Fecal peritonitis in aging rat model. Therapeutic response to different antibiotic strategies

Abstract Purpose: To evaluate the response of aging rats with sepsis to two different antibiotic regimens. Methods: The study was conducted with 30 aging rats (18 month-old) with autologous feces peritonitis. The animals were divided into three groups: Group 0 received no therapeutic intervention (control), while Group 1 received a single dose of 40 mg/kg meropenem and Group 2 received a single dose of 20 mg/kg moxifloxacin. The intervention in both Groups was made 6 hours after induction of peritonitis. The animals were followed up to 15 days for evaluating morbidity and mortality. The weights at baseline were similar in all groups. Results: At the end of follow-up, weight loss was significantly greater (p=0.0045) in Group 0 (non-intervention controls). Culture from a blood sample at the end of follow-up was positive in all the animals in Group 0, in two animals in Group 1 and in four animals in Group 2. Morbidity/mortality was significantly higher in Group 0 compared to both Groups 1 and 2 (p=0.003) but the scores were not significantly different between Groups 1 and 2 (p=0.6967). Conclusion: Both antibiotic regimens rendered promising results for the treatment of fecal peritonitis.

Inactivation of MarR gene homologs increases susceptibility to antimicrobials in Bacteroides fragilis

ABSTRACT Bacteroides fragilis is the strict anaerobic bacteria most commonly found in human infections, and has a high mortality rate. Among other virulence factors, the remarkable ability to acquire resistance to a variety of antimicrobial agents and to tolerate nanomolar concentrations of oxygen explains in part their success in causing infection and colonizing the mucosa. Much attention has been given to genes related to multiple drug resistance derived from plasmids, integrons or transposon, but such genes are also detected in chromosomal systems, like the mar (multiple antibiotic resistance) locus, that confer resistance to a range of drugs. Regulators like MarR, that control expression of the locus mar, also regulate resistance to organic solvents, disinfectants and oxygen reactive species are important players in these events. Strains derived from the parental strain 638R, with mutations in the genes hereby known as marRI (BF638R_3159) and marRII (BF638R_3706) were constructed by gene disruption using a suicide plasmid. Phenotypic response of the mutant strains to hydrogen peroxide, cell survival assay against exposure to oxygen, biofilm formation, resistance to bile salts and resistance to antibiotics was evaluated. The results showed that the mutant strains exhibit statistically significant differences in their response to oxygen stress, but no changes were observed in survival when exposed to bile salts. Biofilm formation was not affected by either gene disruption. Both mutant strains however, became more sensitive to multiple antimicrobial drugs tested. This indicates that as observed in other bacterial species, MarR are an important resistance mechanism in B. fragilis.

Enterotoxigenic and non-enterotoxigenic Bacteroides fragilis from fecal microbiota of children

Enterotoxigenic Bacteroides fragilis (ETBF) is an important part of the human and animal intestinal microbiota and is commonly associated with diarrhea. ETBF strains produce an enterotoxin encoded by the bft gene located in the B. fragilis pathogenicity island (BfPAI). Non-enterotoxigenic B. fragilis (NTBF) strains lack the BfPAI and usually show two different genetic patterns, II and III, based on the absence or presence of a BfPAI-flanking region, respectively. The incidence of ETBF and NTBF strains in fecal samples isolated from children without acute diarrhea or any other intestinal disorders was determined. All 84 fecal samples evaluated were B. fragilis-positive by PCR, four of them harbored the bft gene, 27 contained the NTBF pattern III DNA sequence, and 52 were considered to be NTBF pattern II samples. One sample was positive for both ETBF and NTBF pattern III DNA sequences. All 19 B. fragilis strains isolated by the culture method were bft-negative, 9 belonged to pattern III and 10 to pattern II. We present an updated overview of the ETBF and NTBF incidence in the fecal microbiota of children from Sao Paulo City, Brazil.

