Absceso en dedo por Escherichia vulneris tras traumatismo con una rama

Introducción: Es importante considerar la posible implicación de microorganismos poco frecuentes en infecciones de piel y partes blandas si la muestra obtenida para cultivo es de buena calidad, y además se aísla en cultivo puro, como ocurre con Escherichia vulneris. Caso Clínico: Presentamos en caso de una mujer de 34 años, sin antecedentes mórbidos, quien desarrolló un absceso en el 4° dedo de la mano tras un traumatismo con una rama y que requirió drenaje quirúrgico y tratamiento antibiótico para su resolución. En el contenido del absceso, se aisló E. vulneris en cultivo puro, con un perfil antibiótico multisensible. Discusión y Conclusión: E. vulneris es una enterobacteria cuya patogenicidad ha estado clásicamente discutida, pero que se ha visto que puede tener participación en infección de heridas, especialmente aquellas relacionadas con material vegetal. Este microorganismo, muy relacionado con E. harmannii, presenta buena sensibilidad a los aminoglucósidos, con excepción a la penicilina y al cotrimoxazol. En las infecciones de piel y tejidos blandos causadas por E. vulneris y que cursen como un absceso, es importante realizar desbridamiento quirúrgico, si es necesario para la resolución completa del cuadro, además del tratamiento con amoxicilina/ácido clavulánico que parece adecuado.

Introduction: It is important to assess the possible involvement of rare microorganisms in skin and soft tissue infections if the sample obtained for culture is of good quality, and is isolated in pure culture, as occurs with Escherichia vulneris. Case Report: We present the case of a 34-year-old woman, with no history of morbidity, who developed an abscess in the 4th finger of the hand after trauma with a branch and which required surgical drainage and antibiotic treatment for its resolution. In the content of the abscess, E. vulneris was isolated in pure culture, with a multisensitive antibiotic profile. Discusion: E. vulneris is an Enterobacteriaceae whose pathogenicity has been classically discussed, but it has been seen that it may have participated in the infection of wounds, especially those related to plant material. This organism, closely related to E. harmannii, shows good sensitivity to aminoglycosides, with the exception of penicillin, and cotrimoxazole. In skin and soft tissue infections caused by E. vulneris and that present as an abscess, it is important to perform surgical debridement if necessary for complete resolution of the condition, in addition to treatment with amoxicillin/clavulanic acid, which seems appropriate.

Caracterización de Escherichia coli D7111 productora de ß-LACTAMASA TEM-176 / Characterization of Escherichia coli D7111 producing the ß-LACTAMASA TEM-176

RESUMEN El presente reporte es la descripción original de bla TEM-176. Se caracterizaron los mecanismos de resistencia a antimicrobianos de un aislamiento de Escherichia coli enterotoxigénica, determinándose la resistencia a 22 antimicrobianos categorizados en 15 grupos diferentes mediante difusión en agar, estableciéndose grupo filogenético, mecanismos de resistencia y presencia de integrones de Clase 1 y 2 mediante PCR. Integrones y genes de resistencia a β-lactámicos fueron secuenciados. El aislamiento del grupo filogenético A, mostró resistencia o sensibilidad disminuida a ampicilina, amoxicilina más ácido clavulánico, ácido nalidíxico, ciprofloxacino, estreptomicina, kanamicina, tetraciclina, trimetoprim, sulfisoxazol, cotrimoxazol, azitromicina y nitrofurantoina, detectándose la presencia de bla TEM, aadA1/2, aphA1, sul3, tet(A) y un integron de Clase 2 conteniendo un gen dfrA1. La resistencia a quinolonas se relacionó con la substitución Ser83Ala. La secuencia de TEM mostró la substitución Ala222Val, la cual a la fecha no había sido descrita, reportándose como una nueva β-lactamasa, con el nombre de bla TEM-176.

ABSTRACT The present report is the original description of bla TEM-176. The mechanisms of resistance to antimicrobial agents were determined in an enterotoxigenic Escherichia coli, determining the susceptibility to 22 antimicrobials classified in 15 different groups by agar diffusion and establishing the phylogenetic group, mechanisms of resistance and presence of Class 1 and 2 integrons. Integrons and β-lactam resistance genes were sequenced. The isolate, belonging to phylogenetic group A, showed the presence of resistance or diminished susceptibility to a ampicillin, amoxicillin plus clavulanic acid, nalidíxic acid, ciprofloxacin, streptomycin, kanamycin, tetracycline, trimethoprim, sulfisoxazole, cotrimoxazole, azithromycin and nitrofurantoin, carrying bla TEM, aadA1/2, aphA1, sul3, tet(A) and a Class 2 integron containing a dfrA1 gene. Quinolone resistance was related to the substitution Ser83Ala. The TEM sequencing showed the presence of the new substitution Ala222Val, which led to the description of the new β-lactamase bla TEM-176.

