Molecular epidemiology and antimicrobial resistance of Clostridium difficile in a national geriatric hospital in Costa Rica.

BACKGROUND: The epidemiology of Clostridium difficile infections (CDI) is changing rapidly worldwide; knowledge on the genotypes of C. difficile circulating in specialized geriatric hospitals and their resistance to antibiotics is scarce or non-existent. METHODS: Prospective study of the molecular epidemiology of CDI, conducted in a national geriatric hospital in Costa Rica for a period of 11 months. RESULTS: The study patients exhibited a diverse range of comorbidities, but none were associated with CDI. Polyclonality, including three new ribotypes, and a high level of resistance to antibiotics were determined by analysing the 32 isolates obtained in these cases. Despite the diversity in strains observed, the most frequent types were NAP6/RT002 and NAP2/RT001. NAP9/RT017 was associated with community acquisition. Nineteen types of antimicrobials were used before the onset of diarrhoea in the patients; no particular genotype was associated with the onset of infection or severity. CONCLUSION: Based on the abundance of strain types observed and their resistance to antibiotics in this geriatric hospital, these results contribute to a better overall understanding of the epidemiology of CDI worldwide, and to surveillance programmes targeting geriatric populations.

Caracterización clínico-epidemiológica de las enfermedades cerebro-vasculares en pacientes del Hospital Militar de Holguín: enero 2008- diciembre 2009 / Cerebrovascular Diseases Clinical-Epidemiological Behavior in Patients from Military Hospital: Holguín: January 2008 - December 2009

Se realizó un estudio descriptivo con el objetivo de determinar el comportamiento de las enfermedades cerebro-vasculares en los pacientes atendidos durante enero 2008 a diciembre 2009 en Hospital Militar. Se realizó una revisión de las estadísticas y se realizaron entrevistas a los 36 pacientes con padecimientos de enfermedades cerebro-vasculares. Hubo un incremento de esta enfermedad con la edad, predominó el sexo masculino con una alta incidencia de factores de riesgo de las enfermedades cerebro-vasculares, se encontró la trombosis cerebral como el ictus más frecuente...(AU)

A descriptive study in patients assisted at Military hospital from January to December 2009 was carried out, to determine the cerebrovascular behavior . A statistical review was done and all the patients were interviewed. A disease increase was observed. The male sex predominated and there was a risk factors high incidence of cerebrovascular diseases. Cerebral thrombosis was the most frequent ictus...(AU)

Studies on the toxic interaction between monensin and tiamulin in rats: toxicity and pathology.

The characteristics of the toxic interaction between monensin and tiamulin were investigated in rats. A three-day comparative oral repeated-dose toxicity study was performed in Phase I, when the effects of monensin and tiamulin were studied separately (monensin 10, 30, and 50 mg/kg or tiamulin 40, 120, and 200 mg/kg body weight, respectively). In Phase II, the two compounds were administered simultaneously to study the toxic interaction (monensin 10 mg/kg and tiamulin 40 mg/kg b.w., respectively). Monensin proved to be toxic to rats at doses of 30 and 50 mg/kg. Tiamulin was well tolerated up to the dose of 200 mg/kg. After combined administration, signs of toxicity were seen (including lethality in females). Monensin caused a dose-dependent cardiotoxic effect and vacuolar degeneration of the skeletal muscles in the animals given 50 mg/kg. Both compounds exerted a toxic effect on the liver in high doses. After simultaneous administration of the two compounds, there was a mild effect on the liver (females only), hydropic degeneration of the myocardium and vacuolar degeneration of the skeletal muscles. The alteration seen in the skeletal muscles was more marked than that seen after the administration of 50 mg/kg monensin alone.

Studies on the toxic interaction between monensin and tiamulin in rats: effects on P450 activities.

Studies were carried out to investigate the effects of monensin and tiamulin, and the simultaneous administration of both compounds on microsomal enzymes in rats. In Phase I of the experiments the effects of monensin and tiamulin were studied separately (monensin 10, 30, and 50 mg/kg or tiamulin 40, 120, and 200 mg/kg body weight, respectively), while in Phase II the two compounds were administered simultaneously (monesin 10 mg/kg and tiamulin 40 mg/kg b.w., respectively). When monensin was administered by itself, it exerted no significant effect on microsomal liver enzymes. In a few cases, slight inhibition of certain enzyme activities was seen. Tiamulin provoked a dose-dependent hepatic enzyme induction. The combined administration of monensin and tiamulin at low doses (10 and 40 mg/kg, respectively) resulted in marked elevation of P450-related enzyme activities. The enzyme induction was more pronounced in females than in males. The results suggest that the simultaneous administration of tiamulin may influence the biotransformation of monensin, possibly increasing the amount of reactive metabolite(s) of the ionophore antibiotic.

Toxicological studies on potentiated ionophores in chickens. I. Tolerance study.

The tolerance of chickens to monensin (12.5 mg/kg of feed) and maduramicin (3.0 mg/kg of feed) fed at a reduced dose in the presence of the antioxidant duokvin was studied in two experiments including 2 x 200 Tetra-82 broiler chickens. Tolerance was assessed by the appearance of clinical signs indicative of a toxic effect, the number of deaths, the groups' body weight gain, feed and drinking water intake, the aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) activities, calcium ion, inorganic phosphate and total protein content of the blood plasma, the haematocrit value, and haemoglobin concentration. When applied at a dose that had proved to be optimum in the efficacy studies, neither the monensin-duokvin combination (12.5 mg monensin per kg of feed + 120 mg duokvin per kg of feed) nor the maduramicin-duokvin combination (3.0 mg maduramicin per kg of feed + 120 mg duokvin per kg of feed) exerted a statistically significant influence on the parameters tested.

