Impact of the Economic Crisis on Endocarditis Mortality in Spain: A Nationwide Study.

Economic recession has dire consequences on overall health. None have explored the impact of economic crisis (EC) on infective endocarditis (IE) mortality. We conducted a retrospective, nationwide, temporal trend study analyzing mortality trends by age, sex, and adverse outcomes in patients diagnosed with IE in Spain from 1997 to 2014. Data were divided into two subperiods: pre-EC (January 1997-August 2008) and post-EC (September 2008-December 2014). A total of 25 952 patients presented with IE. The incidence increased from 301.4 to 365.1 per 10 000 000 habitants, and the mortality rate rose from 24.3% to 28.4%. Those aged >75 years experienced more adverse outcomes. Complications due to sepsis, shock, acute kidney injury requiring dialysis, and heart failure increased after the EC onset, and expenditures soared to €16 216. Expenditure per community was related to mortality (P < .001). The EC resulted as an independent predictor for mortality (hazard ratio 1.06; 95% confidence interval 1.01-1.11). Incidence and mortality rate in patients with IE after the onset of the EC have increased as a result of rising adverse outcomes despite an overall increased investment.

[Validation of a questionnaire on attitudes and practice of physical activity and other healthy habits through the Delphi method]. / Validación de un cuestionario sobre actitudes y práctica de actividad física y otros hábitos saludables mediante el método Delphi.

OBJECTIVE: Physical inactivity and sedentary lifestyle are an emerging individual, familiar and social public health problem. The aim of this work was to validate a new questionnaire to know the attitude towards physical activity and other habits in adolescents. METHODS: The Delphi method was used. It was developed in three phases: an initial phase of selection of the panel of experts, an exploratory phase in two rounds of voting using a Likert scale of 1 to 5, and statistical and qualitative analysis of the experts' contributions. The criteria for the choice of items were: average >3.5 and factor V of Aiken ≥0.7. Reliability was assessed with the Cronbach alpha coefficient. A pilot test was carried out to assess the understanding of the instrument. RESULTS: 21 experts agreed to participate. Their participation was 100% in the first round and 95.2% in the second one. Seven items did not meet the criteria. The final questionnaire included 93 questions and 11 dimensions: data of the student, father, mother, physical activity in the educational center, transportation, free time, psychosocial aspects of physical activity, attitude towards physical activity, food, other habits and health perception. A Cronbach's alpha of 0.974 was obtained. CONCLUSIONS: The results support the reliability and validity of the questionnaire. The Delphi method proved to be a useful technique for the proposed objective.

OBJETIVO: La inactividad física y el sedentarismo son un problema de salud pública emergente, tanto a nivel individual como familiar y social. El objetivo de este estudio fue validar un nuevo cuestionario para conocer la actitud ante la actividad física y otros hábitos de los adolescentes. METODOS: Se utilizó el método Delphi. Se llevó a cabo una fase inicial de selección del panel de expertos, una fase exploratoria en dos rondas de votación mediante escala tipo Likert (de 1 a 5), y un análisis estadístico y cualitativo de las aportaciones de los expertos. Los criterios para la elección de ítems fueron un promedio mayor a 3,5 y V de Aiken mayor o igual a 0,7. La fiabilidad se valoró con el coeficiente alfa de Cronbach. Se realizó una prueba piloto para valorar la comprensión del instrumento. RESULTADOS: Aceptaron participar 21 expertos. Su participación fue del 100% en la primera ronda y del 95,2% en la segunda. Siete ítems incumplieron los criterios. El cuestionario final contó con 93 preguntas y 11 dimensiones: datos sobre el alumno, el padre, la madre, la actividad física en el centro educativo, en el transporte y en el tiempo libre, sobre los aspectos psicosociales de la práctica de actividad física, la actitud ante la actividad física, la alimentación y otros hábitos, y sobre la percepción de salud. Se obtuvo un alfa de Cronbach de 0,974. CONCLUSIONES: Los resultados avalan la fiabilidad y validez del cuestionario. El método Delphi resultó ser una técnica útil para el objetivo propuesto.

