Physiotherapy applied to palliative care patients: a descriptive practice-based study.

BACKGROUND: Over the last few years, the presence of physiotherapists in Palliative Care Units (PCU) has considerably grown based on evidence from studies supporting the use of non-pharmacological measures as part of Palliative Care (PC) treatments. However, more accumulated data are needed to definitively establish its added value. The present study describes the type of patients receiving physiotherapy in a PCU and the benefits obtained in relation to their degree of functional dependence. METHODS: An observational, prospective, descriptive, practice-based study was undertaken involving patients admitted to the PCU of Fundación Instituto San José (Madrid, Spain), who according to the PCU´s clinical practice, met the criteria for physiotherapy intervention. Daily clinical practice was unchanged for study reasons. Participants were assessed prior to initiating and at the end of the physiotherapy program using the following standard scales: the Barthel Index, the Functional Ambulation Categories scale, the Palliative Performance Scale, and the Braden scale. A descriptive analysis was performed and scale scores prior to and after treatment were compared using the Wilcoxon signed-rank test. Significance was set at 0.05. RESULTS: A total of 63 patients were included (mean age 71.98 ± 12.72; 61.9% males). Fifty-eight patients (92.1%) were oncological patients; of them, 35 (60.3%) had metastases. Prior to treatment, 28 (44.4%) participants had total dependence according to the Barthel index, and 37 (58.7%) were non-functional ambulator according to the FAC scale. At the end of treatment, the number of patients with total dependence decreased to 15 (23.8%) and those non-functional ambulator to 12 (19.0%). CONCLUSIONS: Patients who benefited from physical therapy during their admission to our PCU were predominantly males with oncological processes, mainly lung cancer. PC including physiotherapy improved their functionality, independence and skills for activities of daily living in this sample of PCU patients.

Factors associated with development of nephrotoxicity in patients treated with vancomycin versus daptomycin for severe Gram-positive infections: A practice-based study.

OBJECTIVE: To evaluate nephrotoxicity development in patients treated with vancomycin (VAN) and daptomycin (DAP) for proven severe Gram-positive infections in daily practice. METHODS: A practice-based, observational, retrospective study (eight Spanish hospitals) was performed including patients ≥18 years with a baseline glomerular filtration rate (GFR)>30 mL/min and/or serum creatinine level<2 mg/dL treated with DAP or VAN for >48h. Nephrotoxicity was considered as a decrease in baseline GRF to <50 mL/min or decrease of >10 mL/min from a baseline GRF<50 mL/min. Multivariate analyses were performed to determine factors associated with 1) treatment selection, 2) nephrotoxicity development, and 3) nephrotoxicity development within each antibiotic group. RESULTS: A total of 133 patients (62 treated with DAP, 71 with VAN) were included. Twenty-one (15.8%) developed nephrotoxicity: 4/62 (6.3%) patients with DAP and 17/71 (23.3%) with VAN (p=0.006). No differences in concomitant administration of aminoglycosides or other potential nephrotoxic drugs were found between groups. Factors associated with DAP treatment were diabetes mellitus with organ lesion (OR=7.81, 95%CI:1.39-4.35) and basal creatinine ≥0.9 mg/dL (OR=2.53, 95%CI:1.15-4.35). Factors associated with VAN treatment were stroke (OR=7.22, 95%CI:1.50-34.67), acute myocardial infarction (OR=6.59, 95%CI:1.51-28.69) and primary bacteremia (OR=5.18, 95%CI:1.03-25.99). Factors associated with nephrotoxicity (R2=0.142; p=0.001) were creatinine clearance<80 mL/min (OR=9.22, 95%CI:1.98-30.93) and VAN treatment (OR=6.07, 95%CI:1.86-19.93). Factors associated with nephrotoxicity within patients treated with VAN (R2=0.232; p=0.018) were congestive heart failure (OR=4.35, 95%CI:1.23-15.37), endocarditis (OR=7.63, 95%CI:1.02-57.31) and basal creatinine clearance<80 mL/min (OR=7.73, 95%CI:1.20-49.71). CONCLUSIONS: Nephrotoxicity with VAN was significantly higher than with DAP despite poorer basal renal status in the DAP group.