Caracterización de Escherichia coli D7111 productora de ß-LACTAMASA TEM-176 / Characterization of Escherichia coli D7111 producing the ß-LACTAMASE TEM-176

RESUMEN El presente reporte es la descripción original de bla TEM-176. Se caracterizaron los mecanismos de resistencia a antimicrobianos de un aislamiento de Escherichia coli enterotoxigénica, determinándose la resistencia a 22 antimicrobianos categorizados en 15 grupos diferentes mediante difusión en agar, estableciéndose grupo filogenético, mecanismos de resistencia y presencia de integrones de Clase 1 y 2 mediante PCR. Integrones y genes de resistencia a β-lactámicos fueron secuenciados. El aislamiento del grupo filogenético A, mostró resistencia o sensibilidad disminuida a ampicilina, amoxicilina más ácido clavulánico, ácido nalidíxico, ciprofloxacino, estreptomicina, kanamicina, tetraciclina, trimetoprim, sulfisoxazol, cotrimoxazol, azitromicina y nitrofurantoina, detectándose la presencia de bla TEM, aadA1/2, aphA1, sul3, tet(A) y un integron de Clase 2 conteniendo un gen dfrA1. La resistencia a quinolonas se relacionó con la substitución Ser83Ala. La secuencia de TEM mostró la substitución Ala222Val, la cual a la fecha no había sido descrita, reportándose como una nueva β-lactamasa, con el nombre de bla TEM-176.

ABSTRACT The present report is the original description of bla TEM-176. The mechanisms of resistance to antimicrobial agents were determined in an enterotoxigenic Escherichia coli, determining the susceptibility to 22 antimicrobials classified in 15 different groups by agar diffusion and establishing the phylogenetic group, mechanisms of resistance and presence of Class 1 and 2 integrons. Integrons and β-lactam resistance genes were sequenced. The isolate, belonging to phylogenetic group A, showed the presence of resistance or diminished susceptibility to a ampicillin, amoxicillin plus clavulanic acid, nalidíxic acid, ciprofloxacin, streptomycin, kanamycin, tetracycline, trimethoprim, sulfisoxazole, cotrimoxazole, azithromycin and nitrofurantoin, carrying bla TEM, aadA1/2, aphA1, sul3, tet(A) and a Class 2 integron containing a dfrA1 gene. Quinolone resistance was related to the substitution Ser83Ala. The TEM sequencing showed the presence of the new substitution Ala222Val, which led to the description of the new β-lactamase bla TEM-176.

An Uncommon Side Effect of a Commonly Used Antibiotic: Amoxicillin-Clavulanic Acid Induced Hepatitis / 가정의학회지

Amoxicillin-Clavulanic acid continues to be one of the most commonly used antibiotic combinations. Hepatic injury due to this antibiotic is rare. We report a case of amoxicillin-clavulanic acid induced hepatitis causing painless jaundice to bring to attention this rare side effect of this commonly used antibiotic. This is a case of a 62-year-old Caucasian female, who presented with acute onset severe painless jaundice, nausea, vomiting, and pruritus of less than 1-week duration. She had completed a course of amoxicillin-clavulanic acid 3 weeks prior to presentation. A careful history pointed to this simple diagnosis. It may be easily missed without an in-depth history and the patient may be subjected to unnecessary expensive tests. This case is reported to highlight cost conscious care by keeping in mind a rare side effect of the commonly used antibiotic.

Amoxicillin-clavulanic acid induced sperm abnormalities and histopathological changes in mice

Objective:To explore the genotoxic potential and histopathological changes induced in liver,kidney,testis,brain and heart after using the antibiotic drug amoxicillin/clavulanic acid (4∶1).Methods:The study included chromosomal aberration analysis in bone-marrow and mouse spermatocytes,induction of sperm morphological abnormalities and histopathological changes in different body organs.The drug was administrated orally at a dose of 81 mg/kg body weight twice daily (Total =162 mg/kg/day) for various periods of time equivalent to 625 mg/men (twice daily).Results:The results revealed non-significant chromosomal aberrations induced after treatment with amoxicillin/clavulanic acid (AC) in both bone marrow and mouse spermatocytes after 7 and 10 days treatment.On the other hand,statistically significant percentages of sperm morphological abnormalities were recorded.Such percentage reached 8.10 ± 0.55,9.86 ± 0.63 and 12.12 ± 0.58 at the three time intervals tested (7,14and 35 days after the 1st treatment respectively) (treatment performed for 5 successive days) compared with 2.78 ± 0.48 for the control.The results also revealed histopathological changes in different body organs after AC treatment which increased with the prolongation of the period of therapy.Congestion of central vain,liver hemorrhage and hydropic changes in hepatocytes were noticed in the liver.Degenerative changes were found in kidney glomerulus and tubules while testis showed atrophy of seminiferous tubules,and reduction of spermatogenesis.AC also induced neurotoxicity and altered brain neurotransmitter levels.Hemorrhage in the myocardium,disruption of cardiac muscle fibers and pyknotic nuclei in cardiomyocytes were recorded as side effects of AC in heart tissue.Contusions:The results concluded that AC treatment induced sperm morphological abnormalities and histopathological changes in different body organs.Clinicians must be aware of such results while describing the drug.

