Caracterización clínico epidemiológica de los pacientes con infecciones por estafilococo dorado / Clinical-epidemiological characterization of patients with Staphylococcus aureus infections

RESUMEN Introducción: El estafilococo dorado es una causa importante de morbilidad y mortalidad en el mundo. En Cuba, es un germen a tener en cuenta como causa de infección intrahospitalaria. Objetivo: Caracterizar, clínica y epidemiológicamente, una muestra de pacientes con infecciones causadas por estafilococo dorado. Métodos: Se realizó un estudio observacional, descriptivo y transversal en el Hospital Militar "Dr. Mario Muñoz Monroy" de Matanzas, durante el período de enero a diciembre del año 2014. La población estuvo constituida por la totalidad de los pacientes hospitalizados con el diagnóstico de infección por estafilococo dorado (120 casos), identificados por el departamento de Microbiología; luego se revisaron las historias clínicas de las cuales se obtuvo la información. Resultados: Existió un predominio del sexo masculino (64,2 por ciento), los mayores de 60 años fueron los más afectados (36,7 por ciento). La diabetes mellitus fue la enfermedad asociada más frecuente (40,8 por ciento) y la mayoría de las infecciones fueron de origen comunitario (67,5 por ciento). Los aislamientos predominaron en las muestras tomadas de las lesiones en piel y los hemocultivos con un 50,8 por ciento y 19,2 por ciento, respectivamente. Se evidenció baja sensibilidad a la vancomicina (49,2 por ciento) y al cotrimoxazol (38,3 por ciento). Conclusiones: Las infecciones por estafilococo dorado fueron más frecuentes en pacientes masculinos geriátricos de su origen extrahospitalario. El germen presentó alta resistencia a los antibióticos y de estos, los aminoglucósidos mostraron la mayor sensibilidad antimicrobiana(AU)

Introduction: Staphylococcus aureus is an important cause of morbidity and mortality in the world. In Cuba, it is a germ to be taken into account as a cause of nosocomial infection. Objective: To characterize, clinically and epidemiologically, a sample of patients with infections caused by Staphylococcus aureus. Methods: An observational, descriptive and cross-sectional study was conducted at the Military Hospital "Dr. Mario Muñoz Monroy "of Matanzas, during the period from January to December of the year 2014. The population was constituted by all the patients hospitalized with the diagnosis of infection by Staphylococcus aureus (120 cases), identified by the department of Microbiology; then the medical records from which the information was obtained were reviewed. Results: There was a predominance of males (64.2 percent) those over 60 were the most affected (36.7 percent). Diabetes mellitus was the most frequent associated disease (40.8 percent) and the majority of infections were of community origin (67.5 percent). Positivity predominated in samples taken from skin lesions and blood cultures with 50.8 percent and 19.2 percent, respectively. Low sensitivity to vancomycin (49.2 percent) and cotrimoxazole (38.3 percent) was evidenced. Conclusions: Staphylococcus aureus infections were more frequent in geriatric male patients of out-of-hospital origin. The germ showed high resistance to antibiotics and of these, the aminoglycosides showed the highest antimicrobial sensitivity(AU)

The Real Practice of Antibiotic Prophylaxis for Prostate Biopsy in Korea Where the Prevalence of Quinolone-Resistant Escherichia coli Is High

