Contamination of liquid soap for hospital use with Raoultella planticola.

This article reports the contamination of a batch of liquid soap for hospital use with Raoultella planticola. The micro-organism was first identified as Klebsiella pneumoniae due to the inability of automated systems to characterize this species. There is a need to strengthen the inspection of cosmetic products to be used in the hospital setting. It is recommended that hospitalized patients at the highest risk of infection should use antimicrobial soaps for personal hygiene. The incidence of infections due to R. planticola is unknown as it is usually misclassified as Klebsiella spp. by automated systems.

In vitro activity of CA(1-8)M(1-18), a synthetic cecropin A-melittin hybrid peptide, against multiresistant Acinetobacter baumannii strains.

The in vitro antibiotic activity of CA(1-8)M(1-18), a synthetic cecropin A-melittin hybrid peptide, was determined by broth microdilution on 20 clinical Acinetobacter baumannii isolates with different resistance profiles. The MIC(50), MIC(90) and ranges were 4 mg/l, 4 mg/l and 2-8 mg/l, respectively, and were independent of resistance pattern. Different assay parameters such as microplate plastic (polystyrene or polypropylene), addition of supplements (5-10% fetal calf serum or 5% horse blood), inoculum size (10(5), 10(6), 10(7) and 10(8) CFU/ml) or incubation period (24 or 48 h) were studied. MIC was independent of the first two parameters, although the MIC values increased both with inoculum size or incubation period. Killing curves were obtained both for a standard strain and a multiresistant isolate over a 45.7-2.8 mg/l (16-1 mM) peptide range, using an initial inoculum of 10(5)-10(6) CFU/ml and 10(9)-10(10) CFU/ml. A concentration of 45.7 mg/l was required for complete killing. Accordingly, CA(1-8)M(1-18) showed good in vitro activity against the A. baumannii strains tested irrespective of the resistance to classical antibiotics, and could be a future candidate for multiresistant A. baumannii infections, although further cytotoxicity and pharmacological studies will be needed.

Control de las determinaciones serológicas de individuos VIH positivos en un centro hospitalario / Hospital control of the serological markers for HIV patients

En el presente estudio se pretenden analizar las determinaciones serológicas realizadas a los pacientes infectados por el virus de la inmunodeficiencia humana (VIH), con la finalidad de poder documentar la repetitividad innecesaria de estos marcadores. Durante los años 1994-1997 se revisaron las pruebas serológicas realizadas a los individuos con infección VIH frente a distintos marcadores de infección, comparando los resultados con los obtenidos para la población general. Se realizaron 21241 determinaciones de anticuerpos antiVIH. El número de analíticas de anticuerpos anti VIH correspondientes a los seropositivos (912) presentaba una alta variabilidad: un 57 por ciento de los individuos presentaba más de una determinación, incluso un 7 por ciento de los sujetos más de 5. También se observó una alta repetitividad en la solicitud de los restantes marcadores serológicos de infección. Las repeticiones indiscriminadas de ciertos marcadores no aportan nada, encarecen los costes y sobrecargan los servicios asistenciales (AU)

Resultados de las peticiones de anticuerpos tiroideos en un Hospital Provincial de Castilla-León / Anti-thyroid antibodies results in a Provincial Hospital in Castilla-Leon

Objetivos: Valorar si la determinación conjunta de los TPOAb y TgAb aporta ventajas significativas respecto a la determinación única de los TPOAb. Materiales y métodos: Cuantificación mediante enzimoinmunoensayo en microplaca de 1236 sueros con petición de perfil tiroideo autoinmune (TPOAb y TgAb). Resultados: Distribución de las asociaciones de ambos autoanticuerpos: TPOAb (-) - TgAb (-), 61.4 por ciento; TPOAb (+) - TgAb (-), 22.8 por ciento; TPOAb (+) - TgAb (+), 13.6 por ciento y TPOAb (-) - TgAb (+), 2.2 por ciento; con una prevalencia muy superior en el sexo femeninorespecto al masculino, 30 por ciento n 6.3 por ciento para los TPOAb y del 13.6 por ciento n 2.2 por ciento en el caso de los TgAb. Conclusiones: La determinación simultánea de ambos autoanticuerpos no aporta ventajas apreciables con respecto a la valoración aislada de los TPOAb. Sólo en casosmuy concretos, como el cáncer diferenciado de tiroides, parece justificada la realización conjunta de ambos. El implantar, por tanto, un protocolo para determinar sólo los TPOAb parece pues razonable (AU)

