Successful treatment with amoxicillin-clavulanic acid: cutaneous nocardiosis caused by Nocardia brasiliensis.

AIM: To emphasize the role of non-sulfonamides in the treatment of Nocardia infection and reduce the adverse reactions caused by sulfonamides. METHODS: We retrospectively analyzed a case of cutaneous nocardiosis in an immunocompetent individual. The colonies obtained by staining the pus in the lesion with antacid and culturing the agar plates were identified by flight mass spectrometry. The pathogenic identification showed Nocardia brasiliensis infection and the patient was treated with amoxicillin-clavulanic acid. RESULTS: After treatment with amoxicillin and clavulanic acid, the ulcer gradually peeled and crusted, leaving dark pigmentation. The patient has finally recovered. CONCLUSION: Sulfonamides are the first-line antibacterial agents for years in treatment of nocardiosis but are of great toxicity and side effects. This patient was successfully treated with amoxicillin-clavulanic acid and it provided a reference protocol for patients with sulfonamide-resistant Nocardia or sulfonamides intolerance.

Absceso en dedo por Escherichia vulneris tras traumatismo con una rama

Introducción: Es importante considerar la posible implicación de microorganismos poco frecuentes en infecciones de piel y partes blandas si la muestra obtenida para cultivo es de buena calidad, y además se aísla en cultivo puro, como ocurre con Escherichia vulneris. Caso Clínico: Presentamos en caso de una mujer de 34 años, sin antecedentes mórbidos, quien desarrolló un absceso en el 4° dedo de la mano tras un traumatismo con una rama y que requirió drenaje quirúrgico y tratamiento antibiótico para su resolución. En el contenido del absceso, se aisló E. vulneris en cultivo puro, con un perfil antibiótico multisensible. Discusión y Conclusión: E. vulneris es una enterobacteria cuya patogenicidad ha estado clásicamente discutida, pero que se ha visto que puede tener participación en infección de heridas, especialmente aquellas relacionadas con material vegetal. Este microorganismo, muy relacionado con E. harmannii, presenta buena sensibilidad a los aminoglucósidos, con excepción a la penicilina y al cotrimoxazol. En las infecciones de piel y tejidos blandos causadas por E. vulneris y que cursen como un absceso, es importante realizar desbridamiento quirúrgico, si es necesario para la resolución completa del cuadro, además del tratamiento con amoxicilina/ácido clavulánico que parece adecuado.

Introduction: It is important to assess the possible involvement of rare microorganisms in skin and soft tissue infections if the sample obtained for culture is of good quality, and is isolated in pure culture, as occurs with Escherichia vulneris. Case Report: We present the case of a 34-year-old woman, with no history of morbidity, who developed an abscess in the 4th finger of the hand after trauma with a branch and which required surgical drainage and antibiotic treatment for its resolution. In the content of the abscess, E. vulneris was isolated in pure culture, with a multisensitive antibiotic profile. Discusion: E. vulneris is an Enterobacteriaceae whose pathogenicity has been classically discussed, but it has been seen that it may have participated in the infection of wounds, especially those related to plant material. This organism, closely related to E. harmannii, shows good sensitivity to aminoglycosides, with the exception of penicillin, and cotrimoxazole. In skin and soft tissue infections caused by E. vulneris and that present as an abscess, it is important to perform surgical debridement if necessary for complete resolution of the condition, in addition to treatment with amoxicillin/clavulanic acid, which seems appropriate.

Use of antibiotics in patients who were attacked by animals that can transmit rabies.

Animal bites have a high probability of becoming infected. In high-risk wounds, the use of antibiotics that kill the associated microorganisms is recommended. The aim of this study was to determine the use of inappropriate antibiotics in patients in different regions of Colombia who were attacked in 2020 by animals that can transmit rabies. This was a retrospective follow-up study of a cohort of patients with wounds caused by animals; the patients were affiliated with the Colombian Health System. Sociodemographic, clinical and pharmacological data were collected. A total of 280 patients were analysed. The median age was 28.0 years, and 52.1% were men. The attacks were attributed to dogs (85.0%) and cats (15.0%), and 9.6% were classified as severe exposure. Antibiotics were used in 71.1% of cases for prophylaxis and in 4.3% of the cases for the treatment of superinfection; cephalexin (37.5%), amoxicillin/clavulanic acid (15.7%) and dicloxacillin (10.4%) were the predominant antibiotics used. A total of 72.0% of patients who received antibiotics received inadequate prescriptions, and 49.2% had no indication to receive prophylaxis. Being treated in the Caribbean region (OR: 4.09; 95% CI: 1.79-9.30) and receiving analgesics (OR: 3.15; 95% CI: 1.25-7.94) were associated with a greater probability of being prescribed antibiotics inadequately; attacks resulting in severe exposure were associated with a lower probability (OR: 0.40; 95% CI: 0.16-0.98). A significant proportion of patients had no indication for prophylactic antibiotics or was prescribed antibiotics not recommended by clinical practice guidelines. There was a low prevalence of prescriptions for amoxicillin/clavulanic acid, the most recommended antibiotic.

