Vertigo in Pregnancy: A Narrative Review.

During pregnancy, physical, hormonal, and psychological changes may occur from conception to labor. Balance is also impacted throughout this time, leading to symptoms such as vertigo and unsteadiness. These symptoms may appear at any time and can cause disability and physical impairment. Little has been published about vertigo in pregnancy. We performed a narrative review of vertigo in pregnant patients. Vertigo in pregnant females may be associated with hormonal changes in peripheral structures and inner ear organs. Meniere's disease, vestibular migraine, and benign paroxysmal positional vertigo are usually exacerbated during pregnancy. Specific changes to hearing and proprioception in the physical examination are also noted between the second and third trimester of pregnancy. These symptoms are usually seen in pregnant patients throughout this time. Some types of vertigo may be exacerbated and others may present at any time of pregnancy. Further research is needed to understand the clinical and pathological association of audiovestibular symptoms during pregnancy.

Alta sensibilidad a la mupirocina en aislados de Staphylococcus aureus que colonizan pacientes en hemodiálisis en una unidad renal de Medellín, Colombia / High mupirocin susceptibility in isolates of Staphylococcus aureus colonizing hemodialysis patients in a dialysis unit at Medellín

RESUMEN Objetivo: describir el porcentaje de resistencia a la mupirocina y a otros antibióticos en aislados de Staphylococcus aureus que colonizan pacientes en hemodiálisis. Métodos: estudio descriptivo en el que se incluyeron pacientes en hemodiálisis en una unidad renal de Medellín. La colonización por S. aureus fue evaluada en las fosas nasales y en la piel. La identificación bacteriana se realizó por PCR y la sensibilidad antibiótica se determinó por el sistema automatizado VITEK-2 y por el método E-test. Las características clínicas de los pacientes fueron evaluadas con la historia clínica. Resultados: se incluyeron 210 pacientes, de estos el 50,5 % (n = 106) fueron mujeres, con una mediana para la edad de 62 años (RIC 51,87-71,13). De las características clínicas se destacó el uso frecuente de antibióticos: 59 % (n = 124) y la historia de hospitalización: 69 % (n = 145). El porcentaje de colonización por S. aureus fue de 33,8 % (n = 71) y el sitio más frecuente de colonización fue las fosas nasales (19 %; n = 40). Todos los aislados fueron sensibles a la mupirocina por el método de VITEK-2. Sin embargo, un aislado presentó resistencia de bajo nivel a la mupirocina por E-test. La colonización por aislados resistentes a meticilina (SARM) fue de 4,8 % (n = 10) y estos presentaron, principalmente, resistencia solamente a la oxacilina (58,3 %; n = 7). Conclusión: la alta sensibilidad a la mupirocina en aislados de S. aureus colonizantes sugiere su uso como terapia profiláctica en pacientes en hemodiálisis con alto riesgo de infección. Es importante fortalecer los programas de uso racional de antibióticos para evitar la diseminación de mecanismos de resistencia a estos y a otros en las unidades renales.

SUMMARY Objective: To describe the resistance percentage to mupirocin and other antibiotics in Staphylococcus aureus isolates colonizing hemodialysis patients. Methods: A descriptive study was conducted at an outpatient dialysis center in Medellín and hemodialysis patients with catheter were included. Colonization by S. aureus was evaluated in nostrils and skin. Bacterial identification was performed by PCR and antibiotic susceptibility was determined by the Vitek-2 automated system and by E-test. Clinical information was obtained from medical records. Results: Two hundred and ten patients were included, of which 50.5% (n=106) were women, with a median for the age of 62 years (IQR 51,87-71,13). Among the clinical characteristics, the frequent use of antibiotics 59% (n=124) and the history of hospitalization 69% (n=145) were highlighted. The percentage of colonization by S. aureus was 33.8% (n=71) and the most frequent site of colonization was nostrils (19%; n=40). All isolates were susceptible to mupirocin by the method of Vitek-2. However, one isolate showed low level resistance to mupirocin by E-test. Colonization by methicillinresistant isolates (MRSA) was 4.8% (n=10); which presented mainly resistance only to oxacillin (58,3%; n = 7). Conclusion: The high susceptibility to mupirocin in isolates of colonizing S. aureus suggests its use as prophylactic therapy in hemodialysis patients with high risk of infection. It is important to strengthen programs for the rational use of antibiotics to prevent the spread of mechanisms of resistance to this and other antibiotics at dialysis units.

