Síndrome de Kounis, un infarto olvidado: reporte de caso / Kounis syndrome, a forgotten infarction: case report

La anafilaxia es una causa poco frecuente de síndrome coronario agudo por vasoespasmo con o sin la presencia de enfermedad coronaria subyacente. Presentamos el caso de un síndrome de Kounis en un paciente masculino sin factores de riesgo conocidos para enfermedad coronaria quien presentó un síndrome coronario agudo con elevación de ST que requirió manejo con adrenalina, soporte vital básico e ingreso a Unidad de Cuidados Intensivos; con arteriografía coronaria sin evidencia de enfermedad subyacente.

Anaphylaxis is a rare cause of vasospasm acute coronary syndrome with or without the presence of underlying coronary disease. We present the case of Kounis syndrome in a male patient with no known risk factors for coronary heart disease who presented with acute coronary syndrome with elevation of ST that required management with epinephrine, basic life support, and admission to the Intensive Care Unit; with coronary arteriography without evidence of underlying disease.

Antibiotic resistance profile in intrahospital pediatric services at third level centers in Dominican Republic / Perfil de resistencia a antibióticos en servicios pediátricos intrahospitalarios en centros de tercer nivel en República Dominicana

Objectives: The Dominican Republic lacks reliable information on antimicrobial resistance (AMR), which would allow physicians to prescribe the best treatment for common infectious diseases. This study aimed to define the antimicrobial resistance profiles of the more common pathogens from pediatric services, where data is even more important due to the vulnerability of the population. Methods: We collected data from patients admitted in the pediatric unit of three third level hospitals in the city of Santiago de los Caballeros, Dominican Republic, showing positive bacterial cultures, during a period of two years. Results: Half of the Gram negative pathogens exhibited third generation cephalosporins (3GC) resistance, 17% were resistant to carbapenems. Serratia marcescens presented an exceptionally high proportion of resistance to 3GC (95.9%). Staphylococcus aureus showed elevated resistance to methicillin (58.4%) and even to clindamycin (35.8%). Conclusion: There are elevated levels of antimicrobial resistance among the Enterobacteriaceae family and the Staphylococcus genus isolated from the pediatric population. Necessary measures should be taken to tackle AMR in the country.

Objetivos: La República Dominicana carece de información confiable sobre las resistencias antimicrobianas en el país, lo que permitiría al personal médico prescribir los mejores tratamientos para infecciones comunes. El objetivo de este estudio es definir los perfiles de resistencia antimicrobiana de los patógenos más comunes en servicios pediátricos, donde esta información es esencial, debido a la vulnerabilidad de la población. Métodos: Se tomaron los datos de reportes microbiológicos con cultivo bacteriano positivo procedentes de pacientes admitidos en la unidad pediátrica de tres hospitales de tercer nivel en la ciudad de Santiago de los Caballeros, República Dominicana, durante un periodo de dos años. Resultados: La mitad de los patógenos Gram negativos mostraron resistencia a cefalosporinas de tercera generación (3GC), 17% eran resistentes a carbapenémicos. Serratia marcescens presentó una resistencia excepcionalmente elevada a 3GC (95.9%). Staphylococcus aureus mostró alta resistencia a meticilina (58.4%) e incluso a clindamicina (35.8%). Conclusión: Existen elevados niveles de resistencia antimicrobiana entre las enterobacterias y los estafilococos en la población pediátrica dominicana. Es necesario tomar medidas para abordar este problema en el país.

Antimicrobial efficacy of a new tri-antibiotic combination against resistant endodontic pathogens: an in-vitro study / Eficácia antimicrobiana de uma nova combinação tripla de antibióticos contra patógenos endodônticos resistentes: um estudo in vitro

Antecedentes: A remoção de todas as bactérias patogênicas do sistema de canais radiculares é de primordial importância para o sucesso da terapia endodôntica. Objetivo: O estudo teve como objetivo determinar a eficácia antimicrobiana de três antibióticos e sua nova combinação contra patógenos endodônticos selecionados. Métodos: Neste estudo in vitro, foram utilizadas cepas bacterianas associadas à condição endodôntica refratária e determinado CIM e MBC de Clindamicina (C), Metronidazol (M), Doxiciclina (D), bem como sua combinação de DMC. Cultivamos Candida Albicans, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecalis, Streptococcus Mutans, Bacillus Subtilis subsp. spizizenii, Actinomyces Actinomycetemcomitans em meios de cultura seletivos. Analisamos os dados usando o teste 't' emparelhado, ANOVA unidirecional e o teste post hoc HSD de Tuckey. Resultados: A clindamicina inibiu significativamente o crescimento de C. Albicans (90%) e S. Mutans (90%) e P. Aeruginosa, E. Coli, E. Coli, E. Faecalis, B. Subtilis e A. Actinomycetemcomitans eram resistentes a ele. O metronidazol não inibiu nenhuma das bactérias. A doxiciclina inibiu significativamente C. Albicans (90%),P. Aeruginosa (90%) e S. Mutans (90%), enquanto E.Coli, E. Faecalis, B. Subtilis e A. Actinomycetemcomitanseram resistentes a ela. A combinação de CMD inibiu significativamente todos os micróbios. Entretanto, em concentrações bactericidas de CMD, E. Faecalis (p = 0,024),B. Subtilis (p = 0,021) e A. Actinomycetemcomitans (p =0,041) foram eliminados significativamente, enquanto C.Albicans (p = 0,164), P. Aeruginosa (p = 0,489), E. Coli (p= 0,106) e S. Mutans (p = 0,121) apresentaram resistência. Conclusão: O CMD combinado pode ser usado contra patógenos endodônticos resistentes para obter resultados endodônticos previsíveis. (AU)

Background: Removal of all the pathogenic bacteria from the root canal system is of prime importance for the success of endodontic therapy. Objective: The study aimed to determine the antimicrobial efficacy of three antibiotics and their new combination against selected endodontic pathogens. Methods: In this in-vitro study, we used bacterial strains associated with the refractory endodontic condition and determined MIC and MBC of Clindamycin (C), Metronidazole (M), Doxycycline (D) as well as their combination CMD. We cultured Candida Albicans, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecalis, Streptococcus Mutans, Bacillus Subtilis subsp. spizizenii, Actinomyces Actinomycetemcomitans on selective culture media. We analyzed the data using paired 't' test, one-way ANOVA, and Tuckey's HSD post hoc test. Results: Clindamycininhibited the growth of C. Albicans (90%) and S. Mutans (90%) significantly and P. Aeruginosa, E. Coli, E. Faecalis, B. Subtilis, and A. Actinomycetemcomitans were resistantto it. Metronidazole did not inhibit any of the bacteria. Doxycycline inhibited C. Albicans (90%), P. Aeruginosa(90%), and S. Mutans (90%) significantly while E. Coli,E. Faecalis, B. Subtilis, and A. Actinomycetemcomitans were resistant to it. The combination of CMD inhibited all the microbes significantly. However, at bactericidal concentrations of CMD, E. Faecalis (p = 0.024), B. Subtilis (p = 0.021) and A. Actinomycetemcomitans(p = 0.041) were eliminated significantly, while C. Albicans (p = 0.164), P. Aeruginosa (p = 0.489), E. Coli (p = 0.106) and S. Mutans (p = 0.121) showed resistance. Conclusion: Combination CMD can be used against resistant endodontic pathogens to achieve predictable endodontic results. (AU)

