Endocarditis polimicrobiana por Streptococcus salivarius y Pseudomonas stutzeri: buena evolución tras cirugía precoz / Polimicrobial endocarditis by Streptococcus salivarius and Pseudomonas stutzeri: good evolution after early surgery

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[Susceptibility of non-typhi Salmonella spp. at the Galdakao Hospital (1992-1998)]. / Estudio de sensibilidad de Salmonella spp. no typhi en el Hospital de Galdakao (1992 a 1998).

Non-typhi Salmonella spp. are a common cause of gastroenteritis. In patients with a greater risk of bacteremia (those with immunosuppression, cardiovascular abnormalities, prostheses, those older than 50, especially those with atherosclerosis, and neonates) the need for antibiotic treatment may be affected by the presence of resistance. We retrospectively studied the evolution of antibiotic resistance of 917 strains isolated from feces, during the period between January 1992 and May 1998. Resistances of 32.1% to ampicillin, 14.6% to amoxicillin- clavulanic acid, 14.8% to chloramphenicol, 3.5% to trimethoprim-sulfamethoxazole and 1.8% to gentamicin were found. All the strains were susceptible to cefotaxime and ciprofloxacin. There was a distinct increase in the ampicillin resistance (12.9% in 1992 to 52.5% in 1998), amoxicillin-clavulanic acid (8.3% in 1992 to 23% in 1998), chloramphenicol (8.3% in 1994 to 23% in 1998) and trimethoprim-sulfamethoxazole (0% in 1992 to 6.6% in 1998). The typhimurium serotype showed higher resistance levels than the enteritidis serotype. Ciprofloxacin and trimethoprim-sulfamethoxazole (in children), used as first-choice antibiotics in patients with intestinal infections caused by non-typhi Salmonella spp., show excellent activity in our area.

Estudio de sensibilidad de Salmonella spp. no typhi en el Hospital de Galdakao (1992 a 1998) / Study of the susceptibility of non-typhi Salmonella spp. in the Galdakao Hospital (1992 to 1998)

Salmonella spp. no typhi es causa frecuente de infecciones intestinales. En los pacientes con mayor riesgo de bacteriemia (inmunodeprimidos, pacientes con enfermedades cardiovasculares, portadores de prótesis, arteriosclerosis en mayores de 50 años, neoplasias, neonatos), la necesidad de tratamiento antibiótico puede verse dificultada por la aparición de resistencias. Estudiamos de forma retrospectiva la evolución de las resistencias en 917 cepas aisladas en heces desde enero de 1992 hasta mayo de 1998. De éstas, el 32,1 por ciento fueron resistentes a la ampicilina, el 14,6 por ciento a amoxicilina-ácido clavulánico, el 14,8 por ciento a cloranfenicol, el 3,5 por ciento a trimetoprima-sulfametoxazol y el 1,8 por ciento a gentamicina. Todas las cepas fueron sensibles a la cefotaxima y el ciprofloxacino. Observamos un aumento significativo de resistencia a la ampicilina (12,9 por ciento en 1992 a 52,5 por ciento en 1998), amoxicilina-ácido clavulánico (8,3 por ciento en 1992 a 23 por ciento en 1998), cloranfenicol (12,3 por ciento en 1994 a 18,2 por ciento en 1998) y trimetoprima-sulfametoxazol (0 por ciento en 1992 a 6,6 por ciento en 1998). El serotipo tiphymurium fue significativamente más resistente que el serotipo enteritidis. Ciprofloxacino y trimetoprima-sulfametoxazol (en niños), tratamientos de elección de infecciones intestinales por Salmonella spp. no typhi, en los casos descritos, mantienen una actividad excelente en nuestro medio (AU)

[In vitro activity of 9 antibiotics and 3 beta-lactamase inhibitors against 107 clinical isolates of Acinetobacter baumanii]. / Actividad in vitro de nueve antibióticos y tres inhibidores de betalactamasas frente a 107 aislados clínicos de Acinetobacter baumannii.

BACKGROUND: Acinetobacter sp. is an important cause of nosocomial infections and it is often resistant to many antibiotics. In our hospital it often causes infections in patients on the intensive care unit. The aim of this study was to know the susceptibility of Acinetobacter sp. strains isolated in our hospital. METHODS: The in vitro activities of nine antimicrobial agents (ticarcillin, piperacillin, ceftazidime, imipenem, meropenem, gentamicin, tobramycin, amikacin and colistin) and three beta-lactamase inhibitors (sulbactam, clavulanate and tazobactam) against 107 clinical isolates of Acinetobacter baumannii were studied. MICs were determined by a dilution agar method, except for colistin, which we used the disk-diffusion agar method. RESULTS: Of the antimicrobial agents tested imipenem and colistin were highly active against all isolates (100% susceptibility), meropenem presented good activity (96.3% susceptibility), ticarcillin presented moderated activity (84.1% susceptibility). Most of the strains were resistant to ceftazidime (4.7% susceptibility), piperacillin (3.7% susceptibility) and the aminoglycosides (amikacin 21.5% susceptibility, gentamicin 2.8% susceptibility and tobramycin 4.7% susceptibility). Sulbactam was the most active agent among the beta-lactamase inhibitors studied (CMI90 = 4 micrograms/ml). CONCLUSIONS: Recent trends indicate increasing antimicrobial resistance of Acinetobacter baumannii, posing a serious threat to hospitalized patients. An strict attention to maintain a good housekeeping and control of the environment and of the antimicrobial usage, appears the measures most likely to control the spread of Acinetobacter baumannii in hospitals.

