Acute noise stress, ACTH administration, and blood pressure alteration.

Two groups of male Wistar rats were submitted to a single noise exposure (2640 Hz, 30 W, 102 dB, 15 min) (St group) or to a single dose of ACTH (1.5 IU/100 g b.wt.) (Ac group), respectively. A control group of nontreated rats (Co group) was used. Blood pressure (BP) was measured using an indirect tail cuff method and corticosterone (B) levels were measured by specific RIA. Haematocrit (Hc) and blood pH values were also evaluated. Acute treatments of both noise exposure and ACTH administration produced corticosterone hypersecretion and blood pressure elevation, with lower haematocrit and higher blood pH values than those found in the Co group. No differences were found between St and Ac treatments.

[Staphylococcus aureus infections in the intensive care unit: clinical and epidemiological characteristics]. / Infecciones por Staphylococcus aureus en cuidados intensivos: características clínicas y epidemiológicas.

INTRODUCTION: There has been an increase in invasive Staphylococcus Aureus infections over the last few years, which have required admission to the pediatric intensive care unit (PICU). PATIENTS AND METHODS: All patients with S. aureus infection who were admitted to PICU were enrolled in a retrospective study (January 2006-June 2010). The patients were classified into 2 groups: community-acquired infection (Group 1) and nosocomial infection (Group 2). We recorded epidemiological data, type of S. aureus (methicillin-susceptible S. aureus [MSSA], methicillin-resistant S. aureus [MRSA]), risk factors, site of infection, presence of hemodynamic instability, respiratory support, and mortality. RESULTS: A total of 51 patients were enrolled, 21 belonging to Group 1 and 30 to Group 2. The median age was lower in Group 1 (1.6 years vs 3.2 years; P=.009). MSSA was isolated in 88% of cases. MRSA was detected in 6/51 (12%) of cases, which were isolated in the later study period (January 2009-June 2010). The risk factors for infection were: immunosuppression, venous catheter, institutionalization, mechanical ventilation, previous surgery, previous trauma and chronic osteomyelitis. A large majority (83%) of the patients with MRSA infection had risk factors. The type of infection was varied, with respiratory tract infection being the most common (75%). Hemodynamic instability was observed in 43% of patients. Most patients (86%) required respiratory support. One patient in Group 1 died of necrotizing pneumonia caused by MSSA. CONCLUSIONS: Infections by S. aureus in children are severe and have a high morbidity. Respiratory infection was the most common in our series. Isolation of MSSA is common in these infections, although, an increase in the number of infections by MRSA was observed during the latter part of the study.

In vitro activity of new quinolones against Clostridium difficile.

We evaluated the in vitro activities of ofloxacin, levofloxacin, grepafloxacin, trovafloxacin and ciprofloxacin against Clostridium difficile. The MIC(90) was 128 mg/L for ofloxacin and levofloxacin, 64 mg/L for ciprofloxacin, 16 mg/L for grepafloxacin and 8 mg/L for trovafloxacin. Thirty per cent of isolates were resistant to trovafloxacin, and rates of resistance to ofloxacin, levofloxacin, grepafloxacin and ciprofloxacin were considerably higher. None of the antimicrobials studied would be a reliable therapeutic option against C. difficile. Whether some of the new fluoroquinolones can induce C. difficile-associated diarrhoea remains to be answered.

In vitro activities of six fluoroquinolones against 250 clinical isolates of Mycobacterium tuberculosis susceptible or resistant to first-line antituberculosis drugs.

Two hundred fifty isolates of Mycobacterium tuberculosis were evaluated for susceptibility to ciprofloxacin, ofloxacin, levofloxacin, grepafloxacin, trovafloxacin, and gemifloxacin (SB-265805). Levofloxacin, ciprofloxacin, and grepafloxacin showed the greatest activity (MIC for 90% of strains tested [MIC(90)] 1 microg/ml), although ofloxacin also showed good activity, with an MIC(90) of 2 microg/ml. Trovafloxacin and gemifloxacin showed lower in vitro activity, with MIC(90)s of 64 and 8 microg/ml, respectively.