Prevalencia de Síndrome de Burn-Out en médicos de áreas críticas de la Clínica Universitaria Reina Fabiola / Prevalence of Burn-Out Syndrome in physicians in critical areas of the Clínica Universitaria Reina Fabiola

El Síndrome de Burn-Out fue descripto en 1974 y se caracteriza por una progresiva pérdida de energía, hasta llegar al agotamiento, con aumento de los síntomas de ansiedad y depresión. Este Síndrome se presenta con agotamiento emocional, despersonalización y disminución del sentimiento de realización personal, acompañado de un sentimiento de pérdida de prestigio o reconocimiento personal. (AU)

Burn-Out Syndrome was described in 1974 and is characterized by a progressive loss of energy, to exhaustion, with increased symptoms of anxiety and depression. This syndrome occurs with emotional exhaustion, depersonalization and diminished feeling of personal fulfillment, accompanied by a feeling of loss of prestige or personal recognition. (AU)

Multidrug-resistant (MDR) Aeromonas recovered from the metropolitan area of Valencia (Spain): diseases spectrum and prevalence in the environment.

Aeromonas infections are rare in Europe and often related to traveller's diarrhoea. A total of 185 Aeromonas isolates from river water, fish and clinical sources, recovered during a 1-year period, were used to investigate the disease spectrum and impact of multidrug-resistant (MDR) strains. They were all identified by biochemical tests and 25% of them were also identified by sequencing of the 16S rRNA gene. The minimum inhibitory concentrations (MICs) of 21 antimicrobials were determined for all isolates by broth microdilution/E-strips methods, and susceptibility was assessed according to the Clinical and Laboratory Standards Institute (CLSI). Strains pathogenicity was determined by using Swiss Webster mice as the animal model. Aeromonas diseases had an incidence of around 20 cases/million inhabitants in the metropolitan area of Valencia (Spain). Acute gastroenteritis in children with no history of travel abroad was the main pathology. These cases were related to A. caviae, A. veronii biovar sobria, A. hydrophila and A. dhakensis. A significant incidence of A. caviae in humans was found, while the other species were equally present in clinical and environmental origins. A. jandaei, A. bestiarum and A. media had mainly an environmental distribution. The prevalence of MDR Aeromonas was maximal in clinical samples, and resistance phenotypes were significantly related to this source. 7.2% of environmental Aeromonas was resistant to at least five drugs; most of them were moderately virulent for mice and, in addition, belonged to clinically significant species. The present study demonstrates a diseases spectrum similar to that reported in tropical countries, and also that pathogenic and heavily MDR Aeromonas are present in environmental reservoirs. MDR Aeromonas from any source analysed were susceptible to aztreonam, netilmicin, cefotaxime, ceftazidime, cefepime and fluoroquinolones.

Early molecular diagnosis of acute Chagas disease after transplantation with organs from Trypanosoma cruzi-infected donors.

Organ transplantation (TX) is a novel transmission modality of Chagas disease. The results of molecular diagnosis and characterization of Trypanosoma cruzi acute infection in naïve TX recipients transplanted with organs from infected deceased donors are reported. Peripheral blood and cerebrospinal fluid samples from the TX recipients of organs from infected donors were prospectively and sequentially studied for detection of T. cruzi by means of kinetoplastid DNA polymerase chain reaction (kDNA-PCR). In positive blood samples, a PCR algorithm for identification of T. cruzi Discrete Typing Units (DTUs) and quantitative real-time PCR (qPCR) to quantify parasitic loads were performed. Minicircle signatures of T. cruzi infecting populations were also analyzed using restriction fragment length polymorphism (RFLP)-PCR. Eight seronegative TX recipients from four infected donors were studied. In five, the infection was detected at 68.4 days post-TX (36-98 days). In one case, it was transmitted to two of three TX recipients. The comparison of the minicircle signatures revealed nearly identical RFLP-PCR profiles, confirming a common source of infection. The five cases were infected by DTU TcV. This report reveals the relevance of systematic monitoring of TX recipients using PCR strategies in order to provide an early diagnosis allowing timely anti-trypanosomal treatment.

Development of wild barley (Hordeum chilense)-derived DArT markers and their use into genetic and physical mapping.