Validación de un cuestionario sobre actitudes y práctica de actividad física y otros hábitos saludables mediante el método Delphi / Validation of a questionnaire on attitudes and practice of physical activity and other healthy habits through the Delphi method

OBJETIVO: La inactividad física y el sedentarismo son un problema de salud pública emergente, tanto a nivel individual como familiar y social. El objetivo de este estudio fue validar un nuevo cuestionario para conocer la actitud ante la actividad física y otros hábitos de los adolescentes. MÉTODOS: Se utilizó el método Delphi. Se llevó a cabo una fase inicial de selección del panel de expertos, una fase exploratoria en dos rondas de votación mediante escala tipo Likert (de 1 a 5), y un análisis estadístico y cualitativo de las aportaciones de los expertos. Los criterios para la elección de ítems fueron un promedio mayor a 3,5 y V de Aiken mayor o igual a 0,7. La fiabilidad se valoró con el coeficiente alfa de Cronbach. Se realizó una prueba piloto para valorar la comprensión del instrumento. RESULTADOS: Aceptaron participar 21 expertos. Su participación fue del 100% en la primera ronda y del 95,2% en la segunda. Siete ítems incumplieron los criterios. El cuestionario final contó con 93 preguntas y 11 dimensiones: datos sobre el alumno, el padre, la madre, la actividad física en el centro educativo, en el transporte y en el tiempo libre, sobre los aspectos psicosociales de la práctica de actividad física, la actitud ante la actividad física, la alimentación y otros hábitos, y sobre la percepción de salud. Se obtuvo un alfa de Cronbach de 0,974. CONCLUSIONES: Los resultados avalan la fiabilidad y validez del cuestionario. El método Delphi resultó ser una técnica útil para el objetivo propuesto

OBJECTIVE: Physical inactivity and sedentary lifestyle are an emerging individual, familiar and social public health problem. The aim of this work was to validate a new questionnaire to know the attitude towards physical activity and other habits in adolescents. METHODS: The Delphi method was used. It was developed in three phases: an initial phase of selection of the panel of experts, an exploratory phase in two rounds of voting using a Likert scale of 1 to 5, and statistical and qualitative analysis of the experts' contributions. The criteria for the choice of items were: average >3.5 and factor V of Aiken ≥0.7. Reliability was assessed with the Cronbach alpha coefficient. A pilot test was carried out to assess the understanding of the instrument. RESULTS: 21 experts agreed to participate. Their participation was 100% in the first round and 95.2% in the second one. Seven items did not meet the criteria. The final questionnaire included 93 questions and 11 dimensions: data of the student, father, mother, physical activity in the educational center, transportation, free time, psychosocial aspects of physical activity, attitude towards physical activity, food, other habits and health perception. A Cronbach's alpha of 0.974 was obtained. CONCLUSIONS: The results support the reliability and validity of the questionnaire. The Delphi method proved to be a useful technique for the proposed objective

[Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation]. / Projeto e validação de um questionário de saúde oral para avaliação pré­anestésica no pré­operatório.

BACKGROUND AND OBJECTIVES: Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. METHODS: Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. RESULTS: The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. CONCLUSIONS: The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.

Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation.

BACKGROUND AND OBJECTIVES: Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. METHODS: Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. RESULTS: The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. CONCLUSIONS: The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.

[Hospital Emergencies Associated with the Consumption of Hypnotics and Sedatives, 2009-2013,Castilla y León, Spain]. / Urgencias hospitalarias asociadas al consumo de hipnóticos y sedantes, Castilla y León, 2009-2013.

