Treatment for T1DM patients by a neuro-fuzzy inverse optimal controller including multi-step prediction.

Diabetes Mellitus is a serious metabolic condition for global health associations. Recently, the number of adults, adolescents and children who have developed Type 1 Diabetes Mellitus (T1DM) has increased as well as the mortality statistics related to this disease. For this reason, the scientific community has directed research in developing technologies to reduce T1DM complications. This contribution is related to a feedback control strategy for blood glucose management in population samples of ten virtual adult subjects, adolescents and children. This scheme focuses on the development of an inverse optimal control (IOC) proposal which is integrated by neural identification, a multi-step prediction (MSP) strategy, and Takagi-Sugeno (T-S) fuzzy inference to shape the convenient insulin infusion in the treatment of T1DM patients. The MSP makes it possible to estimate the glucose dynamics 15 min in advance; therefore, this estimation allows the Neuro-Fuzzy-IOC (NF-IOC) controller to react in advance to prevent hypoglycemic and hyperglycemic events. The T-S fuzzy membership functions are defined in such a way that the respective inferences change basal infusion rates for each patient's condition. The results achieved for scenarios simulated in Uva/Padova virtual software illustrate that this proposal is suitable to maintain blood glucose levels within normoglycemic values (70-115 mg/dL); furthermore, this level remains less than 250 mg/dL during the postprandial event. A comparison between a simple neural IOC (NIOC) and the proposed NF-IOC is carried out using the analysis for control variability named CVGA chart included in the Uva/Padova software. This analysis highlights the improvement of the NF-IOC treatment, proposed in this article, on the NIOC approach because each subject is located inside safe zones for the entire duration of the simulation.

Recomendaciones en el tratamiento antibiótico empírico de la infección intraabdominal / No disponible

No disponible

Recomendaciones en el tratamientoantibiótico empírico de la infecciónintraabdominal / Recommendations in the empiric anti-infective agents of intra-abdominal infection

Un número importante de pacientes con infección intraabdominaldesarrollan estados avanzados de la infeccióny la mortalidad es todavía superior al 20%. El fracaso esmultifactorial y se relaciona con el incremento de resistenciasbacterianas, el tratamiento empírico inapropiado, la mayorcomorbilidad de los pacientes y el mal control del foco de infección.Estas guías analizan cada uno de estos problemas yproponen medidas para evitar el fracaso, basadas en la mejorevidencia científica actual (AU)

A significant number of patients with abdominal infectiondevelop advanced stages of infection and mortalityis still above 20%. Failure is multifactorial and isassociated with an increase of bacterial resitance, inappropriateempirical treatment, a higher comorbidity of patientsand poor source control of infection. These guidelinesdiscuss each of these problems and propose measuresto avoid the failure based on the best current scientificevidence (AU)

[Recommendations in the empiric anti-infective agents of intra-abdominal infection]. / Recomendaciones en el tratamiento antibiótico empírico de la infección intraabdominal.

A significant number of patients with abdominal infection develop advanced stages of infection and mortality is still above 20%. Failure is multifactorial and is associated with an increase of bacterial resistance, inappropriate empirical treatment, a higher comorbidity of patients and poor source control of infection. These guidelines discuss each of these problems and propose measures to avoid the failure based on the best current scientific evidence.

[Multicenter study of in vitro activity of tigecycline in clinical isolates from 30 centers in Spain]. / Estudio multicéntrico de la actividad in vitro de tigeciclina en aislados clínicos en 30 hospitales españoles.