Resistencia inducible a clindamicina en Staphylococcus aureus resistentes a meticilina aislados de pacientes pediátricos en Paraguay / Inducible resistance to clindamycin in methicillin-resistant Staphylococcus aureus isolated from Paraguayan children

Resumen Introducción: El método de difusión de doble disco se presenta como una alternativa diagnóstica que permite identificar aislados de Staphylococcus aureus susceptibles a clindamicina, ante el aumento de resistencia a meticilina, reduciendo así la posibilidad de fallo en el tratamiento. Objetivo: Determinar la frecuencia de resistencia a clindamicina inducida por eritromicina en S. aureus resistentes a meticilina (SARM) aislados de niños paraguayos. Materiales y Métodos: Estudio observacional, descriptivo, de corte transversal. Se colectaron 145 aislados S. aureus que causaron infecciones de piel y tejidos blandos y osteo-articulares en pacientes pediátricos del Hospital Central del Instituto de Previsión Social en el período de diciembre-2012 a noviembre-2013. La resistencia a clindamicina se determinó por métodos automatizados y de difusión de doble disco. Se realizó reacción de polimerasa en cadena para genes ermA, ermB, ermC y msrA de aislados representativos. Resultados: La resistencia global a meticilina y clindamicina fue de 67 y 13%, respectivamente (11% atribuible al mecanismo de resistencia a clindamicina inducible). Los genes ermC y msrA fueron detectados individualmente en 25 y 17% de los aislados, respectivamente, mientras que un aislado presentó ambos genes en simultáneo. Discusión: La frecuencia de mecanismo de resistencia inducible a clindamicina señala la importancia de los métodos de difusión de doble disco en la práctica microbiológica, así como se encuentran en los límites de puntos de cortes considerados como aceptables para el uso de este antimicrobiano para infecciones cutáneas y osteo-articulares causadas por SARM.

Background: The double disc diffusion method is an alternative diagnostic that allows the identification of Staphylococcus aureus isolates apparently susceptible to clindamycin but that may develop resistance due to an induction phenomena, mainly asociated to the increase in resistance to methicillin, thus increasing the possibility of failure in the treatment. Aim: To determine the frequency of induced clindamycin resistance in methicillin-resistant S. aureus (MRSA) isolated from Paraguayan children. Materials and Methods: In this cross sectional study, we collected 145 S. aureus isolates that caused skin and soft tissue and osteoarticular infections in pediatric patients of the Central Hospital I.P.S. in the period from December-2012 to November-2013. Resistance to clindamycin was determined by automated methods and double disc diffusion. PCR was performed for ermA, ermB, ermC and msrA genes from representative isolates. Results: The global resistance to methicillin and clindamycin was 67 and 13%, respectively (11% attributable to the inducible mechanism). The ermC and msrA genes were detected individually in 25 and 17% of the isolates respectively while an isolate presented both genes simultaneously. Discussion: The frequency of inducible resistance to clindamycin indicates the importance of double disc diffusion methods in microbiological practice, as well as being within the cut off points considered acceptable for the use of this antibiotic for skin infections. and osteoarticular caused by MRSA.

Identificación de microorganismos vaginales en pacientes en trabajo de parto pretérmino / Identification of vaginal microorganisms of patients in preterm labor

Resumen OBJETIVO: Identificar los microorganismos vaginales más frecuentes en pacientes en trabajo de parto pretérmino, mediante el A.F. Genital System-Liofilchem®. MATERIALES Y MÉTODOS: Estudio descriptivo, prospectivo y transversal llevado a cabo en pacientes en trabajo de parto pretérmino atendidas en el servicio de Ginecología y Obstetricia de la Fundación Hospital Infantil Universitario de San José de Bogotá, entre julio de 2015 y febrero de 2016 de quienes se obtuvieron muestras de flujo del introito vaginal y se sembraron en el panel del A.F. Genital System-Liofilchem®, de acuerdo con las instrucciones del fabricante. Para el análisis de los datos se utilizó el programa estadístico Stata versión 13 (StataCorp®) y se implementó la prueba no paramétrica de Wilcoxon. RESULTADOS: Los microorganismos aislados con mayor frecuencia fueron: Staphylococcus aureus (89.1%), Ureaplasma urealyticum (43.4%) y Mycoplasma hominis (19.5%). De las muestras positivas para especies de micoplasma, 52.2% tuvo concentración mayor de 105 UFC/mL. De los agentes aislados, Ureaplasma urealyticum y Mycoplasma hominis mostraron resistencia de 100% para clindamicina y eritromicina, respectivamente. CONCLUSIONES: Los microorganismos vaginales representan un factor de riesgo de parto pretérmino. Ureaplasma urealyticum y Mycoplasma hominis muestran resistencia total a clindamicina y eritromicina.

Abstract OBJECTIVE: Determine the frequency of microorganisms present in the vagina of women in preterm labor. MATERIALS AND METHODS: Descriptive, prospective, cross-sectional study of a series of cases of 46 patients treated at the Fundación Hospital Infantil Universitario de San José de Bogotá for preterm labor, who were sampled from the vaginal introitus and planted on the A.F. Genital System-Liofilchem® panel. Genital System by Liofilchem®, according to the manufacturer's instructions. The statistical package Stata version 13 (StataCorp®) was used. The statistical analysis was descriptive, the nonparametric Wilcoxon test was run. RESULTS: The most isolated microorganism was Staphylococcus aureus with a frequency of 89.13%. Ureaplasma urealyticum was detected in 43.48% and Mycoplasma hominis in 19.57 Of the positive samples for genital Mycoplasmas, 52.2% showed a concentration >105 CFU/mL. Ureaplasma urealyticum isolates showed 100% resistance to clindamycin and 100% Mycoplasma hominis for erythromycin. CONCLUSIONS: Microorganisms that have been identified as risk factors for preterm delivery were identified in 93.5% of the vaginal discharge samples. For Ureaplasma urealyticum and Mycoplasma hominis, 100% resistance for clindamycin and erythromycin is identified.