Evaluación farmacocinética/farmacodinámica (PK/PD) de un esquema de administración oral de metronidazol en intervalo ampliado para el manejo de infecciones producidas por Bacteroides fragilis / Pharmacokinetics/pharmacodinamic (PK/PD) evaluation of a short course of oral administration of metronidazole for the management of infections caused by Bacteroides fragilis

Introduction: Metronidazole is the antibiotic of choice for the management of infections caused by anaerobes. Its administration requires multiple daily doses causing increased medication errors. Due to its high post-antibiotic effect and rapid concentration-dependent bactericidal activity, administration of this antibiotic in an extended dosing interval would achieve PK/PD parameters effectively. Objective: To assess the probability of achieving effective PK/PD relationship with the administration of 1,000 mg every 24 hours of metronidazole for Bacteroides fragilis infections. Methods: A clinical trial was conducted in a group of volunteers who received a single oral dose of 500 or 1,000 mg of metronidazole. Determinations of values of Cmax, t max, and AUCC0-24 h. determined using the trapezoidal method, were obtained for a Markov simulation that would allow for determining the likelihood of achieving a AUC0-24 h/MIC ratio above 70 for infections caused by susceptible B. fragilis. Results: Cmax (24,03 ± 6,89 mg/L) and t max (1,20 ± 0.80 hrs) and the value of AUC0-24 h (241.91 ± 48.14 mg * h/L) were determined. The probability of obtaining a AUC0-24 h/MIC ratio greater than 70 was greater than 99%. Conclusion: From a pharmacokinetic perspective, with the administration of a daily dose of 1,000 mg of metronidazole, it is possible to achieve a therapeutic goal of AUC0-24 h/MIC ratio above 70 for the treatment of anaerobic infections.

Introducción: Metronidazol es el antimicrobiano de elección para el manejo de infecciones anaeróbicas. Su administración requiere de dosis múltiples provocando aumento en errores medicamentosos. Debido al efecto post-antibiótico y a la actividad bactericida concentración-dependiente, la administración de metronidazol en intervalos ampliados de administración permitiría alcanzar parámetros PK/PD efectivos. Objetivo: Evaluar la probabilidad de alcanzar una relación PK/PD efectiva con la administración de 1.000 mg cada 24 h de metronidazol para infecciones por Bacteroides fragilis. Método: Se realizó un ensayo clínico sobre un grupo de voluntarios a quienes se les administró una monodosis oral de 500 y 1.000 mg de metronidazol, respectivamente. Se establecieron parámetros farmacocinéticos empleando el método trapezoidal. Se realizó una simulación de Markov que permitiera establecer la probabilidad de alcanzar una relación AUC0-24 h/CIM > 70 en infecciones por B. fragilis. Resultados: Se determinaron los valores de Cmax (24,03 ± 6,89 mg/L), t max (1,20± 0,8h) y AUC0-24 h (241,91 ± 48,14 mg*h/L), con lo cual la probabilidad de alcanzar una relación AUC0-24 h/CIM > 70 con 1.000 mg de metronidazol fue superior a 99%. Conclusión: Con la administración de 1.000 mg cada 24 h sería posible alcanzar una relación PK/PD efectiva para el tratamiento de infecciones anaeróbicas.

Antimicrobial Susceptibility of Clinical Isolates of Bacteroides fragilis Group Organisms Recovered from 2009 to 2012 in a Korean Hospital

BACKGROUND: Periodic monitoring of antimicrobial resistance trends of clinically important anaerobic bacteria such as Bacteroides fragilis group organisms is required. We determined the antimicrobial susceptibilities of clinical isolates of B. fragilis group organisms recovered from 2009 to 2012 in a tertiary-care hospital in Korea. METHODS: A total of 180 nonduplicate clinical isolates of B. fragilis group organisms were collected in a tertiary care hospital. The species were identified by conventional methods: the ATB 32A rapid identification system (bioMerieux, France) and the Vitek MS matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (bioMerieux). Antimicrobial susceptibility was determined by the CLSI agar dilution method. RESULTS: Imipenem and meropenem resistance rates were 0-6% for B. fragilis group isolates. The rate of resistance to piperacillin-tazobactam was 2% for B. fragilis and 0% for other Bacteroides species, but 17% for B. thetaiotaomicron isolates. High resistance rates to piperacillin (72% and 69%), cefotetan (89% and 58%), and clindamycin (83% and 69%) were observed for B. thetaiotaomicron and other Bacteroides spp. The moxifloxacin resistance rate was 27% for other Bacteroides spp. The MIC50 and MIC90 of tigecycline were 2-4 microg/mL and 8-16 microg/mL, respectively. No isolates were resistant to chloramphenicol or metronidazole. CONCLUSIONS: Imipenem, meropenem, chloramphenicol, and metronidazole remain active against B. fragilis group isolates. Moxifloxacin and tigecycline resistance rates are 2-27% and 8-15% for B. fragilis group isolates, respectively.