Actividad in vitro de CA(1-8)M(1-18), un péptido sintético híbrido cecropina A-melitina, frente a aislamientos clínicos multirresistentes de Acinetobacter baumannii / In vitro activity of CA(1-8)M(1-18), a synthetic cecropin A-melittin hybrid peptide, against multiresistant Acinetobacter baumannii strains

El objetivo de este estudio fue determinar la actividad in vitro de CA(1-8)M(1-18), un péptido sintético híbrido cecropina A-melitina, frente a aislamientos clínicos multirresistentes de Acinetobacter baumannii. Se estudió la CMI en 20 aislamientos clínicos de A. baumannii con diferente perfil de resistencia, mediante microdilución en caldo, obteniéndose CMI50 = 4 mg/l, CMI90 = 4 mg/l e intervalo de 2 a 8 mg/l. En la cepa control se ensayó el efecto de diferentes factores, como el material de la placa de microdilución (poliestireno o polipropileno), el suplemento (5 por ciento o 10 por ciento de suero fetal bovino o 5 por ciento de sangre de caballo), el tamaño del inóculo (105, 106, 107 y 108 UFC/ml) y el periodo de incubación (24 o 48 h). La CMI fue similar en los dos tipos de placas de microdilución utilizadas e independiente del suplemento con suero fetal bovino o sangre de caballo; sin embargo, se observó un aumento del valor al utilizar un inóculo elevado o incubación prolongada. La actividad se determinó mediante curvas de muerte a diluciones dobles seriadas del péptido de 45,7 mg/l a 2,8 mg/l (16 a 1 mM) de CA(1-8)M(1-18) en la cepa control y en una cepa multirresistente, con un inóculo inicial de 105-106 UFC/ml y de 109-1010 UFC/ml. Se observó muerte completa de todos los microorganismos a una concentración de 45,7 mg/l. CA(1-8)M(1-18) mostró buena actividad in vitro frente a los aislamientos de A. baumannii probados independientemente del patrón de resistencia a los antimicrobianos clásicos, y podría ser un futuro candidato para tratar infecciones por A. baumannii multirresistente, aunque serán necesarios estudios farmacológicos y de toxicidad (AU)

Evolución de la sensibilidad antimicrobiana en aislamientos clínicos de Acinetobacter baumannii (1995-1997) / Evolution of antimicrobial susceptibility of Acinetobacter baumannii clinical isolates (1995-1997)

Acinetobacter baumannii es un microorganismo frecuentemente implicado en la colonización e infección de pacientes ingresados en hospitales. Durante los últimos años ha desarrollado un gran aumento de la resistencia antimicrobiana, lo que plantea serias dificultades en el tratamiento de las infecciones graves. Se ha estudiado la actividad in vitro de 24 antibióticos (15 betalactámicos y 9 no betalactámicos) en 156 aislamientos clínicos de A. baumannii procedentes de pacientes ingresados (92 por ciento) y de origen ambulatorio (8 por ciento). Se ha analizado la evolución de la sensibilidad desde enero de 1995 a diciembre de 1997. Se ha determinado la CMI, mediante dilución en agar, de ampicilina, ticarcilina, piperacilina, ampicilina-sulbactam, amoxicilina-ácido clavulánico, ticarcilina-ácido clavulánico, piperacilina-tazobactam, cefotaxima, ceftazidima, cefepima, imipenem, meropenem, ácido clavulánico, sulbactam, tazobactam, amikacina, gentamicina, tobramicina, ofloxacino, doxiciclina, fosfomicina, rifampicina, azitromicina y colistina. Se ha observado, salvo en algunas excepciones, una baja sensibilidad antimicrobiana en la mayoría de los aislamientos. La mayor sensibilidad de A. baumannii se ha mostrado frente a colistina, imipenem, meropenem y ampicilina-sulbactam (100 por ciento, 88,4 por ciento, 88,4 por ciento y 84,6 por ciento, respectivamente). Las cepas de A. baumannii de enfermos ingresados han mostrado una menor sensibilidad antimicrobiana que los aislamientos de origen ambulatorio, que presentan un alto porcentaje de sensibilidad a la mayoría de los antibióticos. Rifampicina y azitromicina han tenido cierta actividad in vitro sobre las cepas de A. baumannii más sensibles. Se ha observado una progresiva disminución de la sensibilidad antimicrobiana a lo largo de los tres años, destacando la aparición de cepas resistentes a carbapenémicos a partir de 1996 (AU)

Reference values and methods comparison of a new testosterone assay on the AxSYM system.