Resistencia antimicrobiana en el siglo XXI: ¿hacia una era postantibiótica? / Antimicrobial resistance in the 21st century: towards a post-antibiotic era? / Resistência antimicrobiana no século XXI: rumo a uma era pós-antibiótica?

Resumen Desde el descubrimiento de la penicilina por Alexander Fleming en 1928, inició una era caracterizada por el desarrollo de diferentes grupos de antibióticos que permitieron el tratamiento adecuado de infecciones graves ocasionadas por bacterias que afectaban la población mundial. Sin embargo, de manera casi simultánea al desarrollo de cada clase de antibióticos, se desencadenó la emergencia de bacterias resistentes, debido en parte al uso extendido e inadecuado de estos medicamentos. Como consecuencia, el manejo de las infecciones bacterianas se ha complicado cada vez más y en la actualidad las opciones de tratamiento son pocas, sumado a que el desarrollo de nuevos antimicrobianos ha dejado de ser atractivo para la industria farmacéutica. Esta situación ha conducido a que la Organización Mundial de la Salud advierta sobre la llegada de una era postantibiótica, donde infecciones comunes o anteriormente de fácil tratamiento pueden ocasionar muertes como resultado de la resistencia bacteriana a los diferentes grupos de antibióticos. Por lo anterior, surgen preguntas sobre cómo pudo ser originada esta situación y qué soluciones son necesarias para evitar la temida era, preguntas que tratan de ser respondidas en el presente ensayo, mediante el abordaje de aspectos relacionados no solo con los microorganismos, sino también con contextos sociales, económicos e incluso políticos, que influyen en el aumento de la resistencia antimicrobiana y dificultan su control.

Abstract Alexander Fleming's discovery of penicillin in 1928 marked the beginning of an era characterized by the development of different groups of antibiotics that allowed the proper treatment of serious infections caused by bacteria that affected the world population. However, the development of each class of antibiotics almost simultaneously triggered the emergence of resistant bacteria, due in part to the widespread and inappropriate use of these medicines. As a result, managing bacterial infections has become increasingly complicated and currently there are few treatment options, added to the fact that the development of new antimicrobials is no longer attractive to the pharmaceutical industry. This situation has led the World Health Organization to warn of the arrival of a post-antibiotic era, where common or previously easily treated infections could cause deaths as a result of bacterial resistance to several groups of antibiotics. Therefore, questions arise about how this situation could have come to be and what solutions are needed to avoid the dreaded post-antibiotic era, questions that we attempt to answer in this paper by addressing aspects related not only to microorganisms, but also to social, economic and even political contexts, which influence the increase of antimicrobial resistance and hinder its control.

Resumo Desde a descoberta da penicilina por Alexander Fleming em 1928, iniciou-se uma era caracterizada pelo desenvolvimento de diferentes grupos de antibióticos que permitiram o tratamento adequado de infecções graves causadas por bactérias que afetavam a população mundial. No entanto, quase simultaneamente ao desenvolvimento de cada classe de antibióticos, foi desencadeado o surgimento de bactérias resistentes, devido parcialmente ao uso generalizado e inadequado desses medicamentos. Como consequência, o tratamento de infecções bacterianas tornou-se cada vez mais complicado e atualmente existem poucas opções para fazê-lo, além de que o desenvolvimento de novos antimicrobianos deixou de ser atrativo para a indústria farmacêutica. Essa situação levou a Organização Mundial da Saúde a alertar sobre a chegada de uma era pós-antibiótica, na qual as infecções comuns ou previamente tratadas com facilidade podem causar mortes como resultado da resistência bacteriana a diferentes grupos de antibióticos. Portanto, surgem questões sobre como se originou essa situação e quais soluções são necessárias para evitar a era temida. Este ensaio tenta responder essas questões, abordando aspectos relacionados não apenas aos microrganismos, mas também aos contextos sociais, econômicos e até políticos, que influenciam o aumento da resistência antimicrobiana e dificultam seu controle.

