[Nosocomial bacteremia: epidemiology and current antimicrobial drugs resistances]. / Bacteriemia nosocomial: epidemiología y situación actual de resistencias a antimicrobianos.

Nosocomial bacteremia is a major cause of morbidity and mortality. A change is being observed in the distribution of its causative agents, as well as an increase in the resistances to some antimicrobial drugs. We have analyzed 600 significant bacteremia episodes during the year 2002, studying the resistances to antimicrobial drugs and some epidemiological aspects. Bacteremias caused by gram-positive were 57%, while the ones caused by gram-negative were 46.1%. The three microorganisms more frequently isolated were Staphylococcus epidermidis, Escherichia coli and Staphylococcus aureus. In S. aureus low resistance to oxacillin (10.3%) was observed. Streptococcus pneumoniae with lower sensitivity to penicillin was observed in 49.9%. Resistance of gram-positive microorganisms to vancomycin/teicoplanin was not observed. E. coli and Klebsiella pneumoniae showed low prevalence of expanded spectrum ss-lactamase strains. There are differences in epidemiology of bacteremias at regional level, and continuous local programs for monitoring resistances to antimicrobial drugs are needed.

Bacteriemia nosocomial: epidemiología y situación actual de resistencias a antimicrobianos / Nosocomial bacteremia: epidemiology and current antimicrobial drugs resistances

La bacteriemia nosocomial es una causa importante de morbilidad y mortalidad. Se está observando un cambio en la distribución de sus agentes causales, así como un incremento en las resistencias a algunos antimicrobianos. Hemos analizado 600 episodios de bacteriemias significativas durante el año 2002, estudiando las resistencias a antimicrobianos y algunos aspectos epidemiológicos. Las bacteriemias causadas por grampositivos fueron el 57%, mientras que las producidas por gramnegativos fueron el 46,1%. Los tres microorganismos más frecuentemente aislados fueron Staphylococcus epidermidis, Escherichia coli y Staphylococcus aureus. En S. aureus se observó una resistencia baja a oxacilina (10,3%). Streptococcus pneumoniae con sensibilidad disminuida a la penicilina supuso el 49,9%. No se observó resistencia de los microorganismos grampositivos a vancomicina/teicoplanina. Para E. coli y Klebsiella pneumoniae se obtuvo baja prevalencia de cepas productoras de ß-lactamasa de espectro ampliado. Existen diferencias en la epidemiología de las bacteriemias a nivel regional, siendo necesarios continuos programas de vigilancia y monitorización de las resistencias a antimicrobianos localmente

Nosocomial bacteremia is a major cause of morbidity and mortality. A change is being observed in the distribution of its causative agents, as well as an increase in the resistances to some antimicrobial drugs. We have analyzed 600 significant bacteremia episodes during the year 2002, studying the resistances to antimicrobial drugs and some epidemiological aspects. Bacteremias caused by gram-positive were 57%, while the ones caused by gram-negative were 46.1%. The three microorganisms more frequently isolated were Staphylococcus epidermidis, Escherichia coli and Staphylococcus aureus. In S. aureus low resistance to oxacillin (10.3%) was observed. Streptococcus pneumoniae with lower sensitivity to penicillin was observed in 49.9%. Resistance of gram-positive microorganisms to vancomycin/teicoplanin was not observed. E. coli and Klebsiella pneumoniae showed low prevalence of expanded spectrum ß-lactamase strains. There are differences in epidemiology of bacteremias at regional level, and continuous local programs for monitoring resistances to antimicrobial drugs are needed

Situación actual de la resistencia de Pseudomonas aeruginosa a los antimicrobianos / Current status of Pseudomonas aeruginosa resistance to antibiotics

Pseudomonas aeruginosa es causa de numerosas infecciones, sobre todo en el hospital y en pacientes inmunodeprimidos. Este patógeno posee gran facilidad para adquirir resistencias y, debido al aumento de la prevalencia de aislamientos multirresistentes, se requiere un análisis continuo de la sensibilidad a los antimicrobianos activos frente a él. Por ello hemos evaluado todos los aislamientos de P. aeruginosa procedentes de muestras clínicas de nuestro hospital durante el año 2002, incluyendo únicamente una cepa por paciente. Se estudió la sensibilidad a 11 antimicrobianos activos frente a P. aeruginosa. Tanto la identificación como la determinación de la sensibilidad se realizaron mediante un sistema automatizado (VITEK 2, bioMérieux). Globalmente, el antibiótico más activo in vitro fue piperacilina-tazobactam. El porcentaje de aislamientos multirresistentes (resistencia al menos a dos grupos de antibióticos) fue del 20,9 por ciento. En muestras procedentes de UCI P. aeruginosa tiene valores elevados de resistencia al imipenem (20 por ciento), mientras que los aislamientos de abscesos son extremadamente resistentes a la gentamicina (41,6 por ciento). La resistencia de P. aeruginosa a los antimicrobianos no es uniforme y depende de la procedencia y del tipo de muestra clínica, por lo que debe realizarse una vigilancia individualizada. (AU)

[Current status of Pseudomonas aeruginosa resistance to antibiotics]. / Situación actual de la resistencia de Pseudomonas aeruginosa a los antimicrobianos.