Características clínicas y microbiológicas de las infecciones de piel y tejidos blandos por Staphylococcus aureus en niños de un hospital en Medellín durante los años 2013 a 2015 / Clinical and microbiological characteristics of skin and soft tissue infections caused by Staphylococcus aureus in children in a hospital in Medellin from 2013 to 2015

Resumen Introducción: El principal microorganismo implicado en las infecciones de piel y tejidos blandos (IPTB) es Staphylococcus aureus, con incremento en las cepas resistentes a meticilina en los últimos años. Objetivo: Identificar la frecuencia de S. aureus resistente a meticilina (SARM) en IPTB en niños que consultaron a un hospital de cuarto nivel en la ciudad de Medellín. Métodos: Estudio descriptivo, retrospectivo, a partir de la revisión de historias clínicas. Se incluyeron pacientes menores de 18 años con IPTB causadas por S. aureus que no cumplieran con criterios de enfermedad invasora. Resultados: La prevalencia de SARM en esta población fue de 31%. El principal diagnóstico fue absceso cutáneo (68%), seguido por infección de sitio quirúrgico (15%) y celulitis no purulenta (6%). Tenían alguna co-morbilidad 85% de los pacientes. Todos los aislados fueron sensibles a rifampicina y cotrimoxazol. Ocho por ciento de los aislados fueron resistentes a clindamicina. Se encontró mayor prevalencia de SARM en lactantes comparado con los mayores de 2 años (60 vs 23%, p = 0,0109). Conclusión: Ante la alta prevalencia de SARM en IPTB se recomienda incluir en el tratamiento empírico antimicrobianos con cobertura para estas cepas, principalmente para lactantes.

Background: Skin and soft tissue infections (SSTI) are very common in children and Staphylococcus aureus is the main agent, with an increase of methicillin resistant strains (MRSA) in recent years. Aim: To identify the frequency of MRSA in skin and soft tissue infections (SSTI) in children from a high complex hospital in Medellin, Colombia. Methods: This is a descriptive, retrospective study, information was obtained from medical records. We included patients younger than 18 years with SSTI due to S. aureus who did not meet criteria for invasive disease. Results: The prevalence of MRSA in this population was 31%. The main diagnosis was cutaneous abscess (68%), followed by surgical site infection (15%) and non-purulent cellulitis (6%). Eighty five percent of the patients had at least 1 comorbidity. All isolates were sensitive to rifampicin and cotrimoxazole and 8% of the isolates were resistant to clindamycin. There was a higher prevalence of MRSA in patients under 2 years compared to older (60 vs 23%, p = 0,0109). Conclusion: In view of the high prevalence of MRSA in SSTI, empirical treatment with adequate coverage for MRSA is recommended, especially for patients under 2 years of age.

Impacto de la clindamicina in vitro en la combinación clindamicina - ketoconazol sobre el exopolímero de biopelículas de candida spp de origen urogenital / Impact of in vitro clIndamycIn on the combInatIon of clIndamycIn and ketoconazole on exopolymer of candida spp bIofIlms of urogenItal orIgIn

La mucosa vaginal ha sido utilizada largamente para la administración de antimicrobianos destinados al tratamiento de infecciones endógenas del tracto genital inferior (IETGI) en mujeres embarazadas y no embarazadas. Candida spp elabora biopelículas (BP) y su formación es un proceso complejo que requiere que las células fúngicas establezcan múltiples interacciones con el medio. Las BP están rodeadas por un exopolímero (EPM) que puede restringir la actividad de anticuerpos, la difusión de sustancias y unirse a los antimicrobianos (AM), limitando su acción. Los antimicrobianos (AM) en general y los antimicóticos en particular (AMC) pueden tener dificultades para llegar a las células dentro del EPS. Muchas de las fórmulas que se emplean para el tratamiento empírico usan combinaciones inapropiadas con limitada o nula actividad sobre las biopelículas (BP). La presencia de moléculas que provoquen su inhibición anulando los inductores del EPM o por otro mecanismo, permitirá la actividad del AM específico. Objetivo: demostrar que la actividad de la clindamicina (CLI) en fórmula dual con ketoconazol (KET) actúa sobre BP Candida albicans (CA) y especies no albicans de Candida . (NAC). Métodos: estudiamos la actividad de clindamicina-ketoconazol (CK) sobre la adherencia y dispersión de BP de 8 aislamientos vaginales de CA y 7 de CNA. Se inocularon en 3 tubos con caldo Sabouraud y un dispositivo de vidrio para la formación de la BP según técnica ya descrita. Adherencia: Se incubaron durante 6 horas y se agregó una combinación de CK proveniente del material de óvulos, diluido convenientemente (62,5/260,4 ug/ml), a uno de los tubos de cada aislamiento tomándose como hora 0. Dispersión: esa misma dilución se agregó a otro tubo a las 16 horas. El tercer tubo quedó como testigo sin antimicrobianos. La lectura se efectuó con microscopio óptico a las 24 horas de agregada la combinación CK previa tinción con cristal violeta y se evaluaron con programas fotográficos. Por separado analizamos la actividad de CLI (62,5 ug/ml) y KET (260,4 ug/ml) con técnica similar. Seleccionamos las muestras de 7 pacientes que demostraron candidiasis vulvovaginal (CVV) y las estudiamos con la técnica de capas celulares. Se empleó la combinacion CK para el estudio de la adherencia y dispersión. Resultados: Adherencia se demostró poca influencia de CK en la adherencia con respecto a cada testigo. Dispersión: la influencia de CK se demostró en la mayoría de los aislamientos particularmente en los de CNA que mostraron una mayor presencia de EPM. Las hifas solo se observaron en 1/15 de los aislamientos de Candida spp cuando se agregó CK a las 16 horas. En las BP de las muestras clínicas no aparecieron hifas ni otro elemento micótico en 5/7 con respecto a los testigos. Conclusión: Según estos resultados el uso de una combinación de CK en BP de Candida spp, resulta en una adecuada penetración del AMC demostrada por la dispersión de la BP al cabo de 24 horas. Clindamicina no interfiere con la acción del ketoconazol sino que promovería su actividad anti-candida modificando posiblemente estructuras de superficie y la del EP por inhibición de las moléculas que facilitan la expresión del mismo. In vivo promueve la actividad inmunomoduladora que no se puede demostrar con este modelo in vitro. Su uso combinado en fórmulas duales facilitaría la actividad del AMC sobre Candida spp actuando como inhibidora o modificadora de las BP mediante la dispersión del EPM