Periodontopathogen profile of healthy and oral lichen planus patients with gingivitis or periodontitis / 国际口腔科学杂志·英文版

Oral lichen planus (OLP) is a chronic inflammatory disease that is frequently detected in oral tissues. The aim of our study was to identify the prevalence of the detection of periodontopathogenic microorganisms (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola in OLP patients and to compare with this prevalence of periodontopathogenic microorganisms in healthy non-OLP patients. Our study included 27 (18 chronic periodontitis (OLPP) and 9 gingivitis (OLPG)) patients diagnosed with OLP along with 26 (13 chronic periodontitis (HP) and 13 gingivitis (HG)) healthy non-OLP patients. The multiplex polymerase chain reaction (PCR) with subsequent reverse hybridization method (micro-IDent) was used for identifying periodontopathogenic microorganisms present in subgingival plaque samples. The percentages of detection for A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythia and T. denticola in subgingival plaque samples taken from OLP patients (OLPG and OLPP) were 18.5%, 85.1%, 81.4%, 88.8% and 74%, respectively. Meanwhile, in the non-OLP patients (HG and HP), these values were 7.6%, 50%, 46.1%, 73% and 57.7%, respectively. Thus, comparing the non-OLP groups with the OLP groups, the periodontopathogens' percentages of detection in the OLP groups were higher than those in the non-OLP groups. According to our study results, OLP patients have higher levels of infection with A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythia and T. denticola than non-OLP patients. We argue that the high percentages in patients with OLP may help identify the importance of periodontopathogenic microorganisms in the progress of periodontal diseases of OLP.

Bacteroides fragilis endocarditis: a case report and review of literature

Endocarditis due to Bacteroides fragilis is a rare disorder. This article describes a case of Bacteroides fragilis endocarditis associated with portal and superior mesenteric venous thrombosis in a patient without preexisting valvular heart disease and review the cases of endocarditis due to this anaerobic bacterium in medical literature since 1980.

Distribution, detection of enterotoxigenic strains and antimicrobial drug susceptibility patterns of Bacteroides fragilis group in diarrheic and non-diarrheic feces from Brazilian infants

Despite the importance of gastrointestinal diseases and their global distribution, affecting millions of individuals around the world, the role and antimicrobial susceptibility patterns of anaerobic bacteria such as those in the Bacteroides fragilis group (BFG) are still unclear in young children. This study investigated the occurrence and distribution of species in the BFG and enterotoxigenic strains in the fecal microbiota of children and their antimicrobial susceptibility patterns. Diarrheic (n=110) and non-diarrheic (n=65) fecal samples from children aged 0-5 years old were evaluated. BFG strains were isolated and identified by conventional biochemical, physiological and molecular approaches. Alternatively, bacteria and enterotoxigenic strains were detected directly from feces by molecular biology. Antimicrobial drug susceptibility patterns were determined by the agar dilution method according to the guidelines for isolated bacteria. BFG was detected in 64.3 percent of the fecal samples (55 percent diarrheic and 80.4 percent non-diarrheic), and 4.6 percent were enterotoxigenic. Antimicrobial resistance was observed against ampicillin, ampicillin/sulbactam, piperacillin/tazobactam, meropenem, ceftriaxone, clindamycin and chloramphenicol. The data show that these bacteria are prevalent in fecal microbiota at higher levels in healthy children. The molecular methodology was more effective in identifying the B. fragilis group when compared to the biochemical and physiological techniques. The observation of high resistance levels stimulates thoughts about the indiscriminate use of antimicrobial drugs in early infancy. Further quantitative studies are needed to gain a better understanding of the role of these bacteria in acute diarrhea in children.

Community periodontal index of treatment needs index: An indicator of anaerobic periodontal infection.

Background : Community periodontal index of treatment needs (CPITN) index is commonly used to measure periodontal disease. It's uniqueness, apart from assessing the periodontal status, also gives the treatment needs for the underlying condition. Benzoyl-DL-arginine napthylamide (BANA) test is a chair side diagnostic test used to detect the presence of putative periodontal pathogens. We correlated the CPITN scores of patients with BANA test results to assess the validity of CPITN as an indicator of anaerobic periodontal infection. Objectives : The present study was aimed to correlate the CPITN scores with the BANA activity of subgingival plaque. The objective was to assess the validity of CPITN index as indicator of anaerobic periodontal infection. Patients and Methods : A total of 80 sites were selected from 20 patients with generalized chronic periodontitis. After measuring the probing depth with CPITN C probe, the highest score from each sextant was selected according to the CPITN criteria and subgingival plaque samples were collected using a sterile curette and the BANA test was performed. Results : Kendall's tau-b and Chi- square test were used to assess the correlation between the BANA test results and CPITN scores. Results indicated sensitivity (92.86%), specificity (80%) and agreement (91.25%); indicating the validity of CPITN in assessing anaerobic infection. Conclusion : There was a significant correlation between BANA test results and scores 3 and score 4 of CPITN index (P < 0.001) clearly indicating the presence of anaerobic periodontal infection.

