Toxicidad del formaldehido en trabajadores profesionalmente expuestos. Revisión bibliográfica / Scoping review about formaldehyde toxicity on occupationally exposed workers

La presencia del formaldehido en el ámbito laboral sigue siendo importante. La exposición produce irritación local de mucosas oculares, nasales y del tracto respiratorio superior, y crónicamente se ha asociado con mayor riesgo de desarrollar cáncer a nivel de senos paranasales, naso-orofaringe y pulmón. Esta revisión tiene por objetivo actualizar la bibliografía y categorizar la evidencia científica más actualizada de los efectos que el formaldehido produce sobre el organismo humano. Búsqueda bibliográfica en la base de datos electrónica Medline/PubMed, limitada a los últimos 10 años mediante combinación de lenguaje libre y controlado. Se revisaron 185 artículos con inclusión final de 54 tras descartar por duplicidad, idioma y criterios de inclusión. Se observa un elevado grado de evidencia respecto a la genotoxicidad, evidencia contradictoria, inconsistente o limitada respecto a patologías neoplásicas de origen hematopoyético, laringe, naso-sinusales o de pulmón y falta de evidencia sobre la relación con el asma bronquial. Es preciso efectuar nuevos estudios, especialmente con carácter longitudinal y mayor potencia epidemiológica, para generar nuevo conocimiento sobre el comportamiento de este tóxico

The presence of formaldehyde at workplace remains significant. Exposure to it results in local irritation of the eye, nose and upper respiratory tract mucous membranes, and it has been chronically related to a higher risk of cancer development at the paranasal sinuses, naso-oropharynx and lungs. The aim of our work has been the updating of the bibliography and the categorization of the most up to date scientific evidence of formaldehyde effects on human body. Bibliographic search on the electronic database Medline / PubMed, restricted to the last 10 years through a combination of free and controlled language. Review of 185 scientific articles, finally including 54 due to duplicity, language, and inclusion criteria. We find among the main results a major evidence regarding genotoxicity; limited, inconsistent, and contradictory evidence regarding various neoplastic pathologies; and lack of evidence regarding bronchial asthma. Further studies have to be carried out, especially longitudinal studies and greater epidemiological power, to generate new knowledge about the behavior of this toxic

La presència del formaldehid a l'àmbit laboral segueix sent important. L'exposició produeix irritació local de mucoses, com ara les oculars, nasals i del tracte respiratori superior i de manera crònica s'ha associat amb un major risc de desenvolupar càncer a nivell de mucosa i sinus paranasals, naso-orofaringe i pulmó. L'objectiu del nostre treball ha estat actualitzar la bibliografia i categoritzar l'evidència científica més actualitzada dels efectes que el formaldehid produeix sobre l'organisme humà. Mètode: Revisió de la literatura utilitzant la metodologia "scoping review". Cerca bibliogràfica a la base de dades electrònica Medline/PubMed, limitada als darrers 10 anys mitjançant combinació de llenguatge lliure i controlat. Anàlisi efectuada per un col.lectiu de Metges especialistes en medicina del treball, pertanyents a l'àmbit sanitari i que també han comptat amb la participació d'higienistes i altres professionals de la prevenció de riscos. Resultats: Revisió de 185 articles, amb inclusió final de 54 un cop descartats per duplicitat, idioma i criteris d'inclusió. Entre els principals resultats es troba un elevat grau d'evidència referida a genotoxicitat, evidència contradictòria, inconsistent o limitada pel que fa a diverses patologies neoplàsiques d'origen hematopoiètic, laringe, naso-sinusals o de pulmó i manca d'evidència sobre la relació ambl'asma bronquial. Conclusions: La revisió mostra un canvi de paradigma dels efectes del formaldehid sobre l'organisme humà, amb dades que qüestionen els efectes tòxics clàssicament admesos. Cal efectuar nous estudis, especialment amb caràcter longitudinal i major potència epidemiològica, per generar nou coneixement sobre el comportament d'aquest tòxic

[Scoping review on formaldehyde toxicity in occupationally exposed workers]. / Toxicidad del formaldehido en trabajadores profesionalmente expuestos. Revisión bibliográfica.