INTRODUCTION: In the last years, the increase of antibiotic resistances of gram-positive and gram-negative bacteria is an important therapeutic problem. The antimicrobial activity of tigecycline, a novel glycylcycline, was evaluated against 750 bacterial isolates from 30 centers in Spain. METHODS: Multicenter and retrospective study. In 2005, thirty laboratories participated in this study. Data collected in this study included antimicrobial susceptibilities for S.aureus resistant to methicillin (MRSA), ESBL- E. coli or ESBL- K. pneumoniae, E. coli resistant to quinolons (E.coli- QR), Klebsiella spp and E. faecalis. Trains were obtained of the each Hospital s collection (5 strains of each microorganisms). The susceptibility determinations were performed locally by each laboratory following the standard method usually performed. The tigecycline susceptibility determinations were performed with E/test. RESULTS: Tigecycline was the most potent agent against MRSA, E. faecalis, E.coli-QR and ESBLs enterobacteriaceae; with MIC50-MIC90 values of: 0.125-0.25 g/ml; 0.125-0.5 g/ml; 0.25-0.75 g/ml and 0.38-1.5 g/ml; respectively. CONCLUSIONS: The results of this study confirm the excellent in vitro activity of tigecycline against gram-positive and gram-negative pathogens, including multirresistant microorganisms.

Estudio multicéntrico de la actividad in vitro de tigeciclina en aislados clínicos en 30 hospitales españoles / Multicenter study of in vitro activity of tigecycline in clinical isolates from 30 centers in Spain

Introducción. En los últimos años, el incremento de resistencias de las bacterias grampositivas y gramnegativas a los antimicrobianos constituye un importante problema terapéutico. Se evaluó la actividad antimicrobiana de tigeciclina, una nueva glicilciclina, frente a 750 aislados procedentes de 30 hospitales españoles. Métodos. Estudio multicéntrico y retrospectivo. En el año 2005, 30 laboratorios participaron en este estudio. Se recogieron los datos de sensibilidad para Staphylococcus aureus resistente a la meticilina (SARM); E. coli o Klebsiella productores de BLEE; E. coli resistente a quinolonas (E. coli-RQ); Klebsiella spp. y E. faecalis. Las cepas se obtuvieron del cepario de cada hospital (5 aislados por cada microorganismo). La determinación de sensibilidad se realizó en cada laboratorio participante en el estudio según el método estándar empleado de forma rutinaria. La determinación a tigeciclina se realizó mediante E-test. Resultados. Tigeciclina fue el antibiótico más activo frente a SARM, E. faecalis, E. coli-RQ y enterobacterias productoras de BLEE; con unos valores de CMI50-CMI90 de: 0,125-0,25 g/ml; 0,125-0,5 g/ml; 0,25-0,75 g/ml y 0,38-1,5 g/ml; respectivamente. Conclusiones. Los resultados del presente estudio confirman el excelente perfil de sensibilidad in vitro de tigeciclina frente a microorganismos grampositivos y gramnegativos, incluyendo los multirresistentes (AU)

Introduction. In the last years, the increase of antibiotic resistances of grampositive and gramnegative bacteria is an important therapeutic problem. The antimicrobial activity of tigecycline, a novel glycylcycline, was evaluated against 750 bacterial isolates from 30 centers in Spain. Methods. Multicenter and retrospective study. In 2005, thirty laboratories participated in this study. Data collect- ed in this study included antimicrobial susceptibilities for S.aureus resistant to methicillin (MRSA), ESBL- E. coli or ESBL- K. pneumoniae, E. coli resistant to quinolons (E.coli- QR), Klebsiella spp and E. faecalis. Trains were obtained of the each Hospital ́s collection (5 strains of each microorganisms). The susceptibility determinations were performed locally by each laboratory following the standard method usually performed. The tigecycline susceptibility determinations were performed with E/test. Results. Tigecycline was the most potent agent against MRSA, E. faecalis, E.coli-QR and ESBLs enterobacteriaceae; with MIC50-MIC90 values of: 0.125-0.25 g/ml; 0.125-0.5 g/ml; 0.25-0.75 g/ml and 0.38-1.5 g/ml; respectively. Conclusions. The results of this study confirm the excellent in vitro activity of tigecycline against grampositive and gram-negative pathogens, including multirresistant microorganisms (AU)

Un día en la Microbiología española. Estudio descriptivo de la actividad de los Servicios de Microbiología Clínica / A day in Spanish microbiology. Descriptive study of the activity of the clinical microbiology departments