PURPOSE: Transrectal ultrasonography-guided prostate biopsy (TRUS-Bx) is an essential procedure for diagnosing prostate cancer. The American Urological Association (AUA) Guideline recommends fluoroquinolone alone for 1 day during TRUS-Bx. However, this recommendation may not be appropriate in regions where the prevalence of quinolone-resistant Escherichia coli is high. We investigated the real practice of antibiotic prophylaxis for TRUS-Bx in Korea. MATERIALS AND METHODS: A total of 77 hospitals performing TRUS-Bx were identified and an e-mail was sent to the Urology Department of those hospitals. The questions in the e-mail included the choice of antibiotics before and after the procedure and the duration of antibiotic therapy after TRUS-Bx. RESULTS: A total of 54 hospitals (70.0%) responded to the e-mail. Before TRUS-Bx, all hospitals administered intravenous antibiotic prophylaxis. The percentage of hospitals that used quinolone, cephalosporin, and aminoglycoside alone was 48.1%, 20.4%, and 9.3%, respectively. The percentage of hospitals that used two or more antibiotics was 22.2%. After biopsy, all 54 hospitals prescribed oral antibiotics. The percentage of hospitals that prescribed quinolone alone, cephalosporin alone, or a combination of two or more antibiotics was 77.8%, 20.4%, and 1.8%, respectively. The duration of antibiotic use was more than 3 days in most hospitals (79.6%). Only four hospitals (7.4%) followed the AUA recommendation of a 1-day regimen. CONCLUSIONS: The AUA recommendation was not followed by most hospitals in Korea. This clinical behavior might reflect the high quinolone resistance rate in Korea, and further studies on the most efficient prophylactic antibiotics after TRUS-Bx in Korea are warranted.

The Real Practice of Antibiotic Prophylaxis for Prostate Biopsy in Korea Where the Prevalence of Quinolone-Resistant Escherichia coli Is High

PURPOSE: Transrectal ultrasonography-guided prostate biopsy (TRUS-Bx) is an essential procedure for diagnosing prostate cancer. The American Urological Association (AUA) Guideline recommends fluoroquinolone alone for 1 day during TRUS-Bx. However, this recommendation may not be appropriate in regions where the prevalence of quinolone-resistant Escherichia coli is high. We investigated the real practice of antibiotic prophylaxis for TRUS-Bx in Korea. MATERIALS AND METHODS: A total of 77 hospitals performing TRUS-Bx were identified and an e-mail was sent to the Urology Department of those hospitals. The questions in the e-mail included the choice of antibiotics before and after the procedure and the duration of antibiotic therapy after TRUS-Bx. RESULTS: A total of 54 hospitals (70.0%) responded to the e-mail. Before TRUS-Bx, all hospitals administered intravenous antibiotic prophylaxis. The percentage of hospitals that used quinolone, cephalosporin, and aminoglycoside alone was 48.1%, 20.4%, and 9.3%, respectively. The percentage of hospitals that used two or more antibiotics was 22.2%. After biopsy, all 54 hospitals prescribed oral antibiotics. The percentage of hospitals that prescribed quinolone alone, cephalosporin alone, or a combination of two or more antibiotics was 77.8%, 20.4%, and 1.8%, respectively. The duration of antibiotic use was more than 3 days in most hospitals (79.6%). Only four hospitals (7.4%) followed the AUA recommendation of a 1-day regimen. CONCLUSIONS: The AUA recommendation was not followed by most hospitals in Korea. This clinical behavior might reflect the high quinolone resistance rate in Korea, and further studies on the most efficient prophylactic antibiotics after TRUS-Bx in Korea are warranted.

Optimal aminoglycoside therapy following the sepsis: how much is too much?

Severe sepsis and septic shock are major problems as the result of high rates morbidity and mortality in intensive care units [ICUs]. In the presence of septic shock, each hour of delay in the administration of effective antibiotics is associated with a measurable increase in mortality. Aminoglycosides are effective broad-spectrum antibiotics that are commonly used in ICUs for the treatment of life-threatening Gram-negative infections and as a part of empiric therapy for severe sepsis and septic shock. Knowledge of the pharmacokinetic [PK] and pharmacodynamic [PD] properties of the antibiotics used for the management of critically ill patients is essential for selecting the antibiotic dosing regimens and improving patient outcome. Volume of distribution [Vd] and clearance [CL] of aminoglycosides in critically ill patients differs from general population and these parameters change considerably during the therapy. Pathophysiological changes during the sepsis alter the pharmacokinetic and pharmacodynamic profile of many drugs [increase in Vd and variable changes in CL have been reported for aminoglycosides during the sepsis], therefore, dosing regimen optimization is necessary for achieving therapeutic goal, and critically ill patients should receive larger loading doses of aminoglycosides in order to achieve therapeutic blood levels and due to the considerable variation in kinetic parameters, the use of standard doses of aminoglycosides or dosing nomograms is not recommended in these populations