The vaginal mucosa has been widely used for administering antimicrobial agents to treat endogenous infections of the lower genital tract in pregnant and non-pregnant women. Candida spp. elaborates biofilms, and its formation is a complex process requiring that fungal cells establish multiple interactions with the medium. Biofilms are surrounded by an exopolymer matrix that can restrict the activity of antibodies, the diffusion of substances, and be associated with antimicrobials, therefore limiting its actions. General antimicrobials and particular anti-mycotic agents can face difficulties to access the cells within the exopolymer matrix. Many formulas used for empirical treatment have improper combinations with limited or null activity on the biofilms. The presence of molecules that cause its inhibition, thus eliminating the exopolymer matrix inducers, or by other mechanism, will allow the specific antimicrobial activity. Objective: To show that the activity of clindamycin used in dual formula with ketoconazole works on Candida albicans biofilm and on non- albicans species of Candida . Methods: We studied the activity of clindamycin and ketoconazole regarding the adherence and dispersion of biofilms from eight vaginal isolates of C. albicans and 7 of non- albicans Candida . The isolates were inoculated in three tubes with Sabouraud agar and a glass device to form the biofilm according to a known technique. Adherence : Each isolate was incubated for a six-hour period and a combination of clindamycin and ketoconazole from the material of ovules was added and conveniently diluted to one of the tubes of each isolate (62.5/260.4 ug/mL), considering 0 hour. Dispersion: The same dilution was added to another tube after 16 hours. The third tube was used as a control without antimicrobials. The reading was carried out with an optical microscope after 24 hours that the clindamycin and ketoconazole combination had been added and colored with crystal violet. They were then evaluated using photographic programs. The activity of clindamycin (62.5 ug/mL) and ketoconazole (260.4 ug/mL) was analyzed alone with a similar technique. We chose vaginal samples from seven patients with vulvovaginal candidiasis and studied them through the cell layer technique. The clindamycin and ketoconazole combination was used for studying the adherence and dispersion. Results: Adherence: Little influence of clindamycin and ketoconazole was seen in adherence regarding each control. Dispersion: The clindamycin and ketoconazole influence was seen in most of the isolates, especially in those of non- albicans Candida that showed higher presence of exopolymer matrix . The hyphae were only seen in 1 of 15 isolates of Candida spp after the clindamycin and ketoconazole were added at the 16th hour. In biofilms of clinical samples, neither hyphae nor mycotic elements were seen in 5 of 7 compared with the controls. Conclusion: According to these results, the use of a clindamycin and ketoconazole combination in biofilms of Candida spp results in proper penetration of the antimicrobial agent, which is seen by the biofilm dispersion during 24 hours. Clindamycin does not interfere with the action of ketoconazole, but it would promote its anti- Candida activity and would possibly modify surface and EP structures through inhibition of the molecules that facilitate its expression. The in vivo model promotes the immunomodulatory activity that in vitro models do not. Its combined use in dual formulas would facilitate the antimicrobial activity on Candida spp, therefore working as an inhibitor or modifier of the biofilms after dispersion of the exopolymer matrix

Efecto del cemento endodóntico modificado con antibióticos en la reducción in vitro de enterococcus faecalis / Effect of cement endodontic modified antibiotics in reduction invitro of enterococcus faecalis

Introducción: determinar el efecto del cemento endodóntico Apexit plus combinado con 5 antibióticos por separado contra el enterococcus faecalis, bacteria resistente y asociada directamente al fracaso endodóntico. Materiales y Método: Se utilizarón cepas de Enterococcus faecalis ATCC 29212, las cuales fuerón cultivadas en infusión cerebro-corazón (BHI) a una temperatura de 37ºC y atmosfera facultativa, pasadas las 24 horas esta concentración bacteriana fue vertida en agar y seguidamente fueron dispensadas en las placas petri. Una vez que el agar estuvo gelidificado, se procedió hacer 3 agujeros o pozos por placa; los antibióticos fueron agregados por separado al cemento endodóntico Apexit plus en proporciones establecidas, y se colo caron en los pozos de las placas petri. Como grupo control se utilizaron los cinco antibióticos puros y el Apexit plus. En total fueron examinados 63 halos de inhibición, los que se midieron a las 24 y 48 horas encontrando que no existen diferencias significativas entre amobs tiempos. Resultados: Demostrarón que de todas las combinaciones antibiótico-apexit, la combinación Amoxicilina y Amoxicilina-Ácido clavulánico poseen el mejor efecto antibacteriano. Se encontró que el grupo metronidazol no tiene ningún efecto antibacteriano. Conclusión: El uso de antibióticos combinados ofrece resultados antimicrobianos más efectivos a nivel in vitro frente a cepas de Enterococcus faecalis. (AU)

Introduccións: This research work aims to determine the effect of endodontic Apexit cement plus combined with 5 antibiotics separately against enterococcus faecalis, bacteria resistant and directly associated with endodontic failure. Materials and methods: For this research was used strains of Enterococcus faecalis ATCC 29212, which were cultivated in infusion brain heart infusion (BHI) to a temperature of 37 ° C and atmosphere facultative, past the 24 hours this concentration bacterial was poured in agar and then were dispensed in the plates petri. Once the agar was gelidificado, we proceeded to make 3 holes or wells per plate; antibiotics were added separately to t he cement endodontic Apexit plus in set proportions, and were placed in the wells of the Petri dishes. As a group control are used them five antibiotics pure and the Apexit plus. In total were examined 63 halos of inhibition, which is measured to the 24 and 48 hours finding that not exist differences significant among both times. Results: The results showed that all combinations of antibiotic-apexit, the combination of amoxicillin and amoxicillin-acid clavulanic acid have better antibacterial effect. The Group found themselves metronidazole has no antibacterial effect. Conclusions: the use of antibiotics combined offers results antimicrobial more effective to level invitro facing strains of Enterococcus faecalis. (AU)

Clindamycin microbial resistance in clinical isolates of Staphylococcus sp. derived from blood cultures of hospitalized patients / Resistência microbiana à clindamicina em isolados clínicos de Staphylococcus sp. provenientes de hemoculturas de pacientes hospitalizados

ABSTRACT Introduction: Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) strains have become common in hospitals, and this resistance has limited patients' treatment with beta-lactam antibiotics. Clindamycin is an important therapeutic agent for MRSA infections; however, inducible macrolide-lincosamide-streptogramin B (MLSB) resistance (iMLSB) has resulted in therapeutic failures with the use of this antimicrobial, with a consequent increase in patient mortality and length of stay. Objective: This study was carried out in order to detect phenotypes of inducible and constitutive resistance to clindamycin in blood culture samples of Staphylococcus sp. from hospitalized patients. Material and methods: A hundred bacterial samples from blood cultures of adult patients were evaluated, identified by conventional phenotypic tests, and subject to determination of susceptibility and resistance profiles with cefoxitin, erythromycin, and clindamycin discs; and to phenotypic evaluation of iMLSB resistance using the D-test. The results were interpreted in accordance with the recommendations of the Clinical and Laboratory Standards Institute (CLSI) 2014. Results: In this study, 65% of 60 bacterial strains were susceptible to cefoxitin and 35%, resistant. The constitutive MLSB (cMLSB) resistance phenotype was observed in 15.56% of the methicillin-sensitive Staphylococcus aureus (MSSA) samples, 33.33% of methicillin-sensitive coagulase-negative Staphylococcus (MSCONS), 26.67% of MRSA and 20% of methicillin-resistant coagulase-negative Staphylococcus (MRCONS), while iMLSB resistance was observed only in strains susceptible to cefoxitin, corresponding to 80% in MSSA and 20% in MSCONS. Conclusion: The D-test is a key test for the constant monitoring of the inducible resistance phenotype (which may impair the effectiveness of treatment with clindamycin), minimizing potential medication errors and adverse clinical outcomes.

