Molecular topology: a useful tool for the search of new antibacterials.

Molecular topology has been applied to find new lead antibacterial compounds. Among the selected compounds, hesperidin, neohesperidin and Mordant Brown 24 stand out, with minimum inhibitory concentrations 90, MIC90 < 0.3 mg/mL.

[Knowledge of care activity: another professional factor associated with utilization?]. / El conocimiento de la actividad asistencial: otro factor profesional relacionado con la utilización?

OBJECTIVES: To analyse the doctors' level of understanding of the use of resources in primary care and the relationship of their understanding to the proper use of resources. SETTING: Primary care in the Autonomous Community of Murcia. DESIGN: Descriptive, crossover study. RESULTS: There was little concordance between the real data contributed by the unit of information and registration of primary care management and data calculated by the doctors themselves. The best-known parameters are frequency of attendance (kappa index = 0.11) and patient pressure (kappa = 0.39). The profile of the doctors did not in general relate to this degree of understanding; it was only observed in a tendency in older doctors (p < 0.001) to overvalue frequency of attendance. The doctors with less understanding used radiology resources more with 164 requests per 1000 inhabitants per year, made more specialist referrals (826 per thousand inhabitants per year) and prescribed more medicines (21 prescriptions per inhabitant per year). Likewise, doctors who used resources most tended to underestimate their use of resources (p < 0.001). CONCLUSIONS: The doctor's understanding of his/her health-care activity and of the resources it involves is scant and independent of the doctor's professional characteristics. This is a factor, which we could call the professional factor, clearly related to resource use.

El conocimiento de la actividad asistencial: ¿otro factor profesional relacionado con la utilización? / Understanding of care activity: another professional factor related to use?

Objetivos. Analizar el grado de conocimiento que tienen los médicos sobre el uso de recursos que utilizan en atención primaria y su relación con la propia utilización de aquéllos. Ámbito. Atención primaria de la Comunidad Autónoma de la Región de Murcia. Diseño. Estudio descriptivo y transversal. Resultados. Existe escasa concordancia entre los datos reales aportados desde la Unidad de Información y Registro de la Gerencia de Atención Primaria (UIRGAP) y los estimados por los profesionales. Los parámetros más conocidos son la Frecuentación (índice kappa, 0,11) y la presión asistencial (índice Kapa, 0,39). El perfil profesional no se relaciona en general con este grado de conocimiento, sólo se observa con una tendencia a la sobrevaloración de la frecuentación en los médicos con mayor edad (p < 0,001). Los profesionales que con mayor desconocimiento tienen un mayor uso de recursos de radiología, con 164 peticiones/1.000 hab./año; derivaciones de especialistas, con 826 /1.000/hab./año y de medicamentos (21 recetas/hab./año.). Así mismo se observa una tendencia a subestimar el uso de recursos con los profesionales con mayor utilización (p < 0,001). Conclusiones. El grado de conocimiento del médico sobre su actividad asistencial y los recursos derivados de ella es escaso e independiente de las características profesionales de aquél. Este es un factor que podríamos considerar como profesional, claramente relacionado con el uso de recursos (AU)

[Infection by Staphylococcus lugdunensis: clinico-microbiologic characterization of 25 cases]. / Infección por Staphylococcus lugdunensis: caracterización clinicomicrobiológica de 25 casos.

INTRODUCTION: S. lugdunensis is a recently described staphylococcal species with morphologic characteristic similar to those of S. aureus. It has been associated to a variety of clinical infections. In this paper we present the clinical and microbiological features of S. lugdunensis isolates from 25 patients. MATERIALS AND METHODS: We have studied the S. lugdunensis isolates obtained from clinical specimens in our laboratory over a three-year period, 1994-96. For all isolates we determined the presence of clumping factor, Dnase, free coagulase in tube and ornithine decarboxylase (ODC). Full identification was performed with API ID32-Staph strips (bioMérieux) and antimicrobial susceptibility with commercial broth microdilution MIC panels (PASCO System, Difco). RESULTS: We obtained 38 S. lugdunensis isolates from 25 patients. The clinical specimens were: breast exudate/pus (8), blood (5), surgical wound (2), urine (2), nasal exudate (2), peritoneal fluid (1), pleural fluid (1), venous catheter (1), Tenckoff catheter (1), bartholin pus (1), ulcer (1). The isolates were considered clinically significant in 20 patients, whereas those of the remaining 5 patients were considered mere colonizers. All isolates were clumping factor (+), ODC (+), Dnase (-) and free coagulase (-). 16/23 (69.5%) were susceptible to penicillin and only one isolate was methicillin-resistant. CONCLUSIONS: We have isolated S. lugdunensis from a great variety of clinical specimens (blood, sterile body fluids, urine, skin, abscesses and nasal mucosa). It is specially remarkable the association with non-puerperal mastitis. The presence of clumping factor in all isolates can easily lead to misidentification as S. aureus. The ODC test appears as a good screening method for detecting S. lugdunensis. S. lugdunensis shows a good susceptibility to betalactamic an other antimicrobial agents.