Toxicological studies on potentiated ionophores in chickens. II. Compatibility study.

Two trials were carried out on a total of 2 x 360 Tetra-82 broiler chickens to study how the presence of the antioxidant duokvin as potentiating agent influenced the compatibility of reduced doses of monensin (12.5 mg/kg of feed) or maduramicin (3.0 mg/kg of feed) with other chemotherapeutic agents (tiamulin, erythromycin, sulfaquinoxaline, sulfachlorpyrazine, flumequine, tylosin, kitasamycin) widely used in broiler rearing. Compatibility was assessed on the basis of the appearance of clinical signs suggestive of toxic interaction, the mortality rate, body mass gain, feed consumption and drinking water intake, and changes in AST and LDH activities of the blood plasma. The monensin-duokvin combination (12.5 mg monensin/kg of feed + 120 mg duokvin/kg of feed) was found to be compatible with erythromycin, sulfaquinoxaline, sulfachlorpyrazine, flumequine, tylosin and kitasamycin. For tiamulin, a slight incompatibility was observed; however, this was much less severe than that found for monensin administered at a dose of 100 mg/kg of feed. The maduramicin-duokvin combination (3.0 mg maduramicin/kg of feed + 120 mg duokvin/kg of feed) was compatible with all the compounds tested; thus, it can be safely applied also in combination with tiamulin.

Potentiation of ionophorous anticoccidials with dihydroquinolines: battery trials against Eimeria tenella in chickens.

Seven battery tests, employing a total of 1344 Hybro cockerels, were conducted in order to study the interaction between ionophorous anticoccidials and a new dihydroquinoline-type antioxidant known as duokvin. A significant, non-selective, toxic interaction was established, resulting in growth depression and improved anticoccidal efficacy against Eimeria tenella and E. mitis in these chickens. The duokvin itself showed no appreciable activity against the coccidia. The adverse effects of the interaction were eliminated, and the anticoccidial efficacy of the approved levels of ionophores was maintained, when the dietary levels of monovalent cation ionophorous monensin, salinomycin and narasin were reduced to approximately 12% in the presence of 120 p.p.m. duokvin. No adverse effects on the growth of chickens appeared in the combination with maduramicin, yet the enhancement of anticoccidial activity allowed an approx. 50% reduction of this ionophore as well.

Potentiation of ionophorous anticoccidials with dihydroquinolines: reduction of adverse interactions with antimicrobials.

In two experiments, the compatibility of the anticoccidial combinations of monensin and duokvin, as well as that of maduramicin and duokvin, with some antimicrobials widely used in the broiler production was studied in cockerels. The monensin-duokvin combination was found to be fully compatible with erythromycin, sulphachlorpyrazine, and sulphaquinoxaline. With tiamulin, a slight interaction was observed, but it was far less severe than the toxic interaction between monensin and the diterpene antibiotic. The maduramicin-duokvin combination proved to be compatible with all of the chemotherapeutics tested, including tiamulin. The results of the studies indicate that the adverse interactions of monensin and maduramicin with certain antimicrobials can be considerably diminished or even abolished by using them in reduced doses in combination with the dihydroquinoline compound duokvin.

Target animal safety test of a dexamethasone-prednisolone combination in horses.

The target animal safety of a dexamethasone-prednisolone combination was studied on 12 horses divided into two groups of six each. One group of horses received the therapeutic dose of the combination (25 mg/animal dexamethasone pivalate and 75 mg/animal prednisolone) and the second group was given the threefold dose of it. The preparation was administered intravenously for 2 consecutive days. For assessment of safety a wide range of clinical, haematological, biochemical and urine variables were tested as laid down in the guidelines of the FDA. All horses treated by the therapeutic or the threefold therapeutic doses of the preparation remained in good health throughout the entire study. No signs of clinical abnormalities occurred in either group. The physiological variables tested failed to reveal any significant alteration as a consequence of the medications. Of the haematological and biochemical parameters leucocyte, neutrophil, eosinophil and lymphocyte counts, aspartate aminotransferase activity, glucose, phosphor, total and conjugated bilirubin and creatinine concentrations were significantly affected in both groups. In some animals a transient glucosuria occurred. From the direction and magnitude of these changes it was concluded that they did not reflect any toxic actions of the preparation. Nevertheless, the combination is to be administered only with exact therapeutic indications and the uncontrolled misuse of it must be avoided.

[The compatibility of the new ionophore-coccidiostats with other chemotherapeutics in broilers]. / Zur Kompatibilität der neueren lonophor-Antikokzidika mit anderen Chemotherapeutika bei Broilern.

The compatibility of Salinomycin, Narasin or Maduramycin with Tiamulin, Erythromycin, Tylosin, Kitasamycin, Flumequine, Sulfachlorpyrazine or Sulfaquinoxaline was tested in cockerels in three experiments. It was found that Salinomycin and Narasin are incompatible with Tiamulin, Erythromycin, Sulfachlorpyrazine and Sulfaquinoxaline. The effect of incompatibility was shown more markedly with the administration of Salinomycin than with Narasin. Maduramycin was also shown as incompatible with Tiamulin although this interaction was nowhere near as severe as in the case of Salinomycin or Narasin. It caused a significant weight gain depression without mortality. Because of the significant weight gain depression, however, the administration of Tiamulin in the presence of Maduramycin in feed will not be recommended. At the same time, Maduramycin proved to be fully compatible with Erythromycin, Sulfachlorpyrazine and Sulfaquinoxaline. All three anticoccidials tested showed total compatibility with Tylosin, Kitasamycin and Flumequine.