[Separation and determination of some aminoglycosides antibiotics in injectable pharmaceutical formulations [ampoules] and biological medium [serum] by using reversed phase high performance liquid chromatography Rp-HPLC]

The separation and determination some Aminoglycosides Antibiotics [Amikacin, Tobramicin, Gentamicin] which is considerd non fluorescent compounds [lack of chromophore] after pre-column derivatization with ortho-phthaldehyde [OPA]were done by using reversed phase high performance liquid chromatography RP-HPLC and fluorescence detector [excitation 340 nm, emission 450nm]. Method was developed based on mixture [water: methanol: acetonitrile] ratio [60:35:5] as the mobile phase, flow rate 1ml/min and octadecyle column ODS c18 [250x4.6]. The mixture of three aminoghyccosides Antibiotics was separated and determined by the same mobile phase and same conditions, In addition, this method was applied for separation and determination of Amikacin in serum after liquid/ solid extraction technique. The extraction recoveries for standard sequence were between [95-104.3%] and regression coefficient=0.9997, limit of detection LOD=[0.01 micro g/ml] and limit of quantitation LOQ=[0.3 micro g/ml]. The validation for this method improved system suitability for qualitative studies through retention time, peak shape, selectivity and resolution and for quantitative studies through precision, accuracy, recovery, and linearity

Caracterización de la resistencia a aminoglicósidos mediada por enzimas modificadoras y metilasas de ARN16S en aenterobacterias / Characterization of resistance to aminoglycoside mediated by modifying enzymes and methylases ARN16S in aenterobacterias

Los aminoglicósidos son antimicrobianos ampliamente usados en la práctica clínica. El objetivo del estudio fue evaluar fenotípica y genotípicamente la resistencia a aminoglicósidos en enterobacterias aisladas de centros de salud del área metropokitana de caracas. Se estudiaron 76 cepas de enterobacterias (14 Escherichia coli, 34 klebsiella pneumoniae, 6 Serratia marcescens, 1 citrobacer freundii, 3 Enterobacter aerogenes y 18 Entorabacter cloacae) aisladas de muestras clínicas de pacientes de 11 centros hospitalarios de Caracas entre noviembre 2009 y marzo 2010, incluyéndose solo cepas con resistencia a aminoglicósidos. La identificación bioquímica fue realizada por métodos convencionales y mediante el sistema automatizado VITEK-2. Se determinó su suseptibilidad antibiótica por la técnica de difusión con discos de gentamicina, amikacina, netilmecina y tobramicina según lo establecido por CLSI 2010. Los genes de resistencia se investigaron por PCR empleando iniciadores para los genes codificantes de las enzimas AAC(3')la, AAC(3') lla AAC(6')lb, ANT(2')la, AAC(6')lbcr, APH(3') Vla y las metilasa armA, rmtA, rmtB, rmtC, rmtD y npmA. Fenotípicamente se detectó que 90,8 % de las cepas fueron resistentes a amikacina y 57,9 % presentaron resistencia cruzada a amikacina, gentamicina, tobramicina y netilmicina. De las enzimas modificadoras investigadas la más prevalente fue APH(3')Vla (56,6%) y de las metilasas la RmtD (25 %). Estos resultados sugieren que la APH(3')Vla pudiera ser la responsable de generar altos niveles de resistencia a amikacina en estas cepas, mientras que la RmtD podría ser la causante de la resistencia cruzada a amikacina, gentamicina, tobramicina y netilmicina.