[Beta-hemolytic streptococci in tonsil hypertrophy and recurrent tonsillitis]. / Estreptococos betahemolíticos en la hipertrofia amigdalar y amigdalitis recidivantes.

BACKGROUND: The recurrence of streptococci acute tonsillitis is a complication that often motivates the tonsillectomy. We studied the colonisation of tonsils and adenoids by S. pyogenes and other beta haemolytic streptococci in both surgical indications, recurrent tonsillitis and tonsillar hypertrophy. METHODS: We made for aerobic culture the following specimens, throat swabs, tonsils and adenoids tissue corresponding to 47 children referred for tonsillectomy. RESULTS: S. pyogenes was isolated in 11 cases (23.4%) of tonsils and other beta haemolytic non A streptococci was isolated in 11 cases, of them, group C streptococci was the most frequent with six cases. However in the recurrent tonsillitis group, S. pyogenes was isolated more significantly (47%) that other beta haemolytic streptococci (5.8%). Otherwise in the tonsilar hypertrophy group, S. pyogenes was isolated in the 10% while that other streptococci was isolated in the 33.3%. The culture of 38 adenoids yielded S. pyogenes and beta haemolytic group C streptococci in 6 cases each one (15.7%). CONCLUSIONS: S. pyogenes was isolated more frequently in recurrent tonsillitis that other micro-organisms while that in the tonsilar hypertrophy group predominated streptococci beta haemolytic non A, S. aureus and H. influenzae. Is of interest that the adenoids in our study showed an important reservoir of beta haemolytic streptococci. The throats swabs yielded less of the half of all beta haemolytic streptococci isolated in tonsilar tissue cultured.

[Presence of virulence factors and pathovars in strains of Campylobacter jejuni isolated from patients with diarrhea and healthy children]. / Presencia de factores de virulencia y patovariedades en cepas de Campylobacter jejuni aisladas en pacientes con diarrea y niños sanos.

BACKGROUND: To study the prevalence of virulence factors (adhesion, invasion, cytotoxicity and hemolytic activity) and to establish the presence of pathovars (virulence phenotype) in C. jejuni strains isolated in pediatric patients with inflammatory and secretory diarrhea and asymptomatic carriers. METHODS: We analyzed 95 strains of 48 patients with inflammatory diarrhea (blood and mucus in feces), 30 patients with secretory diarrhea (watery) and 17 strains isolated in asymptomatic children (control group). The study of adherence capacity, invasion and cytotoxicity was made in the Hep-2 cell line, and the analysis of hemolytic activity in blood agar plates with a 5% sheep's blood. The pathovars were defined by the cellular adhesion (phenotypes A and a) and the cytotoxicity (phenotypes E and e). RESULTS: 29.1% of inflammatory strains presented adherence capacity, 66.6% were invasive, 64.5% cytotoxic and 52.1% hemolytic. In the secretory strains the values were 70, 20, 10 and 6.6% respectively; in the control group the 11.7% presented adherence capacity and 5.8% were invasive. We obtained difference statistically significative for the secretory strains in the adherence capacity, and in inflammatory strains in the adherence capacity, cytotoxicity and hemolysis. The phenotype Ae predominate in the secretory strains, and the phenotype ae in the strains belonging to the control group. No pathovar predominates in the inflammatory strains. CONCLUSIONS: The analysis of virulence markers permit us to establish the pathogenic behaviour of the C. jejuni strains isolated in patients with diarrhea. The study of the adherence capacity and cytotoxicity (pathovars) would be used as a virulence markers and to predict the inflammatory or secretory nature of the diarrhea caused by C. jejuni strains.

Evaluation of the API-campy system in the biochemical identification of hippurate negative campylobacter strains isolated from faeces.