The presence of formaldehyde at workplace remains significant. Exposure to it results in local irritation of the eye, nose and upper respiratory tract mucous membranes, and it has been chronically related to a higher risk of cancer development at the paranasal sinuses, naso-oropharynx and lungs. The aim of our work has been the updating of the bibliography and the categorization of the most up to date scientific evidence of formaldehyde effects on human body. Bibliographic search on the electronic database Medline / PubMed, restricted to the last 10 years through a combination of free and controlled language.Review of 185 scientific articles, finally including 54 due to duplicity, language, and inclusion criteria. We find among the main results a major evidence regarding genotoxicity; limited, inconsistent, and contradictory evidence regarding various neoplastic pathologies; and lack of evidence regarding bronchial asthma. Further studies have to be carried out, especially longitudinal studies and greater epidemiological power, to generate new knowledge about the behavior of this toxic.

La presencia del formaldehido en el ámbito laboral sigue siendo importante. La exposición produce irritación local de mucosas oculares, nasales y del tracto respiratorio superior, y crónicamente se ha asociado con mayor riesgo de desarrollar cáncer a nivel de senos paranasales, naso-orofaringe y pulmón. Esta revisión tiene por objetivo actualizar la bibliografía y categorizar la evidencia científica más actualizada de los efectos que el formaldehido produce sobre el organismo humano. Búsqueda bibliográfica en la base de datos electrónica Medline/PubMed, limitada a los últimos 10 años mediante combinación de lenguaje libre y controlado. Se revisaron 185 artículos con inclusión final de 54 tras descartar por duplicidad, idioma y criterios de inclusión. Se observa un elevado grado de evidencia respecto a la genotoxicidad, evidencia contradictoria, inconsistente o limitada respecto a patologías neoplásicas de origen hematopoyético, laringe, naso-sinusales o de pulmón y falta de evidencia sobre la relación con el asma bronquial. Es preciso efectuar nuevos estudios, especialmente con carácter longitudinal y mayor potencia epidemiológica, para generar nuevo conocimiento sobre el comportamiento de este tóxico.

Diferentes diseños de cursos de formación en prevención de riesgos laborales / Different designs for training courses in the prevention of work related risks

La formación es una herramienta muy importante de los Servicios de Prevención (SP) para dar a conocer la prevención de los riesgos a los que están expuestos los trabajadores, promover buenas prácticasy el uso correcto de equios de protección individual. El objeivo de estre trabajo es el de describir los principios y metodología utilizada por el SP propio de un centro hospitalario con una plantila actual de 3.246 trabajadores para la formación de los trabajadores en prevencion de riesgos laborales (PRL). En 1990 se inciió la formación en PRL en el centro. Con el fin de responder a losobjetivos de la formación se han utilizado diversas metodologías determinadas por. A) la necesidad de prevención en el riesgo específico que e petende abordad, b) las necesidades o demandas de cada olectivo en particular, y c) los resultados de la evaluación de riesgos por lugar de trabajo. Nuestro programa de formación en PRL ha seguido una evolución muy relevante hasta la actuaidad. Se han organizado en total una media de unos 30 cursos por año desde 1989 y 005 (campañas de vacunación (1), biológico (2), movilización de cargas, PVD, relajación, manipulación de pacientes, cargas). Os principios y diseños han sido: objetivos claros, específicos, asumibles, y que la formación aporte unamejora objetivable, duración adecuada al contenido y características de los puestos de trabajo y denro el horario labora; adecuación del lugar donde se imparta la formación de acuerdo con lasnecesidades y las posibilidades de desplazamiento del equipo formador a los puesto de trabajo; diseño de condiciones que permitan facilitar la asistencia, crear complicicdad y una asistencia de los responsalbes en los curos, para implicarlos en la apicación de las medidas de prevención (AU)

Training is a very important tool of the prevention Services (PS) for increasing awareness of the prevention of risks to which workers are exposed, for promoting good practices and for the correct use of personal protection equipment. This article describes the principles and methodology used by the PS of a hospital centre which currently employs 3,246 workers for training employees in the prevention of work-related risks (PVR) (AU)

Sepsis neonatal por Eikenella corrodens / Neonatal sepsis due to Eikenella corrodens

No disponible

[Parapneumonic pleural effusion: an 11-year review]. / Derrame pleural paraneumónico: revisión de 11 años.