OBJECTIVE: Household Survey on Alcohol and Other Drugs shows the progressive increase in the consumption of hypnotics, alone or in combination with other substances. The aim of the research was to obtain information about the consumption of hypnotics and sedatives in population of Castilla y León treated in emergency medical services of four monitored hospitals between 2009-2013, describing clinical and epidemiological characteristics of the emergencies and what drugs were consumed, to provide information for future interventions. METHODS: A descriptive cross-sectional study was done by analyzing 3,089 emergencies related to consumption of hypnotics and sedatives, obtained from Emergency Indicator related to the use of psychoactive substances of the National Observatory on Drugs. There were used χ2 test for comparing proportions and t Student test for means. RESULTS: The total number of emergencies was 3,089, ranging in years of study. In 1,814 cases they were consumed only hypnosedatives; 64.7% women and average age of 41 years. The most frequent diagnosis was overdose/attempted suicide with benzodiazepines (29.3%), being lorazepam the most consumed. In 23.3% of cases it was consumed more than one hypnosedative and 9% was associated with psychiatric disorders. CONCLUSIONS: The number of emergencies related to the consumption of at least one hypnosedative in the monitored hospitals in the period studied presented high levels especially in middle-aged women with no psychiatric disorder to justify their use. Benzodiazepines were the most consumed hypnotics, cause of overdose/attempted suicide episodes.

Brote de tuberculosis resistente a isoniacida en una comunidad de inmigrantes en España / Outbreak of isoniazid-resistant tuberculosis in an immigrant community in Spain

Introducción: La tuberculosis (TB) continúa siendo un importante problema de salud pública. En 2013 se declararon 9 millones de casos nuevos de TB activa a nivel mundial, siendo la proporción de nuevos casos de TB multirresistente del 3,5%. Método: Se realizó un estudio de contactos de un caso de TB pulmonar en una paciente de nacionalidad boliviana. Las pruebas diagnósticas se realizaron según los protocolos establecidos a nivel nacional y local. Resultados: Se detectaron 5 casos a partir del caso índice y se constató la existencia de un brote de TB en una comunidad inmigrante. El resultado del genotipado y del antibiograma ampliado de las muestras de esputo fue crecimiento de Mycobacterium tuberculosis (KatG-msp no mutado/inhA C-T 5RBS) resistente a isoniacida. Se realizó la búsqueda activa de convivientes y contactos con un censo total de 39 personas. La incidencia de infección latente fue de 71,43%. Discusión: El estudio de este brote como otros en la literatura constata la importancia de la búsqueda activa de la localización de contactos y su estudio, de la investigación de laboratorio para lograr la mejora en la detección precoz de la TB. Un diagnóstico precoz del enfermo, el cumplimiento de un tratamiento adecuado y la vigilancia de la farmacorresistencia se consideran pilares fundamentales para la prevención y el control de la TB

Background: Tuberculosis (TB) remains a major public health problem. In 2013, 9 million new cases of active TB were estimated globally and the proportion of reported new cases with multi-drug resistance (MDR) was 3.5%. Methods: Contact tracing of a case of pulmonary tuberculosis was performed in a Bolivian patient. Diagnostic tests were performed according to national and local protocols. Results: An outbreak of tuberculosis in an immigrant community was detected, with 5 cases originating from one index case. Genotyping and drug susceptibility testing of the sputum samples determined Mycobacterium tuberculosis resistant to isoniazid (KatG-msp unmutated/inhA 5RBS CT). Active case finding revealed a total of 39 contacts with an incidence of latent infection of 71.43%. Conclusions: The present study confirms the importance of active case finding through contact tracing as well as rapid laboratory diagnosis to achieve improvements in early detection of TB. Early diagnosis of the patient, compliance with appropriate treatment protocols and monitoring of drug resistance are considered essential for the prevention and control of TB

Effect of different agents with potential antibiofilm activity on antimicrobial susceptibility of biofilms formed by Staphylococcus spp. isolated from implant-related infections.

An in vitro study aimed to evaluate the effect of N-acetyl cysteine (NAC) or sub-ICs of erythromycin on antimicrobial susceptibility of staphylococcal biofilms was performed. Staphylococcus aureus and Staphylococcus epidermidis strains were isolated from patients with prosthetic joint infections using a previously published sonication procedure. Conventional susceptibility studies were performed using microdilution according to the CLSI procedures. Biofilm susceptibility was performed using the Calgary methodology. The addition of NAC showed no effect with the S. aureus strains, and a strain-dependent effect with the S. epidermidis strains. No effect was detected with erythromycin for almost all tested strains.

Outbreak of isoniazid-resistant tuberculosis in an immigrant community in Spain. / Brote de tuberculosis resistente a isoniacida en una comunidad de inmigrantes en España.