Aminoglycosides are antimicrobials widely used in clinical practice. The objective of this study was to assess from a phenotypic and genotypic point of view aminoglycoside resistance in enterobacteria isolated from health centers in the metropitan area of Caracas. Seventy six enterobacteriaceae isolates (14 Escherichia coli 34 Klebsiella pneumoniae, 6 serratia marcescens, 1 Citrobacter freundii, 3 Enterobacter aerogenes and 18 Enterobacter cloacae) from clinical samples of patientes from 11 hospitals in Caracas between November 2009 and march 2010 were analyzed, including anly strains with resistance to aminoglycosides. Biochemical identification was carried out by conventional methods and automated VITEK-2. Antibiotic susceptibility was determined by disk diffusion using gentamicin, amikacin, netilmicin and tobramycin discs, according with CLSI 2010. Resistnce genes were investigated by PCR using primers for the genes coding for AAC (3') la, AAC (3') AAC(6')Ib lla, ANT(2') la, AAC(6')Ibcr, Vla APH (3') enzymes and armA, rmtA, rmtB, rmtC, rmtD and npmA metilases. Phenotypically 90.8 % of isolates were resistant to amikacin, and 57.9 % presented cross-resistance to amikacin, gentamicin, tobramycin and netilmicin. The most prevalent modifying ensymes was APH(3')Vla (53.6 %9 and the most prevalent metilase was RmtD (25 %). These results suggest that the APH(3') Vla migth be responsible for generatin high levels of resistance to amikacin inthese isolates, while RmtD was the cause of cross resistance to amikacin, gene, gentamicin, tobramycin and netilmicin.

Baixa prevalência de doenças do ouvido médio em pacientes com fibrose cística / Low prevalence of middle ear disease in cystic fibrosis patients

OBJETIVO: Avaliar a prevalência de alterações do ouvido médio em pacientes com fibrose cística (FC). MÉTODOS: Neste estudo descritivo, 120 pacientes com FC com idade entre 5 meses e 18 anos foram avaliados por meio do histórico clínico, da otoscopia e da timpanometria. Dados sobre a colonização por P. aeruginosa e uso de aminoglicosídeos por via parenteral e/ou inalatória também foram coletados a partir dos prontuários médicos. RESULTADOS: O histórico clínico revelou ausência de otite média prévia em 57 por cento dos pacientes. As membranas timpânicas estavam normais em 94 por cento dos pacientes que se submeteram a avaliação otoscópica; foi sugerida otite média crônica em cerca de 1 por cento dos casos, otite média com derrame (OMD) em 2 por cento, e disfunção da tuba auditiva em 3 por cento. Quanto à timpanometria, 91 por cento dos pacientes que se submeteram ao exame apresentaram resultados normais, foi sugerida OMD em 2 por cento dos casos, e disfunção da tuba auditiva em 7 por cento. CONCLUSÃO: Houve uma baixa taxa de prevalência de alterações do ouvido médio na nossa série de pacientes com FC. O uso de aminoglicosídeos e a colonização por P. aeruginosa não tiveram influência na prevalência das alterações do ouvido médio. Nossos resultados sugerem que um histórico clínico detalhado e uma avaliação otoscópica de rotina podem confirmar ou descartar a maior parte das alterações do ouvido médio em pacientes com FC.

OBJECTIVE: To assess the prevalence of middle ear alterations in cystic fibrosis (CF) patients. METHODS: In this descriptive study, 120 CF patients aged 5 months to 18 years were assessed by clinical history, otoscopy, and tympanometry. Data on P. aeruginosa colonization and parenteral and/or inhaled aminoglycoside use were also collected from medical charts. RESULTS: Clinical history revealed absence of previous otitis media in 57 percent of patients. Tympanic membranes were normal in 94 percent of patients who underwent otoscopic evaluation; chronic otitis media was suggested in about 1 percent of the cases, otitis media with effusion (OME) in 2 percent, and Eustachian tube dysfunction in 3 percent. As for tympanometry, 91 percent of patients who underwent the exam showed normal results, OME was suggested in 2 percent of the cases, and Eustachian tube dysfunction in 7 percent. CONCLUSION: There was a low prevalence rate of middle ear alterations in our series of CF patients. The use of aminoglycosides and colonization by P. aeruginosa did not influence the prevalence of middle ear alterations. Our results suggest that a detailed clinical history and a routine otoscopy evaluation may confirm or rule out most middle ear alterations in CF patients.