Amoxicillin–clavulanic acid induced sperm abnormalities and histopathological changes in mice

Objective To explore the genotoxic potential and histopathological changes induced in liver, kidney, testis, brain and heart after using the antibiotic drug amoxicillin/clavulanic acid (4:1). Methods The study included chromosomal aberration analysis in bone-marrow and mouse spermatocytes, induction of sperm morphological abnormalities and histopathological changes in different body organs. The drug was administrated orally at a dose of 81 mg/kg body weight twice daily (Total = 162 mg/kg/day) for various periods of time equivalent to 625 mg/men (twice daily). Results The results revealed non-significant chromosomal aberrations induced after treatment with amoxicillin/clavulanic acid (AC) in both bone marrow and mouse spermatocytes after 7 and 10 days treatment. On the other hand, statistically significant percentages of sperm morphological abnormalities were recorded. Such percentage reached 8.10 ± 0.55, 9.86 ± 0.63 and 12.12 ± 0.58 at the three time intervals tested (7, 14 and 35 days after the 1st treatment respectively) (treatment performed for 5 successive days) compared with 2.78 ± 0.48 for the control. The results also revealed histopathological changes in different body organs after AC treatment which increased with the prolongation of the period of therapy. Congestion of central vain, liver hemorrhage and hydropic changes in hepatocytes were noticed in the liver. Degenerative changes were found in kidney glomerulus and tubules while testis showed atrophy of seminiferous tubules, and reduction of spermatogenesis. AC also induced neurotoxicity and altered brain neurotransmitter levels. Hemorrhage in the myocardium, disruption of cardiac muscle fibers and pyknotic nuclei in cardiomyocytes were recorded as side effects of AC in heart tissue. Conclusions The results concluded that AC treatment induced sperm morphological abnormalities and histopathological changes in different body organs. Clinicians must be aware of such results while describing the drug.

Clinical efficacy and safety of azithromycin versus amoxicillin-clavulanic acid in the treatment of some acute respiratory infections in children: Systematic evaluation / 国际药学研究杂志

Objective To systematically evaluate the clinical efficacy and safety of azithromycin (Az) versus amoxicillin-clavulanic acid (A-Cva) in the treatment of some acute respiratory infections in children. Methods Pubmed, EMBase, Medline, Cochrane Library and CJFD were retrieved to collect the randomized controlled trial (RCT) of their clinical efficacy and safety in the treatment of acute respiratory infections in children. The methodological quality of included studies was evaluated. The RevMan5.2 software was chosen for data analysis. Results Twenty RCTs involving 4980 pediatric patients were included for assessment of the clinical efficacy. Meta-analysis showed that Az had more significant effect on the treatment of some bacterial repiratory infections in children (OR=0.78, 95%CI (0.65,0.93), P=0.007) than A-Cva. In the treatment of upper respiratory infections, acute otitis media and so on, Az had more significant effect (OR=0.75, 95%CI (0.62,0.91), P=0.003); in the treatment of lower respiratory infections, such as community acquired pneumonia and so on, Az and A-Cva acid had the similar effect (OR=1.20, 95%CI(0.62, 2.33), P=0.58). Thirteen RCT involving 3474 pediatric patients were included for assessment of the clinical safety. Meta-analysis shows that the difference between Az and A-Cva is statistic significant in the treatment of some bacterial repiratory infections in children (OR=0.49, 95%CI (0.40, 0.60), P<0.000 01). Conclusion Overall, Meta-analysis shows that Az is more effective and safer in the treatment of some bacterial repiratory infections in children than A-Cva.