Prevalence of Porphyromonas gingivalis and Bacteroides forsythus in chronic periodontitis by multiplex PCR

Periodontitis is a common inflammatory and infectious disease which destroys the supporting structure of the teeth. Recent studies show that periodontal infection significantly increases the risk of some systemic diseases. It is generally accepted that bacterial species notably Porphyromonas gingivalis and Bacteroides fosythus are highly associated with periodontium. Molecular methods such as Multiplex PCR seem to be more sensitive and faster. Multiplex PCR alone can lower the limit of bacterial detection. Several pathogens can be detected simultaneously by this method. The Subgingival plaque samples from 61 patients including 34 women and 27 men in the age range of 24-69 years and an average age of 43 suffering from chronic periodontitis with probing depth of PD>/=6, and from 40 periodontally healthy controls including 22 women and 18 men in the age range of 21-69 years and an average age of 41.35 were collected by sterile curette. In this study, two species-specific forward primers were used in combination with a single reverse primer. The samples' DNA was extracted and Multiplex PCR was administered. Porphyromonas gingivalis was detected in 51 samples [81.61%] and 16 samples [40%] of the chronic periodontitis patients and the healthy subjects repectively. Moreover, Bacteroides forsythus was detected 32 samples [52.50%] of the chronic periodontitis patients but it was not detected in any of the samples from the healthy group. P. gingivalis and B. forsythus can be simultaneously detected using Multiplex PCR. The present data suggest that P. gingivalis is a more important factor in the etiology of chronic periodontitis. Further studies are needed to determine the spectrum of pathogenicity of the disease and effective management of diagnosis and treatment in order to decrease the risk of periodontal complications such as systemic infections

Antagonic effect of the inhibition of inducible nitric oxide on the mortality of mice acutely infected with Escherichia coli and Bacteroides fragilis

Sepsis, the leading cause of death in intensive care units, is associated with overproduction of nitric oxide (NO) due to inducible NO synthase (iNOS), responsible for some of the pathologic changes. Aminoguanidine (AG) is a selective iNOS inhibitor with reported inconsistent actions in sepsis. To investigate the influence of iNOS, we studied models of acute bacterial sepsis using acute challenges with aerobic (Escherichia coli) and anaerobic (Bacteroides fragilis) bacteria in the presence of AG. Six-week-old, 23 g, male and female BALB/c and C57Bl/6j mice, in equal proportions, were inoculated (ip) with bacteria in groups of 4 animals for each dose and each experiment in the absence or presence of AG (50 mg/kg, ip, starting 24 h before challenge and daily until day 6) and serum nitrate was measured by chemiluminescence. Both types of bacteria were lethal to mice, with an LD50 of 6 nephelometric units (U) for E. coli and 8 U for B. fragilis. Nitrate production peaked on the second day after E. coli inoculation with 8 and 6 U (P < 0.05), but was absent after non-lethal lower doses. After challenge with B. fragilis this early peak occurred at all tested doses after 24 h, including non-lethal ones (P < 0.05). AG-treated mice challenged with E. coli presented higher survival (P < 0.05) and increased LD50. AG-treated mice challenged with B. fragilis had lower LD50 and higher mortality. Control AG-treated animals presented no toxic effects. The opposite effect of iNOS blockade by AG in these models could be explained by restriction of oxygen for immune cells or an efficient action of NO in anaerobic localized infections. The antagonic role of NO production observed in our bacterial models could explain the reported discrepancy of NO action in sepsis.