Introducción. El laboratorio es una parte fundamental del trabajo de los Servicios de Microbiología Clínica (SMC). El objetivo de este estudio es medir la actividad de estos laboratorios. Material y métodos. Encuesta autoadministrada sobre la actividad de un día de trabajo durante octubre de 2007. Resultados. Los 36 hospitales reportaron 14.076 test, siendo el más solicitado la serología (30,3%), seguido por cultivo de orina (27,8%), hemocultivo (13,2%), muestras respiratorias (8%), heces (7,1%), uretra (5,8%), piel (5,3%) y líquido cefalorraquídeo (2,6%). Por tipo de microorganismo, el 73,2% de las muestras correspondía a bacterias (22,9% fueron positivas), el 8,9% a virus (17% de positivos), el 8,1% a hongos (rendimiento: 25,2%), el 5,5% a micobacterias (rendimiento: 5,9%) y a parásitos el 4,5% (positivos: 12,5%). Los sistemas automáticos han sido los más empleados en test de susceptibilidad (62,3%) seguidos de test de difusión (27,1%) y E-test (9,1%). El 5,6% de los antibiogramas demostraron resistencia in vitro a los antibióticos. Se han identificado hongos en 108 aislamientos, sien- do los más frecuentes Candida (85,1%) y Aspergillus (8,3%). El origen de estas muestras es: vías respiratorias bajas (32,4%), aparato genital (24,1%), orina (10,2%), sangre (10,2%) y piel (10,2%). Se han empleado 12 técnicas de identificación; las más frecuentes han sido las morfológicas (54,8%) y bioquímicas (39,7%). Por servicios se remitieron de Unidades de Cuidados Intensivos (UCI) (20,4%), Cirugía (16,7%), Medicina (29,6%) y Atención Primaria (18,5%). Discusión. Aunque se ha medido la carga de trabajo de los laboratorios, no se evaluaron aspectos como el procesamiento de los especímenes, la asesoría o la investigación (AU)

Introduction. The laboratory is an essential part of the work in the Clinical Microbiology Department. This study has aimed to measure the activity of these laboratories. Material and methods. A survey was self-administered on the activity occurring during one work day by each hospital in October 2007. Results. Thirty six hospitals reported 14,076 tests. Serology was the most frequently reported test (30.3%) followed by urine culture (27.8%), blood tests (13.2%), respiratory tract samples (8%), feces (7.1%), urethral (5.8%), skin (5.3%) and cerebrospinal fluid (2.6%). According to species, 73.2% of the isolates were bacteria (22.9% were positive), 8.9% were virus (17% positive), fungi 8.1% (25.2% positive), and 5.5% mycobacterias (5.9% were positive) and parasite 4.5% (12.5% positive). Susceptibility test were performed by automatic methods (62.3%) followed by diffusion test (27.1%) and E-test (9.1%). A total of 5.6% of the susceptibility tests showed in vitro resistance to antibiotics. Fungi were identified in 108 isolates. Candida and Aspergillus were the most frequent genus (85.1% and 8.3%, respectively). Origins of the samples were: lower respiratory tract (32.4%), genital tract (24.1 %), urine (10.2 %), blood (10.2 %) and skin (10.2%). Twelve identification techniques were used, the most frequent being the morphological test (54.8%) and bio- chemical test (39.7%). Broken down by departments, 20.4% were sent from the ICU, 16.7% from surgery, 29.6% from medicine and 18.5% from primary care. Discussion. Although the workload of the laboratories has been measured in this work, aspects such as specimen manipulation, clinical advice and research were not considered (AU)

Prevalencia de infección tuberculosa en las personas inmigrantes de Lorca (Murcia) / Prevalence of tuberculous infection in immigrants in Lorca (Murcia)