INTRODUCTION: In the last few years, the incidence of parapneumonic effusions in children with community-acquired pneumonia seems to have increased. The aim of this study was to determine the clinical features and incidence of parapneumonic effusions throughout an 11-year period. MATERIAL AND METHODS: We retrospectively reviewed the medical records of patients aged < 15 years old with parapneumonic effusions from 1993 to 2003. Annual incidence rates were calculated per 100,000 children < 15 years old from Health Area 5 of Madrid and per 100 children hospitalized in the Infectious Diseases Department of our hospital. The linear association test was used to compare the incidence rates over the previous 11 years. RESULTS: There were 130 patients with parapneumonic pleural effusions. The mean age was 4.7 years. Forty-one percent received antibiotics before diagnosis. The causative organisms were identified in 42 patients (32.3%). The most effective diagnostic method was pleural-fluid culture (18/58, 31%). The most common organisms were Streptococcus pneumoniae (18), Mycoplasma pneumoniae (8), Staphylococcus aureus (4), Streptococcus pyogenes (3), Haemophilus influenzae (3) and Mycobacterium tuberculosis (2). Thirty-two percent of the patients required pleural drainage and 16% underwent video-assisted thoracoscopic surgery. Of 12 S. pneumoniae antibiograms available, 91.7% showed full susceptibility to penicillin and 75% were susceptible to erythromycin. The annual incidence of parapneumonic effusions rose from 18.1 in 1993 to 42.9 in 2003 (p < 0.001) per 100,000 children and from 0.76 in 1993 to 3.3 in 2003 (p < 0.001) per 100 children hospitalized in our unit. CONCLUSION: The incidence of parapneumonic effusions in children with community-acquired pneumonia showed a statistically significant increase between 1993 and 2003. The most common causal organism was S. pneumoniae, with a low rate of penicillin resistance.

Utility of prophylactic antibiotics in pediatric adenoidectomy.

OBJECTIVE: To determine the utility of prophylactic antibiotics in non-risk pediatric patients undergoing adenoidectomy. METHODS: We performed a prospective, controlled, randomized, and double-blind study on patients under 14 years of age, scheduled for adenoidectomy who accomplished the following criteria: absence of immunosuppressive and/or cardiovascular risk factors, no antimicrobial therapy for at least 15 days prior to operation, and no fever 1 week before surgery. Venous blood samples for culture were obtained at 30s and 20 min after the curettage of adenoidal tissue. Likewise, immediate and delayed complications were registered in all cases. The usefulness of prophylaxis was analyzed according to three major standpoints: bacteremia, immediate complications, and delayed complications. RESULTS: One-hundred one patients fulfilled the inclusion criteria and were included in the study. Fifty-one children received prophylaxis and the remainder did not. In the non-prophylactic group incidence of bacteremia at 30s was significantly higher than in the prophylactic group (32.7% versus 4.0%) (p<0.001). Neither bacteremia at 20 min, nor immediate or delayed complications showed statistical differences between both treatment groups. CONCLUSIONS: Preoperative antimicrobial prophylaxis in pediatric adenoidectomy did not offer advantages preventing complications in non-risk patients. Only bacteremia that occurs 30s after the curettage of adenoid tissue is reduced with the employment of prophylactic antibiotics.

Derrame pleural paraneumónico: revisión de 11 años / Parapneumonic pleural effusion: An 11-year review

Introducción En los últimos años parece existir un aumento en la incidencia del derrame pleural asociado a neumonía adquirida en la comunidad. Los objetivos de nuestro estudio fueron describir la etiología y las características clínicas de los derrames paraneumónicos y determinar su incidencia a lo largo de 11 años. Material y métodos Estudio retrospectivo de las historias clínicas de los pacientes menores de 15 años con derrame pleural paraneumónico en el período comprendido entre 1993 y 2003. Se calcularon incidencias anuales por cada 100.000 niños menores de 15 años del Área 5 de la Comunidad de Madrid y por cada 100 ingresos en la Unidad de Enfermedades Infecciosas del hospital y se evaluó su tendencia a aparecer a lo largo del período de estudio mediante el test de asociación lineal. Resultados Se diagnosticaron 130 derrames pleurales paraneumónicos. La edad media fue de 4,7 años. El 41 % recibieron tratamiento antibiótico previo al diagnóstico. Se descubrió la etiología en 42 pacientes (32,3 %). El mejor método diagnostico fue el cultivo de líquido pleural (18 aislamientos de 58 muestras, 31 %). Las bacterias más frecuentes fueron Streptococcus pneumoniae (18), Mycoplasma pneumoniae (8), Staphylococcus aureus (4), Streptococcus pyogenes (3), Haemophilus influenzae (3) y Mycobacterium tuberculosis (2). El 32 % requirieron drenaje pleural y el 16 %, toracoscopia. De los 12 antibiogramas de S. pneumoniae disponibles, 91,7 % fueron sensibles a penicilina y 75 % a eritromicina. La incidencia anual de derrame pleural paraneumónico por cada 100.000 niños aumentó de 18,1 en 1993 a 42,9 en 2003 (p < 0,005) y de 0,76 en 1993 a 3,3 en 2003 (p < 0,005) por cada 100 niños hospitalizados en nuestra unidad. Conclusión Existe un aumento estadísticamente significativo en la incidencia de derrame pleural paraneumónico entre 1993 y 2003. S. pneumoniae es el microorganismo causal más frecuente con un bajo porcentaje de resistencia a penicilina