BACKGROUND: Tuberculosis (TB) remains a major public health problem. In 2013, 9 million new cases of active TB were estimated globally and the proportion of reported new cases with multi-drug resistance (MDR) was 3.5%. METHODS: Contact tracing of a case of pulmonary tuberculosis was performed in a Bolivian patient. Diagnostic tests were performed according to national and local protocols. RESULTS: An outbreak of tuberculosis in an immigrant community was detected, with 5 cases originating from one index case. Genotyping and drug susceptibility testing of the sputum samples determined Mycobacterium tuberculosis resistant to isoniazid (KatG-msp unmutated/inhA 5RBS CT). Active case finding revealed a total of 39 contacts with an incidence of latent infection of 71.43%. CONCLUSIONS: The present study confirms the importance of active case finding through contact tracing as well as rapid laboratory diagnosis to achieve improvements in early detection of TB. Early diagnosis of the patient, compliance with appropriate treatment protocols and monitoring of drug resistance are considered essential for the prevention and control of TB.

Urgencias hospitalarias asociadas al consumo de hipnoticos y sedantes, Castilla y León, 2009-2013 / Hospital Emergencies associated with the consumption of hypnotics and sedatives, Castilla y León, 2009-2013

Fundamentos: La Encuesta Domiciliaria sobre Alcohol y otras Drogas muestra el progresivo aumento del consumo de hipnosedantes, solos o en combinación con otras sustancias. El objetivo de la investigación fue obtener datos sobre el consumo de fármacos hipnosedantes en la población castellano-leonesa atendida de urgencia en cuatro hospitales monitorizados entre 2009-2013, describiendo sus características clínico-epidemiológicas y los fármacos consumidos. Métodos: Se realizó un estudio descriptivo transversal mediante el análisis de 3.089 urgencias hospitalarias relacionadas con consumo de hipnose dantes obtenidas del Indicador de Urgencias relacionadas con el consumo de ustancias psicoactivas del Observatorio Nacional sobre Drogas. Se utilizó el test χ2 para comparación de proporciones y la prueba t de Student para medias. Resultados: La cifra total de urgencias fue de 3.089. En 1.814 casos solo se consumieron hipnosedantes. El 64,7% fueron mujeres y la edad media fue de 41 años. El diagnóstico más frecuente fue sobredosis/intento autolítico con benzodiacepinas (29,3%), siendo lorazepam la más consumida. En 23,3% de los casos se consumió más de un hipnosedante y el 9% se asoció a trastornos psiquiátricos. Conclusiones: El número de urgencias hospitalarias por consumo de al menos un hipnosedante en los hospitales y tiempo monitorizados presentó cifras elevadas, especialmente en mujeres de mediana edad. Las benzodiacepinas fueron los hipnosedantes más consumidos (AU)

Background: Household Survey on Alcohol and Other Drugs shows the progressive increase in the consumption of hypnotics, alone or in combination with other substances. The aim of the research was to obtain information about the consumption of hypnotics and sedatives in population of Castilla y León treated in emergency medical services of four monitored hospitals between 2009-2013, describing clinical and epidemiological characteristics of the emergencies and what drugs were consumed, to provide information for future interventions. Methods: A descriptive cross-sectional study was done by analyzing 3,089 emergencies related to consumption of hypnotics and sedatives, obtained from Emergency Indicator related to the use of psychoactive substances of the National Observatory on Drugs. There were used χ2 test for comparing proportions and t Student test for means. Results: The total number of emergencies was 3,089, ranging in years of study. In 1,814 cases they were consumed only hypnosedatives; 64.7% women and average age of 41 years. The most frequent diagnosis was over-dose/attempted suicide with benzodiazepines (29.3%), being lorazepam the most consumed. In 23.3% of cases it was consumed more than one hypnose-dative and 9% was associated with psychiatric disorders. Conclusions: The number of emergencies related to the consumption of at least one hypnosedative in the monitored hospitals in the period studied presented high levels especially in middle-aged women with no psychiatric disorder to justify their use. Benzodiazepines were the most consumed hypnotics, cause of overdose/attempted suicide episodes (AU)

Developing countries: health round-trip.