The aim was to evaluate the efficacy of the API-Campy system in the biochemical identification of 62 hippurate negative campylobacter strains isolated from the faeces. The strains were identified manually as 34 nalidixic acid susceptible C coli (NAS), 20 nalidixic acid resistant C coli (NAR), and eight C lari. The 34 strains of NAS C coli were identified as such by the API-Campy system. Of the 20 strains of NAR C coli, 15 (75%) were correctly identified by the commercial system. None of the five NAR C coli strains which were also erythromycin resistant was identified as such by the system. The eight C lari strains could not be identified by the API-Campy system because the bionumber obtained does not exist in the database of the computer system. The API-Campy system could be very useful for the identification of NAS C coli. However, failure to allow for a higher percentage of resistance to nalidixic acid in this species does not permit good identification of NAR strains. More important discrepancies are observed in C lari strains. In order to improve the identification of NAR C coli and C lari stains, it is advisable to include, or recommend as complementary, the indoxyl acetate hydrolysis test.

Susceptibilities to 10 antimicrobial agents of 1,220 Campylobacter strains isolated from 1987 to 1993 from feces of pediatric patients.

We report the in vitro antibiotic susceptibility of 1,220 strains belonging to the thermotolerant Campylobacter species, isolated from the feces of pediatric patients with diarrhea in the period from 1987 to 1993. The strains were identified as 1,148 C. jejuni isolates and 72 C. coli isolates. The overall results show that the strains showed drug resistance as follows: 51.8% to ampicillin, 4.4% to clindamycin, 2.6% to chloramphenicol, 21.2% to tetracycline, and 1% to gentamicin. Twenty-one strains (1.7%) displayed resistance to the combination of amoxicillin-clavulanic acid, and 3.2% of the strains were resistant to erythromycin (MIC of > or = 4 micrograms/ml), with a notable difference according to the species under consideration. While C. jejuni remained stable at 0.9 to 4% resistance to erythromycin, for C. coli the percentages detected ranged from 0 to 33%, with overall rates of 2.5 and 15.2% for the two species, respectively. Resistance to nalidixic acid (MIC of > or = 32 micrograms/ml) was found in 27.2% of the strains (27.8% for C. jejuni and 18% for C. coli), and resistance to ciprofloxacin (MIC of > or = 4 micrograms/ml) was found in 24.2% of the strains for C. jejuni and 15.2% for C. coli). Cross-resistance between nalidixic acid and ciprofloxacin was found in 89.1% of the strains (type 1 mutants), while 10.9% were resistant to nalidixic acid but susceptible to ciprofloxacin (type 2 mutants).

[Differential clinical characteristics among pediatric patients with gastroenteritis caused by rotavirus and adenovirus]. / Estudio de las características clínicas diferenciales entre los pacientes pediátricos con gastroenteritis causadas por rotavirus y adenovirus.

BACKGROUND: The differential clinical and epidemiological characteristics of pediatric patients (< 14 years) with gastroenteritis caused by rotavirus or adenovirus were studied. MATERIAL AND PATIENTS: A retrospective study was performed in patients with viral gastroenteritis diagnosed from January 1990 to December 1992. The detection of viral particles was carried out by the agglutination system with latex particles sensitized with antibodies versus rotavirus and adenovirus. Clinical and epidemiological characteristics of the patients were collected reviewing the medical records and emergency charts. RESULTS: Two hundred eighty-nine patients corresponding to 240 cases of infection by rotavirus (83.1%) and 48 (16.9%) by adenovirus, were analyzed. Diarrhea by rotavirus predominated in the winter months (59.7% of the cases from December to March). Nonetheless, those caused by adenovirus were seen throughout the year with a stable incidence being observed. Statistically significant differences were seen in both groups (p < 0.001) with rotavirus infection having a greater tendency to admission and greater incidence of vomiting, fever (> 39 degrees C) and underlying disease. The presence of leukocytosis was different in the adenovirus group as were the greater length of duration of diarrhea prior to attending the Emergency Department (5.2 days) and the total length of stay (11.2 days). No other associated enteropathogenic organisms were detected in 86.3% of the infections by rotavirus and in the 89.8% of those caused by adenovirus. In regard to age group distribution prevalence of diarrhea by rotavirus was observed during the first 3 months of life (76.6%) while adenovirus group it went up to 24 months of age with similar percentages. CONCLUSIONS: Diarrhea by rotavirus is mainly presented in the winter, with vomiting and its shorter in length and the symptoms less prolonged than diarrhea caused by adenovirus. Rotavirus diarrhea generally affect patients admitted with some underlying disease. Nonetheless, microbiologic diagnosis is required to establish the definitive etiology of both clinical processes.