Porfiria cutánea tarda en un paciente con hepatitis C / Porphyria cutanea tarda in a patient with hepatitis C

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Importancia epidemiológica, asistencial y económica del cultivo de orina, en pacientes hospitalizados y de la comunidad / Epidemiological, economical and assistance importance of urine culture on in-patients and out-patients. Hermanos Ameijeira Hospital

Introducción: una de las infecciones más comunes que afectan al ser humano a lo largo de su vida y una de las más frecuentes tanto en el ámbito comunitario como en el nosocomial, son las infecciones del tracto urinario (ITU). Es conocido que los agentes etiológicos se relacionan fundamentalmente con bacilos gramnegativos, pero en la mayoría de los casos, sobre todo en los ambulatorios, no se realiza el cultivo de las muestras de orina antes de iniciar del tratamiento antibacteriano. Al mismo tiempo, una terapia inicial correctamente indicada, tomando como base los datos aportados por el Laboratorio de Microbiología, puede significar evolución favorable y menores costos en sentido general. Objetivos: determinar los principales agentes etiológicos con sus patrones de sensibilidad antimicrobiana, en ITU hospitalarias y de la comunidad, asi como evaluar los costos relacionados con los cultivos microbiológicos, según el tipo de resultado alcanzado. Métodos: se realizó un trabajo retrospectivo y transversal de 13 939 urocultivos recibidos en el Laboratorio de Microbiología del Hospital Hermanos Ameijeiras desde septiembre de 2009 hasta agosto de 2010, de pacientes ingresados y de la comunidad. Resultados: se obtuvo 62 porciento de muestras negativas, 22 porciento positivas y 16 porciento contaminadas, las que representaron un costo de 86 100, 61 980 y 22 300 CUC, respectivamente, con un total general de 170 380 CUC. El microorganismo que se aisló con mayor frecuencia fue Escherichia coli en ambos grupos investigados con 76,4 porcineto y 54,0 porciento, respectivamente, con resistencia superior al 55 porciento para trimetropim/sulfametoxazol y ciprofloxacina; la resistencia a ampicillina estuvo cercana al 90 porciento para casi todos los microorganismos. Para Escherichia coli, la nitrofurantoína fue el antibiótico que presentó los porcentajes más bajos de resistencia. La resistencia antimicrobiana fue mayor en pacientes hospitalizados...(AU)

Introduction: the high incidence and prevalence of urinary tract infections in both hospital patients and outpatients determine that the exact knowledge of the major etiologic agents with antimicrobial susceptibility patterns gain immeasurable epidemiological and economic assistance values. Objective: to do Microbial map for hospital patients, and outpatients suffering from UTIs. Methods: a retrospective and cross study was conducted in 13,939 urine cultures from inpatient and outpatients received in the Microbiology Laboratory at Hermanos Ameijeiras hospital from September 2009 to August 2010. Results: 62 percent of the samples were negative, 22 percent positive, and 16 percent were reported as the contaminated samples representing a cost of 86 100, 61 980, and 22 300 CUC, respectively, with an overall total of 170 380 CUC. The microorganism most frequently isolated was Escherichia coli in both groups (76.4 percent and 54.0 percent respectively), which were higher than 55 percent to trimethoprim/sulfamethoxazole and ciprofloxacin. Ampicillin resistance was close to 90 percent for almost all microorganisms. Nitrofurantoin for Escherichia coli presented the lowest percentages of resistance. Antimicrobial resistance was higher in hospital patients. Conclusions: the monetary cost per patient for a second or third course of antibiotics, in an initial incorrect therapy, may imply spending approximately 100 times more than a correct initial therapy based on scientific evidence(AU)

Sensibilidad antibiótica de bacterias causantes de infecciones del tracto urinario en un hospital general. Enero û junio 2008 / Antibiotic sensitivity of bacteria causing urinary tract infections in a public hospital from January until june, 2008