FUNDAMENTO. La tuberculosis (TB) es una de las enfermedades más importantes a escala mundial por el número de enfermos y muertos que causa. El objetivo del estudio fue determinar la prevalencia de infección tuberculosa en la población inmigrante del municipio de Lorca. MÉTODOS. Estudio observacional descriptivo transversal en población inmigrante, con emplazamiento en Atención Primaria. La captación y reclutamiento se realizó en las consultas de Medicina de Familia entre febrero de 2005 y diciembre de 2006. Se realizó intradermorreacción de Mantoux (IDRM), con 0,1 ml (2UT) de PPD RT-23, previa firma del consentimiento informado. Otras variables recogidas fueron: edad, sexo, país de origen, nivel de estudios, situación laboral, número de convivientes y superficie de la vivienda, vacunación y escara (BCG) y tiempo de residencia en Europa. RESULTADOS. Fueron incluidas 106 personas inmigrantes y completaron el estudio el 95,3% (101), con una edad media de 30,5 ± 10,9. El 54,5% eran mujeres y llevaban un promedio de 2,8 años en Europa. La IDRM fue positiva en 28 (27,7% [IC 95%: 18,3-37,5]). Las personas inmigrantes con Mantoux positivo tenían una edad media de 35,7 años (IC 95%: 28,4-39,2). La prevalencia resultó mayor en los hombres, con diferencias significativas en los mayores de 39 años que residían en Europa ≥ 3 años y de nacionalidad ecuatoriana (17,8%). CONCLUSIONES. La prevalencia de infección por TB encontrada en la población inmigrante del municipio de Lorca es alta, superior a la de la población española. Consideramos que está justificada la realización de un examen de salud en su primer contacto con el Sistema Sanitario para descartarla, siendo el nivel sanitario más adecuado la Atención Primaria (AU)

BACKGROUND. Tuberculosis (TB) is one of the most important worldwide diseases due to the number of patients and deaths it causes. This study has aimed to determine the prevalence of tuberculous infection in the immigrant population of the Lorca municipality. METHODS. This is an observational, described, cross-sectional study in the immigrant population at the Primary Health Care level. Patient capture and enrolment was made in the Family Medicine Out-patient Clinics between February 2005 and December 2006. The Mantoux intradermal reaction (MIDR) with 0.1 ml (2UT) of PPD RT-23 was performed after obtaining signed informed consent. Other variables collected were: age, gender, country of origin, study level, work situation, number of persons living in the housing and its surface, vaccinations and scarring (BCG), time of residence in Europe. RESULTS. A total of 106 immigrants were included with 95.3% (101) completed the study. They had a mean age of 30.5 ± 10.9 and 54.5% were women. They had been living for an average of 2.8 years in Europe. MIDR was positive in 28 [27.7% (95% CI; 18.3-37.5)]. The immigrants with positive Mantoux had a mean age of 35.7 years (95% CI 28.4-39.2). Prevalence was greater in the men, with significant differences in those over 39 years of age, in those who had resided in Europe ≥ 3 years, with Ecuadorian nationality (17.8%). CONCLUSIONS. Prevalence of TB infection found in the immigrant population of the Lorca municipality is high, greater than in the Spanish population. We consider that making an examination of their health in their first contact with the Health Care system to rule out TB is justified, the most adequate level for this being Primary Health Care (AU)

Recomendaciones de tratamiento antifúngico en pacientes con bajo gradode inmunodepresión / Recommendations of antifungal treatment in patients with low grade inmunosuppression

La relevancia que las micosis sistémicas han adquiridoen los pacientes no profundamente inmunodeprimidos, lasdificultades de tratamiento que presentan por el incrementode la especies de Candida no albicans y la necesidad dehacer un mejor uso y más racional de los nuevos antifúngicos(voriconazol, posaconazol, caspofungina, micafungina yanidulafungina) han reunido a un panel de expertos en enfermedadesinfecciosas en representación de la Sociedad Españolade Quimioterapia (SEQ), Sociedad Española de MedicinaInterna (SEMI) y Sociedad Española de Neumología yCirugía Torácica (SEPAR) para hacer unas recomendacionesbasadas en la evidencia científica buscando mejorar la efectividad (AU)

Because of the relevance that the systemic mycoses hasacquired in non-highly immunocompromised patients, thetreatment difficulties they have due to the increase of thenon-albicans Candida species and the need to have a betterand more rational use of the new antifungal agents (voriconazole,posaconazole, caspofungin, anidulafungin and micafungin),an experts' panel on infectious diseases in representationof the Spanish Society of Chemotherapy, SpanishSociety of Internal Medicine, and Spanish Society of Pneumologyand Thoracic Surgery has met in order to make a few recommendations based on the scientific evidence in aneffort to improve their efficiency (AU)

[Recommendations of antifungal treatment in patients with low grade immunosuppression]. / Recomendaciones de tratamiento antifúngico en pacientes con bajo grado de inmunodepresión.