Prevotella intermedia and Porphyromonas gingivalis isolated from osseointegrated dental implants: colonization and antimicrobial susceptibility

Neste estudo foram avaliadas a colonizacão e a susceptibilidade a antimicrobianos de P. intermedia e P. gingivalis isolados de amostras de sulcus gengivais e peri-implantares. As amostras foram coletadas de 30 pacientes submetidos a implantes, em três tempos diferentes: no momento da cirurgia, 20 e 60 dias após a instalacão do implante. Os organismos foram identificados por testes bioquímicos ou por kit comercial API 32-A e por PCR. A susceptibilidade antimicrobiana foi determinada usando-se o método de diluicão em ágar. Foram isolados dezenove P. intermedia (quatro de peri-implantites e 15 de sulco gengival) e somente sete P. gingivalis de sulco gengival. Pelo PCR os organismos foram detectados de sete amostras sete peri-implantares e de 32 gengivais. As bactérias foram susceptíveis aos antibióticos usados exceto para azitromicina com 65% de resistência para P. intermedia. As espécies avaliadas foram sensíveis para cádmio, níquel e paládio, e mostraram diferentes faixas de resistência para titânio, alumínio e bicloreto de mercúrio. A maioria de P. intermedia foi resistente para chumbo, prata, cobre, titânio, zinco, alumínio e bicloreto de mercúrio. As bactérias colonizaram implantes após 60 dias de cirurgia e PCR pode ser usado como ferramenta para a deteccão bacteriana na implantodontia.

Abscesos y flemones del cuello: nuestra experiencia / Neck abscesses: our experience

Antecedentes: Los abscesos y flemones de cuello son una patología grave signada por una elevada morbimortalidad. Objetivo: Efectuar un análisis de nuestros casos y sacar conclusiones para disminuir la morbimortalidad merced a tratamiento adecuado de estos pacientes. Diseño: Análisis retrospectivo. Población: 89 pacientes tratados con procesos infecciosos de distinto origen que desarrollaron abscesos y flemones en el cuello. Método: Revisión de datos de historias clínicas. Resultados: De 89 casos, fueron operados con drenaje y desbridamiento de los tejidos del cuello 84 (94,38 por ciento). 12 pacientes tuvieron mediastinitis descendente. La mortalidad de la serie por sepsis grave fue del 6,74 por ciento. Conclusiones: Las infecciones del cuello son una entidad grave. Su complicación más temida es la mediastinitis descendente. Deben ser intervenidos quirúrgicamente en forma urgente, drenando el absceso cervical y cuando es necesario, el mediastino

Virulence markers and antimicrobial susceptibility of bacteria of the Bacteroides fragilis group isolated from stool of children with diarrhea in São Paulo, Brazil

Bacteroides fragilis has been isolated from several human and non-human monomicrobial and mixed infections. In this study, some virulence markers and the antimicrobial susceptibility of bacteria of the B. fragilis group isolated from children's stools were evaluated. All the 64 isolates showed the following characteristics: capsulated, beta-hemolytic, hydrophilic, and serum-resistant. Only, 24 (37.5 percent) strains were resistant at 60ºC, for 30 min, and among them, 12 (18.75 percent) were resistant at 60ºC, for 60 min. Also, none strain was resistant at 100ºC. Four strains were able to hemagglutinate erythrocytes and D-mannose, D-galactose, D-arabinose, and D-xylose inhibited hemagglutination in 2 B. fragilis strains (p76a, p76b). The hemagglutination in the strain B. uniformis p3-2 was inhibited by D-xylose and D-galactose. The bft gene detection and the enterotoxin production were observed only in 13 EF-enterotoxigenic species. Fragilysin activity was confirmed on HT-29 cells. The antimicrobial determination confirmed that both imipenem and metronidazole were efficient against B. fragilis species; all the strains were resistant to lead and nickel. Plasmids of 2.9, 4.4, 4.8, and 8.9 kb were observed in 6 tested strains. These results show the values of the species identification from clinical infections, as well as of the periodic evaluation of the resistance patterns of the B. fragilis group at Brazilian medical institutions.

Survey of antimicrobial susceptibility patterns of the bacteria of the Bacteroides fragilis group isolated from the intestinal tract of children

The bacteria of the Bacteroides fragilis group are considered important clinical pathogens and they are the most common anaerobes isolated from human endogenous infections. In this study, the susceptibility patterns to antibiotics and metals of 114 species of the B. fragilis group isolated from children with and without diarrhea were determined. Susceptibility was assayed by using an agar dilution method with Wilkins-Chalgren agar. All B. fragilis strains were resistant to lead and nickel, but susceptible to metronidazole and imipenem. beta-lactamase production was detected by using biological and nitrocefin methods, respectively, in 50 percent and 90.6 percent of the isolates of children with diarrhea and in 60 percent and 90 percent of the isolates of children without diarrhea. Our results show an increase of antibiotics and metals resistance in this microbial group, and a periodic evaluation of the antimicrobial susceptibility is needed. In Brazil, the contamination for antibiotics or metal ions is often observed, and it is suggested an increase the antimicrobial resistance surveillance of this microbial group, mainly those isolated from children's diarrhea.