RESUMO Introdução: As infecções causadas por cepas de Staphylococcus aureus resistente à meticilina (MRSA) tornaram-se comuns no âmbito hospitalar, e essa resistência limitou o tratamento dos pacientes com antibióticos betalactâmicos. A clindamicina é um importante agente terapêutico para as infecções por MRSA, porém a resistência a macrolídeos, lincosamida e estreptogramina B (MLSB) induzível (iMLSB) tem conferido falhas terapêuticas ao uso desse antimicrobiano, com consequente aumento da mortalidade e do tempo de internação dos pacientes. Objetivo: Este estudo foi realizado com o propósito de detectar fenótipos de resistência constitutiva e induzível à clindamicina em amostras de hemoculturas do gênero Staphylococcus sp. de pacientes internados. Material e métodos: Foram analisadas 100 amostras bacterianas provenientes de hemoculturas de pacientes adultos, as quais foram identificadas por testes fenotípicos convencionais e submetidas à determinação do perfil de sensibilidade e resistência com discos de cefoxitina, eritromicina e clindamicina e à pesquisa fenotípica de resistência iMLSB pelo D-teste. Os resultados foram interpretados de acordo com as recomendações do Clinical and Laboratory Standards Institute (CLSI) 2014. Resultados: Neste estudo, 65% das 60 amostras bacterianas foram sensíveis à cefoxitina e 35%, resistentes. O fenótipo de resistência MLSB constituído (cMLSB) foi observado em 15,56% das amostras de methicillin-sensitive Staphylococcus aureus (MSSA), 33,33% de methicillin-sensitive coagulase-negative Staphylococcus (MSCONS), 26,67% de MRSA e 20% de methicillin-resistant coagulase-negative Staphylococcus (MRCONS), enquanto a resistência iMLSB foi verificada apenas em isolados sensíveis à cefoxitina, correspondendo a 80% em MSSA e 20% em MSCONS. Conclusão: O D-teste é um teste essencial para o monitoramento constante do iMLSB (que pode comprometer a eficácia do tratamento com clindamicina), minimizando possíveis erros terapêuticos e desfechos clínicos desfavoráveis.

Local treatment of toxoplasmic retinochoroiditis with intravitreal clindamycin and dexamethasone / Tratamento local para a retinocoroidite toxoplásmica com clindamicina e dexametasona intravítrea

ABSTRACTPurpose:To report the clinical outcomes of local treatment of toxoplasmic retinochoroiditis (TRC) with intravitreal injections of clindamycin and dexamethasone.Methods:Study population: 16 eyes (16 patients) with active TRC sparing the macula and juxtapapillary area treated with intravitreal injections of clindamycin (1 mg) and dexamethasone (1 mg) without concomitant systemic antitoxoplasmic or anti-inflammatory therapy. Measured parameters: Best-corrected visual acuity (BCVA) was measured by an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. BCVA and clinical characteristics of retinochoroiditis were assessed at baseline and at 1, 3, 6, and 12 months. Primary outcome measures: Resolution of retinochoroiditis and changes in BCVA.Results:Control of TRC was achieved in all cases with a mean interval of 2.48 ± 1.03 weeks (2-6 weeks). A single injection of intravitreal clindamycin and dexamethasone was performed in 12 patients, and four patients required two intravitreal injections, during the follow-up period. Fourteen eyes (87.5%) improved ≥ 2 ETDRS lines of BCVA, of two or more Early Treatment Diabetic Retinopathy Study lines, BCVA remained stable in two eyes (12.5%), and no patient had decreased BCVA at the end of the follow-up period. No ocular or systemic adverse events were observed.Conclusion:Local treatment with intravitreal injections of clindamycin and dexamethasone without concomitant systemic therapy was associated with resolution of TRC in patients without macular or juxtapapillary involvement. Intravitreal clindamycin and dexamethasone may represent a viable treatment option in patients with allergies or inadequate responses to oral medications.

RESUMOObjetivo:Reportar os resultados clínicos do tratamento local da retinocoroidite toxoplásmica com injeções intravítreas de clindamicina e dexametasona.Métodos:População do estudo: 16 olhos (16 pacientes) com retinocoroidite toxoplásmica ativa sem comprometimento da mácula e da área juxtapapilar, tratados com injeções intravítreas de clindamicina (1 mg) e dexametasona (1 mg) sem terapia sistêmica anti-toxoplásmica ou anti-inflamatória concomitante. Procedimento de observação: A melhor acuidade visual corrigida (BCVA) foi medida através da tabela ETDRS. A BCVA e as características clínicas da retinocoroidite foram avaliadas na qualificação, primeiro, terceiro, sexto e 12º mês. Medidas do resultado principal: resolução da retinocoroidite e mudanças na BCVA.Resultados:O controle da retinocoroidite toxoplásmica foi atingido em todos os casos com um intervalo médio de 2,48 ± 1,03 semanas (intervalo de 2 a 6 semanas). Uma única injeção intravítrea de clindamicina e dexametasona foi aplicada em 12 pacientes, e quatro pacientes precisaram de duas injeções durante o seguimento. Quatorze olhos (87,5%) melhoraram ≥ 2 linhas ETDRS de BCVA, a BCVA ficou estável em 2 olhos (12,5%) e nenhum paciente apresentou diminuição da acuidade visual no final do seguimento. Não foram observados eventos adversos sistêmicos ou oculares.Conclusão:O tratamento local com injeções intravítreas de clindamicina e dexametasona sem terapia sistêmica concomitante esteve associado com a resolução da retinocoroidite toxoplásmica em pacientes sem comprometimento macular ou juxtapapilar. A clindamicina e dexametasona intravítrea representam um tratamento promissor em pacientes com intolerância, contraindicação ou resposta inadequada a medicação oral.

Resistencia a la clindamicina inducida por eritromicina en cepas de Staphylococcus aureus de origen clínico / Clindamycin Resistance Induced by Erythromycin in Strains of Staphylococcus Aureus of Clinical Origin

Staphylococcus aureus es un importante patógeno involucrado en una serie de infecciones cuyo impacto se incrementa por sus múltiples factores de virulencia y su resistencia a los antimicrobianos. La resistencia a clindamicina inducida por eritromicina constituye un problema creciente en diversas partes del mundo. Este estudio fue de tipo retrospectivo y se analizó el comportamiento frente a los antimicrobianos de 4307 cepas de Staphylococcus aureus aisladas en un hospital de la ciudad de Maracaibo entre enero 2006 y diciembre de 2013. Se determinó la frecuencia de resistencia a clindamicina inducida por eritromicina, su asociación con la resistencia a oxacilina y el origen biológico de las muestras a partir de las cuales se aisló el microorganismo. La susceptibilidad a oxacilina se comprobó mediante el método de difusión con discos en agar y la resistencia inducida a clindamicina usando la prueba D-test. Se detectaron 60 cepas D-Test positivo (1,39%), de las cuales 38(63,33%) fueron sensibles a meticilina y 22 cepas fueron resistentes (36,67%). La resistencia total a clindamicina (constitutiva e inducida) representó el 31,43% (1354) del total de cepas evaluadas. La frecuencia de resistencia inducida a clindamicina en cepas de Staphylococcus aureus en la localidad es aún baja tanto en cepas sensibles como resistentes a meticilina.