Implicación del grupo Bacteroides fragilis y otros anaerobios de importancia clínica en apendicitis aguda: ¿Es adecuado nuestro protocolo de terapia empírica? / Implication of the Bacteoirde fragilis group and other anaerobes of clinical improtance in acute apendicitis: Our empirical therapy schem is right?

Introducción. Nuestro objetivo es estudiar la implicación de anaerobios, especialmente del grupo Bacteroides fragilis (B. fragilis), en los procesos de apendicitis aguda y determinar su patrón de resistencia antibiótica en vista a evaluar la adecuación de la terapia empírica empleada. Métodos. La identificación de los microorganismos se realizó mediante pruebas bioquímicas habituales y el estudio de sensibilidad mediante microdilución en caldo. Resultados. En el Hospital Infantil U. Niño Jesús de Madrid, 2007-2011, fueron procesados 596 exudados peritoneales de apendicitis aguda, 320 (54%) muestras fueron positivas, recuperándose 1.052 patógenos. 468 (45%9 anaerobios. El grupo B. fragilis fue el más frecuentemente aislado (67%). Los agentes más activos frente anaerobios son imipenem, metronidazol y la combinación agente β-lactámico/inhibidor de β-lactamasas. Sin embargo, metronidazol no muestra actividad frente a Porphromonas spp. Y Peptococus spp./eptostreptococcus spp. Las tasas de resistencia a cefoxitina y clindamicina del grupo B. fragilis fueron 19% y 48% respectivamente, cuestionando la adecuación del uso empírico de cefoxitina. Mientras la resistencia del grupo B. fragilis a clindamicina no cambia apreciablemente durante el periodo 2007-2010, se observa un progresivo descenso en la resistencia a cefoxitina. Conclusiones. Otros tratamientos empíricos (amoxicilina/ácido clavulánico o metronidazol) serían más apropiados en las infecciones intraabdominales (AU)

Introduction. Our objective is to analyze the involvement of anaerobes, with emphasis on the Bacteroides fragilis (B. fragilis) group, collected from appendicitis and t determine the antimicrobial reistance profile in order to evaluate the adequacy of our empirical therapy scheme. Methods. Microorganisms were identified by standard biochemical methods. Antimicrobial susceptibility was performed using a broth microdilution methods. Results. During 2007-2011, 596 peritoneal exudates of acute appendicitis were received at Hospital U. Infantil Niño Jesús of Madrid, 320 (54%) specimens from 309 patients were positive and 1052 pathogens were recovered: 468 (45%) anaerobe. B. fragilis roup was the most commonly isolated anaerobic organism 867&). Thea gents most active against anaerobic bacteria are imipenem, metronidazole and combination of β-lactam/β-lactamase inhibitor. However, metronidazole does not have activity against Porphyromonas spp. And Peptococcus spp./peptostreptococus spp. The rates of cefoxitin and clindamycin-resistant B. fragilis group were 19% and 48% respectively, which may raise questions about the appropriateness of the empirical use of cefoxitine. While the B. fragilis group resistance to clindamycin does not change significantly during 2007-2010 period, a progressive decrease was found in the resistance rates to cefoxitin. Conclusions. Other empirical treatments (amoxicillin/clavulanic acid or Metronidazole) would be most appropriate in intra-abdominal infections (AU)

Infección por rotavirus en un periodo de 6 años (2007.2012): consideraciones epidemiológicas / Rotavirus infection in a period of 6 years (2007.2012): epidemiological considerations