Clinical efficacy and safety of azithromycin versus amoxicillin-clavulanic acid in the treatment of some acute respiratory infections in children:systematic evaluation / 国际药学研究杂志

Objective To systematically evaluate the clinical efficacy and safety of azithromycin(Az)versus amoxicillin-cla?vulanic acid(A-Cva)in the treatment of some acute respiratory infections in children. Methods Pubmed,EMBase,Medline,Co?chrane Library and CJFD were retrieved to collect the randomized controlled trial(RCT)of their clinical efficacy and safety in the treat?ment of acute respiratory infections in children. The methodological quality of included studies was evaluated.The RevMan 5.2 software was chosen for data analysis. Results Twenty RCTs involving 4980 pediatric patients were included for assessment of the clinical effi?cacy. Meta-analysis showed that Az had more significant effect on the treatment of some bacterial repiratory infections in children〔OR=0.78,95%CI(0.65,0.93),P=0.007〕than A-Cva. In the treatment of upper respiratory infections,acute otitis media and so on,Az had more significant effect〔OR=0.75,95%CI(0.62,0.91),P=0.003〕;in the treatment of lower respiratory infections,such as community acquired pneumonia and so on,Az and A-Cva acid had the similar effect〔OR=1.20,95%CI(0.62,2.33),P=0.58〕. Thirteen RCT in?volving 3474 pediatric patients were included for assessment of the clinical safety. Meta-analysis shows that the difference between Az and A-Cva is statistic significant in the treatment of some bacterial repiratory infections in children〔OR=0.49,95%CI(0.40,0.60),P<0.000 01〕. Conclusion Overall,Meta-analysis shows that Az is more effective and safer in the treatment of some bacterial repiratory infections in children than A-Cva.

Sensibilidad a la amoxicilina de bacterias anaerobias de pacientes con periodontitis agresiva / Susceptibility to amoxycillin of anaerobic bacteria in patientswith aggressive periodontitis

Introducción y ObjetivoSe han utilizado los antibióticos como terapia adjunta al tratamiento periodontal. La amoxicilina y la amoxicilina/ ácido clavulánico son algunos de los más utilizados. Establecer el tipo de bacterias y su sensibilidad a la amoxicilina y a la amoxicilina/ácido clavulánico en pacientes con periodontitis agresiva. Materiales y MétodosEste estudio in vitro estableció la sensibilidad a la amoxicilina y a la amoxicilina/ácido clavulánico de las bacterias aisladas de 19 pacientes con periodontitis agresiva. Se obtuvieron muestras de 6 sitios con bolsas iguales o mayores a 7 mm de profundidad, se realizó cultivo y aislamiento de colonias en condiciones anaeróbicas. Laidentificación de los microorganismos se realizó a través de la coloración de Gram y el Sistema Crystal paraanaerobios; para determinar la sensibilidad a los antibióticos se utilizó la técnica descrita por Wilkins y Thiel.ResultadosEn la periodontitis localizada los microorganismos que se presentaron con mayor frecuencia fueron Veillonellaspecies, Peptostreptococcus prevotii, Staphylococcus saccharoliticus, Bacteroides fragilis, Bacteroidesureolyticus. En la periodontitis generalizada se encontró Fusobacterium nucleatum, Veillonella species, Peptostreptococcus prevotii, Peptostreptococcus saccharolitucus, Staphylococcus saccharoliticus. De las 21 especies identificadas, en la periodontitis localizada 4 fueron resistentes a la amoxicilina y 1 resistente a la amoxicilina/Acido clavulánico. En la periodontitis generalizada se encontró 1 microorganismo resistente a laamoxicilina y 1 resistente a la amoxicilina/Acido clavulánico.ConclusiónSe encontraron bacterias resistentes a la amoxicilina y a la amoxicilina/ácido clavulánico.

Introduction and ObjectiveAntibiotics have been used as an adjunct to periodontal treatment. Amoxicillin and amoxicillin/clavulanicacid are some of the most used.To define the type of bacteria and their susceptibility to amoxycillin and to amoxicillin/clavulanic acid inpatients with aggressive periodontitis.Materials and MethodThis descriptive study stated susceptibility to amoxycillin and to amoxicillin/clavulanic acid of bacteriaisolated from 19 patients with aggressive periodontitis, selected by convenience. Samples from six(6) different sites with periodontal pockets equal or greater than 7 mm of depth were obtained. Thesamples were cultured anaerobically and the isolated colonies were identified by means of the Gramstaining procedure and the Crystal System for anaerobics. The Wilkins and Thiel test was used to assesssusceptibility.ResultsThe microorganisms with the highest presence in localized periodontitis were Veillonella species,Peptostreptococcus prevotii, Staphylococcus saccaharolyticus, Bacteroides fragilis and Bacteroidesureolyticus. Fusobacterium nucleatum, Veillonella species, Peptostreptococcus prevotii, Peptostreptococcussaccharolyticus and Staphylococcus saccharolyticus were found in generalized periodontitis. Four out ofthe 21 microorganisms species identified in localized periodontitis 4 were resistant to amoxycillin and oneto amoxicillin/clavulanic acid. One microorganism was identified as resistant to amoxycillin and one toamoxicillin/clavulanic acid in generalized periodontitis.ConclusionAmoxycillin-resistant and amoxycillin/clavulanic acid-resistant bacteria were found.