Introduction In the last few years, the incidence of parapneumonic effusions in children with community-acquired pneumonia seems to have increased. The aim of this study was to determine the clinical features and incidence of parapneumonic effusions throughout an 11-year period. Material and methods We retrospectively reviewed the medical records of patients aged < 15 years old with parapneumonic effusions from 1993 to 2003. Annual incidence rates were calculated per 100,000 children < 15 years old from Health Area 5 of Madrid and per 100 children hospitalized in the Infectious Diseases Department of our hospital. The linear association test was used to compare the incidence rates over the previous 11 years. Results There were 130 patients with parapneumonic pleural effusions. The mean age was 4.7 years. Forty-one percent received antibiotics before diagnosis. The causative organisms were identified in 42 patients (32.3 %). The most effective diagnostic method was pleural-fluid culture (18/58, 31 %). The most common organisms were Streptococcus pneumoniae (18), Mycoplasma pneumoniae (8), Staphylococcus aureus (4), Streptococcus pyogenes (3), Haemophilus influenzae (3) and Mycobacterium tuberculosis (2). Thirty-two percent of the patients required pleural drainage and 16 % underwent video-assisted thoracoscopic surgery. Of 12 S. pneumoniae antibiograms available, 91.7 % showed full susceptibility to penicillin and 75 % were susceptible to erythromycin. The annual incidence of parapneumonic effusions rose from 18.1 in 1993 to 42.9 in 2003 (p < 0.001) per 100,000 children and from 0.76 in 1993 to 3.3 in 2003 (p < 0.001) per 100 children hospitalized in our unit. Conclusion The incidence of parapneumonic effusions in children with community-acquired pneumonia showed a statistically significant increase between 1993 and 2003. The most common causal organism was S. pneumoniae, with a low rate of penicillin resistance

Bacteremia following pediatric adenoidectomy.

OBJECTIVE: Adenoidectomy is frequently performed in children. The goals of this work were to determine the incidence of bacteremia during the adenoidectomy, to identify the microorganisms implicated, and to analyze the possible association of bacteremia with postoperative complications. METHODS: One hundred pediatric patients operated of adenoidectomy without preoperative antibiotic prophylaxis were prospectively included in this study. They had no immunosuppressive and/or cardiovascular risk factors, no antimicrobial therapy for at least 15 days prior to operation, and no fever 1 week before surgery. Venous blood samples were obtained 30 s and 20 min after the curettage of adenoidal tissue. RESULTS: The 33 and 14% of the samples were positive at 30 s and 20 min. The organism more commonly isolated was the streptococcus viridans. Bacteremia was only related to postoperative acute otitis media (p=0.012). CONCLUSIONS: Bacteremia exists after pediatric adenoidectomy, although it seldom correlates with clinical signs or symptoms. Postoperative acute otitis media is the only complication related to postsurgical bacteremia.

Prosthetic mitral valve endocarditis due to Ochrobactrum anthropi: case report.

We describe a case of infective endocarditis in a prosthetic mitral valve due to Ochrobactrum anthropi. Although O. anthropi is an emerging pathogen in immunocompromised patients, infections with the bacterium have very rarely been documented in healthy hosts, and endocarditis is rare. To our knowledge, only two cases of O. anthropi endocarditis have been reported in the medical literature.

Preemptive treatment with oral ganciclovir for pediatric renal transplantation.

