Antimicrobial resistance in Gram-negative bacilli in Spain: an experts' view.

BACKGROUND: Antibiotic resistance in Gram-negative bacilli poses a serious problem for public health. In hospitals, in addition to high mortality rates, the emergence and spread of resistance to practically all antibiotics restricts therapeutic options against serious and frequent infections. OBJECTIVE: The aim of this work is to present the views of a group of experts on the following aspects regarding resistance to antimicrobial agents in Gram-negative bacilli: 1) the current epidemiology in Spain, 2) how it is related to local clinical practice and 3) new therapies in this area, based on currently available evidence. METHODS: After reviewing the most noteworthy evidence, the most relevant data on these three aspects were presented at a national meeting to 99 experts in infectious diseases, clinical microbiology, internal medicine, intensive care medicine, anaesthesiology and hospital pharmacy. RESULTS AND CONCLUSIONS: Subsequent local debates among these experts led to conclusions in this matter, including the opinion that the approval of new antibiotics makes it necessary to train the specialists involved in order to optimise how they use them and improve health outcomes; microbiology laboratories in hospitals must be available throughout a continuous timetable; all antibiotics must be available when needed and it is necessary to learn to use them correctly; and the Antimicrobial Stewardship Programs (ASP) play a key role in quickly allocating the new antibiotics within the guidelines and ensure appropriate use of them.

[Reference values in the usual laboratory data for sub-Saharan immigrants. Importance in the management of infectious diseases]. / Valores de referencia en los datos de laboratorio habituales en inmigrantes subsaharianos. Importancia en el manejo de las enfermedades infecciosas.

BACKGROUND AND AIMS: The progressive increase in the number of immigrants to Spain in recent years has made it necessary for health-care professionals to be aware about the specific characteristics of this population. An attempt is made in this study to define the normal range of common laboratory values in healthy sub-Saharan adults. SUBJECTS AND METHODS: Common laboratory values were studied (blood cell counts, clotting tests and blood biochemistry values) and were measured in 150 sub-Saharan immigrants previously defined as healthy according to a complete health evaluation that included a clinical history, physical examination, serologic tests and study of stool parasites. These results were compared to those from a control group consisting of 81 age-and-sex matched healthy blood donors taken from the Spanish native population. RESULTS: Statistically significant differences were obtained in the following values. Mean corpuscular volume (MCV), red cell distribution width (RDW), total leukocytes, and serum levels of creatinine, uric acid, total protein content, creatin-kinase (CK), aspartate aminotransferase (AST), gamma-glutamyl-transpeptidase (GGT), Immunoglobulin G (IgG) and M (IgM). If evaluated according to the normal values in native people, a considerable percentage of healthy sub-Saharan immigrants would present <> values (with potential clinical relevance) in the following parameters. MCV, RDW, total leukocyte counts and serum levels of CK, IgG and IgM. CONCLUSIONS: A proper interpretation of the common laboratory values in sub-Saharan immigrants, and probably in other foreign collectives, requires a previously-established range of normality in these parameters for those populations in order to avoid diagnostic mistakes and inadequate work-up and management.

Valores de referencia en los datos de laboratorio habituales en inmigrantes subsaharianos. Importancia en el manejo de las enfermedades infecciosas / Reference values in the usual laboratory data for sub-Saharan immigrants. Importance in the management of infectious diseases

Fundamento y objetivos. El incremento progresivo del número de inmigrantes en España en los últimos años ha obligado a los profesionales sanitarios a considerar las características específicas de esta población. En este estudio se intentan determinar los valores normales de los inmigrantes procedentes del África subsahariana en los valores analíticos solicitados con mayor frecuencia en la práctica clínica. Sujetos de estudio y métodos. Se estudiaron los valores habituales de laboratorio (hemograma, pruebas de coagulación y estudios bioquímicos sanguíneos) en 150 inmigrantes previamente definidos como sanos tras efectuar un examen de salud que incluía una historia clínica protocolizada, estudios serológicos y estudio coproparasitario. Estos datos se compararon con los de un grupo control de 81 donantes sanos, de edad y sexo similares, de población autóctona. Resultados. Se encontraron diferencias estadísticamente significativas entre ambos grupos en la determinación de volumen corpuscular medio(VCM), amplitud de distribución eritrocitaria, leucocitos totales, creatinina, ácido úrico, proteínas totales, creatin quinasa (CK), aspartato aminotransferasa, gamma glutamil transpeptidasa, inmunoglobulinas G y M (IgG, IgM). Teniendo en cuenta los valores de referencia, un porcentaje significativo de personas subsaharianas sanaspresentarían valores «anormales» en las siguientes magnitudes: VCM, ADE, leucocitos totales proteínas totales, CK, IgG e IgM. Conclusiones. La valoración de los datos de laboratorio en la población subsahariana, y posiblemente en otros grupos de inmigrantes, requiere establecer previamente el rango de normalidad adecuado para evitar errores diagnósticos y actitudes terapéuticas erróneas (AU)