Objetivo: Describir la sensibilidad antibiótica de gérmenes prevalentes causantes de infecciones del tracto urinario en un hospital general. Material y métodos: Se realizó un estudio descriptivo, retrospectivo de serie de casos en el Hospital Nacional Cayetano Heredia. Se analizaron los urocultivos positivos realizados en los meses de enero a junio del año 2008. Resultados: De 1249 urocultivos positivos, se aisló en pacientes no hospitalizados; Escherichia coli 76 por ciento seguido de Klebsiella spp. 5 por ciento y Citrobacter sp. 3 por ciento. Escherichia coli fue sensible a amikacina, nitrofurantoína, ceftriaxona y ciprofloxacino en 93,4 por ciento, 88,6 por ciento, 78 por ciento y 44,5 por ciento respectivamente. En pacientes hospitalizados la frecuencia fue; Escherichia coli 49 por ciento seguido de Enterococcus spp. 11,39 por ciento y Klebsiella spp. 8,42 por ciento siendo Escherichia coli sensible a amikacina, nitrofurantoína, ceftriaxona y ciprofloxacino en 88,89 por ciento, 75,26 por ciento, 43,88 por ciento y26,04 por ciento, respectivamente. Nitrofurantoína obtuvo resistencias bajas en hospitalizados 16,49 por ciento y en no hospitalizados 6.48 por ciento para Escherichia coli. Conclusiones: Se observó que amikacina vuelve a ser una buena opción como tratamiento empírico; así mismo hubo aumento en la resistencia a antibióticos comúnmente usados, sin embargo antibióticos poco usados como nitrofurantoína tienen mejores niveles de sensibilidad para Escherichia coli.

Objective: To describe the antibiotic sensitivity of positive urine cultures performed in general hospital. Material and methods: Descriptive and retrospective case series was performed at the Hospital Nacional Cayetano Heredia. We revised the urine positive cultures from January until June, 2008. Results: From a total of 1249 positive urine cultures taken from non-hospitalized patients (1049 cases) the following was isolated: Escherichia coli 76 per cent followed by Klebsiella spp. 5 per cent and Citrobacter sp. 3 per cent. Escherichia coli were found sensitive to amikacina, nitrofurantoína,ceftriaxona and ciprofloxacin in 93.5 per cent, 88 per cent, 78 per cent and 44.59 per cent respectively. In hospitalized patients (204 cases), the frequency was 49.01 per cent for Escherichia coli followed by 11.39 per cent for Enterococcus spp. and 8.42 per cent. for Klebsiella spp. Escherichia coli was found sensitive to amikacina (88.89 per cent), nitrofurantoína (75.26 per cent), ceftriaxona (42.88 per cent) and ciprofloxacin (26.04 per cent). Nitrofurantoin showed low resistance in hospitalized patients (16.49 per cent), as in for nonhospitalized patients (6.48 per cent) Escherichia coli. Conclusions: Amikacin is a good option for empiric treatment. We also found a high resistance percentage in strains isolated with the most common used antibiotics. Nevertheless, less used antibiotics as Nitrofurantoin have a higher sensitivity percentage against Escherichia coli.

Near-patient testing for infection using urinalysis and immuno-chromatography strips.

Urinary tract infections require costly confirmatory tests such as a urine culture to establish the diagnosis. Elimination of the culture step would save resources; diagnosis and treatment could begin in hours rather than days. We tested a new dip-and-read strip that uses immuno-chromatography (IC) to detect infectious agents in urine. We used a goat-derived polyclonal antibody with reactivity to the cell-wall proteins of Escherichia coli (E. coli). Fluorescein linked to the anti-E. coli antibody served to trap the bacteria on a strip coated with an anti-fluorescein mouse antibody. Blue latex particles were linked to anti-E. coli antibodies by standard methods and were used for detection of E. coli. We found that the combination of leukocyte esterase and nitrite dipsticks gave negative predictive values of 93% for culture-negative urines, i.e., there were very few false-negative results. Using the same dipsticks on culture-positive specimens, the positive predictive values were unacceptably low; we obtained too many false-positive values. By contrast, the IC strips gave negative predictive values of 89%. The major advantage of the IC strips is that the positive predictive values were higher, i.e., there were fewer false-positive results. The combined use of both IC strips and urinalysis dipsticks offers the best strategy for diagnosing infection with dipsticks. The IC strip test could reduce the necessity of a urine culture in patients with suspected infections and provide rapid point-of-care testing.

[Adaptation of immunoenzymatic method for detection of antibody coated bacteria in urine]. / Adaptacja metody immunoenzymatycznej do wykrywania bakterii oplaszczonych przeciwcialami w moczu.

The modified immunoenzymatic method for detection of antibody coated bacteria (IP ACB) was compared with immunofluorescence technique (IF ACB) in the diagnosis of urinary tract infection. For the study 100 patients were employed with significant and insignificant bacteriuria. It was found that 81% of the results obtained by IP ACB and IF ACB were identical, however the immunoenzymatic method was more sensitive than immunofluorescence. Moreover, the IP ACB technique is simpler, less time consuming and may be performed by using the ordinary optic microscope.