Diversity arrays technology (DArT) genomic libraries were developed from H. chilense accessions to support robust genotyping of this species and a novel crop comprising H. chilense genome (e.g., tritordeums). Over 11,000 DArT clones were obtained using two complexity reduction methods. A subset of 2,209 DArT markers was identified on the arrays containing these clones as polymorphic between parents and segregating in a population of 92 recombinant inbred lines (RIL) developed from the cross between H. chilense accessions H1 and H7. Using the segregation data a high-density map of 1,503 cM was constructed with average inter-bin density of 2.33 cM. A subset of DArT markers was also mapped physically using a set of wheat-H. chilense chromosome addition lines. It allowed the unambiguous assignment of linkage groups to chromosomes. Four segregation distortion regions (SDRs) were found on the chromosomes 2H(ch), 3H(ch) and 5H(ch) in agreement with previous findings in barley. The new map improves the genome coverage of previous H. chilense maps. H. chilense-derived DArT markers will enable further genetic studies in ongoing projects on hybrid wheat, seed carotenoid content improvement or tritordeum breeding program. Besides, the genetic map reported here will be very useful as the basis to develop comparative genomics studies with barley and model species.

Serotype distribution and susceptibility of Streptococcus pneumoniae isolates from pleural fluid in Spain from 1997 to 2008.

Trends in serotype incidence and susceptibility (1997 to 2008) of Spanish Streptococcus pneumoniae pleural isolates (n = 831) were explored. Penicillin (oral) nonsusceptibility rates and the incidence of 7-valent pneumococcal conjugate vaccine (PCV-7) serotypes showed decreasing trends (R(2) ≥ 0.600; P ≤ 0.002). The incidence of serotypes 1 and 19A showed increasing trends (R(2) ≥ 0.759; P < 0.001), with no trends for serotype 3. Serotypes 19A, 1, and 3 represented 85% of pediatric isolates in 2008. In serotype 19A, the penicillin nonsusceptibility rate was 82.4% in 2008, associated with amoxicillin and cefotaxime nonsusceptibility in 21.4% of isolates. Inclusion of these serotypes in new vaccines offers the broadest coverage.

Cefditoren versus ceftazidime in inducer-substrate combinations for the evaluation of AmpC production in a disc approximation test.

OBJECTIVE: To evaluate cefditoren in inducer-substrate combinations to screen for AmpC induction. METHODS: 100 clinical isolates (25 P. aeruginosa, 25 E. cloacae, 14 M. morganii, 13 S. marcescens, 12 C. freundii, 7 P. rettgeri, and 4 E. aerogenes) were tested by the Kirby-Bauer disc approximation method using cefditoren and ceftazidime discs as substrates, and cefditoren and imipenem discs as inducers. RESULTS: None of the strains showed induction of AmpC with cefditoren-ceftazidime as inducer-substrate combination. Imipenem-cefditoren as inducer-substrate combination was not useful for evaluating strains of P. aeruginosa since no inhibition zones surrounding the cefditoren disc were found. Among evaluable enterobacteria (those showing substrate inhibition zone), inducible Amp C was detected in 48 out of 63 (76.2%) with cefditoren, and in 33 out of 68 (48.5%) isolates with ceftazidime as substrate. Significantly (p=0.013) higher number of AmpC producers were detected with cefditoren versus ceftazidime (76.2% vs. 48.5%), due to the differences found for E. cloacae (72.8% vs. 21.7%; p=0.0009) and S. marcescens (100% vs. 54.5%; p=0.03). Higher mean reductions of diameters around substrate discs were found for cefditoren (4.17 mm) vs. ceftazidime (3.79 mm), reaching statistical significance (p<0.05) for indol-positive proteae: M. morganii (5.32 mm vs. 3.92 mm) and P. rettgeri (3.47 mm vs. 2.64 mm). CONCLUSION: Cefditoren showed no induction capability, and when used as substrate (with imipenem as inducer) it offered detection rates of AmpC inducible enterobacteria higher than the imipenem-ceftazidime combination, mainly for Enterobacter spp. and Serratia spp., with higher diameter reductions for indol-positive proteae.

Exposure-response analysis of tigecycline in pharmacodynamic simulations using different size inocula of target bacteria.

