Intense scuba diving does not alter activity patterns of predatory reef fish: Evidence from a protected tourism hotspot.

The rise of nature-based tourism has provided a new avenue for disturbing animal behaviour, especially in protected areas. One of the most important tourism sectors in aquatic environments is scuba diving, an activity considered sustainable given its non-extractive nature and capability of bringing relevant socio-economic benefits to local communities. However, knowledge about its impact on the activity patterns of aquatic animals is still scarce. Here, we used biotelemetry techniques to assess the importance of scuba diving in modulating the activity patterns of the dusky grouper (Epinephelus marginatus, Lowe, 1834), a marine predatory fish of high interest for fishing and tourism. We implemented Hidden Markov Models (HMMs) on high-resolution acceleration data using a temporal and spatial control while controlling for a set of environmental variables (i.e. photoperiod, time-of-day, moon phase, temperature, wave height, and intensity and direction of marine currents) within a multiple-use marine protected area, and diving tourism hot-spot, of the western Mediterranean Sea. Our results underlined the more decisive influence of environmental-related stressors on the activity patterns of the dusky grouper compared to the impact of scuba diving. A high heterogeneity existed in the response against most of the stressors, including the presence of scuba divers. Overall, the activity of dusky grouper was higher at night than at day, showing a positive relationship with wave height, water temperature, and current intensity and a negative one with the moon phase. Remarkably, our findings, based on novel biotelemetry tools, differed substantially from the common wisdom accepted for this species. In conclusion, there is no clear evidence of scuba divers influence on the general activity patterns of the dusky grouper. Beyond their relevance from an ecological perspective, these results provide useful insights for the sustainable management of coastal resources, suggesting that scuba diving, when properly carried out, can represent an important sector to foster for the blue growth of coastal communities.

Prevalence, incidence and risk factors for foot pressure ulcers in hospitalized elderly patients. An observational and prospective study.

BACKGROUND: Incidence and clinical characteristics of foot pressure ulcers (FPU) in hospitalized elderly patients are not well known. The aim of the study was to determine the incidence of FPU during hospitalization, to describe main FPU characteristics and to assess main risk factors for FPU in hospitalised elderly subjects. METHODOLOGY: An observational prospective study was performed in which patients 65 years or older admitted to Vascular Surgery, Orthopaedic or Geriatric departments were followed from admission to discharge. Trained nurses evaluated all recruited patients on a daily basis for possible FPU. Main characteristics of the patient (age, sex and co-morbidities) and the ulcer (location, grade) were registered. RESULTS: 299 patients were recruited (62.2% women, mean age 82.3 years, mean number of co-morbidities 2.8). Prevalence of FPU was 30.1% at admission and 73.9% at discharge. Incidence of FPU during hospitalization was 9.5 new FPU/100 person-day. 97.0% of the new FPU were grade 1 (erythema) and the most common locations were in the heel (57.6%), the external lateral part of the foot (13.1%), and the hallux of the fist toe (11.8%). Apart from immobility, main risk factors for FPU are age, geriatric residence origin and not able to outdoor life. CONCLUSIONS: FPU has a high incidence among hospitalised elderly patients; most of them are grade 1 and located in the heel. More attention must be paid in the prevention of pressure ulcers in hospitalized frail subjects.

[Is stratification of antibiotic susceptibility of urinary pathogens useful in the Emergency Department?] / ¿Es útil la estratificación de la sensibilidad antibiótica de los patógenos urinarios en el Servicio de Urgencias?