OBJECTIVES: We have contributed to the Design Validation Protocol of the new Abbott AxSYM Testosterone assay with a study on reference values and methods comparison. DESIGN AND METHODS: For reference values a population of 45 women and 30 men was tested. In methods comparison, 132 samples for the AxSYM vs. ACS-180, and 30 for the AxSYM vs. Elecsys were used. Pearson and intraclass concordance coefficients and Passing-Bablock test were performed for overall group, men and women. RESULTS: Reference values were 0.9-3.1 (females) and 1.0-30.2 nmol/L (males). Globally, a good agreement between methods in both the AxSYM vs. ACS-180 (slope: 0.88, y-intercept: 0.67, r = 0.961) and the AxSYM vs. Elecsys (slope: 1.08, y-intercept: 0.31, r = 0.935) studies was found. Slightly worse results were observed for women. CONCLUSIONS: The reference range of testosterone by the AxSYM system matches with those published for other methods. An acceptable agreement between the AxSYM Testosterone assay and both a classical (ACS-180) and a more recent (Elecsys) methodology was observed.

[Evolution of antimicrobial susceptibility of Acinetobacter baumannii clinical isolates]. / Evolución de la sensibilidad antimicrobiana en aislamientos clínicos de Acinetobacter baumannii (1995-1997).

Acinetobacter baumannii is a microorganism frequently implicated in colonization and infection in hospitalized patients. An increase of resistance has been observed in recent years making these infections difficult to treat. The in vitro activity of 24 antibiotics, 15 betalactam agents and nine nonbetalactams, was studied in 156 A. baumannii clinical isolates. The strains were collected from different clinical samples obtained from inpatients (92%) and 8% were from outpatients. Evolution of susceptibility from January 1995 to December 1997 was studied. MIC of the following antibiotics was determined by the agar dilution method: ampicillin, ticarcillin, piperacillin, ampicillin-sulbactam, amoxicillin- clavulanic acid, ticarcillin-clavulanic acid, piperacillin-tazobactam, cefotaxime, ceftazidime, cefepime, imipenem, meropenem, clavulanic acid, sulbactam, tazobactam, amikacin, gentamicin, tobramycin, ofloxacin, doxycycline, fosfomycin, rifampin, azithromycin and colistin. Low antimicrobial susceptibility was observed in most A. baumannii strains. Colistin, imipenem, meropenem and ampicillin-sulbactam showed the greatest susceptibility (100, 88.4, 88.4 and 84.6%, respectively). A. baumannii strains from inpatients showed a lower antimicrobial susceptibility than strains from outpatients, who showed a high percentage of susceptibility to most antibiotics. Rifampin and azithromycin showed certain in vitro activity against the most susceptible A. baumannii strains. A progressive decrease in susceptibility to most antibiotics was observed during the period studied. Carbapenem-resistant A. baumannii emerged in 1996 and increased in 1997.

[In vitro activity of beta-lactam agents and beta-lactamase inhibitors in clinical isolates of Acinetobacter baumannii]. / Actividad in vitro de antibióticos betalactámicos e inhibidores de betalactamasas en aislamientos clínicos de Acinetobacter baumannii.