Staphylococcus aureus is an important pathogen involved in a series of infections whose impact is increased by its multiple factors of virulence and antimicrobial resistance. Erythromycin-induced clindamycin resistance is a growing problem in various parts of the world. This study was retrospective and analyzed the behavior in response to antimicrobials of 4307 strains of Staphylococcus aureus isolated in a hospital in the city of Maracaibo between January 2006 and December 2013. The frequency of erythromycin-induced clindamycin resistance, its association with resistance to oxacillin and the biological origin of the samples from which the microorganism was isolated were determined. Susceptibility to oxacillin was checked by diffusion method with disk agar and the induced clindamycin resistance was evaluated using the D-test. 60 D-Test positive strains were detected (1.39%), of which 38 (63.33%) were sensitive to methicillin and 22 strains were resistant (36.67%. The total resistance to clindamycin (constitutive and induced) represented 31.43% (1354) of the total number of strains tested. The frequency of induced resistance to clindamycin in Staphylococcus aureus strains in the locality is still low for both methicillin sensitive and resistant strains.

Manejo de toxoplasmosis ocular severa con clindamicina y triamcinolona intravitreas: reporte de 22 casos / Management of severe ocular toxoplasmosis with intravitreal clindamycin and triamcinolone: report of 22 cases

Objetivo: determinar la eficacia del uso secuencial de clindamicina - triamcinolona intravítreas en el tratamiento de la toxoplasmosis retinal severa (definida como aquella que afecta la macula y/o el nervio óptico) y de las toxoplasmosis atípicas difusas. Métodos: se evaluaron prospectivamente 22 ojos de 22 pacientes con diagnóstico de toxoplasmosis retinal severa, manejados con clindamicina intravítrea (4,5mg/0,03 cc) seguida, una semana después, de la aplicación de triamcinolona intravítrea (4mgs/0,1 cc). La agudeza visual se midió y se convirtió a LogMAR y se realizó una comparación con la prueba de Wilcoxon para establecer diferencias. Resultados: el 82% (18 pacientes) de los ojos tratados con este esquema presentaron mejoria de la agudeza visual, el 9 % (2 pacientes), se estabilizaron, el 9% (2 pacientes), empeoraron después del tratamiento. Sin tratamiento, el 74% de los pacientes (16 pacientes) tenían visión menor a 20/200. Con el tratamiento, este porcentaje disminuyó al 26% (6 pacientes). La agudeza visual expresada en LogMAR cambió después del tratamiento, pasando de 1.05 antes del tratamiento a 0,51, con una significancia estadística valor de p=0.002. Luego del tratamiento, 12 de los 22 pacientes (54%), estaban por encima de 20/50, logrando 20/20 en tres casos y 20/25 en cinco casos. No se observaron casos de hipertensión ocular, y se reportaron cinco complicaciones durante el tratamiento. Conclusiones: el tratamiento de toxoplasmosis retinal severa con el esquema de clindamicina intravítrea seguida de triamcinolona intravítrea muestra resultados positivos. Este tratamiento se puede recomendar para casos de toxoplasmosis retinales severas, definidas como aquellas que comprometen mácula, nervio óptico o toxoplasmosis difusas atípicas.

Objective: to determine the efficacy of sequential use of intravitreal clindamycin - intravitreal triamcinolone in the treatment of retinal toxoplasmosis severe (defi ned as one that affects the macula and / or the optic nerve) and diffuse atypical toxoplasmosis. Methods: we prospectively evaluated 22 eyes of 22 patients diagnosed with severe retinal toxoplasmosis, managed with intravitreal clindamycin (4,5mg/0,03 cc) followed a week later, the application of intravitreal triamcinolone(4mgs/0,1 cc). Visual acuity was measured and converted to LogMAR. Comparisons were made using Wilcoxon test. Results: 82% (18 patients) of eyes treated with this system showed improved visual acuity, 9% (2 patients), stabilized, 9% (2 patients), worsened after treatment. Without treatment, 74% of patients (16 patients) had less than 20/200 vision. With treatment, this percentage decreased to 26% (6 patients). Visual acuity in LogMAR changed after treatment from 1,05 to 0,51 with statistical significance p=0,002. After treatment, 12 of 22 patients (54%) were above 20/50, 20/20 achieved in three cases and 20/25 in five cases. No cases of ocular hypertension and five complications were reported during treatment. Conclusions: The treatment of severe retinal toxoplasmosis with clindamycin scheme followed by intravitreal triamcinolone shows positive results. This treatment could be recommended for severe cases of retinal toxoplasmosis, defined as those that involve the macula, optic nerve, or diffuse atypical toxoplasmosis.

Prevalência de resistência constitutiva e induzível à clindamicina em cocos Gram positivos isolados de pacientes hospitalizados em Santa Maria, RS / Prevalence of clindamycin constitutive and inducible resistance in Gram positive cocci isolated from hospitalized patients in Santa Maria, RS

O objetivo deste estudo foi determinar a prevalência de resistência constitutiva e induzível à clindamicina em pacientes hospitalizados . Foram analisados 63 isolados de diversos sítios infecciosos de pacientes internados em um hospital privado de Santa Maria - RS, Brasil. Para determinação dos mecanismos de resistência foi utilizado o método de difusão em disco (D-teste). Foi verificado que três cepas de Staphylococcus aureus (4,8%) apresentaram-se positivas no D-teste, ou seja, exibiram resistência induzível à clindamicina (MLSBi), possivelmente pela presença do gene em (A), em microrganismos dessa espécie. Ademais, foi observado a presença de resistência constitutiva (MLSBc)em 22 amostras, caracterizando, possivelmente, a presença do gene em (B), em Streptococcus sp e em (C), em Staphylococcus sp. A prevalência do mecanismo de resistência, mediado por bomba de efluxo, em 19 amostras foi caracterizada, provavelmente pela presença do gene mrsA. A introdução de mudanças, na rotina do laboratório, através da inclusão do D-teste deve ser encorajada. A pesquisa desses mecanismos de resistência são de elevada importância na escolha e eficácia terapêutica, pois representam, na prática, uma maior segurança para os pacientes e evitam a troca desnecessária de medicação e, consequentemente, a falha terapêutica.

