Periodontal therapy and biomarkers related to cardiovascular risk.

In the last 15-20 years the association between periodontitis and cardiovascular diseases has received greater attention. Clinical evidence also suggests that periodontitis is associated with a systemic host response and with a low-grade inflammatory state, as assessed by raised serum levels of CRP and endothelial dysfunction. This is a perturbation of the normal function of the endothelial cells that are responsible for a normal vascular function (dilatation, constriction). The objective of this review was to systematically appraise the available evidence on the effect of periodontal therapy on systemic biomarkers related to cardiovascular risk. An electronic search was conducted using MEDLINE via PubMed to identify published literature. The electronic search identified 836 references, of which 643 were considered irrelevant for this review. Full texts of 183 possible relevant articles were assessed, with exclusion of 174. Nine studies were included in the review. The overall effect of periodontal therapy was associated with a reduction in CRP of 0.50 mg/ml (95% CI 0.15, 0.85) (P=0.005). In conclusion, this review supports the hypothesis of an association between periodontitis and systemic inflammation. Further research is needed on the possible impact of periodontitis on cardiovascular disease events.

Specific antibody profile in human brucellosis.

The results of classic serological tests were compared with those of enzyme-linked immunosorbent assay in studies of immunoglobulins to Brucella in 761 serum samples from 75 patients with brucellosis. Except for five instances involving the IgM ELISA, all serological tests gave positive results at admission. Among the 63 patients without relapse, rates of persistent ELISA positivity (determined by the Kaplan-Meier method) 12 months after therapy were 25% for IgM, 69% for IgA, and 89% for IgG. Among the 12 patients with relapse, a second peak of ELISA IgG and IgA was often detected. The persistence of high serum antibody titers in patients without relapse was due mainly to IgG and was often associated with high titers at admission or with the presence of focal disease. Overall, serological changes were better detected by ELISA than by classic serological tests. While a second peak of ELISA IgG and IgA is a good marker of relapse, the persistence of high titers of IgG by itself is not a good predictor of chronic infection.

Specific antibodies detected during relapse of human brucellosis.

We studied 10 patients who had a relapse of brucellosis for significant serological changes during relapse. By the Coombs test, the pre-relapse and post-relapse median (range) titers of antibody to Brucella were 1:1120 (1:40-1:10,240) and 1:10,240 (1:40-1:81,920), respectively (P = .0069); by enzyme-linked immunosorbent assay (ELISA) for IgG, these values were 1:2240 (1:60-1:10,240) and 1:10,240 (1:160-1:81,920; P = .0069); by ELISA for IgA, the median titer increased 3.36 times but did not reach statistical significance (P = .0929); by tube agglutination, dithiothreitol (DTT) agglutination, and ELISA for IgM, median titers did not change. Nine patients had a significant titer increase by Coombs test and IgG ELISA, three had a significant increase by tube and DTT agglutination, none had significant increases by IgM ELISA, and one had no significant increase after relapse. Our findings show that for most patients with a relapse of brucellosis, there is an increase in IgG titers, as detected by ELISA and Coombs test, but no change in IgM titers.

Incidence of strains producing plasmid determined beta-lactamases among carbenicillin resistant Pseudomonas aeruginosa.

A total of 1056 strains of Pseudomonas aeruginosa isolated from human clinical specimens from patients was collected from eight laboratories in order to study the frequency of plasmid-determined beta-lactamase producers and the different enzymes represented. The strains from each laboratory comprised consecutive, non-repeated, clinical isolates. In the 166 strains selected because they were carbenicillin resistant, the isoelectric points of the beta-lactamases were studied by means of analytical isoelectric focusing and the different types of plasmid-determined beta-lactamases identified. Seventy-five of the strains (45.18%) were plasmid-mediated beta-lactamase producers; the frequency varied among laboratories from 0% to 100%. Overall the most frequently identified beta-lactamase type was PSE-1 (49.34%) followed by TEM-1 (37.34%). The remaining carbenicillin-resistant strains did not produce plasmid-determined beta-lactamases.

Plasmid-determined beta-lactamases identified in a group of 204 ampicillin-resistant Enterobacteriaceae.

Information is presented on the plasmid-determined beta-lactamases identified in 204 strains of ampicillin-resistant Enterobacteriaceae. The type most frequently identified was TEM-1 (in 85.3% of the strains), followed by SHV-1 (14.70%). Two types of plasmid-determined beta-lactamase were identified in 20 strains; in 18 of them one of the two was TEM-1 and in 13, SHV-1 (the TEM-1 + SHV-1 combination was observed in 12 strains). In the 41 Klebsiella strains the most frequently identified enzyme was SHV-1 (in 28 of the strains) and the proportion of strains with two plasmid-determined beta-lactamases was higher than in the other species studied.

Activity of ciprofloxacin (BAYo 9867) against Pseudomonas aeruginosa and ampicillin-resistant Enterobacteriaceae.