[Comparative study of 2 culture methods by seeding, in hemoculture bottles, the dialysis fluid from patients in continuous ambulatory peritoneal dialysis]. / Estudio comparativo de dos métodos de cultivo, por siembra en frascos de hemocultivo, de líquidos de diálisis en pacientes en diálisis peritoneal continua ambulatoria.

BACKGROUND: Peritonitis remains a major complication of continuous ambulatory peritoneal dialysis (CAPD). The accurate diagnosis of peritonitis is a requirement for a successful CAPD program. A prospective study was performed to evaluate two culture methods. METHODS: 1. Culture of 10 ml of uncentrifuged peritoneal fluid and 2. Culture of the sediment of 50 ml centrifuged and resuspended in 20 ml of distilled water, into aerobe/anaerobe hemoculture bottles (Hemoline, BioMérieux). We processed 162 PF from 138 CAPD peritonitis episodes, 33 of whom were in antimicrobial drug therapy. RESULTS: The sensibility/specificity of both methods (87.0/70.8 method 1 and 81.9/79.2) were similar. Both methods were more sensitive (p = 0.001) when the patient was no in antimicrobial drug therapy (60.6/88.6 method 1 and 69.7/92.4 method 2). We isolated 132 microorganisms, 64.4% Gram positive, 25.0% Gram negative, 4.6% anaerobes and 6.1% levures. CONCLUSION: Both methods were similar and the more important factor to increase the yield of culture is to remove the antibiotic presents in centrifuged fluid.

[Microbiological diagnosis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. Review of 5 years at the Hospital de Galdakao]. / Diagnóstico microbiológico de peritonitis en pacientes en diálisis peritoneal continua ambulatoria. Revisión de 5 años en el Hospital de Galdakao.

BACKGROUND: With the aim of knowing the etiology of infectious peritonitis in patients undergoing continuous ambulatory peritoneal dialysis in our Hospital and the yield of our method of culture, we have made a revision of cases recorded during a five years period. METHODS: The peritoneal fluids of 105 patients with peritonitis was processed as following: 10 ml of uncentrifuged liquid was placed in hemocultures bottles, aerobe and anaerobe (Hemoline, Biomérieux) and incubated for up to 15 days at 37 degrees C. An additional 50 ml of peritoneal fluid was centrifuged and the sediment used for Gram stain and placed on enriched chocolate agar. Plates were incubated for up to two days at 37 degrees C in 5% of CO2. During the last year of the review the sediment of 50 ml resuspended in sterile distilled water was placed, too, in hemoculture bottles. In 18 cases we had only the hemoculture bottles inoculated by the nurse of the Nephrology Service (those patients came at a time when the laboratory was closed). Subcultures were identified with routine methodology. RESULTS: 96 (91.43%) of the 105 dialysis effluents processed were culture positive; 91.67% were bacterial and 8.33% fungal peritonitis. 64 (69.56%) of the bacterial isolates were Gram positive and 28 (30.43%) Gram negative. CONCLUSION: We remark the good yield of a simple culture method and the high rate of Gram negative and fungal peritonitis.

Moraxella catarrhalis bacteremic pneumonia in adults: two cases and review of the literature.

Moraxella (formerly Branhamella) catarrhalis is a gram-negative coccus now recognized as one of the common pathogens in respiratory infections. Documented cases of bacteremic pneumonia due to this organism, however, have been a rarity. Two cases of Moraxella catarrhalis bacteremic pneumonia in immunosuppressed adult patients are reported. The clinical characteristics of these patients together with those of the seven adult and the six pediatric patients reported to date in the literature, are analyzed. All patients had an underlying condition and most were male. The mean age was 64.9 years. No adult patient had skin lesion, although purpuric rash was frequent in children. The overall morality rate was only 13.3%, in spite of the underlying diseases. In three patients the pneumonia was nosocomial. The seasonal recovery of Moraxella catarrhalis in respiratory infections is significantly increased during the late fall through early spring period. Because most strains are beta-lactamase positive, empiric use of penicillin, ampicillin or amoxicillin for this organism can no longer be recommended.