This study explored tigecycline exposure-bacterial responses in pharmacodynamic simulations (in vitro kinetic model) using different inocula. One meticillin-resistant vancomycin-heteroresistant Staphylococcus aureus, one Enterococcus faecium and one extended-spectrum beta-lactamase-producing Escherichia coli with equal tigecycline minimum inhibitory concentrations/minimum bactericidal concentrations (MICs/MBCs) (0.12/0.25 microg/mL) were used. A computerised pharmacodynamic bicompartmental model simulated three tigecycline twice-daily dosing regimens over 48h: 50mg (100mg loading dose); 100mg; and 150 mg. Areas under bacterial growth curves were calculated, and differences between the growth curve used as control and the killing curve of bacteria exposed to tigecycline (ABBC) were determined. With standard inocula [ca. 1 x 10(6)colony-forming units (CFU)/mL], linear increases in area under the concentration-time curve (AUC)/MIC (25.6 for 50mg, 53.76 for 100mg and 79.52 for 150 mg) produced linear increases in activity against Gram-positive organisms (mean ABBCs of 120.60, 143.20 and 195.80 log CFU x h/mL for S. aureus and of 95.75, 172.55 and 216.90 log CFUxh/mL for E. faecium, respectively), with the activity of the 150 mg regimen being significantly higher (P<0.01) than that of the other two regimens. ABBCs obtained with the 100mg regimen using standard inocula were similar to those obtained with the 150 mg regimen when using high inocula (ca. 1 x 10(7)CFU/mL). Against E. coli, the highest dosing regimen was required to obtain significant antibacterial activity compared with control (mean ABBCs of 145.75 log CFU x h/mL with standard inocula and 63.33 log CFU x h/mL with high inocula). An increase in tigecycline dosing appears to be an interesting therapeutic option to maximise antibacterial activity owing to its linear pharmacokinetics and pharmacodynamics, especially when severe infections with high bacterial load are suspected.

Influence of media and testing methodology on susceptibility to tigecycline of Enterobacteriaceae with reported high tigecycline MIC.

The tigecycline susceptibility of six different Enterobacteriaceae strains with reported high tigecycline MICs was determined in quintuplicate by four methodologies using Mueller-Hinton agar and broth from six manufacturers. The MICs determined by Etest were a >or=1-fold dilution lower than those determined by broth microdilution and agar dilution, with the highest modal values given by agar dilution. The highest modal MICs were obtained using Oxoid medium, and the lowest inhibition zone values (disc diffusion) were obtained using Oxoid and bioMérieux media. The lowest MICs were obtained by Etest using Difco or Merck media.

In vitro killing activity of crevicular concentrations of tinidazole plus common oral antibiotics against high-density mixed inocula of periodontal pathogens in strict anaerobic conditions.

BACKGROUND: Odontogenic infections are polymicrobial. This study explores the in vitro killing activity by concentrations similar to those found in crevicular fluid of tinidazole in combination with amoxicillin/clavulanic acid, clindamycin and levofloxacin against four groups of high-density mixed inocula of anaerobes (Prevotella buccae, Fusobacterium nucleatum, and Veillonella spp.) and facultative (Capnocytophaga spp. and Streptococcus spp.) isolates of periodontal pathogens. METHODS: Killing curves were assessed under strict anaerobic conditions with antibiotics alone and in combination with tinidazole at concentrations similar to those achieved in crevicular fluid against approximately 10(7) colony forming units (CFU)/ml inoculum (1:1:1:1:1 proportion of the five bacterial isolates) of the four bacterial groups. Group 1 did not include beta-lactamase-producing strains; groups 2, 3, and 4 included one, two, and three beta-lactamase-producing strains, respectively. RESULTS: In single-drug experiments, at 48 hours, tinidazole alone did not show significant killing of the entire bacterial population, whereas reductions in the initial inocula > or =2.09 log(10) CFU/ml with clindamycin, > or =3.26 log(10) CFU/ml with amoxicillin/clavulanic acid, and > or =3.83 log(10) CFU/ml with levofloxacin were obtained. When combined with tinidazole, reductions were significantly higher for all antibiotics: > or =5.28 log(10) CFU/ml with clindamycin, > or =4.78 log(10) CFU/ml with amoxicillin/clavulanic acid, and > or =6.17 log(10) CFU/ml with levofloxacin. CONCLUSION: In addition to its high activity against anaerobic periodontal pathogens, tinidazole offered synergism with other antibiotics against the large strict anaerobic subpopulation and the small facultative subpopulation of a high-density mixed inocula of odontogenic pathogens under strict anaerobic conditions, similar to those of odontogenic infections.

Bactericidal activity of daptomycin versus vancomycin in the presence of human albumin against vancomycin-susceptible but tolerant methicillin-resistant Staphylococcus aureus (MRSA) with daptomycin minimum inhibitory concentrations of 1-2microg/mL.