Outcome of multi-drug resistant tuberculosis cases treated by individualized regimens at a tertiary level clinic.

AIM: To determine the clinical, radiological and drug resistance profile as well as the factors associated with treatment outcome of Multi-Drug Resistant Tuberculosis (MDR-TB). MATERIAL AND METHODS: All newly diagnosed patients with pulmonary MDR-TB from August 2002 to December 2004 enrolled at New Delhi Tuberculosis Centre, were included in the study. They were followed up clinically, radiologically and bacteriologically by sputum smear, culture and Drug Susceptibility Testing (DST) at regular intervals. According to their DST pattern and previous history of Anti-Tubercular Treatment (ATT), individualized treatment regimens were tailored for each patient. RESULTS: Out of total 27 bacteriologically proven cases of MDR-TB included in this study, 19 were males (mean age and weight 38.5 years and 52.6 kgs, respectively) and eight females (mean age and weight 34.3 years and 40.7 kgs, respectively). A majority (18) were residents of Delhi and the rest hailed from different parts of North India. All of them had a history of previous treatment ranging from six to 34 months. Cavity on chest X-rays was seen in 81%, while 44% showed extensive involvement. The patients received at least four "second line drugs" during their treatment with a mean of 6.2 anti-tubercular drugs during their intensive phase. Of the 27 patients, 13 were cured, 10 defaulted, one died, one is still on treatment and two were referred for surgery. Radiological improvement was observed in two third of cases and chest X-ray of two patients showed a complete resolution. Six predictors were identified for successful outcome of MDR-TB. They include weight gain at six months, culture conversion, radiological improvement during treatment, disease with M. tuberculosis strains exhibiting resistance to less than or up to three anti-tubercular drugs, use of less than or up to three second line drugs in treatment and no change of regimen during treatment. CONCLUSION: Default from treatment was observed to be a major challenge in the treatment of MDR-TB due to long duration and expense of ATT.

Avaliação da nefrotoxicidade induzida por aminoglicosídeos através do clearance de creatinina / Evaluation of nephrotoxicity by aminoglycosides through of creatinine clearance

Objetivo: Aminoglicosídeos são drogas potencialmente nefrotóxicas e seu uso requer monitorização da função renal. O objetivo foi avaliar a nefrotoxicidade induzida por aminoglicosídeos através dos níveis de creatinina sérica e do clearance da creatinina. Métodos: Estudo retrospectivo no período de maio/2002 a abril/2004, em que foram avaliados os prontuários médicos de todos os pacientes que receberam gentacimina ou amicacina, com dosagem sérica de creatinina antes e durante ou após o uso de drogas. A nefrotoxicidade foi definida através de dois parâmetros: como aumento maior ou igual 0,05 mg/dL na creatinina sérica ou redução maior ou igual 20% no clearence da creatinina, a partir dos valores basais. Resultados: Foram avaliados 89 pacientes hospitalizados (74,2% homens e 25,8% mulheres) que receberam gentamicina (70,8%) ou amicacina (29,2%), totalizando 98 ciclos monitorizados pela creatinina sérica. Em 34 ciclos (34,7%) houve aumento da creatinina sérica e em quatro casos (11,8%) este foi indicativo de nefrotoxicidade, comparado a 15 pacientes (44,1%) com nefrotoxicidade pelo parâmetro de redução do clearance da creatinina. Este parâmetro apresentou especificidade (77,1%) e valor preditivo positivo (44,1%) maiores que o observado para creatinina sérica (68% e 11,7%, respectivamente). A associação de cefalosporina e a depleção de potássio sérico foram mais frequentes (p menor que 0,05, teste exato de Fisher) no grupo de pacientes que desenvolveram nefrotoxicidade, comparado ao grupo sem essa alteração. Conclusões: O parâmetro da creatinina sérica apresentou menor valor preditivo para a nefrotoxicidade induzida pelos aminoglicosídeos, comparado ao clearance da creatinina. Os principais fatores de risco detectados para a nefrotoxicidade foram associação de cefalosporina e depleção de potássio sérico.