Pseudomonas aeruginosa is responsible for numerous infections, mainly in hospitals and in immunocompromised patients. This pathogen has a great ability to acquire resistance. Given the increase in prevalence of multiresistant isolates, a continuous analysis of the susceptibility of P. aeruginosa to antimicrobial drugs is required. We therefore evaluated all the P. aeruginosa isolates from clinical samples taken at our hospital in 2002, and included only one sample per patient. We studied the susceptibility of P. aeruginosa to 11 active antimicrobial drugs. Identification of the isolate and determination of susceptibility were carried out using an automated system (VITEK 2, bioMerieux). Overall, the antibiotic with the highest in vitro activity was piperacillin-tazobactam. The percentage of multiresistant isolates (resistance to at least two groups of antibiotics) was 20.9%. In samples taken from the ICU, it showed high resistance to imipenem (20%). P. aeruginosa isolated from abscesses was extremely resistant to gentamicin (41.6%). The resistance of P. aeruginosa to antimicrobial drugs is inconsistent as it depends on the source of the isolates and the type of clinical samples. Consequently, individualized monitoring should be conducted.

Staphylococcus aureus resistente a la meticilina. Prevalencia actual en un área del sur de España / Methicillin-resistant Staphylococcus aureus. Present prevalence in an area in southern Spain

Las cepas de Staphylococcus aureus resistentes a meticilina (SARM) suponen un grave problema en algunos lugares. Su prevalencia varía según las áreas, e incluso dentro de un mismo país. Es importante conocer la prevalencia de estas resistencias en cada lugar para aplicar la terapéutica empírica correcta cuando se sospechen tales infecciones. Se han estudiado todas las muestras de S. aureus aisladas consecutivamente en nuestro hospital durante los años 2000 y 2001, incluyendo sólo un aislamiento por paciente. Tanto la identificación como la determinación de la sensibilidad a los antibióticos se realizaron por un sistema automatizado (VITEK, bioMérieux). Se halló una elevada resistencia a la oxacilina (25,89 por ciento), observándose una resistencia también elevada a otros antibióticos como eritromicina (41,22 por ciento), amoxicilina-ácido clavulánico (26,48 por ciento) y ciprofloxacino (25,74 por ciento). La resistencia de S. aureus a la oxacilina en muestras de catéter fue del 67,64 por ciento, y del 44,11 por ciento en muestras de orina. SARM multirresistente (a más de cinco antibióticos) suponía un 66,6 por ciento, siendo un 4 por ciento resistentes sólo a dos antibióticos. SARM es un problema grave en nuestra zona y su prevalencia sigue aumentando progresivamente, así como la multirresistencia. Es necesario ampliar las medidas de vigilancia y control de estas cepas. (AU)

Bacteriemia por Capnocytophaga spp. en pacientes neutropénicos / Capnocytophaga spp. bacterimia in neutropenic patients

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[Methicillin-resistant Staphylococcus aureus. Present prevalence in an area in southern Spain]. / Staphylococcus aureus resistente a la meticilina. Prevalencia actual en un área del sur de España.

Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious problem in some geographic areas. Its prevalence can change according to area and can even vary within a country. It is important to know the prevalence of resistance in each area so that the correct empirical treatment can be applied when these infections are suspected. We studied all the consecutive S. aureus isolates collected in our hospital from 2000-2001 and included only one isolate per patient. Identification of the isolate and determination of susceptibility were carried out using an automated system (VITEK, bioMérieux). High resistance to oxacillin was identified and high resistance was observed for erythromycin (41.22%), amoxicillin-clavulanic acid (26.48%), and ciprofloxacin (25.74%). S. aureus resistance to oxacillin was found to be 67.64% in catheter samples and 44.11% in urine samples. Multiresistant MRSA (to more than five antibiotics) accounted for 66.6%, with 4% resistant to two antibiotics. MRSA is a serious problem in our area and its prevalence is on the rise, as is multiresistance. The means of monitoring and controlling these strains need to be increased.

Cinc y enfermedad pulmonar obstructiva crónica / Zinc and chronic pulmonary obstructive disease