We studied the in vitro activity of ciprofloxacin against 570 strains of ampicillin-resistant Enterobacteriaceae and 286 Pseudomonas aeruginosa strains. 95.26% of the Enterobacteriaceae and 53.45% of the P. aeruginosa were inhibited by 0.1 mg/l of ciprofloxacin. 2 mg/l of ciprofloxacin inhibited all of the Enterobacteriaceae strains and 4 mg/l all of the P. aeruginosa. We compared the activity of ciprofloxacin with that of temocillin in the Enterobacteriaceae strains. In the P. aeruginosa strains, classified according to their susceptibility to carbenicillin and gentamicin, we compared the activity of ciprofloxacin with that of ceftazidime. In the strains studied, the in vitro activity of ciprofloxacin is superior to that of temocillin against the Enterobacteriaceae and to that of ceftazidime against the P. aeruginosa strains.

Complementary activity of mezlocillin and the combination of amoxicillin with clavulanic acid on Enterobacteriaceae.

The MICs of amoxicillin, mezlocillin and BRL 25,000, a combination of two parts amoxicillin and one part clavulanic acid (2AM + 1CA), were measured for 331 Enterobacteriaceae strains which produced beta-lactamases as demonstrated by nitrocefin. The MIC values for mezlocillin and the combination 2AM + 1CA were very similar for the total number of the strains investigated. When investigated separately according to the bacterial species, three different sensitivity groups were established for the above-mentioned preparations: 1) species with the same or similar sensitivity to mezlocillin and 2AM + 1CA (Escherichia coli and Shigella spp., amoxicillin-resistant strains); 2) species which were more sensitive to mezlocillin than to the combination 2AM + 1CA (Citrobacter spp., Enterobacter cloacae, Serratia spp. and indole-positive Proteus as well as strains of E. coli and Shigella spp. which produce a cephalosporinase and are sensitive to amoxicillin); 3) species which are more sensitive to 2AM + 1CA than to mezlocillin (amoxicillin-resistant Salmonella spp., Proteus mirabilis and Klebsiella pneumoniae). This complementary activity of mezlocillin and 2AM + 1CA against Enterobacteriaceae depended on the beta-lactamases produced.

[Cefsulodin, a new antibiotic of the group of cephalosporins: its action on Pseudomonas aeruginosa (author's transl)]. / Acción de la cefsulodina, nuevo antibiótico del grupo de las cefalosporinas, sobre Pseudomonas aeruginosa.

Cefsulodin is a new second generation cephalosporin with a narrow antibacterial spectrum. Its main use is in the treatment of Pseudomonas aeruginosa infections. It is resistant to the action of the beta-lactamases of gram negative bacilli, especially to that of the cephalosporinases. We have studied 170 strains of P. aeruginosa and 10 of other species of Pseudomonas, determining the MIC by the serial dilution test in solid medium and the sensitivity by the agar diffusion test. With 8 microgram/ml, a concentration which is accepted as a limit of sensitivity from the therapeutic point of view, 90% of the P. aeruginosa strains studied are inhibited; the MIC50 is obtained with 2 microgram/ml. Within the strains considered sensitive (MIC less than 8 microgram/ml) there is a marked dispersion of the zone diameters corresponding to each of the values of MIC. This behavior limits the value of the regression line. We have also studied the MIC of carbenicillin for nearly all the strains and we have also studied the MIC of carbenicillin for nearly all the strains and we have found that 86.58% are sensitive to both preparations, 4.96% are sensitive to cefsulodin and resistant to carbenicillin, 4.02% resistant to cefsulodin and sensitive to carbenicillin and 4.69% are resistant to both preparations. From the clinical point of view the number of strains sensitive (or resistant) is similar with both substances but cefsulodin is in absolute values from 8 to 128 times more day active than carbenicillin. Cefsulodin is administered by a parenteral route and is eliminated by the urine in active form. The recommended therapeutic dose for the treatment of systemic infections is 2 g daily IV. This dose may be increased if it is considered advisable. There is good local tolerance (IM and IV), it is only slightly toxic, hardly alters the intestinal flora and may be used at all ages, in patients with immunological alterations and in patients with an altered renal function.

[Sensitivity of Salmonella species to four "classical" antibiotics and seven new beta-lactamic antibiotics (author's transl)]. / Sensibilidad de las salmonelas a cuatro antibióticos "clásicos" y a siete nuevos antibióticos beta-lactámicos.

A study of the minimal inhibitory concentration (MIC) for 200 strains of Salmonella sp. has been performed with the following beta-lactamic antibiotics: mezlocillin and azlocillin (penicillins), cephaclor, cephamandole, cephuroxime and cephotaxime (cephalosporins), and cephoxytine (cephamycin). The MIC has been compared with that of chloramphenicol, ampicillin, amoxicillin and cotrimoxazole, all of them widely used antibiotics for the treatment of Salmonella infections in Spain. The different species and serotypes of Salmonella studied were all sensitive to all the beta-lactamic antibiotics tested. Of particular relevance is the fact that cephotaxime (HR 756) MIC was extraordinarily low even for strains resistent to the penicillins. The MIC of cephaclor, and oral cephalosporin, was similar to that of the parenteral cephalosporins.