This study explored the influence of vancomycin tolerance and protein binding on the bactericidal activity of vancomycin versus daptomycin (protein binding 36.9% vs. 91.7%, respectively) against four vancomycin-tolerant methicillin-resistant Staphylococcus aureus (MRSA) [minimum inhibitory concentration/minimum bactericidal concentration (MIC/MBC)=0.5/16, 1/32, 2/32 and 1/32microg/mL for vancomycin and 1/1, 1/2, 2/2 and 2/4microg/mL for daptomycin]. Killing curves were performed with vancomycin/daptomycin concentrations equal to serum peak concentrations (C(max)) (65.70/98.60microg/mL) and trough concentrations (C(min)) (7.90/9.13microg/mL) in the presence and absence of a physiological human albumin concentration (4g/dL), controlled with curves with the theoretical free drug fraction of vancomycin/daptomycin C(max) (41.45/8.18microg/mL) and C(min) (4.98/0.76microg/mL). Vancomycin C(max) and C(min) concentrations, regardless of the media, showed a bacteriostatic profile not reaching a reduction of 99% or 99.9% of the initial inocula during the 24-h experimental time period. Daptomycin antibacterial profiles significantly differed when testing C(max) and C(min). C(max) was rapidly bactericidal (< or =4h) with >5 log(10) reduction in the initial inocula for all strains, regardless of the presence or not of albumin or the use of concentrations similar to free C(max). C(min) exhibited similar final colony counts at 0h and 24h in curves with albumin, but with >3 log colony-forming units (CFU)/mL reduction at < or =4h for strains with an MIC of 1microg/mL and ca. 2 logCFU/mL reduction at < or =6h for strains with an MIC of 2microg/mL. This activity was significantly higher than the activity of the free C(min) fraction. The results of this study reinforce the idea that pharmacodynamics using concentrations calculated using reported protein binding are unreliable. Daptomycin exhibited rapid antibacterial activity against vancomycin-tolerant MRSA isolates even against those with high daptomycin MICs in the presence of physiological albumin concentrations.

In vitro interference of beta-lactams with biofilm development by prevalent community respiratory tract isolates.

Interference of cefditoren (CDN) and amoxicillin/clavulanic acid (AMC) with biofilm production was studied using 11 Streptococcus pneumoniae isolates with minimum inhibitory concentrations (MICs) ranging from 0.015microg/mL to 0.5microg/mL for CDN and from 0.06microg/mL to 2microg/mL for AMC (except for one isolate with an AMC MIC of 8microg/mL) and 5 Haemophilus influenzae isolates with MICs of 0.03-0.06microg/mL for CDN and 0.5-16microg/mL for AMC. Slime production was assessed in antibiotic-free medium and with 0.03microg/mL CDN or 1/0.5microg/mL AMC by measuring the optical density at 450nm (OD(450)). Significantly lower mean OD(450) values were obtained for S. pneumoniae with antibiotics compared with controls (CDN, 0.088 vs. 0.118, P=0.003; and AMC, 0.095 vs. 0.112, P=0.003), with significant correlation between both antibiotics (r=0.752; P=0.008). Percent reduction in OD(450) values was higher for CDN compared with AMC (24.02% vs. 15.92%; P=0.008). For H. influenzae, significantly lower mean OD(450) values were obtained with CDN compared with controls (0.083 vs. 0.096; P=0.043) but not with AMC (0.086 vs. 0.095; P=0.08). Comparing percent reductions in S. pneumoniae versus H. influenzae for each antibiotic, no differences were found for AMC (15.92% vs. 9.40%; P=0.36), with a tendency for CDN (24.02% vs. 13.79%; P=0.069). Different beta-lactams may have different capabilities of interfering with S. pneumoniae biofilm development when tested under the same experimental conditions.

Safety profile of cefditoren. A pooled analysis of data from clinical trials in community-acquired respiratory tract infections.

INTRODUCTION: A high number of individuals in the population are exposed to antibiotics for the treatment of respiratory tract infections. It is important to review the adverse events profile related to antibiotic exposure during the clinical development of drugs that are or have been recently included in the therapeutic armamentarium. MATERIAL AND METHODS: Safety data from all 13 clinical trials of cefditoren on community acquired respiratory infections were reviewed. Safety population was defined as all randomized patients with at least one dose intake. Adverse events considered by investigators as related during antibiotic exposure were considered. RESULTS: The overall safety population consisted in 4,592 patients for cefditoren and 2,784 for comparators. Overall reported diarrhoea related to cefditoren administration was significantly higher (p < or = 0.001) than comparators (9.9% vs 6.9%) due to the significant difference in the pooled pharyngotonsillitis studies (8.3% vs 3.2%), while no significant differences in others pathologies were found, with 9.4% (with cefditoren) vs 10.3% (with comparators) in the case of community-acquired pneumonia (CAP). Dyspepsia and abdominal pain were reported as adverse events in < 2.7% patients regardless the treated disease. In females population lower related vaginosis rate was found in cefditoren vs comparators, mainly due to differences among patients treated for sinusitis (4.5% vs 8.1%) and CAP (2.3% vs 5.5%) although differences were not significant (p = 0.017 and p = 0.008, respectively). CONCLUSION: This study analysing reported adverse events from clinical trials showed an adverse events profile of cefditoren similar to those of standard antibiotics used in the treatment of respiratory tract infections.