OBJECTIVE: The aim of the study wat to analyze the antibiotic susceptibility of the pathogens causing urinary tract infection (UTI) and to stratify the results in function of patient´s clinical and demographic dates. METHODS: The susceptibility of the pathogens isolated in the urine of 144 patients with UTI randomly chosen was analyzed. The results were stratified in function of sex, age, type of UTI, previous UTI and previous antibiotic treatment. RESULTS: The susceptibility of the all isolates and of the Escherichia coli isolates was analyzed. There were significant differences between groups in function of sex (fluoroquinolones), age (cefuroxime, ertapenem and gentamicin), type of UTI (cefuroxime, cefotaxime, ertapenem and fluoroquinolones), previous UTI and previous antibiotic treatment (cefotaxime, fluoroquinolones and fosfomycin). CONCLUSIONS: The use of clinical and demographic data according to population and local resistance epidemiology of the pathogen causing UTI may help to select an adequate empirical treatment for UTI.

Is it possible to extrapolate the rates of resistance of Escherichia coli from asymptomatic bacteriuria in pregnant women to those of E. coli in uncomplicated community-acquired UTI?

OBJECTIVE: Treatment of uncomplicated urinary tract infections in primary care is generally empirical without requesting urine culture and based on biased resistance data collected from selected patients, most of them having risk factors for the isolation of resistant microorganisms. In order to overcome the lack of information on the real resistance rates in uncomplicated UTI, we compared antimicrobial phenotype and genotype of Escherichia coli isolated from pregnant women with asymptomatic bacteriuria (culture always performed) with those from women with uncomplicated acute cystitis (culture rarely performed) of different age groups. METHODS: Between September 2017 and March 2018, 103 urines were randomly collected from pregnant women aged between 16 and 47 with asymptomatic bacteriuria (AB) (n=42), not hospitalized women in the same age range with uncomplicated acute cystitis (UAC) (n=31) and women older than 47 not hospitalized with UAC (n=30). Bacteria identification was performed using mass spectrometry and the antibiogram by broth microdilution. Genetic typification was carried out by pulsed-field gel electrophoresis. RESULTS: There are no significant differences between the groups of patients in the antibiotic susceptibility. Likewise, as expected, a wide genetic diversity is observed among the strains of E. coli studied without significant differences between the three groups. CONCLUSIONS: We propose a simple model that could provide better guidance for selection of empirical antimicrobial therapy for non-pregnant women with UAC than do generic hospital antibiogram data based on reliably extrapolating the susceptibility data of strains isolated from pregnant women with AB as representation of women with community-acquired UAC.

Osteointegración con el sistema Keep Walking Advanced® en una paciente amputada transfemoral / Osseointegration with the Keep Walking Advanced® system in a transfemoral patient

Aproximadamente una tercera parte de los pacientes con una amputación transfemoral van a padecer problemas crónicos relacionados con el encaje de su prótesis. El 72% de los pacientes amputados refieren sudoración o sensación de calor por culpa del encaje, el 62% reportan lesiones cutáneas o irritaciones de la piel del muñón, el 53% fatiga del muñón, el 51% dolor del muñón y el 38% acaban abandonando el uso de la prótesis. La osteointegración es una técnica que evita estos problemas generados en la piel del paciente, ya que permite un anclaje directo de la prótesis al implante intramedular colocado en el fémur del paciente. Presentamos el caso de una paciente amputada transfemoral de 38 años tratada mediante una cirugía de osteointegración con el implante Keep Walking Advanced® para mejorar el uso de la prótesis sin la necesidad de encaje (AU)

Approximately one third of patients with a transfemoral amputation will have chronic problems related to the fitting of the prosthesis. More than two thirds (72%) of amputees report sweating or feeling hot because of the socket, 62% report skin lesions or skin irritation of the stump, 53% stump fatigue, 51% stump pain and 38% do not use the prosthesis. Osseointegration is a technique that avoids these problems in the patient's skin, allowing direct anchoring of the prosthesis to the intramedullary implant placed in the patient's femur. We report the case of a 38-year-old transfemoral amputee who underwent implantation of the Keep Walking Advanced® implant to improve the use of the prosthesis without the need for socket fitting (AU)

Behaviour in a standardized assay, but not metabolic or growth rate, predicts behavioural variation in an adult aquatic top predator Esox lucius in the wild.

