distasonis meningitis

Se present ael caso de una paciente de 50 años que durante la internación por un severo cuadro de artritis reumatoidea, desarrolló una bacteriemia por Bacteroides distasonis a partir de una colecistitis no reconocida y cuya expresión final fue una meningitis. La evolución de la paciente no fue favorable por no haber recibido la terapia antibiótica adecuada en forma temprana. El diagnóstico etiológico fue realizado a través del estudio microbiológico del líquido cefalorraquídeo transportado y cultivado en aero y anaerobiosis. Este procedimiento es importante en aquellos pacientes que presentan procesos infecciosos agudos o crónicos pulmonares, intraabdominales o craneofaciales y que además son inmunocomprometidos. En tales casos debe incorporarse al esquema terapéutico inicial un antibiótico efectivo en el tratamiento de los gérmenes anaerobios que pudieran estar involucrados

Meningitis por Bacteroides distasonis. / [Bacteroides distasonis meningitis]

A 50 year old woman while undergoing severe treatment for rheumatoid arthritis, developed anaerobic meningitis. The cerebrospinal fluid (CSF) sample was transported and cultivated aerobically and anaerobically. After 48 h at 37 degrees C the anaerobically incubated plate, the enriched fluid thioglycollate medium and the anaerobic culture medium yielded luxuriant growth of an anaerobic Gram negative bacillum. The biochemical and antimicrobial susceptibility patterns were consistent with those for Bacteroides distasonis. Most of the strains of the 5 species included in the Bacteroides fragilis group (B. fragilis, B. vulgatus, B. ovatus, B. thetaiotaomicron and B. distasonis) are resistant to penicillins, cephalosporins of first generation and aminoglycosides. Anaerobic polyresistant flora from an intraabdominal focus (chronic cholecystitis) might have been selected by treatment with gentamicin and cephalotin, and proliferated into meningeal dissemination. It is important that CSF from immunocompromised patients with acute or chronic pulmonary, intraabdominal or cranium-facial infectious processes be transported and cultured in aerobic and anaerobic conditions. These patients must be treated with an initial therapeutic scheme that includes an effective antibiotic for the anaerobic microorganism that may be involved.

Meningitis por bacteroides distasonis / Bacteroides distasonis meningitis

Se present ael caso de una paciente de 50 años que durante la internación por un severo cuadro de artritis reumatoidea, desarrolló una bacteriemia por Bacteroides distasonis a partir de una colecistitis no reconocida y cuya expresión final fue una meningitis. La evolución de la paciente no fue favorable por no haber recibido la terapia antibiótica adecuada en forma temprana. El diagnóstico etiológico fue realizado a través del estudio microbiológico del líquido cefalorraquídeo transportado y cultivado en aero y anaerobiosis. Este procedimiento es importante en aquellos pacientes que presentan procesos infecciosos agudos o crónicos pulmonares, intraabdominales o craneofaciales y que además son inmunocomprometidos. En tales casos debe incorporarse al esquema terapéutico inicial un antibiótico efectivo en el tratamiento de los gérmenes anaerobios que pudieran estar involucrados (AU)