Safety profile of cefditoren. A pooled analysis of data from clinical trials in community-acquired respiratory tract infections / Perfil de seguridad de cefditoren. Análisis combinado de los datos de ensayos clínicos en el tratamiento de infecciones respiratorias comunitarias

Introducción. Gran número de sujetos en la población se expone a antibióticos como tratamiento de infecciones respiratorias. Por ello es importante la revisión del perfil de acontecimientos adversos relacionados con la exposición a los antibióticos durante el desarrollo clínico de aquellos que han sido o van a ser incluidos en el arsenal terapéutico. Material y métodos. Se revisaron los datos de seguridad de 13 ensayos clínicos de cefditoren en el tratamiento de infecciones respiratorias comunitarias. La población para análisis de seguridad se definió con todos los pacientes randomizados que recibieron al menos una dosis de la medicación del estudio. Se analizaron los acontecimientos adversos considerados por los investigadores como relacionados a la exposición al antibiótico. Resultados. La población para análisis de seguridad consistió en 4.592 pacientes tratados con cefditoren y 2.784 con los comparadores. La tasa global de diarrea comunicada con cefditoren fue significativamente mayor (p ≤ 0,001) que la de los comparadores, debido a la diferencia significativa en el análisis de los estudios de faringoamigdalitis (8,3 % frente a 3,2 %). No hubo diferencias significativas en las otras patologías estudiadas, con unas tasas de diarrea relacionada de 9,4% para cefditoren y 10,3% para los comparadores en el caso de la neumonía adquirida en la comunidad (NAC). Se comunicó dispesia y dolor abdominal en menos del 2,7% de los pacientes con independencia de la infección tratada o tratamiento. En mujeres, la tasa de vaginosis fue menor con cefditoren frente a comparadores, fundamentalmente debido a las diferencias en sinusitis (4,5% frente a 8,1%) y NAC (2,3% frente a 5,5%), aunque éstas no alcanzaron significación estadística (p = 0,017 y p = 0,008, respectivamente). Conclusión. Cefditoren presenta un perfil de acontecimientos adversos similar al de los antibióticos comúnmente utilizados en el tratamiento de la infección respiratoria comunitaria (AU)

Introduction. A high number of individuals in the population are exposed to antibiotics for the treatment of respiratory tract infections. It is important to review the adverse events profile related to antibiotic exposure during the clinical development of drugs that are or have been recently included in the therapeutic armamentarium. Material and methods. Safety data from all 13 clinical trials of cefditoren on community acquired respiratory infections were reviewed. Safety population was defined as all randomized patients with at least one dose intake. Adverse events considered by investigators as related during antibiotic exposure were considered. Results. The overall safety population consisted in 4,592 patients for cefditoren and 2,784 for comparators. Overall reported diarrhoea related to cefditoren administration was significantly higher (p ≤ 0.001) than comparators (9.9% vs 6.9%) due to the significant difference in the pooled pharyngotonsillitis studies (8.3% vs 3.2%), while no significant differences in others pathologies were found, with 9.4% (with cefditoren) vs 10.3% (with comparators) in the case of community-acquired pneumonia (CAP). Dyspepsia and abdominal pain were reported as adverse events in < 2.7% patients regardless the treated disease. In females population lower related vaginosis rate was found in cefditoren vs comparators, mainly due to differences among patients treated for sinusitis (4.5% vs 8.1%) and CAP (2.3% vs 5.5%) although differences were not significant (p = 0.017 and p = 0.008, respectively). Conclusion. This study analysing reported adverse events from clinical trials showed an adverse events profile of cefditoren similar to those of standard antibiotics used in the treatment of respiratory tract infections (AU)

Influence of testing methodology on the tigecycline activity profile against presumably tigecycline-non-susceptible Acinetobacter spp.

