La hiponatremia al momento de ingreso como factor de riesgo de mortalidad hospitalaria / Hyponatremia on admission to the emergency room as a risk factor for hospital mortality

Background: Patients who develop hyponatremia during their hospitalization have higher hospital mortality. Aim: To determine if the presence of hyponatremia on admission to the emergency room is a risk factor for hospital mortality. Patients and Methods: Two hundred forty five patients consecutively admitted to the emergency room and then transferred to the Medicine Department, where they finally died, were matched for age and gender with 245 control subjects admitted to the emergency room and hospitalized in the Medicine Department at the same time, but survived. The dependent variable was death, and the exposure variable was hyponatremia. Admission diagnosis and Charlson comorbidity index was considered as confounding variables. Results: Hyponatremia at admission occurred in 30 and 17 percent of patients who died and survived, respectively, rendering an adjusted odds ratio for death of 2.13 (95 percent confidence intervals = 1.27-3.57). Charlson Comorbidity Index according to age score was higher in subjects with hyponatremia compared to those without hyponatremia (8.1 ± 3.1 and 7.2 ± 2.8; p = 0.01). Multivariate analysis showed that age, gender, length of stay, cause of hospitalization and chronic diseases did not significantly modify the effect of hyponatremia on hospital mortality. Conclusions: Hyponatremia on admission at emergency room had a significant association with hospital mortality. Subjects with hyponatremia had a higher Charlson Comorbidity Index score.

Caracterización de los pacientes con diarrea asociada a clostridium difficile en el hospital dr. Gustavo Fricke entre los años 2003-2008 / Characterization of patients with clostridium difficile associated diarrhea in hospital dr. Gustavo Fricke between the years 2003-2008

Introducción: la mayoría de las diarreas nosocomiales en la población adulta son producidas por Clostridium diffícile. Suele asociarse con terapia antimocrobiana previa al cuadro clínico, en especial Clindamicina. Objetivo: caracterizar el cuadro de diarrea por C. diffícile, en pacientes hospitalizados en el Hospital Gustavo Fricke (HGF). Material y Método: se consideró el registro de exámenes del Laboratorio de Microbiología del Hospital para la detección de toxina A de C. diffícile desde Junio de 2003 a Marzo de 2008, debiendo excluirse 57 casos de 169 por registro incompleto. Se procedió a revisar fichas, tomando en cuenta 22 variables que se analizaron con el programa estadístico SPSS. Se define caso como aquel en que se detectó la toxina A en una muestra de deposiciones de un paciente con diarrea; resolución al cese de la diarrea a los 5 días de terapia con metronidazol oral en dosis convencionales; fracaso como la persistencia de diarrea luego de 5 días con metronidazol oral; recaída a la reaparición de diarrea con un nuevo examen de toxina A positiva luego de al menos una semana de evolucionar con deposiciones normales. Resultados: del total de 112 casos, 52,6 por ciento eran sexo masculino. El promedio de edad fue de 59,9 años. Un 45 por ciento del total de pacientes era diabético tipo 2 y un 41 por ciento hipertenso. Los diagnósticos de ingreso más frecuentes fueron neumonía adquirida en la comunidad (14,2 por ciento) y pie diabético complicado (12 por ciento). Se analizó el número de casos por servicio en relación a sus egresos durante el período en estudio, siendo el servicio más afectado la Unidad de Cuidados Intensivos con 0,45 por ciento casos por cada 100 egresos. Un 98 por ciento del total de pacientes tenía el antecedente de uso de antibiótico previo al inicio de síntomas, ya sea terapia antimicrobiana asociada o monoterapia. En ambos casos las cefalosporinas fueron los mas involucrados, destacando Ceftriaxona.

Introduction: the majority of nosocomial diarrhea in adults ar caused by Clostridium difficile. Often it is associated with antimicrobial therapy prior to clinical symptoms, especially clindamycin. Objective: to characterize C. difficile associated diarrhea in patients hospitalized in the Hospital Gustavo Fricke (HGF). Patients and Methods: we considered the record of examinations of the Laboratory of Microbiology of the detection of C. difficile toxin A from June 2003 to March 2008, with 57 cases excluded for incomplete record. We reviewed medical records, including 22 variables, analyzed with the statistical program SPSS. Case is defined as one in which the toxin A was detected in a stool sample from a patient with diarrhea, resolution as the cessation of diarrhea within 5 days of therapy with conventional-dose of oral metronidazole; failure as the persistence of diarrhea after 5 days with oral metronidazole; relapse as a recurrence of diarrhea with a new examination of toxin A positive after at least a week to move with normal stools. Results: a total of 112 cases were studied, 52,6 percent were male. The average age was 59.9 years. 45 percent of patients hay Type 2 Diabetes and 41 percent hypertension. The most frequent diagnosis on admission was community-acquired pseumonia (14.2 percent) and complicated diabetic foot (12 percent). We analyzed the number of cases by service in relation to their expenditures during the period under review, the most affected was the Intensive Care Unit with 0.45 cases per 100 discharges; 98 percent patients had a history of antibiotic use prior to onset of symptoms, either alone or associated with antimicrobial therapy. In both cases cepthalosporins were the most involved, including ceftriaxone.

