Soft tissue infections with Arcanobacterium haemolyticum: report of three cases.

We report here three polymicrobial wound infections associated with Arcanobacterium haemolyticum in rural patients aged between 60-65 years. In two patients, one with cellulitis and the other with postoperative wound infection following amputation of the limb, Arcanobacterium haemolyticum was isolated repeatedly along with beta haemolytic streptococci (BHS). The BHS belonged to Lancefield's group G and group C respectively. In another patient, who was a diabetic with chronic osteomyelitis, Arcanobacterium haemolyticum was isolated along with Proteus vulgaris . All the three isolates of Arcanobacterium haemolyticum isolated by us were uniformly resistant to cotrimoxazole and sensitive to penicillin, erythromycin, clindamycin, ciprofloxacin and gentamicin. Erythromycin alone or combined therapy of penicillin with erythromycin or penicillin with ciprofloxacin was effective in treating these infections.

Outer membrane proteins responsible for multiple-drug resistance in proteus vulgaris

The role of outer membrane proteins in the development of multiple-drug resistance in Proteus vulgaris. Three Proteus vulgaris clinical isolates obtained from Microbiology laporatory at King Abdul Aziz University Hospitals. One of these isolates that is characterized by its sensitivity to all the used antimicrobial agents was selected for further studies. A total of 5 spontaneous ciprofloxacin-resistant mutants were isolated from Proteus vulgaris clinical isolate on agar plates containing ciprofloxacin at concentration of 6 MIC. Four of these mutants [PvM2-PvM5] are characterized by cross-resistance to other fluoroquinolones [norfloxacin. and ofloxacin], beta-lactam antibiotics [cefamandole, cefoperazone, cefotaxime, ceftazidime, ceftriaxone, and cefepime], and aztreonam. While the fifth mutant [PvM1] is characterized by selective resistance to the tested fluoroquinolones. The outer membrane proteins [OMPs] analysis showed a significant reduction [in PvM4 and PvM5 mutants] or disappearance [in PvM2 and PvM3 mutants] of 39 KDa OMP as compared to the parent isolate. In case of mutant PvM1, no significant change in the OMP profile was observed. The four multiple-drug resistant mutants [PvM2-PvM5] had about 2.3 to 3.8 time lower rate of norfloxacin uptake than that of the parent isolate, while no significant change in norfloxain uptake was observed in case of PvM1 mutant. The results of beta-lactamase induction and DNA gyrase assay showed no difference between the selected mutants and their parent, with exception for PvM1 mutant in a which a significant decrease in the DNA gyrase sensitivity to ciprofloxacin was observed. Reduction or disappearance of 39 KDa OMPs in P. vulgaris isolate is associated with cross-resistance to fluoroquinolones. Beta-Iactam antibiotics, and aztreonam

Cultivo de antimicrobianos en pacientes con sepsis del pie diabético / Cultures and antimicrobial agents used in patients coursing with diabetic foot injuries

Objetivo: Evaluar la repercusión del uso empírico de antimicrobianos y con cultivos, en la morbilidad y estancia hospitlaria en el pie diabético. Diseño: Estudio prolectivo, comparativo y observacional. Sede: División de cirugía general. Centro Médico Nacional, IMSS, en Veracruz, Ver. Sujetos de estudio: De julio de 1993 a marzo de 1994 se estudiaron 63 pacientes con lesiones sépticas del pie por diabetes mellitus tipo 2. Principales mediciones: Comparación de la morbilidad y la estancia hospitalaria con : 1) el tratamiento empírico: monoterapia, doble y triple esquema; 2) la congruencia con el germen cultivado: (subgrupos del A al E) y 3) la respuesta del cirujano a los resultados del cultivo: (subgrupos del 1 al 4). Análisis estadístico: Prueba de chi cuadrada o exacta de Fisher y ANOVA. Resultados: El principal esquema utilizado fue el doble (68 po ciento) y la monoterapia (19 por ciento). No se cubrió el germen aislado (GC) en el 62 por ciento; fue excesivo (GA) en el 31 por ciento; inespecífico (GD) en un caso, y sin pacientes en los grupos B (adecuado) y E(antibiótico redundante). El cirujano no modificó el esquema empírico en dos casos (G1), adicionó en tres (G2), los cambió correctamente en siete (G3) e incorrectamente en uno (G4). La morbilidad y la estancia hospitalaria fueron independientes del uso empírico de uno o más antibióticos y de las modificaciones del cirujano ante el germen aislado (p> 0.05). Conclusiones: La monoterapia de amplio espectro o el régimen combinado presentaron complicaciones y estancia hospitalaria similares. Estas fueron independientes de los cultivos realizados y los ajustes del cirujano al intentar cubrir el germen aislado

Prevalência de enterobactérias e pseudomonas em ambiente hospitalar / Prevalence of enterobacteriaceae end pseudomonas in hospital environment

A autora, estudando a prevalência de Enterobactérias e Pseudomonas em ambiente hospitalar, em Goiânia-Go, observou a alta incidência de Klebsiella, Proteus, Escherichia coli e Pseudomonas aeruginosa. O isolamento destes microrganismos foi feito em hospital pediátrico, a partir de "swabs" de nasofaringe, pele, mäos de médicos, enfermeiras, pessoal de apoio, pacientes, além de pias e apartamentos, enfermarias e lactários. O alto percentual observado e os riscos que podem representar os dados encontrados também por outros autores säo discutidos