Background and aims. The progressive increase in the number of immigrants to Spain in recent years has made it necessary for health-care professionals to be aware about the specific characteristics of this population. An attempt is made in this study to define the normal range of common laboratory values in healthy sub-Saharan adults. Subjects and methods. Common laboratory values were studied (blood cell counts, clotting tests and blood biochemistry values) and were measured in150 sub-Saharan immigrants previously defined as healthy according to a complete health evaluation that included a clinical history, physical examination, serologic tests and study of stool parasites. These results were compared to those from a control group consisting of 81 age-and-sex matched healthy blood donors taken from the Spanish native population. Results. Statistically significant differences were obtained in the following values. mean corpuscular volume (MCV), red cell distribution width (RDW), total leukocytes, and serum levels of creatinine, uric acid, total protein content, creatin-kinase (CK), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase(GGT), Immunoglobulin G (IgG) and M(IgM). If evaluated according to the normal values in native people, a considerable percentage of healthy sub-Saharan immigrants would present «abnormal» values (with potential clinical relevance) in the following parameters. MCV, RDW, total leukocyte counts and serum levels of CK, IgG and IgM. Conclusions. A proper interpretation of the common laboratory values in sub-Saharan immigrants, and probably in other foreign collectives, requires a previously-established range of normality in these parameters for those populations in order to avoid diagnostic mistakes and inadequate work-up and management (AU)

Medicina Interna e infecciones en inmigrantes / Internal Medicine and insections in immigrants

No disponible

[The Sister Joseph's nodule-like manifestation of carcinoma of unknown origin: presentation of one case]. / Nódulo de la hermana María José como manifestación de cáncer de origen desconocido: presentación de un caso.

The Sister Joseph's nodule represents an umbilical cutaneous metastasis. It is related to one intraabdominal neoplasia habitually. We presents a 71-year-old male, with the Sister Joseph's nodule, detected in the context of unknown origin carcinoma. The fine needle aspiration cytology (FNAC) of the Sister Joseph's nodule showed carcinoma. We comments the usefulness diagnosis of this clinical sign and the poor prognosis that it represents.

Miocarditis por fiebre Q: presentación de un caso / Myocarditis for Q fever: presentation of one case

La miocarditis por Coxiella burnetii es una forma rara depresentación clínica de la fiebre Q aguda, y, al igual que la pericarditis,sola o asociadas, se detecta en alrededor del uno porciento de los casos de fiebre Q aguda. Se presenta un caso demiocarditis por fiebre Q aguda, en un varón de 55 años, que ingresócon clínica de insuficiencia cardíaca congestiva, tras síndromefebril autolimitado. La ecocardiografía reveló un ventrículoizquierdo muy dilatado con hipoquinesia difusa y fracciónde eyección del 45 por ciento. El cateterismo cardíaco confirmódichos hallazgos, siendo las coronarias normales. El estudio serológicofue compatible con fiebre Q aguda. La evolución contratamiento con furosemida, espirolactona, captopril, acenocumaroly doxiciclina fue favorable, y la ecocardiografía al cabode 11 meses puso de manifiesto importante mejoría de las alteracionescardíacas, persistiendo en dicho momento criterios serológicosde fiebre Q aguda

The myocarditis by Coxiella burnetii is a rare form of clinicalpresentation of acute Q fever, and, with the pericarditis, onlyor in association, is detected in one per cent of cases of acute Qfever. A case of myocarditis by acute Q fever is showed, in a man55-year-old who was admitted with congestive heart failure clinical,after self-limited febrile syndrome. The echocardiographyrevealed a very dilated left ventricle with a global decreaseof the mobility and ejection fraction of 45 percent. Thecardiac catheterization confirmed these findings. The coronaryarteries were normal. The serologic study was compatible withacute Q fever. The evolution with treatment with furosemide,spirolactone, captopril, acenocumarol and doxycycline was favourable,and the echocardiography after 11 months showedimportant improvement of the cardiac alterations, persisting inthis moment serology of acute Q fever

Nódulo de la hermana María José como manifestación de cáncer de origen desconocido: presentación de un caso / The sister Joseph´s nodule like manifestation of unknown origin carcinoma: presentation of one case

El nódulo de la hermana María José representa una metástasis cutánea umbilical, relacionada habitualmente con una neoplasia intraabdominal. Se presenta un paciente de 71 años, con el nódulo de la hermana María José, detectado en el contexto de un carcinoma de origen desconocido, que fue diagnosticado por punción aspiración con aguja fina (PAAF) de dicho nódulo. Se comenta la utilidad diagnóstica de dicho signo clínico, y el pobre pronóstico que representa

The Sister Joseph's nodule represents an umbilical cutaneous metastasis. It is related to one intraabdominal neoplasia habitually. We presents a 71-year-old male, with the Sister Joseph's nodule, detected in the context of unknown origin carcinoma. The fine needle aspiration cytology (FNAC) of the Sister Joseph's nodule showed carcinoma. We comments the usefulness diagnosis of this clinical sign and the poor prognosis that it represents