International travel can pose various risks to health, depending both on the health needs of the traveller and on the type of travel to be undertaken. Travellers intending to visit a destination in a developing country should consult a travel medicine clinic or medical practitioner before the journey. General precautions can greatly reduce the risk of exposure to infectious agents. Vaccination is a highly effective method of preventing certain infectious diseases. The aim of this study is to know the risks involved and the best way to prevent them.

Malaria in developing countries.

Malaria still poses a real threat to travellers, particularly in areas with high transmission rates such as sub-Saharan Africa, Papua New Guinea, and the South Pacific islands. Malaria causes an estimated 660,000 deaths each year from 219 million cases of illness. It is a preventable and curable disease. Malaria symptoms appear after a period of seven days or longer, and without treatment, the disease can lead to death. Mosquito bite prevention is the main way to reduce malaria transmission. Chemoprophylaxis recommendations depend on travelers' age, destination, type of travelling, or length of stay. Pregnant women, children, and immunosuppressed travelers are the most susceptible. There are currently no licensed vaccines against malaria. Results about a research vaccine candidate known as RTS,S/AS01 are expected in 2015.

In vitro susceptibility to antibiotics of staphylococci in biofilms isolated from orthopaedic infections.

Prosthetic joint infections (PJIs) are related to the formation of biofilms, mainly by Staphylococcus aureus and Staphylococcus epidermidis. Therapy is usually selected according conventional susceptibility testing, but these data may be insufficient to detect the true antibiotic susceptibility in the biofilm. In total, 32 clinical strains (17 S. aureus and 15 S. epidermidis) isolated from patients with PJIs as well as 2 collection strains (S. aureus 15981 and S. epidermidis ATCC 35984) were tested against nine antibiotics commonly used in the treatment of PJIs (rifampicin, vancomycin, tigecycline, clindamycin, trimethoprim/sulfamethoxazole, ciprofloxacin, cloxacillin, daptomycin and fosfomycin) using the Calgary Biofilm Device. None of the antibiotics proved to be totally effective against biofilms in both species, with minimum biofilm eradication concentrations (MBECs) highly above the minimum inhibitory concentrations for most of the antibiotics (>1024 mg/L). Rifampicin and tigecycline showed MBECs slightly lower, mainly against S. epidermidis biofilms, and only two strains of this staphylococcal species were susceptible to almost all of the antibiotics tested. These results show that the search for new compounds with antimicrobial and antibiofilm properties is mandatory as well as the development of other strategies that could lead to the prevention and treatment of PJIs. In addition, more studies are necessary to obtain a better understanding of the mechanisms involved in antimicrobial resistance of biofilms.

In vitro susceptibility of Staphylococcus aureus and Staphylococcus epidermidis isolated from prosthetic joint infections.

Prosthetic joint infections (PJI) are severe complications in Orthopedics, with Staphylococcus aureus and Staphylococcus epidermidis being the most commonly isolated pathogens. The variable antimicrobial susceptibility found in these microorganisms, along with the increasing number of methicillin-resistant strains, increases the difficulty of antibiotic selection and makes it necessary to perform individual susceptibility studies to select the optimal antibiotic treatment. The aim of this study was to evaluate the in vitro susceptibility pattern of 35 clinical strains isolated from PJI (17 S. aureus and 18 S. epidermidis) against rifampin, vancomycin, tygecicline, clindamycin, cotrimoxazole, cloxacillin, ciprofloxacin, daptomycin and fosfomycin. In vitro susceptibility assays were performed using the broth microdilution method and agar dilution for fosfomycin. MBC was also determined. Tygecicline and daptomycin showed the highest antimicrobial activity with low MIC(90) values, and no resistant strains were detected. On the other hand, ciprofloxacin and cloxacillin exhibited a poor antimicrobial effect with a high percentage of nonsusceptible strains in both species. Bactericidal activity rates revealed the bacteriostatic behavior of rifampin, tygecicline, cotrimoxazole, fosfomycin and clindamycin, whereas vancomycin and cloxacillin showed species- and strain-dependent behavior. Daptomycin and ciprofloxacin were observed to be efficient bactericidal agents against the tested strains. According to our data, rifampin, tigecycline, daptomycin and fosfomycin showed high in vitro activity against most staphylococcal strains isolated from the PJIs tested, although daptomycin seems to be the best alternative to vancomycin therapy.