OBJECTIVES: To compare the tigecycline activity profile against Acinetobacter spp. by Etest versus broth microdilution in isolates with high Etest MIC. METHODS: Acinetobacter spp. isolates with tigecycline MICs of >or=0.5 mg/L determined by commercially developed Etests strips (January 2006 to July 2007) in five Spanish hospitals were considered. Values were rounded to the nearest upper double-dilution. Susceptibility by broth microdilution following CLSI (formerly NCCLS) recommendations, as the reference method, was determined in a central laboratory. BSAC breakpoints were used: susceptible 2 mg/L. RESULTS: One hundred and forty-eight isolates were collected: 12 isolates with a tigecycline Etest MIC of 0.5 mg/L, 14 with 1 mg/L, 86 with 2 mg/L, 31 with 4 mg/L and 5 with 8 mg/L. Isolates with Etest MICs of 0.5-1 mg/L showed the same values by broth microdilution. Among isolates with Etest MICs of 2 mg/L, only 5.8% of strains showed the same value by both methods (88.4% showed values that were one or two dilutions lower by microdilution). None of the 36 isolates with Etest MICs of 4-8 mg/L showed the same value by both methods, with values at least two dilutions lower by microdilution. Weak correlation (R = 0.238; P or=2 mg/L for Acinetobacter spp. since strains with Etest MICs of 2-4 mg/L are susceptible when tested by microdilution. False non-susceptibility by Etest may exclude tigecycline as a therapeutic option in a field where multiresistance is the rule.

Management in the emergency room of patients requiring hospital treatment of community-acquired pneumonia.

INTRODUCTION: To identify factors influencing decisions in initial management of community-acquired pneumonia (CAP) admitted to hospital through Emergency departments. METHODS: Records of CAP adult patients admitted to 24 Spanish hospitals in January-March 2003 were reviewed. Patients sent for ambulatory treatment were excluded. RESULTS: 341 patients (67.0 +/- 24.6 years; 65.3% males) were included; 39% were taking antibiotics at attendance. PSI was (% patients): I-II (19.7%), III (14.7%), and IV-V (65.6%). Comorbidities were: COPD (37.2%), heart disease (24.6%), hypertension (17%), diabetes mellitus (10.8%), and malignancies (10%). Pneumococcal/Legionella urinary antigens were performed in 34.0%/42.2% patients. Fewer (p < or = 0.006) rapid tests were performed in class IV-V (p = 0.001), with higher (p < or = 0.01) pneumococcal positive results in class V. Initial treatment was fluoroquinolone (37.5%), beta-lactam + macrolide (26.4%), beta-lactam (22.9%), macrolide (4.7%), and others (8.5%). Patients referred to Internal Medicine had higher heart disease (p = 0.06) and hypertension (p = 0.001) as comorbidity than those at Short-Stay Units or Pneumology. COPD patients were equally distributed between Internal Medicine and Pneumology, with differences vs. Short-Stay Units. CONCLUSIONS: Rapid diagnostic tests were underused, maybe due to broad empirical treatments covering drug-resistant pneumococci and L. pneumophila (regardless PSI and comorbidity). Presence of comorbidities or positive results in rapid diagnostic tests seems to influence the medical ward to which the patient is referred to, but not initial treatment.

[Clinical experience with tigecycline in the treatment of nosocomial infections caused by isolates exhibiting prevalent resistance mechanisms]. / Experiencia clínica con tigeciclina en el tratamiento de infecciones nosocomiales producidas por aislados con mecanismos de resistencia prevalentes.

This article reviews the clinical experience with tigecycline in the treatment of infections caused by microorganisms with prevalent resistance mechanisms among nosocomial microbiota, as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, multidrug- resistant Acinetobacter baumannii and enterobacteria producing extended spectrum beta-lactamases. Most of articles found in the literature describe the use of tigecycline in the treatment of severe infections (sepsis and septic shock, nosocomial pneumonia and ventilator-associated pneumonia...) produced by multidrug-resistant microorganisms, in patients with multiple comorbidities (admitted in ICU, with malignancies, transplants and/or immunodepressed...) and in many occasions after failures of previous antibiotic treatments. Favourable outcomes with tigecycline are reported in most articles. However, an accurate global assessment is difficult since, in addition to the described confounding factors, there are concomitant or sequential antibiotic treatments in several communications, and lack of relevant clinical (as comorbidities), microbiological (as susceptibility) and outcome (different criteria by different authors) data in others. More even, the described series are retrospective and lack of control groups. Nevertheless the usefulness of this revision is based on the fact that in daily clinical practice the use of tigecycline will increase, since epidemiology of specific hospital medical units shows multidrug resistance among nosocomial isolates and tigecycline can be one of the scarce available compounds active against multidrug-resistant strains/clones.

