[Study of bacteriology and resistances in pediatric appendicitis]. / Estudio de la flora patógena y resistencias en apendicitis pediátricas.

UNLABELLED: There is controversy about the convenience of performing a bacteriological peritoneal culture in pediatric appendicitis. We performed a sero-epidemiological survey of the bacteria found in peritoneal swabs from pediatric appendicitis operated in our hospital. METHODS: Ambispective study. Retrospective revision of the bacteriological results from peritoneal swabs performed in pediatric appendicitis from january 2009 to december 2010 (2 years) and prospective study of peritoneal swabs collected between january 2011 and december 2011 (one year). RESULTS: We found 728 pediatric patients (mean age 7.1, range: 2-11 years). Among these, 108 were < 5 years. Cultures were performed in 328 (45.1%). A positive result was found in 155 swabs, (47.3%). Positive cultures were more frequent in patients < 5 years (69.2% vs 40.4%, p < 0.001). The most frequent pathogens were E. coli: 122 specimens, Streptococcus spp (50 swabs), P. aeruginosa: (45) and B.fragilis: (35) Younger age was strongly associated with P. aeruginosa: (30.8% vs 8.4%, p < 0.001. OR: 4.8. IC 95%: 2.3-9.8). So was the detection of E. coli (50% vs 33.2% p = 0.01). 21.3% (26 swabs) of E. coli were resistant to amoxicillin-clavulanic acid. There were 15 (12.3%) multiresistant (ESBL) E. coli. Among the Streptococcus, 32% (16 out of 50) were resistant to clindamicin, and so were 28.6% of the B. fragilis (10 out of 35). DISCUSSION: . The most frequent pathogens were E. coli, Streptococcus spp and P. aeruginosa. P. aeruginosa is five times more frequent in patients < 5 years. Resistance of E. coli to amoxiclavulanate was high: 21.3% of the specimens. We found that 12.3% of the E. coli produced ESBL.

Estudio de la flora patógena y resistencias en apendicitis pediátricas / Study of bacteriology and resistances in pediatric appendicitis

Objetivos. Existe controversia sobre la utilidad del cultivo de líquido peritoneal en las apendicitis pediátricas. Hemos investigado la situación epidemiológica de la fl ora bacteriana en las apendicectomías pediátricas. Material y métodos. Revisión retrospectiva de apendicectomías realizadas en menores de 12 años, en dos años (enero/2009-diciembre/2010) y análisis prospectivo durante un año (enero/2011-diciembre/2011). Resultados. Encontramos 728 pacientes (media 7,1 años, rango 2-11). De ellos, 108 eran <5 años. Se recogió cultivo de líquido perineal en 328 (45,1%). Los cultivos fueron positivos en 155 de esas 328 muestras (47,3%). Fue más frecuente encontrar cultivo positivo en <5 años (69,2% vs. 40,4%, p <0,001. OR: 3,3. IC 95%: 1,8-5,9). Las bacterias más habituales fueron Escherichia coli, con 122 aislamientos, Streptococcus spp (50 aislamientos), P. aeruginosa, (45 aislamientos) y B. fragilis (35). La frecuencia de P. aeruginosa fue cinco veces mayor en el grupo de < 5 años (30,8% vs. 8,4%, p<0,001. OR: 4,8. IC 95%: 2,3-9,8). Asimismo, la presencia de E. coli se duplicó en el grupo de < 5 años (50% vs. 33,2% p = 0,01. OR: 2,01. IC 95%: 1,1-3,4). 26 (21,3%) especímenes de E. coli eran resistentes a amoxicilina-clavulánico. Hubo 15 (12,3%) cepas de E. coli multirresistentes. 16 cepas de Streptococcus (32%) y 10 aislamientos de B. fragilis (28,6%) fueron resistentes a clindamicina. Conclusiones. En < 5 años existe más riesgo de infección por Pseudomonas. Encontramos una alta tasas de resistencia de E. coli a la amoxicilina-clavulánico y 12,3% de E. coli eran multirresistentes