This prospective study examines 42 children in the first year after renal transplantation. They all received intravenous ganciclovir prophylaxis for cytomegalovirus in the immediate post-transplant period. Quantitative antigenemia (pp68) determinations and blood, urine and throat cultures were done on a scheduled basis to detect cytomegalovirus. Infection was detected in 22 children (52.4%) within an average 44.31 +/- 27.38 days; 5/22 were symptomatic. The antigenemia was positive (+) in all the infected patients, and so were blood culture in 68.2%, urine culture in 59.1% and throat culture in 31.8%. A positive antigenemia was the earliest finding in all cases but 1. The 5 children with clinical symptoms received intravenous ganciclovir. Asymptomatic infected children received oral ganciclovir at an average dose of 47.64 +/- 8.10 mg/kg/day (median 46.58 (range 33-58.7) mg/kg/day) for an average of 58.47 +/- 27.76 days (median 58 (range 26-211) days). No patient developed disease or ganciclovir resistance during the treatment. No patient presented acute graft rejection or renal dysfunction and their glomerular filtrate rate at 1 year was similar to that of noninfected children (90.38 +/- 26.51 vs. 93.93 +/- 36.24 ml/min/1.73 m2). We conclude that preemptive treatment with oral ganciclovir is useful and safe in children with renal transplantation and that monitoring blood antigenemia is a sensitive and early method to detect and control CMV infection.

Bacteriemia por Salmonella no typhi en niños: revisión de 11 años / Non-typhi salmonella bacteremia in children: an 11-year review

Objetivos: Revisar los aspectos clínicos y bacteriológicos de los pacientes pediátricos con bacteriemia por Salmonella no typhi (SNT).Métodos Se revisaron las historias clínicas de niños menores de 14 años con hemocultivo positivo para SNT en un hospital de referencia de Madrid durante los últimos 11 años. Resultados: Se diagnosticaron un total de 29 casos de bacteriemia por SNT y fueron analizados 27 de ellos. La edad media fue de 11,1 meses (rango de 3 días a 11 años); 46 por ciento eran menores de un año. Once niños (41 por ciento) tenían una enfermedad de base. Éstas incluían 7 inmunodeficiencias (3 pacientes oncológicos, uno con déficit de IgA-IgG2, uno con enfermedad granulomatosa crónica, uno con infección por virus de la inmunodeficiencia humana (VIH) y uno con lupus eritematoso sistémico en tratamiento con corticoides), tres enfermedades hepáticas y una encefalopatía hipóxico-isquémica. Las manifestaciones clínicas en la primera visita fueron: fiebre superior a 39 °C (86 por ciento), diarrea (66 por ciento), y vómitos (37 por ciento). Dos pacientes presentaron bacteriemia oculta. Tres niños (11 por ciento) requirieron cuidados intensivos por sepsis grave. Cinco pacientes presentaron infecciones extraintestinales focales: 2 artritis, 1 osteomielitis, 1 infección del tracto urinario y 1 neumonía. Ninguno de los niños presentó meningitis o falleció como consecuencia de la infección por Salmonella. Los serogrupos más frecuentemente aislados fueron Salmonella D9 y B4-5 (38 por ciento cada una). Once cepas (38 por ciento) fueron resistentes a amoxicilina y 5 (17 por ciento) resistentes a cotrimoxazol. Sólo un paciente desarrolló bacteriemia persistente. Todos los niños se recuperaron completamente sin complicaciones. Conclusiones: La bacteriemia por SNT es una entidad infrecuente pero debe ser considerada en lactantes y niños inmunocomprometidos. Aunque pueden existir complicaciones focales, estos niños suelen recuperarse completamente con tratamiento antimicrobiano apropiado (AU)

[Non-typhi Salmonella bacteremia in children: an 11-year review]. / Bacteriemia por Salmonella no typhi en niños: revisión de 11 años.

OBJECTIVES: To review the clinical and bacteriological features of pediatric patients with non-typhi Salmonella (NTS) bacteremia. METHODS: We reviewed the medical records of children aged less than 14 years with culture-proven NTS bacteremia in the previous 11 years in a referral hospital in Madrid, Spain. RESULTS: A total of 29 cases of NTS bacteremia were diagnosed. Of these, 27 were used for study purposes. The mean age was 11.1 months (range: 3 days to 11 years); 48% were infants aged < 1 year. Eleven children (41%) had an underlying disease. These included immunodeficiency in seven (malignant disease in three, IgA-IgG2 deficit in one, chronic granulomatous disease in one, HIV infection in one, and systemic lupus erythematosus in one patient on steroid treatment), liver disease in three, and hypoxic-ischemic encephalopathy in one. Clinical manifestations at the initial visit included: fever > 39 C (85%), diarrhea (67%), and vomiting (37%). Seven patients had occult bacteremia. Three children (11 %) required intensive care management for severe sepsis. Five patients presented extraintestinal focal infections: arthritis in two, osteomyelitis in one, urinary tract infection in one, and pneumonia in one. None of the children had meningitis or died as a result of NTS infection. The most common serogroups isolated were Salmonella D9, and B4-5 (38% each). Eleven strains (38%) were resistant to amoxicillin and five (17%) were resistant to cotrimoxazole. Only one patient developed persistent bacteremia. All the children made a complete recovery without further complications. CONCLUSIONS: NTS bacteremia is an uncommon entity but it should be considered in infants and immunocompromised children. Although focal complications may occur, the usual outcome with appropriate antimicrobial treatment is a full recovery.