Because of the relevance that the systemic mycoses has acquired in non-highly immunocompromised patients, the treatment difficulties they have due to the increase of the non-albicans Candida species and the need to have a better and more rational use of the new antifungal agents (voriconazole, posaconazole, caspofungin, anidulafungin and micafungin), an experts' panel on infectious diseases in representation of the Spanish Society of Chemotherapy, Spanish Society of Internal Medicine, and Spanish Society of Pneumology and Thoracic Surgery has met in order to make a few recommendations based on the scientific evidence in an effort to improve their efficiency.

In vitro susceptibility of community-acquired urinary tract pathogens to commonly used antimicrobial agents in Spain: a comparative multicenter study (2002-2004).

The susceptibility patterns of 2724 uropathogens isolated in 9 Spanish regions during 2002, and 3013 obtained in 2004 were determined. The antibiotics tested were fosfomycin trometamol, amoxicillin, co-amoxiclav, cefixime, cefuroxime-axetil, pipemidic, ceprofloxacin, trimethoprim plus sulphamethoxazole and nitrofurantoin. Escherichia coli was the main pathogen in both studies (73% vs. 68.3%) followed by Proteus mirabilis 7.2% vs. 6.4%) and Klebsiella pneumoniae (5.4% vs. 5.2%). Enteroccocus spp. (4.7% vs. 6.8%), Streptoccocus agalactiae (1.7% vs. 3.1%) and Staphyloccocus saprophyticus (0.7% vs. 1.3%)were the most frequent Gram-positive pathogens. 31.3% of E. coli in 2002 and 32% in 2004 were susceptible to all antibiotics tested. Around 40% of E. coli were resistant to a single agent. 21.6-24.1% were resistant to two antibiotics. 35.4% of first period isolates, and 37.6% of second period ones were resistant to two or more classes of antibiotics. Fosfomycin (2.1- 2.8%) and nitrofurantoin (3.5-5.7%) had the lowest resistance rates for E. coli. Amoxicillin (58.2-58.7%), co-trimoxazole (30.8-33.8%) and ciprofloxacin (22.6-22.7%) showed the highest resistance rates, and their suitability as empiric treatments for UTI should probably be re-evaluated.

The Meropenem Yearly Susceptibility Test Information Collection antimicrobial susceptibility program in Spain: a 5-year analysis.

The Meropenem Yearly Susceptibility Test Information Collection program is a global study providing in vitro surveillance data on antimicrobial susceptibility in centers prescribing meropenem. This study summarizes data on the activity of meropenem and 5 comparators against 4022 clinical isolates from 7 centers in Spain (1999-2003). Those bacteria intrinsically resistant to meropenem were excluded. Among Enterobacteriaceae, 100% of Enterobacter spp., Citrobacter spp., and Serratia spp. were susceptible to meropenem. Escherichia coli and Klebsiella pneumoniae susceptibilities to carbapenems were 100% and > or =98%, respectively. Extended-spectrum beta-lactamase-producing Enterobacteriaceae were 3.8% of isolates, and all of them were susceptible to meropenem. Ciprofloxacin resistance in E. coli was around 20%. Meropenem and piperacillin/tazobactam were the most active agents against Pseudomonas aeruginosa. Acinetobacter baumannii were 61-90% susceptible to carbapenems, but only 6-21% susceptible to ciprofloxacin. In this period, around 100% of oxacillin-susceptible staphylococci were susceptible to meropenem. There was no significant decrease in susceptibility to the carbapenems throughout the 5-year period. The clinical use of meropenem in 7 Spanish centers did not increase bacterial resistance to this agent in the microorganisms evaluated.

¿Dispondremos de antimicrobianos adecuados frente a Staphylococcus aureus resistentes a la meticilina? / Do we have adequate antimicrobials against methicillin-resistant Staphylococcus aureus?