Resistencia a los antimicrobianos en agentes causantes de infección del tracto urinario en 11 hospitales chilenos: proyecto PRONARES / Antimicrobial resistance of agents causing urinary tract infections in 11 chilean hospitals: PRONARES project

Background: the computer program WHONET generates a common database to analyze local or general antimicrobial resistance of bacteria. A surveillance of agents causing urinary tract infections in Chile has been performed using this program. Aim: to report the results after 12 months of urinary tract infection agent surveillance. Material and methods: since november, 1997, a surveillance of in vitro antimicrobial resistance, using agar diffusion techniques, has been performed in 20 to 40 bacterial strains per month, isolated from 11 hospitals in the country. Results have been analyzed using WHONET program. Results: in first 12 months, 3144 strains, 1625 coming from outpatients, have been studied. Seventy four percent of isolated strains were E. coli, 19 percent were other enterobacteria, 4.1 percent were non fermenting bacilli and 2.1 percent were Gram (+) cocci. Sixty five percent of E coli strains were resistant to ampicillin, 11 percent to cefazolin, 2.5 percent to cefuroxime, 19 percent to ceftriaxone, 9 percent to ceftazidime, 4.2 percent to gentamicin 1.3 percent to amikacin, 5.6 percent to ciprofloxacin, 8.4 percent to grepafloxacin, 4.3 percent to nitrofurantoin and 43 percent to trimeproprim/sulphamethoxazole. Eighty two percent of other enterobacteria strains were resistant to ampicillin, 45.5 percent to cefazolin, 33.5 percent to cefuroxime, 26.6 percent to ceftriaxone, 21.5 percent to ceftazidime, 30.3 percent to gentamicin 17.2 percent to amikacin, 21 percent to ciprofloxacin, 16.3 percent to grepafloxacin, 48.2 percent to nitrofurantoin and 44.6 percent to trimeproprim/sulphamethoxazole. There were differences in betalactamic resistance among hospitals. Conclusions: noteworthy is the high resistance rates to third generation cephalosporins, evidenced when the new cutoff values for E coli and klebsiella spp are used. This national surveillance provides updated information on antimicrobial resistance of agents causing urinary tract infections

Bacterial chemistry. VI. Biological activities and cytotoxicity of 1, 3-dihydro-2H-indol-2-one derivatives

The biosynthetic pigment from Chromobacterium violaceum BB-78, 1,3-dihydro-2H-indol-2-one and its derivatives exhibit biological activities such as antimicrobial action, low hemolytic effects on red blood cells and in vitro trypanocide activity. A relatively high cytotoxicity on V-79 hamster fibroblast cells of the biosynthetic pigment was found, although with the methylol derivative the toxicity was almost eliminated. The methylol derivative exhibited similar toxicity as Nifurtimox, a known, commercial trypanocide compound

Antibiotic and heavy metal resistence associated to plasmids in clinical isolates of Klebsiella pneumoniae in Chile

Resistência a antibióticos e metais pesados associada a plasmídio em isolados clínicos de Klebsiella de origem hospitalar no Chile. Isolados clínicos de Klebsiella pneumoniae de origem hospitalar apresentaram resistência múltipla para antibióticos e metais pesados associada a presença de plasmídio

Bacterial chemistry-III: preliminary studies on Trypanosomal activities of Chromobacterium violaceum products

It has been found that the pigment-I from Chromobacterium violaceum, 3 [1,2 dihydro 5 (5 hydroxy 1H indol 3 yl) 2 oxo 3H pyrrol-3 ylidiene] 1,3 dihydro 2H indol 2 one, has trypanocide activity. The formylated derivatives, pigment-III, immobilized 100% of the Trypanosoma cruzi at a level of 46 micronM after 48h of interaction with a total growth inhibition in the same period. Pigment I exhibited low toxicity and a DNA synthesis inhibition similar to that of Nifurtimox, a known trypanocide compound

Sensibilidad a antibióticos y tolerancia a desinfectantes en cepas de Acinetobacter calcoaceticus anitratus

Desde hace algunos años, bacterias que se consideraban saprófitos, han ido adquiriendo una importancia significativa en Infecciones Intrahospitalarias como patógenos oportunistas. Se destacan entre estas bacterias Gram negativas no fermentadoras (BNF), el Acinetobacter calcoaceticus subesp. Anitratus. En el presente trabajo, se estudia la sensibilidad a antibióticos según Bauer y Kirby como también la tolerancia a desinfectantes y antisépticos por medio de la prueba de capacidad de kelsey,en 25 cepas de Acinetobacter calcoaceticus subesp. Anitratus aisladas de diferentes servicios clínicos del Hospital. Las cepas presentavan multirresistencia a antibióticos, agrupándose en ocho antibiotipos diferentes como también mostraban una alta tolerancia a los desinfectantes y antisépticos de uso común. Se logra afirmar la importancia y la atención que se debe prestar al Acinetobacter calcoaceticus como patógeno oportunista