Evaluación de la citotoxicidad de la Clindamicina en cultivos de fibroblastos gingivales humanos / Evaluation of the cytotoxicity of Clindamycin in cultures of gingival human fibroblasts

Introducción: la presencia de microorganismos residuales post-preparación químico-quirúrgico de los conductos radiculares, sugiere el empleo de medicación intracanal eficaz y biológicamente compatible con los tejidos periapicales. Objetivo: comparar la citotoxicidad de medicaciones de uso intracanal en fibroblastos gingivales humanos. Métodos: estudio de tipo experimental. Con cuatro diferentes grupos: control (G1), Clorhidrato de Clindamicina 2g asociado a fosfato de dexametasona 0,32g (Clindex) vehiculado en solución alcohólica (G2), Clindex Vehiculado en polietilenoglicol 400 (G3), y NDP: paramonoclorofenol asociado a fosfato de dexametasona 0,32g vehiculado en polietilenoglicol 400 y solución salina (G4). Las células fueron estimuladas con las medicaciones por 24, 48 y 72 horas y la viabilidad celular fue evaluada usando la técnica de análisis de MTT y la lectura fue realizada en el espectrofotómetro de ELISA. Resultados: fueron analizados por medio de la actividad mitocondrial y mostraron que el G2 obtuvo los mejores resultados en los tres tiempos estudiados, seguido por el G3 y el G4. Se realizó análisis estadístico (ANOVA y complementado con la prueba de Tukey) mostraron diferencias significante a nivel de 1% G2 y G3 cuando se compararon con el G4. Conclusión: la combinación Clindamicina dexametasona independiente del vehículo presentó mayor viabilidad celular que el paramonoclorofenol asociado a fosfato de dexametasona.

Introduction: the presence of residual microorganisms after chemical-surgical preparation of root canals suggests the use of effective intracanal medication, biologically compatible with periapical tissues. Objective: compare the cytotoxicity of intracanal medications in gingival human fibroblasts. Methods: an experimental study was conducted with four different groups: control (G1), Clindamycin Hydrochloride 2g associated to dexamethasone phosphate 0.32g (Clindex) vehicled in alcoholic solution (G2), Clindex vehicled in polyethylene glycol 400 (G3), and NDP: paramonochlorophenol associated to dexamethasone phosphate 0.32g vehicled in polyethylene glycol 400 and saline solution (G4). The cells were stimulated with the medications for 24, 48 and 72 hours. Cell viability was evaluated with the technique of MTT analysis. Readings were performed in an ELISA spectrophotometer. Results: the groups were analyzed in terms of mitochondrial activity. G2 had the best results in the three times studied, followed by G3 and G4. A statistical analysis was performed (ANOVA and complemented by Tukey's test). Significant differences of 1% were found when comparing G2 and G3 with G4. Conclusion: the Clindamycin dexamethasone combination, irrespective of the vehicle, showed greater cell viability than paramonochlorophenol associated to dexamethasone phosphate.

Análise microbiológica da placa bacteriana da doença periodontal em cães e o efeito da antibioticoterapia sobre ela / Microbiological analysis of bacterial plaque of periodontal disease on dogs and effects of antibioticotherapy on it

Objetivou-se determinar a microbiota da placa bacteriana subgengival de cães com doença periodontal (DP) e estabelecer o efeito da antibioticoterapia. Avaliaram-se 20 cães com graus variados de DP e coletaram-se amostras da placa bacteriana subgengival antes e após antibioticoterapia. Preconizou-se antibioticoterapia distinta em dois grupos, com 10 animais cada: clindamicina (G1) e metronidazol + espiramicina (G2). Observou-se crescimento bacteriano subgengival na maioria dos cães com DP e correlação entre a severidade da DP e a idade dos animais. Houve redução significativa no crescimento bacteriano após a antibioticoterapia e o antibiograma demonstrou maior sensibilidade à clindamicina, seguido da espiramicina; todos os microrganismos foram resistentes ao metronidazol.

The objective was to determine microbiote of the subgingival bacterial plaque of dogs with periodontal disease (PD) and establish the effect of antibioticotherapy on its reduction. Twenty dogs with varied stages of PD were evaluated and samples of their subgingival bacterial plaque were collected. Distinct antibiotic protocols were used in two groups with ten animals each: clindamycin (G1) and metronidazole + espiramycin (G2). New subgingival samples were collected 15 days after antibiotic therapy started. There were observed subgingival bacterial culture on most dogs with PD and correlation between severity of PD and age. There was reduction of bacterial growth in 20 percent of the samples after treatment and antibiogram showed higher sensibility to clindamycin, followed by espiramycin - all microorganisms were resistant to metronidazole.

Eficácia da combinação tópica de peróxido de benzoíla 5 por cento e clindamicina 1 por cento para o tratamento da hipomelanose macular progressiva: um estudo randomizado, duplo-cego, placebo-controlado / Efficacy of topical combination of benzoyl peroxide 5 percent and clindamycin 1 percent for the treatment of progressive macular hypomelanosis: a randomized, doubleblind, placebo-controlled trial

FUNDAMENTOS: A hipomelanose macular progressiva é uma dermatose sem etiologia definida. Não há consenso ou medicação de primeira linha para o seu tratamento e os tratamentos utilizados são pouco eficazes. OBJETIVO: Avaliar a eficácia terapêutica da combinação tópica de peróxido de benzoíla 5 por cento e clindamicina 1 por cento associada à exposição solar para o tratamento da hipomelanose macular progressiva. MATERIAIS E MÉTODOS: Trata-se de um estudo randomizado, duplo-cego, placebo-controlado, no qual os pacientes foram divididos em dois grupos: o Grupo A utilizou a combinação tópica de peróxido de benzoíla 5 por cento e clindamicina 1 por cento e o Grupo B usou um creme gel como placebo. Os pacientes foram orientados à exposição solar diária, avaliados e fotografados sistematicamente. Os dados coletados foram inseridos e analisados pelo software Epi Info. Definiu-se a significância estatística por valor de p<0,05. RESULTADOS: Dos 23 pacientes incluídos, 13 foram do Grupo A e 10, do Grupo B. Onze pacientes do primeiro grupo (85 por cento) obtiveram melhora clínica importante e apenas dois (20 por cento) do segundo grupo obtiveram uma melhora clínica equivalente (p=0,003). Os efeitos colaterais foram mais frequentes nos pacientes do Grupo A (p=0,003). CONCLUSÃO: A combinação tópica de peróxido de benzoíla 5 por cento e clindamicina 1 por cento é eficaz no tratamento da hipomelanose macular progressiva.

BACKGROUND: Progressive macular hypomelanosis is a dermatosis without definite etiology. There is no consensus or first-line therapy in the treatment of progressive macular hypomelanosis, and the treatment options used are very little effective. OBJECTIVE: To evaluate the therapeutic efficacy of the topical combination of benzoyl peroxide 5 percent and clindamycin 1 percent associated with sun exposure for the treatment of progressive macular hypomelanosis. MATERIALS AND METHODS: This is a randomized, double-blind, placebo-controlled study in which patients were divided into two groups. Group A used the topical combination of benzoyl peroxide 5 percent and clindamycin 1 percent and Group B used gel cream as a placebo. Patients were advised to expose themselves to the sun on a daily basis and were systematically evaluated and photographed. The collected data were entered and analyzed using Epi Info. A p value < 0.05 was considered statistically significant. RESULTS: Out of the 23 patients included in the study, 13 were in group A and 10 in group B. Eleven patients (85 percent) in group A had significant clinical improvement and only two patients (20 percent) in group B showed an equivalent clinical improvement (p = 0.003). Side effects were more frequent in group A (p = 0.003). CONCLUSION: The topical combination of benzoyl peroxide 5 percent and clindamycin 1 percent is effective in the treatment of progressive macular hypomelanosis.

