[Diagnostic protocol for imported febrile syndrome]. / Protocolo diagnóstico del síndrome febril importado.

In this protocol we shall set out the steps to follow in the clinical assessment of the patient with fever and where there is an epidemiological history of travel to tropical or subtropical areas. This is not intended to be exhaustive, but as a guide to doctors in their initial diagnostic approach to the patient who has come from the tropics consulting with a fever in the Emergency Department or the hospital ward. Differential diagnosis should be approached first and foremost on the basis of excluding malaria, but haemorrhagic fevers, rickettsiosis, typhoid fever and many other infections, some that are unique to tropical areas, and others that are cosmopolitan but more prevalent in such areas should also be taken into account.

[Empiric therapy protocol for nosocomial pneumonia]. / Protocolo terapéutico empírico de la neumonía nosocomial.

Nosocomial pneumonia is one of the most common infections in hospitalized patients and is associated with high morbidity and mortality. The treatment for these patients is established empirically and should be administered as soon as possible to improve their clinical prognosis. In most cases, microbiological documentation of the pneumonia's etiology is not achieved. There is therefore a well-established need for clear action protocols directed to all medical professionals who are in charge of caring for these patients.

[Multidrug resistant Acinetobacter baumanii:clinical update and new highlights]. / Acinetobacter baumanii multirresistente:situación clínica actual y nuevas perspectivas.

The role of multidrug resistant Acinetobacter baumanii and its clinical relevance have been recently appreciated as a ubiquitous opportunistic nosocomial pathogen. Risk factors associated with A. baumanii infection include severe underlying diseases, previous surgery, invasive procedures, treatment with broad-spectrum antibiotics, length of hospital stay, admission to intensive care units (ICU). Carbapenem-multidrug resistant A. baumanii infections are probably associated to greater severity and more complications; in our cohort mortality was 49.3% and related mortality (within 72 hours) was 10.39%. However, severe underlying diseases probably play an important role in the clinical outcome of patients with MDR-C A. baumanii infection and controversy exists regarding the real mortality attributable to antimicrobial resistance because a high proportion of deaths took place > 7 days after diagnosis. Nevertheless, in our experience, carbapenem resistance, inappropriate therapy and monotherapy are associated to a higher mortality. Special attention should be paid to design well-controlled prospective clinical trials to determine the optimal antimicrobial therapy in critically ill patients suspected of having MDR Acinetobacter infection.

Penetration of linezolid into the anterior chamber (aqueous humor) of the human eye after intravenous administration.

We determined the linezolid concentrations in serum samples and aqueous humors (AHs) from 21 patients undergoing cataract extraction. Cataract removal was performed at various times (from 60 to 270 min) after the end of a 30-min infusion of 600 mg of linezolid. Serum samples were obtained 1 h after the end of linezolid administration to determine the maximum concentration of linezolid (C(max)); AHs and a second serum sample were taken simultaneously during the operation, and the concentrations of linezolid in AH (C(AH)) and serum (C(S)) were determined. The mean C(AH) 1 h after linezolid administration was 4.94 micro g/ml, and the mean ratio of C(AH) to C(S) (R = C(AH)/C(S)) was 0.43. All patients had a C(AH) of >2 micro g/ml, which was higher than the MIC at which 90% of Staphylococcus epidermidis strains are inhibited.