Synergy of Arbekacin-based Combinations Against Vancomycin Hetero-intermediate Staphylococcus aureus

This study was undertaken to evaluate the in vitro activities of arbekacin-based combination regimens against vancomycin hetero-intermediate Staphylococcus aureus (hetero-VISA). Combinations of arbekacin with vancomycin, rifampin, ampicillin-sulbactam, teicoplanin, or quinipristin-dalfopristin against seven hetero-VISA strains and two methicillin-resistant S. aureus strains were evaluated by the time-kill assay. The combinations of arbekacin with vancomycin, teicoplanin, or ampicillinsulbactam showed the synergistic interaction against hetero-VISA strains. Data suggest that these arbekacin-based combination regimens may be useful candidates for treatment options of hetero-VISA infections.

Antibiotics in older adults

Antibiotics are frequently prescribed in the older person, the dosification needs special care, since the pharmacokinetic parameters changes with aging and the side effects can be different in the older person. The creatinine clearance changes and we must modify the way we prescribe such antibiotics to the elderly, calculating. The variety of antibiotics now available led us to consider this paper in which we have presented the antimicrobial agents that can be considered in the treatment of the older person. We present several groups: the penicillins, cephalosporins, monobactams, carbapenems and betalactamase inhibitors or the great betalactam group. Other trimetroprin-sulfame-thoxazole, the newer macrolides (azithromycin and clarithromycin) as well as the aminoglycosides, vancomycin, clindamycin, metroridazole. The indications and contraindications are presented and reviewed.

Avaliação do uso e monitorização de aminoglicosídeos em pacientes internados em um Hospital Universitário / Evaluation of use and monitoring of aminoglycosides in patients from an universitary hospital

Avaliar o uso e monitorização de aminoglicosídeos em pacientes internados em um hospital universitário. Estudo prospectivo e observacional, em que foram avaliadas as fichas de prescrição de antibióticos e os prontuários de pacientes internados no HE/FMTM, que receberam aminoglicosídeo, durante o período de maio/2002 a abril/2003. Foram avaliados 325 pacientes (65,2 por cento homens e 34,8 por cento mulheres) recebendo gentamicina (77,2 por cento) ou amicacina (22,8 por cento), no total de 376 ciclos. As culturas foram realizadas em 81 (21,5 por cento) ciclos, sendo negativas em 45,7 por cento e positivas em 54,3 por cento casos, com crescimento de Gram-negativos em 52,3 por cento das culturas. A principal bactéria isolada foi Escherichia coli (39,2 por cento), seguida de Enterobacter cloacae (17,4 por cento) e Klebsiella pneumoniae (17,4 por cento). O antibiograma mostrou que as amostras foram sensíveis a outros antibióticos. A monitorização dos níveis séricos de creatinina foi feita antes e após (ou durante) o tratamento em 68 (18,1 por cento) ciclos. Aumento de creatinina sérica foi detectado em 22 (32,2 por cento) ciclos; em 21 (95,4 por cento) o aumento foi menor que 0,5 mg/dL e em um (4,6 por cento) caso foi indicativo de nefrotoxicidade (³0,5 mg/dL acima do basal). Dentre esses pacientes, seis (27,3 por cento) tiveram redução do clearance da creatinina abaixo do limite inferior de normalidade, considerando sexo, idade e peso. A gentamicina foi o principal aminoglicosídeo utilizado, principalmente de forma empírica. O antibiograma mostrou que existem alternativas eficazes aos aminoglicosídeos em pacientes com fatores de risco para toxicidade renal. Comparado à creatinina sérica, o clearance da creatinina foi um parâmetro mais útil para avaliar possível nefrotoxicidade.