Usefulness of SBA-15 mesoporous ceramics as a delivery system for vancomycin, rifampicin and linezolid: a preliminary report.

Bone infections are a challenge for modern medicine. The most common pathogen is Staphylococcus aureus, which usually develops a biofilm inside the infected bone. Local release of antibiotics within the infected tissue may diminish this problem because high concentrations of the antibiotic would be delivered to the required place. This study was carried out to evaluate silica-based mesoporous material SBA-15 as a delivery system for three antibiotics with activity against S. aureus, namely vancomycin, rifampicin and linezolid, alone or in combination. SBA-15 disks were loaded with antibiotics by adsorption using a 1000 mg/L solution. Measurements of biological activity were carried out by bioassay tests, and antibiotic release was monitored by high-performance liquid chromatography (HPLC). In all cases, the ceramic disks released most of the antibiotics at the initial stage of the experiments, with concentrations above the susceptibility breakpoints. The most active antibiotic was rifampicin, with an active concentration of 96.14 mg/L at 24 h, followed by linezolid (7.2 mg/L) and vancomycin (5.5 mg/L). In the HPLC measurements, the antibiotic that showed the best release was linezolid, followed by vancomycin; rifampicin alone could not be measured by HPLC with precision. Taking into account all these results, the antibiotic that remains most active after loading and release is vancomycin (77.46%), followed by linezolid (24%). The results presented here demonstrate the efficacy of SBA-15 bioceramics for local release of antibiotics, which could be of interest in the context of bone infection.

PCR-hybridization after sonication improves diagnosis of implant-related infection.

PURPOSE: We wanted to improve the diagnosis of implant-related infection using molecular biological techniques after sonication. METHODS: We studied 258 retrieved implant components (185 prosthetic implants and 73 osteosynthesis implants) from 126 patients. 47 patients had a clinical diagnosis of infection (108 components) and 79 patients did not (150 components). The fluids from sonication of retrieved implants were tested in culture and were also analyzed using a modified commercial PCR kit for detection of Gram-positive and Gram-negative bacteria (GenoType BC; Hain Lifescience) after extraction of the DNA. RESULTS: 38 of 47 patients with a clinical diagnosis of infection were also diagnosed as being infected using culture and/or PCR (35 by culture alone). Also, 24 patients of the 79 cases with no clinical diagnosis of infection were identified microbiologically as being infected (4 by culture, 16 by PCR, and 4 by both culture and PCR). Comparing culture and PCR, positive culture results were obtained in 28 of the 79 patients and positive PCR results were obtained in 35. There were 21 discordant results in patients who were originally clinically diagnosed as being infected and 28 discordant results in patients who had no clinical diagnosis of infection. INTERPRETATION: For prosthetic joint infections and relative to culture, molecular detection can increase (by one tenth) the number of patients diagnosed as having an infection. Positive results from patients who have no clinical diagnosis of infection must be interpreted carefully.

Adherence of Streptococcus pneumoniae to polystyrene plates and epithelial cells and the antiadhesive potential of albumin and xylitol.

Aimed to prevent Streptococcus pneumoniae biofilm infections, we studied the adherence of nine pneumococcal strains to polystyrene plates and on epithelial cells and the antiadhesive effect of albumin and xylitol. The adherence was variable among strains, but there was a good correlation between their adherent ability and binding to abiotic material and cells. Strains of serotypes 6B and 23F were the most adherent organisms, whereas serotype 3 strains were the least adherent. Human serum albumin (HSA) enhanced bacterial growth at low concentrations (0.5-2.5%) but inhibited it at 10%. Xylitol inhibited bacterial growth of all strains at concentrations ranging from 5 to 15%. Exposure to 0.5-5% HSA in solubilized form and to 5% HSA precoating of plates diminished adherence to polystyrene >80% for all strains, except for serotype 3 strains. Contrarily, 0.5 and 5% xylitol did not diminish significantly pneumococcal adherence to polystyrene plates or on epithelial cells. Our results suggest that 1) the potential application of HSA coatings on medical devices to inhibit pneumococcal adherence and 2) the possible beneficial effect of xylitol in preventing some pneumococcal infections could be because of its antimicrobial activity rather than to an antiadhesive effect.