This study tested for links among behaviour, state and life-history variables as predicted by the pace-of-life hypothesis in adult pike Esox lucius. First, a standardized open-field behavioural assay was developed to assess individual behaviour of wild-captured adult E. lucius. Behaviour within the standardized assay predicted swimming behaviour in the lake, providing an ecological validation of the assay. There was no relationship between standardized behaviour and any of the life-history and state variables, including metabolism, body condition, juvenile growth rate and adult growth rate in contrast to predictions from the pace-of-life hypothesis. This study demonstrates that it is possible to assess ecologically relevant behavioural variation in a large-bodied top predator using a standard open-field assay, but it is noteworthy that this standardized behaviour is not systematically related to standard metabolism or growth.

Concurrent interspecies and clonal dissemination of OXA-48 carbapenemase.

Several isolates of four different carbapenemase-producing Enterobacteriaceae species were recovered from a patient hospitalized for 4 months in a teaching hospital in Madrid. These species comprised seven Klebsiella pneumoniae belonging to ST15, four Escherichia coli belonging to ST2531, two Serratia marcescens and one Citrobacter freundii. This patient was the index case of a small outbreak of four patients infected and/or colonized by carbapenemase-producing K. pneumoniae. Molecular results identified the bla(OXA-48) gene in all Enterobacteriaceae isolates from the index case and in all isolates from the other three patients, suggesting intra- and interpatient dissemination. Our results highlight the great ability of OXA-48 carbapenemase to spread among different enterobacterial species by both clonal and nonclonal dissemination.

Comentario a: «Infección urinaria en pacientes con vejiga neurógena: consideraciones sobre el tratamiento antibiótico» / Comment to «Urinary Infection in Patients With Neurogenic Bladder: Patterns of Resistance to the Most Frequent Uropathogens»

No disponible

Activity of ertapenem and other antimicrobials against ESBL-producing enterobacteria isolated from urine in patients from Madrid.

The objective of this study was to evaluate the activity of ertapenem and other antimicrobials against extended-spectrum beta-lactamase (ESBL)-producing enterobacteria isolated from patients' urine samples at 4 community healthcare centers in the Madrid (Spain) area and to determine the prevalence of ESBL-producing enterobacteria in community-acquired urinary tract infections. The antibiotic susceptibility results were compared by patient age and sex. A total of 293 strains were studied. The minimum inhibitory concentration (MIC) for each antibiotic was determined using the agar dilution method. The tested carbapenems were the antibiotics with the greatest activity (ertapenem MIC(90)=0.06 mg/l; imipenem MIC(90)=0.5 mg/l), with no intermediate or resistant strains being observed. High rates of resistance to ciprofloxacin (80.9%) and cotrimoxazole were observed (62.1%). The global prevalence of ESBL-producing enterobacteria was 3.6% (293/8,139). Prevalence according to areas was 5.3% in Getafe, 3.45% in Arguelles, 3.02% in Alcala de Henares and 3.56% in Mostoles. The global prevalence of ESBL-producing Escherichia coli was 4.15% (279/6,721). The analysis of resistance according to patient sex (males versus females) showed no significant differences. The analysis of resistance according to patient age (<50 years versus > or = 50 years) showed statistically significant differences (more resistance among subjects > or = 50 years old) for cotrimoxazole (OR=0.43, 95%CI: 0.20-0.93, p=0.018) and ciprofloxacin (OR=0.32, 95%CI: 0.14-0.74, p=0.0027). In view of the good activity shown by ertapenem, and the continuous increase in the prevalence of ESBL strains, this antibiotic and some of the others could be a good choice for the treatment of community-acquired urinary tract infections produced by such bacteria in Spain.

Quinolone resistance in female outpatient urinary tract isolates of Escherichia coli: age-related differences.