Eficacia de la clindamicina como antibioticoterapia profiláctica en la cirugía de los terceros molares

El uso de antibiótico-terapia profiláctica en pacientes sanos sometidos a cirugía bucal es una constante a pesar de ser éste un tema controversial. La Asociación Americana de Cardiología (A.H.A) establece como primera elección en antibioticoterapia profiláctica a la penicilina y dado que un porcentaje importante de la población es alérgico a este antimicrobiano, determina en estos casos que la Clindamicina es una de las drogas indicada para tal fin. El objetivo de este estudio fue determinar la efectividad de la Clindamicina como antibioticoterapia profiláctica en la cirugía de los terceros molares. Para tal fin fueron seleccionados al azar 90 pacientes con indicación de cirugía de los terceros molares, provenientes de la sala clínica de postgrado de la Facultad de Odontología de la U.C.V. a quienes se les asignó el tratamiento farmacológico estableciendo 6 grupos de 15 pacientes: el grupo A recibió 2 cápsulas de 300 miligramos de Clindamicina para su administración una hora antes de la Cirugía. El grupo A1 recibió 4 cápsulas de 500 miligramos de Amoxicilina (TrimoxalÒ) para su administración una hora antes de la Cirugía. El grupo B recibió 12 cápsulas de 300 miligramos de Clindamicina para ser administradas a razón de 1 cápsula cada 6 horas, por vía oral, comenzando una hora antes de la cirugía hasta por tres días después de la cirugía de los terceros molares. El grupo B1 recibió 21 cápsulas de 500 miligramos de Amoxicilina (TrimoxalÒ) para ser administradas a razón de 1 cápsula cada 8 horas, por vía oral durante 7 días después de la cirugía de los terceros molares. Los grupos C y C1 no recibieron antibioticoterapia sino Placebo. Adicionalmente, todos los grupos recibieron como terapia analgésica y anti-inflamatoria 600 miligramos de Ibuprofeno (MotrínÒ) cada 6 horas, por vía oral, por tres días. Se realizaron varios controles evaluando la presencia de dolor, exudado, mal olor y mal sabor como síntomas y signos de infección. La evaluación de resultados demostró que la clindamicina es tan efectiva como la amoxicilina en cualquiera de los esquemas terapéuticos propuestos. De acuerdo a nuestros resultados es recomendable indicar el esquema de una sola dosis de Clindamicina antes de la intervención quirúrgica en pacientes alérgicos a la Penicilina.

The use of the prophylactic therapy in healthy patients under surgery oral procedures is still controversial. In accordance to the American Academy of Cardiology, penicillin continues to be the antibiotic of choice for patients who are to undergo certain dental procedures as a third molars extraction. For patients allergic to penicillin, the antibiotic of choice is Clindamycin. The aim of this study was to determine the effectivity of the clindamycin as a prophylactic therapy in the surgery of third molars. We included ramdonly 90 patients who required third molars extraction from the School of Dentistry, Universidad Central de Venezuela distributed in six groups of 15 patients. The individuals in the drug treatment A group received 2 capsules of 300 mg of Clindamycin (DalacinÒ) to be used one hour before surgery. The A1 group received 4 capsules of 500 mg of Amocicillin (TrimoxalÒ) to be used 1 hour before surgery. The B group received a prophylactic regimen of 12 capsules of Clindamycin orally, 1 capsule every six hours, starting one hour before surgery, until 3 days after third molar extraction. The B1 group received 21 capsules of Amoxicillin 500 mg (TrimoxalÒ) to be administered 1 capsule every 8 hours, orally for 7 days after surgery. C and C1 groups were control groups who did not receive any type of prophylaxis . Aditionally all the groups received as a analgesic and antiinflamatory therapy, Ibuprofen (MotrínÒ) orally every six hours for 3 days. We evaluated some variables including presence of pain, exudate, infection. Ours results demonstrate that the Clyndamycin had the same efficacy than the Amocicillin for all the groups. We recomendad the administration of one dose of Clindamycin as the antibiotic prophylaxis in the third molar extractions in patients allergic to penicillin.

Resistencia inducible a clindamicina en Staphylococcus aureus meticilino resistente / Clindamycin inducible resistance in methicillin-resistant Staphylococcus aureus

The increase in methicillin-resistant Staphylococcus aureus (MRSA) infections has limited the use of efective available antibiotics. Clindamycin, an alternative against MRSA, might have inducible resistance that is not detected by common antibiograms. The disk diffusion method (D-test) detects the inducible resistance. Objetive: To establish the frecuency of inducible resistance in MRSA from blood and secretion samples obtained from hospitalyzed patients. Methods: Prospective and descriptive research, including MRSA positive blood and secretion samples from patients of Hospital Luis Calvo Mackenna, between July 2005-July 2006. A D-test was performed to the samples. Results: 220 MRSA samples were obtained and D-test was performed on 155 of them. 80 percent of the samples carne from tracheobronquial secretion and 90 percent> had used antibiotics. From all analyzed MRSA isolates, 32 (20.6 percento) were Clindamycin susceptible and 14 (43.8 percent) had Clindamycin inducible resistance (D-test+). Conclusions: A high percentage of MRSA Clindamycin resistant was found. From MRSA Clindamycin susceptible, 43.8 percent> had Clindamycin inducible resistance (D test+). D-test was implemented in the Microbiology Laboratory at Hospital Luis Calvo Mackenna, allowing the identification of MRSA isolates suceptible to Clindamicyn treatment.

El aumento de infecciones por Staphylococcus aureus meticilino resistente (SAMR) ha disminuido las alternativas de antimicrobianos efectivos. Clindamicina, una alternativa contra SAMR, puede presentar resistencia inducible no detectable con antibiogramas habituales. El test de difusión en disco (D test) detecta esta resistencia inducible. Objetivo: Determinar la frecuencia de resistencia inducible a clindamicina en muestras de sangre y/o secreciones positivas para SAMR de pacientes del hospital. Materiales y Métodos: Estudio prospectivo descriptivo, incluyó muestras de sangre y secreciones positivas para SAMR de pacientes del Hospital Luis Calvo Mackenna, recolectadas entre Julio 2005 y Julio 2006. A cada muestra se le realizó el D-test estandarizado según pautas CLSI. Resultados: Se recolectaron 220 cepas de SAMR, se realizó D test a 155. El 80 por ciento de las muestras era secreción tráqueo-bronquial. El 90 por ciento tenía antecedente de uso de antimicrobianos. Del total de cepas estudiadas, 32 (20,6 por ciento) resultó sensible a clindamicina y 14 (43,8 por ciento) presentaron resistencia inducible a clindamicina (D-test +). Discusión: Se encontró alto porcentaje de SAMR resistentes a clindamicina en nuestro medio hospitalario. Aquellos SAMR informados como sensibles a clindamicina, 43,8 por ciento presenta resistencia inducible a clindamicina (D-Test +). Se implemento en el Laboratorio de Microbiología la técnica de D test, permitiendo identificar cepas de SAMR susceptibles de tratar con clindamicina.