ABSTRACT
Few studies have been performed in Puerto Rico concerning the antimicrobial resistance pattern of clinically significant Gram-negative bacilli. The antimicrobial resistance patterns of 5,590 Gram-negative bacteria obtained from three Community-Private Hospitals (CPH) and three University-Affiliated Hospitals (UAH) were evaluated utilizing the institutions' antimicrobial susceptibility reports for the year 2000. The objectives of this study were: to retrospectively evaluate the reported in vitro resistance of clinical isolates of E. coli, K. pneumoniae, E. cloacae, S. marcescens, P. aeruginosa and A. baumannii to selected standard antibiotics and to compare the antimicrobial resistance patterns between Community-Private (CPH) and University Affiliated hospitals (UAH). E. coli was the most common Gram-negative enteric bacilli in both CPH and UAH. In UAH, E. coli demonstrated a statistically significant higher resistance to the selected beta lactams and amikacin antibiotics but not to ciprofloxacin or gentamicin. For K. pneumoniae, the antimicrobial resistant pattern showed that UAH isolates were significantly more resistant to the tested antibiotics with the exception of ceftriaxone. In CPH, E. cloacae isolates were significantly more resistant to piperacillin-tazobactam, ciprofloxacin and gentamicin, while in UAH this organism was more resistant to amikacin. In UAH, S. marcescens isolates demonstrated a statistically significant higher resistance to all tested antibiotics with the exception of imipenem, which was similar in both hospitals group. Pseudomonas aeruginosa demonstrated a statistically significant higher resistance in UAH to all selected antibiotics with the exception of ciprofloxacin and gentamicin, which was similar in both hospitals group. Acinetobacter baumannii was the most resistant organisms in both hospitals group. UAH isolates were significantly more resistant than CPH isolates for all tested antibiotics. When compare with other large-scale antimicrobial resistance studies, the present study results suggest an apparent higher resistance in the Puerto Rican isolates. The high numbers of antimicrobial resistant Gram-negative bacilli in our study strongly suggest multiple mechanisms of antimicrobial resistance including the presence of extended spectrum and chromosomally derepressed beta-lactamases.
Subject(s)
Gram-Negative Bacteria/drug effects , Hospitals, Private/statistics & numerical data , Hospitals, University/statistics & numerical data , Hospitals, Urban/statistics & numerical data , Cross Infection/microbiology , Gram-Negative Bacterial Infections/microbiology , Drug Resistance , Gram-Negative Bacteria/isolation & purification , Cross Infection/epidemiology , Gram-Negative Bacterial Infections/epidemiology , Puerto Rico/epidemiology , Retrospective Studies , Urban PopulationABSTRACT
The antimicrobial resistance patterns of 2,462 selected Gram-positive cocci obtained from three Community-Private Hospitals (CPH) and three University-Affiliated Hospitals (UAH) were evaluated utilizing the institutions' antimicrobial susceptibility reports for the year 2000. The objectives of this study were: 1) to evaluate the in vitro resistance to selected standard antibiotics of Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium and Streptococcus pneumoniae clinical isolates, and 2) to compare the antimicrobial resistance patterns between community-private (CPH) and university-affiliated hospitals (UAH). Staphylococcus aureus was the most common Gram-positive isolated organism in CPH (63.3 per cent) followed by E. faecalis (31.0 per cent). In UAH, the most prevalent cocci were E. faecalis (51.7 per cent) followed by S. aureus (43.9 per cent). Enterococcus faecium represented 2.3 per cent and 4.4 per cent of CPH and UAH isolates, respectively. Streptococcus pneumoniae represented 3.4 per cent of the total Gram-positive isolates from CPH, no S. pneumoniae was reported in UAH. The antimicrobial susceptibility results showed that for Staphylococcus aureus there was a statistically significant higher resistance to methicillin and thrimethoprim sulfamethoxazole in UAH, while resistance to erythromycin was significantly higher in CPH. There was no difference in the resistance of S. aureus to other antimicrobial agents between hospitals groups. A statistically significant resistant to vancomycin was found between enterococcal isolates from UAH (43 per cent) and CPH (12.7 per cent). High-level aminoglycoside resistance (HLAR) was observed among UAH enterococcal isolates with E. faecium showing a higher resistance than E. faecalis, no data for HLAR in CPH could be obtained. For pneumococci 46 per cent of CPH isolates were resistant to penicillin. In summary, there are important differences in the prevalence and antimicrobial resistance between the Gram-positive bacteria isolated from community and teaching hospitals.
Subject(s)
Humans , Gram-Positive Cocci/isolation & purification , Hospitals, Community/statistics & numerical data , Hospitals, University/statistics & numerical data , Gram-Positive Bacterial Infections/microbiology , Drug Resistance, Multiple, Bacterial , Gram-Positive Cocci/drug effects , Gram-Positive Bacterial Infections/drug therapy , Microbial Sensitivity Tests , Puerto Rico/epidemiologyABSTRACT
Se describe la técnica (DCB) utilizada por los autores en el tratamiento de 12 casos de craniosinostosis. Está basada en la distracción cráneo-orbito maxilar sin craneotomía del hueso frontal, ahorrando de esta manera riesgos y morbilidad. Se evalúan los resultados y se describen los antecedentes de esta modificación
Subject(s)
Humans , Child , Jaw , Osteogenesis, Distraction , Osteotomy , Skull , Synostosis , Surgery, PlasticABSTRACT
Los pacientes con retrognatia y glosoptosis evolucionan favorablemente en la mayoría de los casos con pautas de alimentación y posturales.Algunos,con mayor severidad de los síntomas,pueden presentar insuficiencia ventilatoria,broncoaspiración,frecuentes infecciones pulmonares,falta de aumento de peso y están predispuestos a contraer otras infecciones.Utilizamos la distracción mandibular en siete pacientes sintomáticos,a razón de 1-2 mn/día,con desaparición de todos los síntomas,sin complicaciones.La evaluación se hizo tomando parámetros clínicos como la desaparicióndel tiraje esternocostal y de los episodios de apneala inmediata alimentación oral con aumento de la curva de peso hasta su normalización.Se trata de un procedimiento simple,efectivo,rápido y de bajo costo.Se evitan la traqueostomía y otros procedimientos quirúrgicos de poca efectividad