During a 1-year period, from November 2003 to October 2004, urinary Escherichia coli isolates were collected from 20 clinical microbiology laboratories across Spain. The main objective was to assess the resistance of E. coli to the antimicrobials most commonly prescribed for community-acquired urinary tract infections depending on the patient's age. A total of 2,230 valid E. coli strains from female outpatients were isolated and sent to a single central reference laboratory for confirmation and susceptibility testing using an agar dilution method. A two-sided chi-squared test was used to assess the differences in resistance between age groups (< or =65 and >65 years). E. coli resistance was found to be more common to ampicillin (52.1%), cotrimoxazole (26%) and quinolones (18%), whereas resistance to amoxicillin-clavulanic acid, cefuroxime axetil and fosfomycin were below 3%. In women older than 65 years, resistance to ciprofloxacin reached up to 29% compared with 13% of those in the under 65 age group (p <0.001). For cotrimozaxole, rates were 32% vs. 23% (p <0.001) and for ampicillin 56% vs. 50% (p=0.02), respectively. It was concluded that fosfomycin, amoxicillin-clavulanic acid and cefuroxime axetil are the most suitable antimicrobials for empirical treatment in Spain given the high 18% and 26% resistance rates to quinolones and cotrimoxazole, respectively. Being older than 65 years of age was associated with higher resistance rates to ciprofloxacin (29%). These results should be considered when recommending empirical therapy for acute cystitis in women.

[Biological cost associated with fosfomycin resistance in Escherichia coli isolates from urinary tract infections]. / Coste biológico asociado a la resistencia a la fosfomicina en aislamientos de Escherichia coli de orina.

Resistance to fosfomycin develops rapidly in experimental conditions, although despite its frequent use in UTI, resistance in E. coli, the main uropathogen, is very low (1-3%), and has remained so for many years. The objective of this study was to ascertain whether E. coli fosfomycin-resistant strains have less fitness than those that are fosfomycin-sensitive in competing, and would therefore tend to disappear in their competition with fosfomycin-sensitive strains in the absence of antibiotics. Fosfomycin-resistant strains (n=11) with different phenotypes of resistance to other antibiotics were used. All but one were lactose (+). Fosfomycin-susceptible strains (n=15) that had the same phenotypes of resistance to other antibiotics as the resistant strains and which had the opposite pattern of lactose fermentation were also used. Thirty-three (33) competition experiments by pairs of strains were conducted in nutrient broth. Equal amounts of the strains were challenged (approx. 50% and approx. 50%) for 4 days, with a daily change to a new medium. Five differential counts were performed on days 0, 1, 2, 3 and 4. In 20 experiments (60.6%) there was a relative increase in the fosfomycin-sensitive strain. In 6 experiments (18.2%) there was a relative increase in the fosfomycin-resistant strain. In 7 experiments (21.2%), on the fourth day none of the strains reached 60%. When the data of the 26 (20+6) experiments in which there were changes were analyzed by the chi2 test there was a statistically significant difference (p=0.044). Resistance to fosfomycin could entail a biological cost (less fitness) for the majority of the E. coli strains assayed.

Activity of ertapenem and other antimicrobials against ESBL-producing enterobacteria isolated from urine in patients from Madrid