Biofilm formation by Streptococcus pneumoniae strains and effects of human serum albumin, ibuprofen, N-acetyl-l-cysteine, amoxicillin, erythromycin, and levofloxacin.

Streptococcus pneumoniae ability to produce biofilms may induce persistent infections and difficulties for eradication in vivo. We investigated the ability of 11 pneumococcal strains (serotypes 3, 6B, 9V, 19F, and 23F) to form biofilms on polystyrene plates at 16 and 24 h. The extent of biofilm was greater at 24 h in 10 strains, being the highest magnitude for serotype 3 strains. Human serum albumin at 25,000 microg/mL and ibuprofen at 128 microg/mL significantly reduced biofilm formation in 7 and 5 strains, respectively. Amoxicillin, erythromycin, and levofloxacin at supra-MIC concentrations were very active against planktonic cells of 3 selected strains but lower on biofilm-associated organisms in 2 strains and null against the third. Although N-acetyl-l-cysteine had very little activity against both planktonic and biofilm-forming organisms, when combined with the 3 antibiotics, a slightly enhanced activity against biofilm-embedded organisms in 1 strain and combined with amoxicillin in another one was observed.

Comparative efficacy of novobiocin and amoxicillin in experimental sepsis caused by beta-lactam-susceptible and highly resistant pneumococci.

Therapeutic alternatives are needed against infections caused by highly multidrug-resistant Streptococcus pneumoniae. Novobiocin, an old antibiotic, was tested in vitro and in a murine sepsis model against one amoxicillin-susceptible and three amoxicillin-resistant strains [minimum inhibitory concentrations (MICs) 8-64 mg/L]. Novobiocin MICs for all strains were 0.25-0.5 mg/L. In sepsis, novobiocin and amoxicillin were evaluated at 25, 50, 100 and 200 mg/kg given at 1, 5, 24 and 48 h post bacterial challenge. The most effective regimens in animals infected with the amoxicillin-susceptible strain were 200 mg/kg novobiocin and 25 mg/kg amoxicillin, achieving 100% survival and undetectable organisms in the peritoneum. Among mice infected with amoxicillin-resistant S. pneumoniae, 200 mg/kg novobiocin gave the highest protection (90-100% survivors), followed by 200mg/kg amoxicillin (60-100%), 100 mg/kg novobiocin (50-87.5%) and 50 mg/kg amoxicillin (14.3-25%). The killing effect of antibiotics in the peritoneum (mean Deltalog(10) colony-forming units/mL between treated and control mice) was as follows: 200 mg/kg novobiocin (-6.6)>200 mg/kg amoxicillin (-5.6)>100 mg/kg novobiocin (-3.7) > 50 mg/kg amoxicillin (-0.7). Total plasma and ultrafiltrate pharmacokinetics of novobiocin (200 mg/kg, single dose) in non-infected mice showed, respectively, half-lives of 151 min and 215 min, area under the concentration-time curves (AUCs) of 945.0 mgh/L and 136.6 mgh/L and maximal concentrations of 147 mg/L and 18 mg/L. Novobiocin may be a promising agent for therapy of highly beta-lactam-resistant pneumococcal infections.

Antimicrobial susceptibility of multidrug-resistant Streptococcus pneumoniae strains with penicillin MICs of 8 to 32 mg/L.

The in vitro activity of 22 antibiotics (including novobiocin) and beta-lactam/gentamicin combinations was assessed against 11 multidrug-resistant pneumococcal strains. Among orally administered drugs, only telithromycin, levofloxacin, and linezolid were active against all isolates, but their use is not indicated in pediatrics. Novobiocin could be a potential therapeutic alternative.