Incidencia de E. Coli en infecciones urinarias / Incidence of E.coli in urinary infections

Se realizo un estudio bacteriològico en muestras de orina de pacientes atendidos en el Hospital San Gabriel durante el periodo comprendido entre mayo de 1994 a septiembre de 1995. El diagnòstico clìnico fuè ITU (Infecciòn del tarcto urinario); de dichas muestras, 414 evidenciaron una bacteria como microorganismo causal. El estudio realizado, demuestra a E. coli como agente causal màs frecuente en ITU (88,4 porciento), lo cual concuerda con reportes internacionales previos

Markers of ventilator-associated pneumonia.

The diagnosis of ventilator-associated pneumonia (VAP) is difficult for several reasons. Firstly, clinical markers show a large percentage of false-positive and false-negative results. Secondly, microbiological diagnosis based on quantitative cultures of protected specimen brush (PSB), bronchoalveolar lavage (BAL), and endotracheal aspirates also present false-positive and false-negative results. Furthermore, definite results are delayed for 48-72 hours. For all these reasons it would be an advantage to have a biological marker of ventilator-associated pneumonia in clinical practice. Since clinical features of pneumonia in mechanically ventilated patients are neither specific nor sensitive, rapid markers of pneumonia might be of great assistance to the clinician in deciding whether to start an empiric antibiotic regimen. A marker of ventilator-associated pneumonia could be a rapid alternative diagnostic method which permits the definite diagnosis of pneumonia. Accordingly, specific markers of VAP, namely the presence of intracellular microorganisms, the detection of elastin fibres, the antibody-coated bacteria test, the level of endotoxin in bronchoalveolar lavage fluid, the local production of interleukin-8, the levels of lactate dehydrogenase, and decreased surfactant protein A, may be important as they can provide a rapid diagnosis of VAP. Among the markers alluded to above, the search for intracellular bacteria in polymorphonuclear leukocytes or macrophages is the most widely validated technique with an excellent specificity, provided that prior antibiotics are not given. However, this technique has its own limitations; it requires a considerable time effort for the microbiologist, and also compels the performance of BAL, a technique not always harmless to the patient.

Opsonophagocytosis in infected urine: relation to pH and osmolality.

Polymorphonuclear neutrophils (PMN) in freshly voided urines from 20 symptomatic bacteriuric patients were examined. Although the PMN were viable (median 85%), in only 2 cases could phagocytosis of the infecting organisms be demonstrated, even after the addition of serum opsonins. Polymorphonuclear neutrophils from urines of 12 patients were also unable to phagocytose added opsonized Staphylococcus aureus. These urines were found to be of pH < 6.0 and/or osmolality > 700, or < 180 mOsm. However, the phagocytic function of these PMN was restored when transferred to Hanks balanced salt solution (HBSS). By contrast, most PMN in urines of suitable pH (> or = 6.0) and osmolality (between 200 to 700 mOsm.) phagocytosed the opsonized S. aureus. When bacteria cultured from the infected urine were incubated in the same urine and then transferred to HBSS, in 17 of 19 cases opsonization occurred and the organisms were phagocytosed when PMN, isolated from blood, were added. IgG appeared to be the prime opsonin in the urines, and heat-stable opsonins for S. aureus were also present. It is concluded that lack of opsonization is not a major cause of the absence of phagocytosis by urinary PMN. Low pH and adverse osmolality are largely responsible, correction of which may restore PMN function in vivo.

[Determination of the level of urinary tract infection in children by antibodies coating bacteria from urinary sediment]. / Otkrivanje mesta infekcije u urinarnom sistemu kod dece pomocu oblazucih antitela na bakterijama u sedimentu urina.

The article deals with the evaluation of the significance of surface antibodies in urinary sediment bacteria by direct immunofluorescence in children with urinary tract infection caused by Escherichia coli (E. coli), so as of determination of location of the infection. Sixty five children were studied, aged from 1 to 16.5 years. Based on the recognized criteria in literature, all patients were classified into three groups: chronic pyelonephritis (CP)--10 patients, acute pyelonephritis (AP)--34 patients, and lower urinary tract infections (LUTI)--21 patients. On the basis of the analysis of the relationship among the three groups of patients in relation to the absence or various presence rates (up to 5%, 6-10% and 11-15% respectively) of fluorescent antibodies in urine sediment, and using the Fischer's test of absolute probability, we obtained a highly significant difference (p = 0.00006) only between the groups AP and LUTI. This difference caused the presence of fluorescence in the AP group and its absence in the LUTI group. By adding the positive fluorescence findings we found that it was present in 80% of CP patients, in 91.17% of AP patients, and in 14.28% of LUTI patients. chi2 test showed a highly significant difference (chi2 = 34.79; p < 0.01), which confirmed that bacterial fluorescence was most often present in the urine of AP patients and absent in LUTI patients. Bacterial fluorescence was significantly more frequent in CP patients in relation to LUTI patients. These results indicate that the method for detecting surface antibodies in urine bacteria, aimed at determinig the location of infection, is more reliable and noninvasive as compared to other methods.