El objetivo de nuestro estudio fue evaluar la actividad del ertapenem y de otros antimicrobianos frente a cepas de enterobacterias productoras de BLEE aisladas de orina de pacientes de la comunidad en cuatro áreas sanitarias de Madrid, así como establecer la prevalencia de enterobacterias productoras de BLEE en este tipo de infecciones. Los resultados de sensibilidad antibiótica se compararon por edad y sexo. Se estudiaron 293 cepas. La CMI de cada antibiótico se determinó por el método de dilución en agar. Los carbapenemes probados fueron los antibióticos con mayor actividad (ertapanem CMI90=0,06 mg/l; imipenem CMI90=0,5 mg/l), sin que se observara ninguna cepa con sensibilidad intermedia o resistente. Se encontraron altas tasas de resistencia a ciprofloxacino (80,9%) y a cotrimoxazol (62,1%). La prevalencia global de enterobacterias productoras de BLEE fue del 3,6% (293/8139). La prevalencia según el área de salud fue del 5,3% en Getafe, del 3,45% en Argüelles, del 3,02% en Alcalá de Henares y del 3,56% en Móstoles. La prevalencia global de Escherichia coli productoras de BLEE fue del 4,15% (279/6721). En el análisis de la resistencia por sexo (hombres frente a mujeres) no se encontraron diferencias significativas. En el análisis por edad (<50 años frente a ≥ 50 años) se encontraron diferencias estadísticamente significativas (más resistencia en ≥50 años) para el cotrimoxazol (OR=0.43, IC95%: 0,20-0,93, p=0.018) y el ciprofloxacino (OR=0.32, IC95%: 0,14-0,74, p=0.0027). Considerando la buena actividad mostrada por el ertapenem y el continuo aumento en la prevalencia de cepas productoras de BLEE, este antibiótico y algún otro podrían ser una buena elección para el tratamiento de las infecciones del tracto urinario adquiridas en la comunidad producidas por cepas productoras de BLEE en España

The objective of this study was to evaluate the activity of ertapenem and other antimicrobials against extended-spectrum β-lactamase (ESBL)- producing enterobacteria isolated from patients’ urine samples at 4 community healthcare centers in the Madrid (Spain) area and to determine the prevalence of ESBL-producing enterobacteria in community-acquired urinary tract infections. The antibiotic susceptibility results were compared by patient age and sex. A total of 293 strains were studied. The minimum inhibitory concentration (MIC) for each antibiotic was determined using the agar dilution method. The tested carbapenems were the antibiotics with the greatest activity (ertapenem MIC90=0.06 mg/l; imipenem MIC90=0.5 mg/l), with no intermediate or resistant strains being observed. High rates of resistance to ciprofloxacin (80.9%) and cotrimoxazole were observed (62.1%). The global prevalence of ESBL-producing enterobacteria was 3.6% (293/8,139). Prevalence according to areas was 5.3% in Getafe, 3.45% in Argüelles, 3.02% in Alcalá de Henares and 3.56% in Móstoles. The global prevalence of ESBL-producing Escherichia coli was 4.15% (279/6,721). The analysis of resistance according to patient sex (males versus females) showed no significant differences. The analysis of resistance according to patient age (<50 years versus ≥ 50 years) showed statistically significant differences (more resistance among subjects ≥ 50 years old) for cotrimoxazole (OR=0.43, 95%CI: 0.20-0.93, p=0.018) and ciprofloxacin (OR=0.32, 95%CI: 0.14-0.74, p=0.0027). In view of the good activity shown by ertapenem, and the continuous increase in the prevalence of ESBL strains, this antibiotic and some of the others could be a good choice for the treatment of community-acquired urinary tract infections produced by such bacteria in Spain

Coste biológico asociado a la resistencia a la fosfomicina en aislamientos de Escherichia coli de orina / Biological cost associated with fosfomycin resistance in Escherichia coli isolates from urinary tract infections