There is controversy about the convenience of performing a bacteriological peritoneal culture in pediatric appendicitis. We performed a sero-epidemiological survey of the bacteria found in peritoneal swabs from pediatric appendicitis operated in our hospital. Methods. Ambispective study. Retrospective revision of the bacteriological results from peritoneal swabs performed in pediatric appendicitis from january 2009 to december 2010 (2 years) and prospective study of peritoneal swabs collected between january 2011 and december 2011 (one year).Results. We found 728 pediatric patients (mean age 7.1, range: 2-11 years). Among these, 108 were <5 years. Cultures were performed in 328 (45.1%). A positive result was found in 155 swabs, (47.3%). Posi-tive cultures were more frequent in patients < 5 years (69.2% vs 40.4%, p <0,001). The most frequent pathogens were E. coli: 122 specimens, Streptococcus spp (50 swabs), P. aeruginosa: (45) and B. fragilis: (35). Younger age was strongly associated with P. aeruginosa: (30.8% vs8.4%, p<0,001. OR: 4.8. IC 95%: 2.3-9.8). So was the detection of E. coli (50% vs 33.2% p=0,01). 21.3% (26 swabs) of E. coli were resistant to amoxicillin-clavulanic acid. There were 15 (12.3%) multiresistant (ESBL) E. coli. Among the Streptococcus, 32% (16 out of 50) were re-sistant to clindamicin, and so were 28.6% of the B. fragilis (10 out of 35). Discussion. The most frequent pathogens were E. coli, Streptococ-cus spp and P. aeruginosa. P. aeruginosa is fi ve times more frequent in patients <5 years. Resistance of E. coli to amoxiclavulanate was high: 21.3% of the specimens. We found that 12.3% of the E. coli produced ESBL

Influence of harvest bacterial contamination on autologous peripheral blood progenitor cells post-transplant.

Microbiological contamination of manipulated blood products, including hematopoietic progenitors obtained from peripheral blood, is an infrequent but persistent problem in transplant units. The relevance of such contamination in causing patient infection has been reported as insignificant, but the effect on the post-transplant course has not been well documented. We studied the incidence of bacterial contamination in autologous peripheral blood progenitor cell transplants in two of the bench processing steps, as well as the repercussions in the post-transplant course affecting incidence of infections, transfusion requirements and time to engraftment. A total of 365 aphereses performed on 152 patients were cryopreserved in 617 bags. In 31 of these bags (5.0%), bacterial cultures were positive for Coagulase-negative Staphylococcus (31.1%), S. epidermidis (21.9%), Corynebacterium sp. (6.3%), S. warneri (6.3%), Stenotrophomonas maltophilia (6.3%), Streptococcus sp. (9.4%), Viridans group Streptococcus (3.1%) and more than one bacteria (Coagulase-negative Staphylococcus plus Corynebacterium) (15.6%). Half of the bags were contaminated at the time of freezing and the others at the time of thawing. The 31 contaminated bags were infused into 17 patients. In five of these the same contaminating bacteria was found. No difference between the two groups of patients (contaminated and non-contaminated) was found on the day the fever started, length of fever, blood transfusion requirements and engraftment, but length of hospitalization was significantly greater in patients receiving contaminated transplants.

Use of direct latex agglutination testing of selective broth in the detection of group B strepptococcal carriage in pregnant women.

Direct latex agglutination testing of selective broth medium for the detection of group B streptococci was evaluated. Results were compared with those obtained by the recommended subculture method. Among the 551 vaginal-rectal specimens tested, 101 (18.3%) were positive by the subculture method. Of these subcultures, latex agglutination testing detected 99 (98%) positive specimens. Agglutination testing of selective broth is a sensitive method which offers the advantage of saving 24 h in the turnaround time for detection of group B streptococci in pregnant women.

Sensibilidad a antimicrobianos de aislamientos clínicos de Pseudomonas aeruginosa en Murcia / Antimicrobial susceptibility of Pseudomonas aeruginosa clinical isolates in Murcia. Spain

En este trabajo hemos estudiado la sensibilidad a diversos antimicrobianos de 1293 aislamientos de Pseudomonas aeruginosa obtenidos de diversas muestras clínicas durante los años 1996 a 1999. P. aeruginosa se aisló más frecuentemente en las muestras de orina (61,2 por ciento) en los pacientes ambulatorios y en las muestras de vías respiratorias bajas (40,2 por ciento) en los pacientes hospitalizados. Los antimicrobianos más activos, con resistencia 10 por ciento, fueron amikacina, ceftazidima, imipenem y tobramicina. Aztreonam, ciprofloxacino y gentamicina mostraron resistencia >10 por ciento. Los porcentajes de resistencia para ceftazidima, aztreonam e imipenem de los aislamientos intrahospitalarios y de los servicios de máximo riesgo fueron significativamente superiores a los encontrados en los de procedencia comunitaria y de otros servicios hospitalarios. Durante los cuatro años del estudio se produce un aumento estadísticamente significativo de la resistencia de P. aeruginosa a todos los antimicrobianos estudiados excepto al imipenem (AU)

[Antimicrobial susceptibility of Pseudomonas aeruginosa clinical isolates in Murcia, Spain]. / Sensibilidad a antimicrobianos de aislamientos clínicos de Pseudomonas aeruginosa en Murcia.