Caracterización de Escherichia coli D7111 productora de ß-LACTAMASA TEM-176 / Characterization of Escherichia coli D7111 producing the ß-LACTAMASA TEM-176

RESUMEN El presente reporte es la descripción original de bla TEM-176. Se caracterizaron los mecanismos de resistencia a antimicrobianos de un aislamiento de Escherichia coli enterotoxigénica, determinándose la resistencia a 22 antimicrobianos categorizados en 15 grupos diferentes mediante difusión en agar, estableciéndose grupo filogenético, mecanismos de resistencia y presencia de integrones de Clase 1 y 2 mediante PCR. Integrones y genes de resistencia a β-lactámicos fueron secuenciados. El aislamiento del grupo filogenético A, mostró resistencia o sensibilidad disminuida a ampicilina, amoxicilina más ácido clavulánico, ácido nalidíxico, ciprofloxacino, estreptomicina, kanamicina, tetraciclina, trimetoprim, sulfisoxazol, cotrimoxazol, azitromicina y nitrofurantoina, detectándose la presencia de bla TEM, aadA1/2, aphA1, sul3, tet(A) y un integron de Clase 2 conteniendo un gen dfrA1. La resistencia a quinolonas se relacionó con la substitución Ser83Ala. La secuencia de TEM mostró la substitución Ala222Val, la cual a la fecha no había sido descrita, reportándose como una nueva β-lactamasa, con el nombre de bla TEM-176.

ABSTRACT The present report is the original description of bla TEM-176. The mechanisms of resistance to antimicrobial agents were determined in an enterotoxigenic Escherichia coli, determining the susceptibility to 22 antimicrobials classified in 15 different groups by agar diffusion and establishing the phylogenetic group, mechanisms of resistance and presence of Class 1 and 2 integrons. Integrons and β-lactam resistance genes were sequenced. The isolate, belonging to phylogenetic group A, showed the presence of resistance or diminished susceptibility to a ampicillin, amoxicillin plus clavulanic acid, nalidíxic acid, ciprofloxacin, streptomycin, kanamycin, tetracycline, trimethoprim, sulfisoxazole, cotrimoxazole, azithromycin and nitrofurantoin, carrying bla TEM, aadA1/2, aphA1, sul3, tet(A) and a Class 2 integron containing a dfrA1 gene. Quinolone resistance was related to the substitution Ser83Ala. The TEM sequencing showed the presence of the new substitution Ala222Val, which led to the description of the new β-lactamase bla TEM-176.

Caracterización de Escherichia coli D7111 productora de ß-LACTAMASA TEM-176 / Characterization of Escherichia coli D7111 producing the ß-LACTAMASE TEM-176

RESUMEN El presente reporte es la descripción original de bla TEM-176. Se caracterizaron los mecanismos de resistencia a antimicrobianos de un aislamiento de Escherichia coli enterotoxigénica, determinándose la resistencia a 22 antimicrobianos categorizados en 15 grupos diferentes mediante difusión en agar, estableciéndose grupo filogenético, mecanismos de resistencia y presencia de integrones de Clase 1 y 2 mediante PCR. Integrones y genes de resistencia a β-lactámicos fueron secuenciados. El aislamiento del grupo filogenético A, mostró resistencia o sensibilidad disminuida a ampicilina, amoxicilina más ácido clavulánico, ácido nalidíxico, ciprofloxacino, estreptomicina, kanamicina, tetraciclina, trimetoprim, sulfisoxazol, cotrimoxazol, azitromicina y nitrofurantoina, detectándose la presencia de bla TEM, aadA1/2, aphA1, sul3, tet(A) y un integron de Clase 2 conteniendo un gen dfrA1. La resistencia a quinolonas se relacionó con la substitución Ser83Ala. La secuencia de TEM mostró la substitución Ala222Val, la cual a la fecha no había sido descrita, reportándose como una nueva β-lactamasa, con el nombre de bla TEM-176.