La resistencia a la fosfomicina surge rápidamente en condiciones experimentales, pero aunque su uso es frecuente en las infecciones del tracto urinario, la resistencia de Escherichia coli, el principal uropatógeno, es muy baja (1% a 3%) y ha permanecido así por muchos años. El objetivo de este estudio fue evaluar si las cepas de E. coli resistentes a la fosfomicina tienen menos competitividad (fitness) que las sensibles, y por tanto tenderían a desaparecer al competir con las cepas sensibles en ausencia de antibióticos. Se utilizaron cepas resistentes a la fosfomicina (n=11) con diferentes fenotipos de resistencia a otros antibióticos, y cepas sensibles a la fosfomicina (n=15) con los mismos fenotipos de resistencia al resto de los antibióticos que algunas de las cepas resistentes, pero con el patrón opuesto de fermentación de la lactosa. Se realizaron 33 experimentos de competición por pares en caldo nutriente. Se utilizaron cantidades iguales de cada cepa (50%-50%) durante cuatro días, con cambio diario a un nuevo medio. Se hicieron cinco recuentos diferenciales, los días 0, 1, 2, 3 y 4. En 20 experimentos (60,6%) hubo un incremento relativo de la cepa sensible a la fosfomicina. En seis experimentos (18,2%) hubo un incremento relativo de la cepa resistente a la fosfomicina. En siete experimentos (21,2%) ninguna cepa mostró un incremento relativo. Cuando los datos de los 26 experimentos en que había cambios se analizaban por X2 había una diferencia estadísticamente significativa (p=0.044). La resistencia a la fosfomicina puede suponer un coste de competitividad para la mayoría de las cepas de E. coli probadas

Resistance to fosfomycin develops rapidly in experimental conditions, although despite its frequent use in UTI, resistance in E. coli, the main uropathogen, is very low (1-3%), and has remained so for many years. The objective of this study was to ascertain whether E. coli fosfomycin- resistant strains have less fitness than those that are fosfomycin-sensitive in competing, and would therefore tend to disappear in their competition with fosfomycin-sensitive strains in the absence of antibiotics. Fosfomycin-resistant strains (n=11) with different phenotypes of resistance to other antibiotics were used. All but one were lactose (+). Fosfomycin-susceptible strains (n=15) that had the same phenotypes of resistance to other antibiotics as the resistant strains and which had the opposite pattern of lactose fermentation were also used. Thirty-three (33) competition experiments by pairs of strains were conducted in nutrient broth. Equal amounts of the strains were challenged (approx. 50% and approx. 50%) for 4 days, with a daily change to a new medium. Five differential counts were performed on days 0, 1, 2, 3 and 4. In 20 experiments (60.6%) there was a relative increase in the fosfomycin-sensitive strain. In 6 experiments (18.2%) there was a relative increase in the fosfomycin-resistant strain. In 7 experiments (21.2%), on the fourth day none of the strains reached 60%. When the data of the 26 (20+6) experiments in which there were changes were analyzed by the X2 test there was a statistically significant difference (p=0.044). Resistance to fosfomycin could entail a biological cost (less fitness) for the majority of the E. coli strains assayed

Antimicrobial susceptibility of clinical Escherichia coli isolates from uncomplicated cystitis in women over a 1-year period in Spain.

High usage of antibiotics in Spain has led to an increase in resistance in urinary Escherichia coli isolates in different geographic regions. The problem of resistance in urinary E. coli in Spain was investigated by gathering a large number of isolates from 20 different sites nationwide over a 1-year period from November 2003 to October 2004 in a large population of women. The objectives of this study were to assess the resistance to the antibiotics most commonly prescribed for community-acquired urinary tract infections (UTIs), according to age and different geographical areas of Spain, and to evaluate the potential association between geographical differences in quinolone consumption and resistance to E. coli. A total of 2,292 valid E. coli strains from female outpatients were isolated and sent to a single central reference laboratory for confirmation and susceptibility testing. Of these, 2,230 isolates were available for the age analysis. A two-sided chi2 test was used to identify differences in resistance between age groups. Antibiotic units per province were purchased from IMS and consumption was expressed in units per 1,000 people per year. Univariate correlation (Pearson coefficient) between resistance to ciprofloxacin and quinolone consumption was calculated using a two-sided p-value. Resistance shown by E. coli was more common to ampicillin (52.1%) and cotrimoxazole (26%), followed by quinolones (18%), whereas resistance to amoxicillin-clavulanic acid, cefuroxime-axetil and fosfomycin was less than 3%. In the subgroup of women aged >65 years, resistance to ciprofloxacin was 29% compared to 13% for the subgroup of women <65 years (p<0.001). For these same subgroups, resistance rates were 32% vs. 23% for cotrimoxazole (p<0.001) and 56% vs. 50% for ampicillin (p=0.02), respectively. Statistically significant correlations were found between consumption of quinolones and E. coli resistance to ciprofloxacin (r=0.5; p=0.025). Resistance of E. coli isolates to quinolones varied significantly according to geographical areas, ranging from a high of 16.5% and 16.6% in the southern and eastern regions of Spain, respectively, to a low of 8% in the north in women aged <65 years. Additionally, the susceptibility to quinolones of E. coli isolates recovered from women aged >65 years was significantly lower across all regions of Spain than that of isolates recovered from younger women. Fosfomycin, amoxicillin/clavulanic acid and cefuroxime-axetil are the most suitable antibiotics for empirical treatment in Spain given the high 18% and 26% resistance rates to quinolones and cotrimoxazole, respectively. Higher resistance rates to ciprofloxacin were associated with being aged 65 years and over. These data need to be considered when recommending empirical therapy for acute cystitis.