The source and antimicrobial susceptibility of 1293 clinical isolates of Pseudomonas aeruginosa obtained from 1996 to 1999 were studied. Urine was the most common source for outpatient isolates (61.2%), while for hospitalized patients respiratory samples were the most frequent (40.2%). The most active antimicrobials with resistance rates <=10% were ceftazidime, imipenem, tobramycin and amikacin. By contrast, aztreonam, ciprofloxacin and gentamicin showed resistance levels >10%. The percentages of resistance to ceftazidime, aztreonam and imipenem in isolates from inpatients and from patients in the intensive care unit were significantly higher than those in isolates from outpatients and other clinical departments. Comparison of susceptibility data from 1996 to 1999 showed a significant increase in the resistance rate for all of the antibiotics studied but imipenem.

The effect of BCG vaccination on tuberculin reactivity and the booster effect among hospital employees.

BACKGROUND: We estimated the effect of remote BCG vaccination on tuberculin reactivity and the booster effect among hospital employees. METHODS: Cross-sectional survey at a university hospital. All personnel employed during a 24-month period were included in the study. Employees were administered 2-step tuberculin testing, and BCG vaccination scars were verified. RESULTS: Of 665 hospital employees studied, 239 (36%) had been vaccinated with BCG in childhood. Significant tuberculin reactions (> or =5 mm) were more frequent among BCG-vaccinated (60%) than among nonvaccinated (29%) employees (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.6-5.2). The predictive value of tuberculosis infection increased with increasing reaction size and greater age (from 37% in subjects 30 years or younger with indurations > or =5 mm to 100% in subjects 50 years or older with indurations > or =15 mm). Among 374 employees with a negative tuberculin test reaction who underwent a second test, 39 (43%) of 91 vaccinated subjects had a positive booster reaction in contrast to 51 (22%) of 232 nonvaccinated subjects (OR, 3.4; 95% CI, 2-5.7). Neither different size criteria nor different definitions of the booster effect had an impact on the predictive value of tuberculosis infection. CONCLUSIONS: Remote BCG vaccination largely influences the tuberculin reaction and the boosting phenomenon among hospital employees. The interpretation of the results of 2-step tuberculin testing in a BCG-vaccinated subject must take into account age, size of the reaction, and local prevalence of tuberculosis infection. No single criterion, however, can accurately separate reactions caused by true infection from those caused by BCG vaccination.

[Occupational exposures to blood-borne pathogens in health care workers]. / Exposición a patógenos hemáticos en el personal sanitario.

OBJECTIVE: To determine the rate of occupational exposures to blood-borne pathogens in different occupations of health care workers. To analyze the characteristics and outcome of the occupational exposure. MATERIAL AND METHODS: We have evaluate occupational exposures to blood-borne pathogens reported by health care workers during 1996-1999. The following data were collected: characteristics of the workers, type of occupational exposure, immunity status of the exposed worker, infectivity of the source patient and follow up serologic testing of the worker. RESULTS: A total of 407 occupational exposures were reported. The highest rate of occupational exposure was found among nurses (61.6%). Needlestick accident was the most often occupational exposure reported (84.5%). Mucosal exposures with accidental splashes were reported in 15.2% of cases. In 14.5% of these accidents workers were at risk for occupational transmission of blood-borne pathogens. Among the different occupations of health care workers, the rate of exposures with a source infected patient was higher in medical staffs (28.3%) than nurses (13.9%) The rate of exposures with a source infected patient was higher in accidental splashes than in percutaneous exposures (33.8% vs 13.3%), besides in none of the accidental splashes, employees had used appropriate barrier precautions. There were no cases of transmission of occupational blood-borne infections. CONCLUSIONS: Although nurses are the health care workers with highest rates of occupational exposures, medical staffs are the most often occupationally exposed to a source infected patient. Universal barrier precautions are no appropriately used in most of the occupational accidents, specially in those involving mucosal exposures.

Cytopathic effect inhibition assay for determining the in-vitro susceptibility of herpes simplex virus to antiviral agents.

We compare a rapid dilution method for the determination of antiviral susceptibility of herpes simplex virus (HSV) with the plaque reduction assay. A total of 84 HSV clinical isolates were studied by both methods to detect in-vitro resistance to acyclovir and foscarnet. The rapid method showed for the detection of HSV isolates resistant to acyclovir and foscarnet, a sensitivity of 96. 8% and 100% and specificity of 100% and 100%, respectively. This method provides an easy and accurate screening procedure for the susceptibility testing of HSV to antiviral agents.