Topical quinolones versus topical aminoglycosides in the medical management of chronic suppurative otitis media; A comparative trial

The objective of this clinical trial was to asses the efficacy of topical quinolones and compare it with the most commonly used aminoglycoside [gentamicin hydrocortisone] ear drops. Patients and methods: One hundred and twenty patients were recruited in this comparative clinical trial and divided into two groups: aminoglycoside group of 60 patients were treated with gentamycin hydrocortisone ear drops and quinolone group of 60 patients were prescribed norfloxacin topical solution with a dose of 6 drops in the affected ear twice daily for two weeks. In the aminoglycoside group 30 patients had complete cessation of the discharge, in 12 discharge decreased in amount and mucoid in nature and 18 had no change in the amount and nature of discharge. In the quinolone group in 43 patients discharge stopped completely, in 12 discharge reduced and became mucoid whereas in 5 no change in the amount and nature of the discharge occurred. We recommend that in the medical management of chronic suppurative otitis media, the topical quinolones should be considered first line of treatment as there are no ototoxic effects of quinolones, which can be used safely in the presence of tympanic membrane perforation

Artritis séptica en el Hospital "José Manuel de Los Ríos" Caracas Venezuela: años 1990-1999 / Septic arthritis at the José Manuel de Los Ríos Hospital Caracas Venezuela: years 1990 and 1999

Se ha realizado un estudio de tipo descriptivo y retrospectivo sobre artritis séptica en el Hospital "José Manuel de Los Ríos", Caracas-Venezuela, en el período 1990-1999; obteniéndose sólo 148 casos con esta patología. Se encuentra una mayor incidencia en varones (56,08 por ciento) que hembras (43,91 por ciento) y se observa el mayor número de casos en los lactantes (43,24 por ciento). La articulación más afectada es la rodila en un (40,78 por ciento). La mayoría de los pacientes (78,37 por ciento) proceden del área metropolitana. Las principales causas que la predisponen son traumatismos (22,96 por ciento) e infecciones respiratorias altas (8,78 por ciento). Staphylococcus, Streptococcus y bacilos Gram negativos; son los gérmenes predominantes. El dolor articular, signo de flogosis e impotencia funcional es la sintomatología principal. El diagnÓstico se basa en clínica, laboratorio e imagenología. A todos se le coloca tratamiento médico endovenoso; siguiendo las penicilinas, aminoglicósidos y cloranfenicol los más usados. Se practica la artrotomía evacuadora sólo en un (44,58 por ciento). Las secuelas más frecuentes son hipotrofia y acortamiento de la articulación. No hubieron casos de mortalidad y se observó una evolución satisfactoria en la mayoría de los casos

Uso de Aminoglucósidos en dos Hospitales Comunitarios de la ciudad de Cartagena de Enero a Diciembre de 1994 / Use of amiglycosides in two communitary Hospitals in Cartagena from January to December 1994

Se realizó un estudio descriptivo, retrospectivo en dos hospitales universitarios de tercer nivel de la ciudad de Cartagena, Colombia, con el objetivo de evaluar los parámetros usados en la dosificación de los aminoglucósidos. Se revisaron 251 historias clínicas de pacientes hospitalizados en los Servicios de Medicina Interna de enero a diciembre de 1994, que tuieran indicado y hubieran recibido un aminoglucósido. Fueron tomados los siguientes datos: Edad, peso, talla, sexo, determinación de creatinina sérica, tipo de aminoglucósido, dosis de carga y de mantenimiento, intervalo entre dosis, determinaciones plasmáticas del aminoglucósido, tipo y duración del tratamiento y vía de administración. Para facilitar la evaluación se consideraron como casos diferentes los paicentes en quienes hubo cambios en el tipo de aminoglucósido, dosis de mantenimiento o en la vía de administración. Para aquellos pacientes en los que todos los parámetros citados estuvieron anotados en la historia clínica, se calcularon los estimados de las concentraciones mínimas y máximas y se compararon con los datos reportados en la literatura. Se encontró que en 234 casos (93.23 por ciento) se dosificó sin tener en cuenta los datos de talla, peso o concentración de creatinina sérica inicial; sólo cuatro casos (1.59 por ciento) recibieron una dosis adecuada; en 110 casos (43.82 por ciento) no se monitorizó la función renal o por lo menos ete dato no se encontró en la historia clínica del paciente y en ningún caso se determinaron concentraciones plasmáticas del aminoglucósido utilizado. Se resalta la importancia de tener en cuenta parámetros claros para un mejor uso de estos fármacos