Antimicrobial susceptibility of clinical Escherichia coli isolates from uncomplicated cystitis in women over a 1-year period in Spain

La frecuente utilización de antibióticos en España ha permitido la aparición de resistencias en las cepas de E. coli urinarias aisladas en distintas regiones geográficas. Nosotros hemos analizado el problema de las resistencias de E. coli urinaria en España recogiendo un gran número de muestras en 20 centros distintos de todo el país durante un periodo de un año (noviembre de 2003 a octubre de 2004), procedentes de una gran población de mujeres. Los objetivos de este estudio fueron valorar las resistencias a los antibióticos que con más frecuencia se prescriben como tratamiento de las infecciones de vías urinarias adquiridas en la comunidad, así como según la edad de las pacientes y las distintas regiones geográficas de España, y valorar una posible asociación entre las diferencias geográficas en la utilización de quinolonas y las resistencias de E. coli. Se aislaron en total 2292 cepas de E. coli válidas de mujeres en régimen ambulatorio y se remitieron a un único laboratorio de referencia central para la confirmación del diagnóstico y la realización de las pruebas de sensibilidad. De todas estas muestras, 2230 estuvieron disponibles para el análisis por edad. Se realizó una prueba de χ2 de dos colas para analizar las diferencias de las resistencias entre los grupos de edad. La información sobre unidades de antibióticos en cada provincia se obtuvo del IMS y el consumo se expresó en unidades por mil personas-año. Se realizó una correlación univariable (coeficiente de Pearson) entre la resistencia al ciprofloxacino y el consumo de quinolonas usando un valor de p bilateral. Las resistencias que mostró E. coli fueron principalmente frente a ampicilina (52,1%), cotrimoxazol (26%) y después quinolonas (18%), mientras que las resistencias a amoxicilina-ácido clavulánico, cefuroxima axetilo y fosfomicina fueron inferiores al 3%. En el grupo de mujeres mayores de 65 años, las resistencias al ciprofloxacino alcanzaron el 29%, lo que contrasta con el 13% en las de menor edad (p <0.001). En el caso del cotrimoxazol estos valores fueron del 32% y el 23% (p <0.001), y para ampicilina del 56% y el 50% (p=0.02). Se encontró una correlación estadísticamente significativa entre el consumo de quinolonas y la resistencia de E. coli al ciprofloxacino (r=0.5; p=0.025). Las resistencias a las quinolonas de los aislamientos de E. coli variaron de forma significativa en función de las regiones geográficas, oscilando entre una elevada frecuencia, del 16,5% y 16,6%, en las regiones sur y este de España, hasta otras bajas como el 8% descrito en la zona norte del país en mujeres menores de 65 años. Además, la sensibilidad a las quinolonas de las cepas de E. coli aisladas en mujeres mayores de 65 años fue significativamente menor en todas las regiones de España en comparación con las aisladas de mujeres más jóvenes. Fosfomicina, amoxicilina-ácido clavulánico y cefuroxima axetilo son los antibióticos más adecuados para el tratamiento empírico en España, dadas las elevadas frecuencias de resistencia a las quinolonas y el cotrimoxazol, del 18% y el 26%, respectivamente. La edad mayor de 65 años se asoció a una frecuencia de resistencias al ciprofloxacino superior a la observada en mujeres más jóvenes. Esta información se debe tener en cuenta a la hora de recomendar un tratamiento empírico para la cistitis aguda