Acinetobacter is a Gram-negative coccobacillus frequently associated with nosocomial infections, especially pneumonia in patients using mechanical ventilators in ICUs. Many of the clinical isolates of Acinetobacter baumannii are now resistant to most antibiotics, including the betalactams, making these infections difficult to treat. We compared the in vitro activity of betalactam agents (ampicillin, piperacillin and ticarcillin), betalactamase inhibitors (clavulanic acid, sulbactam and tazobactam) alone and in combination with betalactam agents (amoxicillin-clavulanic acid, ampicillin-sulbactam, piperacillin-tazobactam and ticarcillin-clavulanic) against 156 clinical isolates of A. baumannii using an agar dilution method. In general, we observed a low susceptibility to the betalactam agents tested (ampicillin: 1.9% susceptibility; piperacillin: 10.2%; ticarcillin: 19.8%). We did not observe a significant reduction of the MIC in the combination of betalactam agents and betalactamase inhibitors; only ampicillin/sulbactam showed a high antimicrobial activity (84.6% compared to 14.1%, 37.8% and 33.9% for amoxicillin-clavulanic acid, piperacillin-tazobactam and ticarcillin-clavulanic acid, respectively). Sulbactam was the only betalactamase inhibitor which showed good in vitro activity, with a low MIC(50) and MIC(90) (8 and 32 mg/l, respectively) similar to ampicillin/sulbactam (2 and 16 mg/l, respectively). Sulbactam could be a good therapeutic alternative for the treatment of multiresistant A. baumannii infections.

[In vitro activity of piperacillin-tazobactam against Klebsiella pneumoniae clinical isolates, producers or not of extended spectrum beta-lactamases]. / Actividad in vitro de piperacilina-tazobactam en aislamientos clínicosde Klebsiella pneumoniae productores o no de betalactamasas de espectro ampliado.

The aim of this study was to determine the in vitro activity of piperacillin-tazobactam against 81 clinical isolates of Klebsiella pneumoniae. The clinical specimens were processed according to standard microbiological procedures and 81 K. pneumoniae isolates were identified using MicroScan Panels following the manufacturer's recommendations. A double disk diffusion method was applied to detect extended spectrum betalactamases (ESBL) (43 isolates were positive and 38 were negative). Minimum inhibitory concentrations (MIC) were determined by an agar dilution technique using Mueller-Hinton. The following antibiotics were studied: piperacillin with 4 mg/l of tazobactam, amoxicillin-clavulanic acid in a 2:1 proportion, cefotaxime, ceftriaxone, cefepime, imipenem and meropenem. The MIC(90) were 16/4 mg/l for piperacillin-tazobactam, 16/8 for amoxicillin-clavulanic acid, 16 for ceftriaxone, 16 for cefotaxime, 4 for cefepime, 0.25 for imipenem and 0.032 for meropenem in ESBL-positive strains. In ESBL-negative strains the MIC90 were as follows: 4/4 mg/l for piperacillin-tazobactam, 8/4 for amoxicillin-clavulanic acid, 0.064 for ceftriaxone, 0.125 for cefotaxime, 0.125 for cefepime, 0.125 for imipenem and 0.016 for meropenem. All betalactams showed excellent in vitro activity against ESBL non-producer K. pneumoniae. Moreover, piperacillin-tazobactam and both carbapenems showed good in vitro activity against EBSL-producer K. pneumoniae.

Effect of cadmium and parathion on renal function in rat.

Our results suggest that parathion induces a stimulating effect on PAH uptake. The simultaneous presence of cadmium does not modify this effect. The simultaneous presence of cadmium and parathion produced an hepatotoxic effect in the rat.

Carbapenem resistance mediated by beta-lactamases in clinical isolates of Acinetobacter baumannii in Spain.

Four patients colonized/infected with carbapenem-resistant strains of Acinetobacter baumannii are described. The first patient had a decubitus ulcer infection and had been on intravenous imipenem for 50 days. Two other patients, from whom Acinetobacter baumannii was isolated from urine, were hospitalized in the same ward as the first patient. The fourth patient had been mechanically ventilated in the intensive care unit for 4 month and had nosocomial pneumonia. He had been on intravenous meropenem for 1 month. Minimum inhibitory concentrations (MICs) of imipenem (128 mg/l) and meropenem (> 128 mg/l) were the same for the isolates from the first three patients, and all of these isolates had the same repetitive extragenic palindromic polymerase chain reaction (rep-PCR) pattern. The MICs of carbapenems were lower for patient 4's isolate, which also had a different rep-PCR pattern. Beta-lactamases that hydrolyzed imipenem were detected in all four isolates; isoelectric points were 8.6-7.7 in the first three isolates and 6.8-7 in the fourth isolate.