[Bacterial meningitis in pediatrics. Study of 166 cases]. / Meningitis bacteriana en la edad pediátrica. Estudio de 166 casos.

OBJECTIVE: The purpose of this study was to evaluate the clinical and epidemiological characteristics of meningitis in our environment. PATIENTS AND METHODS: A retrospective study of 166 cases of meningitis diagnosed in our hospital during a 10 year period (1986-1995) was performed. The patients were between 1 month and 14 years of age. RESULTS: Sixty-six percent of the patients were male and 34% female. Eleven cases were younger than 2 months (6.6%), 122 cases (73.5%) were between 3 months and 5 years of age and 33 cases (19.9%) were older than 5 years. The most frequent symptoms and signs were fever (96%), vomiting (60%), impairment of consciousness (24%) and meningeal signs (49%). CSF cultures were positive in 52% and blood cultures in 32%. The pathogen isolated was N. meningitidis in 53 cases (32%), H. influenzae in 38 (23%), S. pneumoniae in 9 patients (5%) and others in 3 children (2%). Meningitis due to H. influenzae increased each year. No microorganism was isolated in blood and CSF in 63 cases (38%). Meningitis in children between 3 months and 5 years of age was due to N. meningitidis in 40 children (33%) and H. influenzae in 36 (29%). The mortality rate was 3%. The most frequent complications were sepsis (36%) and seizures (16%). CONCLUSIONS: The most frequently isolated agent in our study was N. meningitis. Meningitis due to H. influenzae is increasing such that H. influenzae and N. meningitis currently show similar frequency in children between 3 months and 5 years of age.

[Staphylococcus coagulase negative infection in neonates caused by intravascular catheters. Prospective study]. / Sepsis por staphylococcus coagulasa negativo en recién nacidos portadores de catéteres intravasculares. Estudio prospectivo.

We present a prospective study about 100 intravascular catheters inserted into 88 newborns. 35 positive blood cultures were obtained; 19 with clinical signs of sepsis and 16 in asymptomatic newborns. Coagulase-negative Staphylococci were the most common isolated organisms -84.2% in the symptomatic cases, 100% in the asymptomatic ones. A comparative study was realized between cases of catheter-related sepsis with positive blood culture of coagulase-negative Staphylococcus (n = 14) versus asymptomatic cases with positive blood culture (n = 16). Risk factors in the appearance of symptoms are: prematurity, newborns old age when catheters are inserted and days of catheter placement.

[Antibiotic therapy of infected cerebrospinal fluid in hydrocephalus treated by a shunt]. / Antibioticoterapia del LCR infectado en hidrocefalias tratadas con shunt.

Nine hydrocephalic shunted children with infected cerebrospinal fluid (CSF) were treated. Ages ranged from 0 to 10 years. Diagnosis was made through clinical symptoms, CSF examination, echographic and computed tomography (CT). The microorganism which was seen more frequently, was S. epidermidis. This germ was more often found in young children. Treatment of these patients consisted of a systematic change of the shunt which was externally diverted, implantation of a CSF Ommaya reservoir in the lateral ventricle, and intraventricular and systemic administration of antibiotic, were made. Using this protocol CSF sterilization was obtained in all cases, after 5 to 12 days of treatment. CSF shunt infected with S. epidermidis can be effectively cleaned with daily intra-shunt vancomycin, and shunt infected with gram-negative are also cleaned with daily intra-shunt gentamycin.

In vitro activity of N-formimidoyl thienamycin against 98 clinical isolates of Brucella melitensis compared with those of cefoxitin, rifampin, tetracycline, and co-trimoxazole.

IN vitro susceptibilities of 98 isolates of Brucella melitensis to N-formimidoyl thienamycin, tetracycline, co-trimoxazole, rifampin, and cefoxitin were determined. N-Formimidoyl thienamycin showed good activity which was similar to those of tetracycline and rifampin and different from that of the other beta-lactam antibiotic tested (cefoxitin), which showed poor activity. Co-trimoxazole showed good activity.