In vitro susceptibility of methicillin-resistant Staphylococcus aureus isolates from skin and soft tissue infections to vancomycin, daptomycin, linezolid and tedizolid.

INTRODUCTION: Treatment of multidrug-resistant Gram-positive infections caused by Staphylococcus aureus remains as a clinical challenge due to emergence of new resistance mechanisms. Tedizolid is a next-generation oxazolidinone, recently approved for skin and soft tissues infections. We conducted a study to determine in vitro susceptibility to vancomycin, daptomycin, linezolid and tedizolid in MRSA clinical isolates from adult patients with skin and soft tissue infections. MATERIAL AND METHODS: Methicillin-resistant S. aureus isolates were collected in three tertiary-care hospitals of Medellin, Colombia, from February 2008 to June 2010 as part of a previous study. Clinical characteristics were assessed by medical records and MIC values were determined by Epsilometer test. Genotypic analysis included spa typing, MLST, and SCCmec typing. RESULTS: A total of 150 MRSA isolates were evaluated and tedizolid MIC values obtained showed higher in vitro activity than other antimicrobials, with MIC values ranging from 0.13µg/mL to 0.75µg/mL and lower values of MIC50 and MIC90 (0.38µg/mL and 0.5µg/mL). In contrast, vancomycin and linezolid had higher MIC values, which ranged from 0.5µg/mL to 2.0µg/mL and from 0.38µg/mL to 4.0µg/mL, respectively. Tedizolid MICs were 2- to 5-fold lower than those of linezolid. Clinical characteristics showed high previous antimicrobial use and hospitalization history. The majority of the strains belong to the CC8 harboring the SCCmec IVc and were associated with the spa t1610 (29.33%, n=44). CONCLUSION: In vitro effectiveness of tedizolid was superior for isolates from skin and soft tissue infections in comparison with the other antibiotics evaluated. The above added to its less toxicity, good bioavailability, daily dose and unnecessity of dosage adjustment, make tedizolid in a promising alternative for the treatment of infections caused by MRSA.

Acinetobacter baumannii: importancia clínica, mecanismos de resistencia y diagnóstico / Acinetobacter baumannii: Clinical importance, resistance mechanisms and diagnosis

Acinetobacter baumannii ha emergido como una bacteria de gran importancia clínica. Esta bacteria ha sido relacionada con altos porcentajes de mortalidad y posee una alta capacidad para diseminarse en el ambiente hospitalario. Con el paso del tiempo, Acinetobacter baumannii ha adquirido diferentes mecanismos de resistencia a los antibióticos y en la actualidad se reporta resistencia a carbapenémicos, aminoglicósidos, quinolonas y polimixinas, lo que ha complicado el manejo de las infecciones ocasionadas por esta bacteria. El problema se agrava aún más con las limitaciones en el diagnóstico y la carencia de métodos fenotípicos estandarizados que permitan detectar los mecanismos de resistencia específicos. En Colombia se han descrito altos porcentajes de resistencia a los carbapenémicos, lo que ha limitado las opciones terapéuticas y hace necesario el conocimiento de la epidemiología local para establecer medidas de control más certeras.

Currently Acinetobacter baumannii has become in a microorganisms of great clinical importance. It has an extraordinary capacity to spread in the hospital environment and it has been associated with high mortality rates. Acinetobacter baumannii has acquired different resistance mechanisms to antibiotics with reports resistance to carbapenems, aminoglycosides, quinolones and polymyxins; which has complicated the therapy of the infections caused for this pathogen. The problem is further due to the limitations in the diagnosis and the lack of standardized phenotypic methods to detect specific resistance mechanisms. In Colombia has reported high percentages of resistance to carbapenems, which has reduced therapeutic options. The knowledge of local epidemiology is necessary for establish more assertive control measures.