Antimicrobial resistance of Escherichia coli in Mexico: how serious is the problem?

INTRODUCTION: This study aimed to determine the resistance patterns of Escherichia coli (E. coli) in Mexico to several antibiotics and research some therapeutic options. METHODOLOGY: Positive cultures for E. coli isolated from bronchial secretions, urine, central catheter, blood, and infected wounds in the Culiacan General Hospital, Sinaloa, Mexico from 30 June 2004 to 1 July 2007 were studied. Resistance against multiple antibiotics was measured and compared by gender and the hospital unit where the bacteria were isolated. RESULTS: In total, 1511 specimens were analyzed from men (45.4%) and women (54.5%), of which 251 were positive for E. coli. Antimicrobial resistance was highest in the neurosurgery service (58.4%). Samples included sputum (14.7%), bronchial secretions (17.9%), wounds (35.4%), urine/Foley catheter tip (35.5%), central catheter tips (5.6%), and blood cultures (7.2%). Resistance to ampicillin was highest at 91% followed by ciprofloxacin at 80.6%, trimethoprim-sulfamethoxazole at 70.2%, piperacillin/tazobactam at 14.4%, and imipenem at 6.8%. CONCLUSIONS: Trimethoprim should not be recommended as an empiric option for E. coli infections and the benefit of quinolones is low. It is important to understand the resistance of the bacteria in each medical center, consider its frequency in each service within the same hospital, and take all necessary measures to ensure and create a clinical attitude of prevention.

Absceso Hipofisiario: presentación de un caso / Hypophyseal abscess: A case

Los abscesos hipofisarios se diagnostican en la mayoría de los casos solo después del drenaje transesfenoidal, el abordaje terapéutico de elección; son subdiagnosticados y representan una enfermedad con alta mortalidad sin el tratamiento correcto y oportuno. Este es el caso clínico de una paciente de 38 años de edad con amenorrea de un año de evolución, galactorrea, cefalea y déficit campimétrico manifestado por hemianopsia bitemporal. La resonancia magnética nuclear mostró una imagen compatible con adenoma hipofisario, por lo que se realizó abordaje transesfenoidal confirmándose por reporte histopatológico un absceso cerebral. Se llevó terapia antibiótica empírica con vancomicina, metronidazol y ceftriaxona a dosis meníngeas, sin obtener el agente causal en los cultivos. Se concluyó que los abscesos hipofisiarios son una patología potencialmente curable que al manifestarse como una masa selar la gran mayoría recibe un abordaje terapéutico adecuado por vía transesfenoidal, y en la mayoría de los casos dicho procedimiento arroja el diagnóstico y el tratamiento definitivo al mismo tiempo.

Pituitary abscesses are defined as the affection of the pituitary gland by an intrasellar suppurative process caused by an infectious agent. Pituitary abscesses represent less than 1% of the pathologies of the sellar region, the clinical manifestations are due to pituitary dysfunction or mass effect. The diagnosis in most of the cases is only after transsphenoidal drainage which is the therapeutic approach of choice, being underdiagnosed and becoming a disease with high mortality if the right and appropriate treatment is not instituted. Case report. A case of a 38-year-old-female patient with amenorrhea of one year of evolution, galactorrhea, headache and visual field deficits manifested by bitemporal hemianopsia is reported. Magnetic resonance imaging showed an image compatible with pituitary adenoma, a transsphenoidal approach was performed and histopathologic report confirmed a brain abscess. Antibiotic therapy was empirically started with vancomycin, metronidazole and ceftriaxone at meningeal doses, failed to get the agent in cultures. Conclusions. Pituitary abscesses are a potentially curable disease that present as a sellar mass, most receive the appropriate therapy by transsphenoidal approach and in most of the cases this procedure gives the definitive diagnosis and treatment simultaneously.

Therapeutic hypothermia: critical review of the molecular mechanisms of action.

Therapeutic hypothermia (TH) is nowadays one of the most important methods of neuroprotection. The events that occur after an episode of ischemia are multiple and hypothermia can affect the various steps of this cascade. The mechanisms of action of TH are varied and the possible explanation for the benefits of this therapy is probably the multiple mechanisms of action blocking the cascade of ischemia on many levels. TH can affect many metabolic pathways, reactions of inflammation, apoptosis processes, and promote neuronal integrity. To know the mechanisms of action of TH will allow a better understanding about the indications for this therapy and the possibility of searching for other therapies when used in conjunction with hypothermia will provide a therapeutic synergistic effect.