No disponible

Encuesta multicéntrica nacional sobre utilización de antibióticos intravenosos / National multicenter survey: the use of intravenous antimicrobial agents

Las enfermedades infecciosas constituyen uno de los mayores problemas de salud, por lo que tanto la infección hospitalaria como la adquirida en la comunidad implican una carga asistencial y un gasto sanitario importante en los hospitales, sobre todo en unidades como las de Cuidados Intensivos, Medicina Interna y Cirugía. Dadas las peculiaridades de los enfermos hospitalizados, el uso de antimicrobianos intravenosos es habitual. Este estudio multicéntrico pretende conocer el manejo de los antimicrobianos y los procedimientos empleados con más frecuencia en relación con su administración en los hospitales españoles. Para ello se ha realizado una encuesta entre el personal sanitario de los servicios anteriormente mencionados de 63 hospitales españoles, en la cual se recogen datos referentes al manejo del catéter, tanto central como de vía periférica, y a la administración de antimicrobianos intravenosos. Los resultados indican que, en España, tanto el manejo del catéter (inserción, mantenimiento y retirada) como la administración de antimicrobianos son realizados por el personal de enfermería, siguiendo protocolos establecidos, fundamentalmente en el manejo del catéter central. Además, la Unidad de Cuidados Intensivos presenta los porcentajes más elevados tanto de pacientes portadores de catéteres como de pacientes con algún tratamiento antimicrobiano, frecuentemente en asociación. Se concluye que el uso de antimicrobianos intravenosos en los hospitales supone una gran parte del trabajo asistencial, así como un gasto sanitario importante, sin olvidar los riesgos asociados a la presencia de un catéter vascular

Infectious diseases are currently one of the major health problems worldwide. As a consequence, both nosocomial and community-acquired infections are responsible for a significant increase in workload and health costs for hospitals, particularly in Intensive Care Units (ICU), Internal Medicine and Surgery. The use of intravenous antimicrobial agents is common in hospitalized patients. In order to determine the use of antimicrobial agents and the most frequent procedures used for their administration in Spanish hospitals, a national multicenter survey was undertaken among ICU, Internal Medicine and Surgery health staff from 63 hospitals, in which data were collected on central and peripheral catheter manipulation and intravenous administration. Results showed that, in Spain, both catheter manipulation (insertion, maintenance and removal) and administration of antimicrobial agents are performed by the nursing staff following established protocols, particularly for central catheters. Moreover, the ICUs had the highest rates of catheter-bearing patients, as well as patients undergoing antimicrobial treatment, sometimes in combination. The use of intravenous antimicrobial agents in Spanish hospitals results in an increased workload for the nursing staff and higher health costs, not to mention the risk involved with the use of vascular catheters

Molecular epidemiology of drug-resistant Salmonella Typhimurium in Spain.

One hundred and forty-seven Salmonella serotype Typhimurium strains isolated in three provinces in the midwest of Spain were studied. Of these, 93.6% were drug resistant. There were two predominant resistance phenotypes: 43 isolates (29.3%) were resistant to amoxicillin, tetracyclines, chloramphenicol, streptomycin and sulphamethoxazole and 27 isolates (18.4%) to amoxicillin, amoxicillin/clavulanic acid, tetracyclines, chloramphenicol, streptomycin and sulphamethoxazole. Randomly amplified polymorphic DNA (RAPD) analysis and pulsed field gel electrophoresis (PFGE) were performed for molecular typing. Thirty-six DNA band profiles were differentiated by RAPD, and 38 by PFGE. We found a high level of clonality; 27% of strains were identical by both methods. There were additional smaller clonal lines within every area. The highest discriminatory power was obtained with PFGE, but the greatest degree of genetic diversity was observed among Salmonella Typhimurium using both RAPD and PFGE.