Introducción. Rotavirus es una causa importante de gastroenteritis aguda (GEA) en niños de hasta 5 años. El objetivo del trabajo fue investigar la incidencia de las infecciones nosocomiales y comunitarias por rotavirus, y analizar sus características epidemiológicas en estos pacientes en 2007-2012. Métodos. Se estudiaron las heces procesadas para detección de antígenos de rotavirus, mediante prueba inmunocromatográfica, de pacientes con GEA de hasta 5 años atendidos en el Hospital Infantil Universitario Niño Jesús, de Madrid. Resultados. Se procesaron para detección de rotavirus 4.590 heces de pacientes con GEA, detectándose rotavirus en 709 pacientes (808 heces): 52% pacientes con infección comunitaria y 48%, nosocomial. Cuarenta y dos episodios nosocomiales (12%) correspondieron a pacientes oncológicos. La distribución anual de pacientes en 2007-2012 fue 124 (18%), 98 (14%), 83 (12%), 138 (20%), 173 (24%) y 96 (14%), respectivamente. Un 86% de pacientes con GEA por rotavirus tenían≤1 año. La coinfección por rotavirus y adenovirus fue la más frecuente (65%). Conclusiones. Se detectó una elevada tasa de infección nosocomial y cambios en el patrón estacional, desde una marcada estacionalidad en 2007 a un patrón irregular en 2008-2012. Este cambio indica una transmisión viral sostenida que podría comprometer las medidas preventivas (AU)

Introduction. Rotavirus is a major cause of acute gastroenteritis (AGE) in children aged 5 years or under. The objective was to assess the incidence of nosocomial and community –acquired rotavirus infections, and its epidemiological characteristics in 2007-2012. Methods. Stools specimens were collected form children with AGE<5 years treated at the H.I.U Niño Jesús, Madrid, for the presence of rotavirus antigen by enzyme-linked immunosorbent assay. Results. A total of 4590 stools from patients with AGE were tested for rotavirus antigen. Rotavirus was detected in 709 patients (808 tools): 52% patients with community infections and 48% with nosocomial infections. Of these rotavirus nosocomial AGE, 12% were immunocompromised children. The number of patients with rotavirus in 2007-2012 was 124 (18%), 98 (14%), 83 (12%), 138 (20%), 173 (24%) and 93 (14%), respectively. Eighty-six percent of the patients with rotavirus AGE were ≤1 year of age. Rotavirus and adenovirus (65%) were the association most frequently detected. Conclusions. There are a high rate of nosocomial infection and changes in the seasonal pattern. From a marked seasonality in 2007, the pattern became irregular in 2008-2012. This change indicates a viral transmission more sustained which might reduce the efficiency of prevention measures (AU)

Infeccion invasora por Blastoschizomyces capitatus / Invasive infection due to Blastoschizomyces capitatus

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Kingella kingae como causa de infección en dos niños menores de dos años / Kingella kingae infections in two children younger than two years old

Kingella kingae es un cocobacilo gramnegativo, aerobio, pertenenciente a la familia de las Neisseriaceae. Presentamos dos casos clínicos de infección por Kingella kingae: bacteriemia y artritis séptica, diagnosticados en nuestro centro en el intervalo de un mes. Kingella kingae forma parte de la flora orofaríngea habitual, pudiendo ser la puerta de entrada de las infecciones sistémicas. Desde la administración de la vacuna frente a Haemophilus influenzae tipo b, Kingella kingae está siendo la principal bacteria gramnegativa implicada en infecciones osteoarticulares en niños menores de tres años. Kingella kingae es muy sensible a los antibióticos que normalmente se utilizan de forma empírica. Las infecciones por Kingella kingae habitualmente siguen un curso clínico benigno, y se han descrito casos de resolución espontánea. Queremos hacer hincapié en el hecho de que este microorganismo no es sospechado o buscado en infecciones en pacientes pediátricos. Kingella kingae es un microorganismo de difícil aislamiento, poco resistente en condiciones adversas, por lo que es importante inocular la muestra de sangre o líquido articular en frasco de hemocultivo (AU)