ABSTRACT The present report is the original description of bla TEM-176. The mechanisms of resistance to antimicrobial agents were determined in an enterotoxigenic Escherichia coli, determining the susceptibility to 22 antimicrobials classified in 15 different groups by agar diffusion and establishing the phylogenetic group, mechanisms of resistance and presence of Class 1 and 2 integrons. Integrons and β-lactam resistance genes were sequenced. The isolate, belonging to phylogenetic group A, showed the presence of resistance or diminished susceptibility to a ampicillin, amoxicillin plus clavulanic acid, nalidíxic acid, ciprofloxacin, streptomycin, kanamycin, tetracycline, trimethoprim, sulfisoxazole, cotrimoxazole, azithromycin and nitrofurantoin, carrying bla TEM, aadA1/2, aphA1, sul3, tet(A) and a Class 2 integron containing a dfrA1 gene. Quinolone resistance was related to the substitution Ser83Ala. The TEM sequencing showed the presence of the new substitution Ala222Val, which led to the description of the new β-lactamase bla TEM-176.

Sensibilidad a la amoxicilina de bacterias anaerobias de pacientes con periodontitis agresiva / Susceptibility to amoxycillin of anaerobic bacteria in patientswith aggressive periodontitis

Introducción y ObjetivoSe han utilizado los antibióticos como terapia adjunta al tratamiento periodontal. La amoxicilina y la amoxicilina/ ácido clavulánico son algunos de los más utilizados. Establecer el tipo de bacterias y su sensibilidad a la amoxicilina y a la amoxicilina/ácido clavulánico en pacientes con periodontitis agresiva. Materiales y MétodosEste estudio in vitro estableció la sensibilidad a la amoxicilina y a la amoxicilina/ácido clavulánico de las bacterias aisladas de 19 pacientes con periodontitis agresiva. Se obtuvieron muestras de 6 sitios con bolsas iguales o mayores a 7 mm de profundidad, se realizó cultivo y aislamiento de colonias en condiciones anaeróbicas. Laidentificación de los microorganismos se realizó a través de la coloración de Gram y el Sistema Crystal paraanaerobios; para determinar la sensibilidad a los antibióticos se utilizó la técnica descrita por Wilkins y Thiel.ResultadosEn la periodontitis localizada los microorganismos que se presentaron con mayor frecuencia fueron Veillonellaspecies, Peptostreptococcus prevotii, Staphylococcus saccharoliticus, Bacteroides fragilis, Bacteroidesureolyticus. En la periodontitis generalizada se encontró Fusobacterium nucleatum, Veillonella species, Peptostreptococcus prevotii, Peptostreptococcus saccharolitucus, Staphylococcus saccharoliticus. De las 21 especies identificadas, en la periodontitis localizada 4 fueron resistentes a la amoxicilina y 1 resistente a la amoxicilina/Acido clavulánico. En la periodontitis generalizada se encontró 1 microorganismo resistente a laamoxicilina y 1 resistente a la amoxicilina/Acido clavulánico.ConclusiónSe encontraron bacterias resistentes a la amoxicilina y a la amoxicilina/ácido clavulánico.

Introduction and ObjectiveAntibiotics have been used as an adjunct to periodontal treatment. Amoxicillin and amoxicillin/clavulanicacid are some of the most used.To define the type of bacteria and their susceptibility to amoxycillin and to amoxicillin/clavulanic acid inpatients with aggressive periodontitis.Materials and MethodThis descriptive study stated susceptibility to amoxycillin and to amoxicillin/clavulanic acid of bacteriaisolated from 19 patients with aggressive periodontitis, selected by convenience. Samples from six(6) different sites with periodontal pockets equal or greater than 7 mm of depth were obtained. Thesamples were cultured anaerobically and the isolated colonies were identified by means of the Gramstaining procedure and the Crystal System for anaerobics. The Wilkins and Thiel test was used to assesssusceptibility.ResultsThe microorganisms with the highest presence in localized periodontitis were Veillonella species,Peptostreptococcus prevotii, Staphylococcus saccaharolyticus, Bacteroides fragilis and Bacteroidesureolyticus. Fusobacterium nucleatum, Veillonella species, Peptostreptococcus prevotii, Peptostreptococcussaccharolyticus and Staphylococcus saccharolyticus were found in generalized periodontitis. Four out ofthe 21 microorganisms species identified in localized periodontitis 4 were resistant to amoxycillin and oneto amoxicillin/clavulanic acid. One microorganism was identified as resistant to amoxycillin and one toamoxicillin/clavulanic acid in generalized periodontitis.ConclusionAmoxycillin-resistant and amoxycillin/clavulanic acid-resistant bacteria were found.