Molecular epidemiology of drug-resistant Salmonella Typhimurium in Spain

One hundred and forty-seven Salmonella serotype Typhimurium strains isolated in three provinces in the midwest of Spain were studied. Ofthese, 93.6% were drug resistant. There were two predominant resistance phenotypes: 43 isolates (29.3%) were resistant to amoxicillin, tetracyclines,chloramphenicol, streptomycin and sulphamethoxazole and 27 isolates (18.4%) to amoxicillin, amoxicillin/clavulanic acid, tetracyclines,chloramphenicol, streptomycin and sulphamethoxazole. Randomly amplified polymorphic DNA (RAPD) analysis and pulsed field gelelectrophoresis (PFGE) were performed for molecular typing. Thirty-six DNA band profiles were differentiated by RAPD, and 38 by PFGE. Wefound a high level of clonality; 27% of strains were identical by both methods. There were additional smaller clonal lines within every area.The highest discriminatory power was obtained with PFGE, but the greatest degree of genetic diversity was observed among SalmonellaTyphimurium using both RAPD and PFGE

Se estudiaron 147 de cepas de Salmonella serotipificadas como Typhimurium procedentes de tres provincias españolas del medio-oeste. El93,6% de ellas eran resistentes a los antimicrobianos. Hubo dos fenotipos de resistencia predominantes: 43 cepas (29,3%) fueron resistentesa amoxicilina, tetraciclinas, cloranfenicaol, estreptomicina y sulfametoxazol, y 27 (18,4%) a amoxicilina, amoxicilina-ácido clavulánico, tetraciclinas,cloranfenicol, estreptomicina y sulfametoxazol. Los distintos patrones de resistencia se determinaron por técnicas de biología molecular:RAPD (Randomly Amplified Polymorphic DNA) y PFGE (Pulsed Field Gel Electrophoresis). Por RAPD se diferenciaron 36 patrones debandas, y por PFGE 38. Se encontró una proporción alta de clones: el 27% de las cepas fueron idénticas por ambos métodos. Además, encada área se encontraron algunos clones diferentes adicionales. Con PFGE se obtuvo el mayor poder discriminatorio, pero el mayor gradode diversidad genética se observó usando ambas técnicas conjuntamente

[Patterns of susceptibility to antibiotics of Enterobacteriaceae causing intra-abdominal infection in Spain: SMART 2003 study outcomes]. / Patrones de sensibilidad a antimicrobianos de Enterobacteriaceae causantes de infecciones intraabdominales en España: resultados del estudio SMART 2003.

SMART (Study for Monitoring Antimicrobial Resistance Trends) is an ongoing global antimicrobial surveillance program focused on clinical isolates from intra-abdominal infections. The objective of this subanalysis was to assess antimicrobial susceptibility patterns among Entero-bacteriaceae recovered at 13 participating Spanish sites during 2003. Antimicrobial susceptibility testing was performed using broth microdilution techniques according to the CLSI (formerly NCCLS) guidelines for MIC testing. The presence of extended-spectrum beta-lactamases (ESBL) was confirmed in isolates with a MIC of ceftriaxone, ceftazidime, or cefepime>or=2 mg/l by comparing cefepime MICs with and with-out clavulanate. A total of 981 Enterobacteriaceae recovered from 840 patients were tested, of which 398 (41%) were community-acquired. Escherichia coli was the most common isolate (571 isolates; 58%), followed by Klebsiella spp. (153; 16% Enterobacter spp. (97; 10%), and Proteus spp. (63; 6%). A total of 191 isolates (19%) from 176 patients produced inducible beta-lactamases. The carbapenems and amikacin were the most consistently active agents against the Enterobacteriaceae (susceptibility>or=99%). Resistance rates for ceftazidime, cipro-floxacin, and levofloxacin exceeded 10%. ESBLs were detected phenotypically in 61 (6%) isolates, being the most common E. coli (61%), Klebsiella spp. (20%), and Enterobacter spp. (8%). Antimicrobial resistance among Enterobacteriaceae isolated from intra-abdominal infections is a problem in Spain. A significant proportion of inducible beta-lactamase and ESBL-producing Enterobacteriaceae causing intra-abdominal infection were acquired in the community. The carbapenems ertapenem, imipenem and meropenem and the aminoglycoside amikacin were highly active in vitro against Enterobacteriaceae isolated from intra-abdominal sites, including ESBL-producing organisms.