[Localization of the urinary tract infection by the ACB method]. / Estudio de la localización de la infección urinaria mediante el método de ACB.

We used the ACB (antibody coated bacteria) on 214 urinary samples with bacteriuria. Patients were grouped in 14 clinical entities at the beginning of the study. Later, after supplementary examinations had been conducted, the findings were compared. ACB testing was positive in 37 cases (17.45%). Of 25 patients with signs and symptoms of acute pyelonephritis, 18 (72% sensitivity) were positive. In contrast, of 64 patients with clinical symptoms of lower urinary infection, tests were positive only in 4.7%--3 patients--(95.5% specificity). The paper includes a review of international literature on the method's behaviour in certain clinical diagnoses and a comparison is made with that in our study. We conclude stating that the method is simple, economical, non-aggressive and useful for U.I.'s location and evolution follow-up.

[Clinical evaluation of SD-8828 (antibody coated bacteria assay kit) in urinary tract infection].

Clinical usefulness of a newly developed assay kit for ACB (SD-8828) which detects urinary bacteria coating IgG was evaluated and compared to the enzyme antibody plate method. A total of 48 patients including 20 patients with acute simple cystitis and 28 patients with acute or chronic pyelonephritis, who were shown to have pyuria of at least 5 cells/HPF, bacteriuria of at least 10(4) CFU/ml were enrolled in this study. By enzyme antibody method. ABC was positive in 92.9% of patients with upper urinary tract infection and negative in 100% of patients with lower UTI, this difference being statistically significant (p < 0.02). By SD-8828, 85% of positive coincidence rate and 100% of negative coincidence rate, compared to the enzyme antibody technique, was obtained. The overall coincidence rate was high (91.7%). This SD-8828, a new simple assay for ACB, which detects IgG alternating the plate method, may be used as a convenient method in clinical practice.

Semen parameters in men with and without proven chronic prostatitis.

In patients with complaints of chronic prostatitis, analysis of prostatic secretions for leukocytes and the use of the four-specimen technique allow a distinct classification of chronic bacterial (CBP), nonbacterial prostatitis (NBP), and prostatodynia (Pd). In this study, 32 men with CBP, 102 men with NBP, 142 men with Pd, and 42 volunteers, classified as mentioned above, underwent a two-fold ejaculate analysis using WHO criteria. Sperm count, progressive motility, range of abnormal spermatozoa, increased numbers of common bacteria, and peroxidase-positive leukocytes were analyzed. Additionally, antibody-coated bacteria (ACB), numbers of ureaplasmas in semen, and urethral colonization by chlamydia were investigated. Mean values of sperm density, motility, and morphology revealed no differences between the groups. Significant bacteriospermia (greater than or equal to 10(3) bacterial/ml) was evident in only 47% of the CBP group versus 6.8% (NBP), 16% (Pd), and 4.2% (controls). ACB was positive in 31 of 32 men with CBP versus 3 of 102 with NBP, 9 of 142 with Pd, and none of the controls. Increased numbers of leukocytes were evident in CBP and NBP patients compared to the controls (p less than or equal to 0.001) but were also present in patients of the NBP and Pd groups with chlamydial infections.

Do antibody-coated bacteria prove bacterial prostatitis?

Using the immunofluorescence technique in 187 patients with bacteriologically proven prostatitis according to the Meares-Stamey test demonstrated a significant amount of antibody-coated bacteria (ACB) in their ejaculates. The ACB test was useful to discriminate between chronic bacterial prostatitis and prostatodynia with a sensitivity of 65% and a specifity of 92%; likewise the ACB test is superior to complement and coeruloplasmin estimation in the ejaculate by radial immunodiffusion usually recommended for the differential diagnosis of inflammatory and psychosomatic diseases of the prostate.

Antibody coated bacteria in urine of patients with recent spinal injury.