Papel actual de los aminoglucósidos en infecciones severas / Present paper of the aminoglycoside in severe infections

Los aminoglucósidos-gentamicina, tobramicina, amikacina y netilmicina se recomiendan para controlar infecciones causadas por bacilos Gram negativos. Estos medicamentos impiden la síntesis de proteínas en microrganismos susceptibles y se han usado para tratamiento de infecciones desde hace más de 50 años. En este trabajo se revisa su empleo como bactericidas y algunos aspectos sobre resistencia microbiana. También se analiza la absorción, distribución y eliminación de dichos fármacos.

Tratamiento de la sepsis abdominal sin el uso de drenaje peritoneal / Treatment of abdominal sepsis without peritoneal drainage

Objetivo: Informar la experiencia de los autores en el manejo de la sepsis abdominal de origen gastrointestinal, sin el uso de drenaje peritoneal. Diseño: Estudio clínico, prospectivo, observacional y comparativo. El análisis estadístico fue realizado con la chi cuadrada. Sede: Hospital General Regional 25 del Instituto Mexicano del Seguro Social en la Ciudad de México, D.F. Pacientes: Se incluyeron 40 pacientes con sepsis abdominal que fueron divididos en dos grupos, 20 se manejaron con drenaje peritoneal y 20 sin el. Se dividieron en tres fases de acuerdo a la gravedad de la sepsis y se incluyeron en el estudio sólo los pacientes en fase I y II. Se analizaron las siguientes variables; edad, sexo, curso clínico, origen de la sepsis y operación realizada. Resultados: De los 20 pacientes sin drenaje, 12 fueron hombres y 8 mujeres, en 18 casos la sepsis fue secundaria a apendicitis aguda, en 1 por herida penetratante de abdomen y en uno más por perforación colónica secundaria a colitis pseudomenbranosa. Quince de estos casos se encontraban en la fase I de la sepsis y 5 en la fase II, ninguno de estos pacientes presentó complicaciones postoperatorias. De los otros 20 pacientes con drenaje abdominal, 18 fueron del sexo masculino y 2 del femenino, en 12 de los pacientes el origen de la sepsis fue apendicitis aguda, en 4 más por herida penetrante de abdomen, en 2 por úlcera péptica perforada, uno por vólvulos del ciego y uno por dehiscencia de anastomosis. Ocho de estos paciente presentaron complicaciones postoperatorias: infección de herida quirúrgica, sepsis residual, eventración, fístula entérica, fascitis necrotizante, etcétera. Conclusión: En este estudio resultó demostrativo que el uso de drenajes incrementa la morbilidad en la sepsis abdominal

Infective endocarditis in children

A total of 14 cases of infective endocarditis [IE] in children aged 6 months to 10 years were seen from December 1987 to December 1992 at the pediatric unit of Ayatollah Taleghani Medical Center. The majority of patients [12 of 14] were between 5 and 10 years of age. Acyanotic congenital heart disease was known to preexist in 78.6% and rheumatic valvular heart disease in 21.4% of cases. Organisms were identified by blood culture in 50%, the majority being Streptococcus viridans [36% of cases]. Vegetations were detected by echocardiography in 64%. The overall death rate was 21.4%. Two patients with aortic stenosis developed IE after cardiac surgery for repair of stenotic valves and both of them died. One patient with rheumatic aortic and mitral valve insufficiency underwent valve replacement due to intractable heart failure. In conclusion, the frequent presence of underlying heart disease, the rarity of IE in infancy, and the ominous prognosis of postoperative endocarditis and aortic valve involvement are emphasized