High usage of antibiotics in Spain has led to an increase in resistance in urinary Escherichia coli isolates in different geographic regions. The problem of resistance in urinary E. coli in Spain was investigated by gathering a large number of isolates from 20 different sites nationwide over a 1-year period from November 2003 to October 2004 in a large population of women. The objectives of this study were to assess the resistance to the antibiotics most commonly prescribed for community-acquired urinary tract infections (UTIs), according to age and different geographical areas of Spain, and to evaluate the potential association between geographical differences in quinolone consumption and resistance to E. coli. A total of 2,292 valid E. coli strains from female outpatients were isolated and sent to a single central reference laboratory for confirmation and susceptibility testing. Of these, 2,230 isolates were available for the age analysis. A two-sided χ2 test was used to identify differences in resistance between age groups. Antibiotic units per province were purchased from IMS and consumption was expressed in units per 1,000 people per year. Univariate correlation (Pearson coefficient) between resistance to ciprofloxacin and quinolone consumption was calculated using a two-sided p-value. Resistance shown by E. coli was more common to ampicillin (52.1%) and cotrimoxazole (26%), followed by quinolones (18%), whereas resistance to amoxicillin-clavulanic acid, cefuroxime-axetil and fosfomycin was less than 3%. In the subgroup of women aged >65 years, resistance to ciprofloxacin was 29% compared to 13% for the subgroup of women 65 years was significantly lower across all regions of Spain than that of isolates recovered from younger women. Fosfomycin, amoxicillin/clavulanic acid and cefuroxime-axetil are the most suitable antibiotics for empirical treatment in Spain given the high 18% and 26% resistance rates to quinolones and cotrimoxazole, respectively. Higher resistance rates to ciprofloxacin were associated with being aged 65 years and over. These data need to be considered when recommending empirical therapy for acute cystitis

Efficacy and safety of sclerotherapy using polidocanol foam: a controlled clinical trial.

OBJECTIVE: To assess the efficacy and safety of sclerotherapy performed with polidocanol foam compared to liquid polidocanol. METHODS: Controlled clinical trial with 1 year follow up in which each patient acted as his/her own control. A total of 75 patients (six men and 69 women) with reticular or postoperative varices were enrolled and sclerotherapy was performed with liquid and with foam (Tessari method) using the same quantity of sclerosant for homogeneous varicose regions, to a total of 150 procedures. The sclerosant concentration was adjusted according to the vein diameter as assess by ultrasonography. The foam group was given 50% lower concentrations of sclerosant than liquid sclerosant group. Clinical assessment (pain, inflammation, pigmentation) and ultrasound examination (diameter of the lumen and length of sclerosed vein) were carried out at 15, 30, 90, and 365 days. RESULTS: Foam allowed complete sclerosis at 90 days in 94.4% of patients compared with 53% for liquid (p<.001) and also allowed a more extensive venous sclerosis (10.1cm compared with 7.2 cm; p<.001). Pain, signs of inflammation, and pigmentation appeared more often with foam sclerosis, with significant difference. The degree of satisfaction was similar for both techniques. CONCLUSIONS: Efficacy of venous sclerosis with foam seems to be greater than with liquid although there is a higher risk of minor secondary effects.