Twenty patients with an acute spinal injury were prospectively studied to assess the clinical importance of antibody coated bacteria (ACB) in the urine and the association among the different bacterial species with a positive antibody coated bacteria test. Clinical urinary tract infection was associated with a positive ACB test on 45% of occasions. Three hundred and ninety nine urine samples containing 541 bacterial isolates were assessed for the presence of ACB; 13% were found to be positive and 87% negative for ACB; 67% of urines contained a single bacterial isolate. Pseudomonas aeruginosa was most commonly associated with clinical urinary tract infection, found in 25% of episodes, followed by Proteus mirabilis (17.5%), Klebsiella sp (12.5%), and Proteus morganii (10%). Providencia stuartii, however, was most commonly associated with a positive ACB test (found in 17%). Other bacteria associated with a positive ACB test included Klebsiella sp (14%), Acinetobacter sp (12.5%), Pseudomonas aeruginosa (12%), Citrobacter sp (11.5%). A positive ACB test is not to be expected from a patient with spinal injury who has a catheter in place, and the test may provide a useful guide to identify those patients with an invasive infection. It is doubtful that a decision to treat or not treat bacteriuria could rest on the identification of the bacterial species alone.

Clinical significance of the antibody-coated bacteria test in patients with candiduria.

The clinical significance of the antibody-coated bacteria (ACB) test was evaluated with urine from 20 patients with candiduria. The relationship between the in vitro antibody-coating test for Candida albicans, urinary immunoglobulin (Ig) levels and serum antibody titres was evaluated in 40 patients without candiduria, 23 of whom had bacterial urinary tract infection (UTI). Urine specimens from 19 of the 20 patients with candiduria gave a positive result regardless of clinical symptoms; 12/23 specimens of urine from patients with bacterial UTI were positive for antibody-coated C. albicans cells, but there were no positive samples in the patients without UTI. All of the coating-positive patients had serum antibody titres greater than or equal to 1:160, the class of antibody being dependent on the urinary Ig levels. The ACB test for candiduria is of little clinical value in indicating invasive Candida UTI as the Candida cells appear to adhere to antibodies in urine contaminated with circulating fluids.

Technique for the detection of Toxoplasma gondii antigens in mouse urine

A simple and rapid staphylococcal coagglutination test for the detection of Toxoplasma gondii antigens in mice urine is described. A suspension of protein-A containing Staphylococcus aureus coated with rabbit hyperimmune serum was used as reagent. The sensitivity of the antigen assay was found to be at least 118 ng of the antigen protein per ml. No coagglutination was observed when the reagent was challenged against antigenic solutions of other parasites. The suitability of the method for detecting antigens of T. gondii in urine samples was studied by experimental toxoplasma infection in mice. Before the staphylococcal test, the urine samples were double serially diluted in 0.1 M PBS. From the second day on all samples from infected mice were positive at 1/16 dilution. At this dilution, all samples from non infected mice were negative or did not produce coagglutination. This method might be used in the rapid etiological diagnosis also in human cases of acute toxoplasmosis

[Comparative studies of the effectiveness of 1-day treatment and 7-day treatment with sulfamerazine/trimethoprim (Berlocombin) of patients with urinary tract infection]. / Vergleichende Untersuchungen zur Wirksamkeit einer Ein-Tages-Behandlung und einer Sieben-Tage-Behandlung mit Sulfamerazin/Trimethoprim (Berlocombin) bei Patienten mit einer Harnwegsinfektion.

Insights into the pathogenesis of urinary tract infections warrant reflections on new therapeutic strategies. Of particular interest is the phenomenon of bacterial adherence to cells, as the adhesion of microorganisms to uroepithelial cells plays an important role in the development of the disease. In 21 women with an acute episode of lower urinary tract infection who were known of having chronic pyelonephritis, we studied the influence of a one-day (n = 7) and a seven-day treatment by administering the regular sulfamerazine/trimethoprime (Berlocombin) dose (2 X 2 tablets from the 2nd day, n = 7) or a reduced amount (2 X 1 tablet from the 2nd day, n = 7). All treatment regimes led to a disappearance of the clinical symptoms; however, in one case of the group receiving one-day treatment, dysuric complaints recurred as early as on day 3 after therapy. Only when employing the regular schedule of therapy, the controls of the urine cultures revealed sterility of the urine for all cases still on the 21st day after treatment. This treatment regimen most clearly influenced the ability of the microorganisms to adhere to the uroepithelial cells of the probands (in-vivo adherence). The one-day treatment was not able to reduce the rates of bacterial adherence to the cells. In all patients, the acute disease resulted in an increase in microorganisms coated with antibodies; on day 21 following therapy, however, the findings registered were as before onset of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Physiopathology and risk factors of urinary tract infection in intensive care patients]. / Physiopathologie et facteurs de risque de l'infection urinaire en réanimation.

Nosocomial urinary infection complicating permanent probing is not an inverifiable inevitability. Analysis of simple physiopathological mechanisms lead to safety tactical forming an association with probing protocol and management of vesical taping line with enclosed method like a pernickety management of cleaning and changing.