Fundamento. Evaluar las concentraciones orgánicas de cinc en la enfermedad pulmonar obstructiva crónica (EPOC) y en controles sanos, así como evidenciar si existen diferencias entre ambos grupos. Determinar si las concentraciones de cinc plasmático se correlacionan con las halladas en hematíes y faneras. Pacientes y métodos. Se estudian 40 pacientes con EPOC, varones, edad media de 62 ñ 7 años e índice de masa corporal (IMC) de 27 ñ 4. El grupo control lo forman 40 individuos; edad media de 57 ñ 9 años e IMC de 24 ñ 5. Se excluyeron los pacientes con patologías concomitantes o en tratamientos que pudieran aumentar la excreción de cinc. A todos los pacientes se les ha realizado historia clínica y exploración física completas, analítica general con hemograma, bioquímica con parámetros hepáticos y lipídicos y determinación del cinc ungueal, plasmático, en cabellos y en hematíes, mediante espectrofotometría de absorción atómica. El método estadístico empleado ha sido el análisis de la varianza de una vía y el coeficiente de correlación lineal de Pearson para estudiar la asociación entre variables. Resultados. El cinc plasmático, intraeritrocitario y ungueal fue similar en los sujetos sanos y en los pacientes; en cambio, la concentración media en cabellos resultó significativamente menor en los pacientes (156 ñ 46) respecto al grupo control (185 ñ 64) con p < 0,05. No se han encontrado diferencias significativas entre fumadores y no fumadores, ni entre bebedores y no bebedores respecto a las concentraciones de cinc orgánico. Conclusión. Los pacientes con EPOC tienen unas concentraciones de cinc en pelo inferiores a la de los sujetos sanos, mientras que el cinc en hematíes, plasma y a nivel ungueal fue similar en ambos grupos. La determinación de cinc en cabellos puede ser un buen método para detectar deficiencias crónicas y asintomáticas de este metal en el organismo. No se ha encontrado correlación entre la determinación de cinc plasmática y las determinaciones en hematíes y faneras. (AU)

[Nocturnal arterial pressure and the cardiovascular risk factors in patients with arterial hypertension]. / Presión arterial nocturna y factores de riesgo cardiovascular en pacientes con hipertensión arterial.

BACKGROUND: Blood pressure (BP) has a circadian rhythm. Most of the people presents a BP fall between 10-20% during nighttime hours (dipper condition). Measurement of these circadian variations is performed by continuous blood pressure ambulatory monitoring. We have studied the possible relation between blood pressure nocturnal fall and cardiovascular risk factors in hypertensive patients. METHODS: We selected 100 hypertensive patients from the Hypertension and Lipids Unit of San Cecilio University Hospital of Granada, Spain. They were divided into two groups: dippers group and non-dippers, depending of whether or not the fall of nocturnal systolic and diastolic BP was > 10%. All patients included in the study underwent complete clinical history, exhaustive physical examination, complementary examinations, urine and hematology tests, and continuous blood pressure ambulatory monitoring by the Space Labs system. RESULTS: The heart rate was found to be significantly higher (p = 0.0253) in the hypertensive dippers group than in the non-dippers. The latter showed higher plasma creatinine values (p = 0.0343) and lower potassemia values (p = 0.0140) than the dippers group. The dippers group presented concentrations of HDL-cholesterol significantly higher (p = 0.008) and diurnal diastolic BP values (p = 0.0211) also higher than the other group. CONCLUSIONS: Non dippers hypertensive patients present a higher number of cardiovascular risk factors as well as a higher tendency to renal lesions, and worse prognosis than the dippers group.

[Zinc and chronic obstructive pulmonary disease]. / Cinc y enfermedad pulmonar obstructiva crónica.

BACKGROUND: To evaluate the zinc organic concentration in the chronic obstructive pulmonary disease (COPD) in relation to a control group. Also, to analyze if the serum zinc levels are related with zinc concentration in erythrocyte, nail and hair. PATIENTS AND METHODS: Forty patients of COPD have been studied, all males, average age 62 +/- 7 years and body mass index (BMI) of 27 +/- 4. Forty patients were included in the control group, with average age 57 +/- 9 years and BMI of 24 +/- 5. The patients with concomitant disease or booth treatment that could increase the zinc excretion were excluded. In all patients clinical history and examination, hematology and biochemistry tests, hepatic and lipid parameters, and nail, plasma, hair and erythrocyte zinc levels by atomic absorption spectrophotometry were done. Variance analysis and Pearson test were done. RESULTS: Blood, intraerythrocyte and nail zinc were similar in healthy subjects and patients; however, the median concentration of zinc in hair was significantly lower in patients (156 +/- 46 micrograms/g versus control group (185 +/- 64 micrograms/g) (p < 0.05). No differences were found between smokers and no smokers, and drinkers and no drinkers in relation with body concentration of zinc. CONCLUSION: The zinc concentration in hair can be a good method to evaluate the chronic deficiency in the human body. The COPD patients could be susceptible to develop zinc deficiency; the situation increases the possibility of infection diseases.

[Liver abscess caused by Klebsiella pneumoniae in diabetic patients]. / Absceso hepático por Klebsiella pneumoniae en pacientes diabéticos.

Pyogenic liver abscess are macroscopic collections of pus within the hepatic parenchyma after a bacterial infection. These infections are usually polymicrobial in nature, and in most occasions due to biliary tract diseases or cryptogenetic in origin. Monomicrobial hepatic abscess caused by Klebsiella pneumoniae are uncommon lesions in western countries. These lesions are associated with underlying diseases, particularly diabetes mellitus, and are frequently complicated with septic metastasis. We report here three cases of monomicrobial liver abscess caused by Klebsiella pneumoniae in diabetic patients, without septic metastasis and a favourable outcome.