Management in the emergency room of patients requiring hospital treatment of community-acquired pneumonia / Manejo en la sala de urgencias de pacientes con neumonía adquirida en la comunidad que requieren tratamiento hospitalario

Introduction. To identify factors influencing decisions ininitial management of community-acquired pneumonia(CAP) admitted to hospital through Emergency departments.Methods. Records of CAP adult patients admitted to 24Spanish hospitals in January-Mars 2003 were reviewed. Patientssent for ambulatory treatment were excluded.Results. 341 patients (67.0 ± 24.6 years; 65.3 % males)were included; 39 % were taking antibiotics at attendance.PSI was (% patients): I-II (19.7 %), III (14.7 %), and IV-V(65.6 %). Comorbidities were: COPD (37.2 %), heart disease(24.6 %), hypertension (17 %), diabetes mellitus (10.8 %),and malignancies (10 %). Pneumococcal/Legionella urinaryantigens were performed in 34.0 %/42.2 % patients. Fewer(p ≤ 0.006) rapid tests were performed in class IV-V(p = 0.001), with higher (p ≤ 0.01) pneumococcal positiveresults in class V. Initial treatment was fluoroquinolone(37.5 %), beta-lactam + macrolide (26.4 %), beta-lactam(22.9 %), macrolide (4.7 %), and others (8.5 %). Patients referredto Internal Medicine had higher heart disease(p = 0.06) and hypertension (p = 0.001) as comorbidity thanthose at Short-Stay Units or Pneumology. COPD patientswere equally distributed between Internal Medicine andPneumology, with differences vs. Short-Stay Units.Conclusions. Rapid diagnostic tests were underused,maybe due to broad empirical treatments covering drug-resistantpneumococci and L. pneumophila (regardless PSI andcomorbidity). Presence of comorbidities or positive resultsin rapid diagnostic tests seems to influence the medicalward to which the patient is referred to, but not initialtreatment (AU)

Introducción. Identificación de los factores que influyenen el manejo inicial de los pacientes con neumoníaadquirida en la comunidad (NAC) ingresados en el hospitala través de los Servicios de Urgencias.Material y métodos. Se revisaron los registros de pacientesadultos con NAC admitidos en 24 hospitales españolesen el período comprendido entre los meses deenero-marzo de 2003. Los pacientes remitidos para tratamientoambulatorio fueron excluidos.Resultados. Se incluyeron 341 pacientes (67,0 ± 24,6años; 65,3 % varones). El 39 % estaba tomando antibióticosen el momento de atención en Urgencias. El grado deFine de los pacientes fue (% pacientes): I-II (19,7 %),III (14,7 %), y IV-V (65,6 %). Las comorbilidades fueron:EPOC (37,2 %), enfermedad coronaria (24,6 %), hipertensión(17 %), diabetes mellitus (10,8 %) y neoplasia (10 %). Lostests de antígenos urinarios de neumococo y Legionellafueron realizados en 34,0 % y 42,2 % pacientes respectivamente.En las clases IV-V (p ≤ 0,006) se realizaron menostests rápidos, con mayor número de resultados positivospara neumococos (p ≤ 0,01) en la clase V. El tratamientoinicial fue fluoroquinolonas (37,5 %), betalactámico +macrólido(26,4 %), betalactámico (22,9 %), macrólido (4,7 %),y otros (8,5 %). Los pacientes ingresados en Medicina Internatenían una mayor incidencia de enfermedad cardiaca(p = 0,06) e hipertensión (p = 0,001) como comorbilidadque aquellos ingresados en Neumología o en Unidades deCorta Estancia. Los pacientes con EPOC fueron igualmentedistribuidos entre Medicina Interna y Neumología, con diferenciasrespecto a las Unidades de Corta Estancia.Conclusiones. Los tests diagnósticos rápidos fueron infrautilizados,debido posiblemente a la amplia cobertura delos tratamientos empíricos cubriendo neumococo resistente yL. pneumophila (independientemente del Fine y la comorbilidad) (AU)