Invasive disease caused by ciprofloxacin-resistant uropathogenic Escherichia coli.

To evaluate the invasiveness of ciprofloxacin-resistant Escherichia coli isolated from the urinary tract, the susceptibility to ciprofloxacin of Escherichia coli strains from patients with invasive urinary tract infection was compared with that of isolates from patients with noninvasive disease. In a 14-month period, 2054 different isolates of Escherichia coli were analyzed, of which 554 (27%) were resistant to ciprofloxacin. One hundred twelve (5.4%) strains were isolated from patients with invasive disease. Resistance was significantly less frequent in isolates from patients with invasive disease (4.5%) than in isolates from patients with noninvasive disease (28.3%) (OR, 0.12; CI 95%, 0.05-0.29; P<0.001). Most ciprofloxacin-resistant strains associated with invasive disease were isolated from bacteremic patients who had recently undergone an invasive procedure involving the urinary tract. Invasive disease is caused more frequently by ciprofloxacin-susceptible strains of Escherichia coli, suggesting that resistance to ciprofloxacin may decrease the invasiveness of uropathogenic Escherichia coli.

[Infective endocarditis caused by unusual microorganisms]. / Endocarditis infecciosa por microorganismos poco frecuentes.

All series of infective endocarditis had a variable proportion of cases without an etiologic agent because all cultures were negative. New microbiologic techniques have permitted the discovery of the role of many microorganisms in infective endocarditis. C. burnetii is an increasing causative agent of subacute infective endocarditis. In the diagnosis, to the detection of antiphase-I antibodies, immunohistochemical, molecular techniques and cellular cultures have been added. Total cure is difficult to obtain. The combination of doxicicline plus ciprofloxacin for at least 3 years has been proposed as the treatment of choice. Surgery must be reserved for patients with cardiac insufficiency. Less than 2% of cases of acute brucellosis are complicate with infective endocarditis. Infective endocarditis produces serious and rapid valvular destruction with high mortality rates if valve surgery is not performed. For medical treatment at least 3 active agents are required. Bartonella has recently been described as an etiologic agent of infective endocarditis. It mainly affects to homeless people living in poor hygienic conditions. The aortic valve is most commonly involved and, frequently, valve insufficiency requires valve replacement. Blood culture isolation needs long incubation periods. Parenteral nutrition, immunosuppression, wide spectrum antibiotic regimens, intravenous drug addiction and cardiovascular surgery are risk factors previously described in the development of fungal endocarditis. C. albicans and Aspergillus spp. are most frequent etiologic agents. Infective endocarditis should be suspected in any patient with systemic fungal disease. Blood cultures are often negative except for Candida spp. Peripheral emboli and large vegetations are frequent. Mortality is high, antifungal therapy combined with surgery is the treatment of choice. Legionella, Mycoplasma, Chlamydia, Mycobacteria, viruses are potential agents of infective endocarditis, and difficult to diagnose because of special culture requirements. Epidemiological clues, serologic and molecular techniques and blood cultures could identify them.

Postsurgical mediastinitis: a case-control study.

We report the results of a case-control study of postsurgical mediastinitis (PSM) that we conducted from 1985 to 1993. The incidence of PSM was 2.2% (81 of 3,711 cases who underwent sternotomy); we analyzed the findings for 73 cases and 73 controls. Univariate analysis revealed that the risk factors for PSM were emergency surgery (27% of cases vs. 13% of controls), New York Heart Association functional class IV (46.5% vs. 21.9%), heart transplantation (12% vs. 0), and coronary artery bypass graft (CABG) surgery (60% vs. 41%). The incidences of fever, reoperation for bleeding, pacemaker placement, use of vasoactive drugs, prolonged mechanical ventilation, use of central lines, and treatment in the intensive care unit were also higher for cases. Multivariate analysis identified the following independent risk factors for PSM: reoperation (risk ratio [RR], 9.2), need for vasoactive drugs (RR, 3.5), CABG surgery (RR, 3.2), and fever that persisted after the third postsurgical day (RR, 406). The related mortality was 13.7%, and death was significantly more frequent among cases (17.7%) than among controls (2.7%). Multivariate analysis identified the following independent risk factors for mortality: bacteremia (RR, 21.5), the use of an intraaortic balloon (RR, 14.9), advanced age (RR, 1.14 per year), and prolonged mechanical ventilation (RR, 1.1 per day).