Detection of non-enterotoxigenic and enterotoxigenic Bacteroides fragilis in stool samples from children in Säo Paulo, Brazil

Non-enterotoxigenic bacteria of the Bacteroides fragilis group and enterotoxigenic B. fragilis were identified from children with and without aqueous acute diarrhea. In this study, 170 stool samples from 96 children with and 74 without diarrhea were analyzed. Enterotoxin production and the toxin gene detection were detected by cytotoxicity assay on HT-29/C1 cells and by PCR, respectively. B. fragilis species was prevalent in both groups and enterotoxigenic B. fragilis strains were isolated from two children with diarrhea. More studies are important to evaluate the role of each bacteria of the B. fragilis group, including enterotoxigenic strains play in the diarrheal processes in children

Detecçäo de bacterioides forsythus em dez casos de infecçäo endodôntica pelo método da polymerase chain reaction / Polymerase chain reaction of bacteroides forsythus in ten cases of endodontic infection

Este trabalho tem como objetivo relatar dez casos de infecçäo endodôntica onde foi detectada a ocorrência da espécie bacteriana Bacteroides forsythus. Após coleta do material, a identificaçäo desta espécie foi realizada através do método da Reaçäo em Cadeia da Polimerase (Polymerase Chain Reaction - PCR). Nossos resultados indicaram que o B. forsythus pode ser um componente da microbiota presente em canais radiculares infectados, podendo estar associado à etiologia de lesöes perirradiculares

Mixed anaerobic and aerobic testicular abscess in a neonate.

A premature baby developed a testicular abscess on day 28 of life. The pus aspirated from the abscess grew a mixture of beta hemolytic Streptococcus and a Bacteroides species. The source of this infection could not be identified. The baby improved on antibiotic therapy. This is the first reported case of a polymicrobial testicular infection involving an anaerobe in a neonate. The relevant literature is reviewed.

Tromboflebitis séptica de la vena porta asociada a hipertensión portal reversible / Septic thrombophlebitis of the portal vein associated with reversible portal hypertension

Septic thrombophlebitis of the portal vein is an unusual and serious complication of abdominal infection. We present a patient with thrombophlebitis of the portal vein of unknown origin, suffering from fever, abdominal pain, jaundice, abnormal liver test function and bacteremia related to Bacteroides fragilis. Ultrasonography, with doppler of the portal vein, was performed which showed thrombosis of the portal vein together with signs of portal hypertension. The patient underwent six weeks of antibiotic treatment. The evolution was favourable, the infection was overcome and the portal vein was de-obstructed as a consequence of which the signs of portal hypertension disappeared.

Pie diabético: estudio comparativo de tratamiento antibiótico: Clindamicina vs. Metronidazol / Diabetic foot: comparative study of the antibiotic treatment: Clindamycin vs Metronidazole

El pie diabético es una entidad patológica que ha incrementado su incidencia en los últimos años, constituyendo un gran porcentaje de ingresos a los servicios de emergencia de nuestros hospitales por lo que es meritorio magnificar esfuerzos pro – mejora de su tratamiento y pronóstico. El objetivo de este estudio de investigación es comparar los resultados obtenidos en el seguimiento de 40 pacientes admitidos en el Servicio de Cirugía del Hospital Luis Vernaza entre noviembre de 1999 a mayo de 2000 con la utilización de los dos antibióticos más empleados en este tipo de tratamiento demostrando así la superioridad del antibiótico Bactericida como el Metronidazol contra la acción de un antibiótico Bacteriostático como la Clindamicina, a diferencia de otros autores que presentan una equivalencia entre los dos antibióticos.

The diabetic foot is a pathological entity that has increased it’s incidence through the years, constituting a great percentage of the admissions in the emergency service. The goal of this investigation is to compare the results obtained by the control of 40 patients admitted in the surgery service in the Luis Vernaza Hospital from November of 1999 to May of 2000, with the employment of two of the most used antibiotics for the treatment of this pathology, proving the excellence of a bactericide like metronidazole over the action of a bacteriostatic like clindamycin.