[High percentage of clarithromycin and metronidazole resistance in Helicobacter pylori clinical isolates obtained from Spanish children].

OBJECTIVE: To determine the primary and secondary resistance to several antimicrobial agents in Spanish Helicobacter pylori clinical isolates obtained from paediatric patients from January 2002 to June 2006. METHODS: Samples were collected from gastric biopsies of symptomatic paediatric patients and H. pylori cultured according to standard microbiological procedures. Resistance was determined by E-test. Strains were considered resistant if minimal inhibitory concentration (MIC) > or = 2 mg/l for amoxycillin, > or = 4 mg/l for tetracycline, > or = 8 mg/l for metronidazole, > or = 1 mg/l for clarithromycin, MIC > or = 4 mg/l for ciprofloxacin, MIC > or = 32 mg/l for rifampicin and intermediate if MIC = 0.5 mg/l for clarithromycin, and MIC = 2 mg/l for ciprofloxacin. RESULTS: A total of 101 patients were included: 38 males and 63 females (sex ratio M/F: 0.6). Average age was 10 years (range: 4-18 years). All strains were susceptible to amoxycillin, tetracycline and rifampicin, 35.7% were resistant to metronidazole, 54.6% to clarithromycin and 1.8% to ciprofloxacin. 2.0% were intermediate to clarithromycin and 1.8% to ciprofloxacin. Double resistance to metronidazole and clarithromycin rated at 17.2%. Thirty-five patients (34.7%) had a history of treatment failure, and were considered as secondary H. pylori. Primary resistance rates to metronidazole and clarithromycin were 32.8% and 49.2%, respectively, and secondary resistance rates were 41.2% and 70.6%, respectively. CONCLUSIONS: Resistance to clarithromycin (56.6%) was higher than to metronidazole (35.7%) in the H. pylori strains studied. Clarithromycin resistance was very high even in strains from paediatric patients not previously treated for H. pylori infection.

High percentage of clarithromycin and metronidazole resistance in Helicobacter pylori clinical isolates obtained from Spanish children / Alto porcentaje de resistencia a claritromicina y metronidazol en aislamientos clínicos de Helicobacter pylori procedentes de pacientes pediátricos

Introducción. Determinar la resistencia primaria y secundaria a varios agentes antibióticos en aislamientos clínicos de Helicobacter pylori procedentes de pacientes pediátricos desde enero de 2002 a junio de 2006. Métodos. Las muestras fueron biopsias gástricas procedentes de pacientes pediátricos sintomáticos. H. pylori fue cultivado acorde con los estándares de los procedimientos microbiológicos. La resistencia a antibióticos fue determinada mediante E-test. Los aislamientos fueron considerados resistentes si la CMI ≥ 2 mg/l para amoxicilina, ≥ 4 mg/l para tetraciclina, ≥ 8 mg/l para metronidazol, ≥ 1 mg/l para claritromicina, ≥ 4 mg/l para ciprofloxacino y ≥ 32 mg/l para rifampicina, y fue considerado intermedio si la concentración mínima inhibitoria (CMI) = 0,5 mg/l para claritromicina, y CMI = 2 mg/l para ciprofloxacino. Resultados. De los 101 pacientes incluidos en el estudio: 38 fueron hombres y 63 mujeres. La media de edad fue de 10 años. Todas las cepas fueron sensibles a amoxicilina, tetraciclina y rifampicina. El 35,7% de los aislamientos fueron resistentes a metronidazol, el 54,6% fue- ron resistentes a claritromicina y el 1,8% a ciprofloxacino. El 17,2% de los aislamientos tuvieron doble resistencia a metronidazol y claritromicina. Treinta y cinco pacientes (34,7%) tuvieron un fallo en el tratamiento frente a H. pylori, previamente. La resistencia primaria a metronidazol y claritromicina fue del 32,8 y 49,2%, respectivamente, y la resistencia secundaria fue de un 41,2 y 70,6%, respectivamente. Conclusión. La resistencia a claritromicina (56,6%) fue más alta que a metronidazol (35,7%) en los aislamientos clínicos de H. pylori estudiados. La resistencia a claritromicina fue alta incluso en los pacientes que no habían tenido tratamientos previos frente a H. pylori (AU)

Objective. To determine the primary and secondary resistance to several antimicrobial agents in Spanish Helicobacter pylori clinical isolates obtained from paediatric patients from January 2002 to June 2006. Methods. Samples were collected from gastric biopsies of symptomatic paediatric patients and H. pylori cultured according to standard microbiological procedures. Resistance was determined by E-test. Strains were considered resistant if minimal inhibitory concentration (MIC) ≥ 2 mg/l for amoxycillin, ≥ 4 mg/l for tetracycline, ≥ 8 mg/l for metronidazole, ≥ 1 mg/l for clarithromycin, MIC ≥ 4 mg/l for ciprofloxacin, MIC ≥ 32 mg/l for rifampicin and intermediate if MIC = 0.5 mg/l for clarithromycin, and MIC = 2 mg/l for ciprofloxacin. Results. A total of 101 patients were included: 38 males and 63 females (sex ratio M/F: 0.6). Average age was 10 years (range: 4-18 years). All strains were susceptible to amoxycillin, tetracycline and rifampicin, 35.7% were resistant to metronidazole, 54.6% to clarithromycin and 1.8% to ciprofloxacin. 2.0% were intermediate to clarithromycin and 1.8% to ciprofloxacin. Double resistance to metronidazole and clarithromycin rated at 17.2%. Thirty-five patients (34.7%) had a history of treatment failure, and were considered as secondary H. pylori. Primary resistance rates to metronidazole and clarithromycin were 32.8% and 49.2%, respectively, and secondary resistance rates were 41.2% and 70.6%, respectively. Conclusions. Resistance to clarithromycin (56.6%) was higher than to metronidazole (35.7%) in the H. pylori strains studied. Clarithromycin resistance was very high even in strains from paediatric patients not previously treated for H. pylori infection (AU)

[Management of 90 patients presenting with suspected severe acute respiratory syndrome. Experience of a collaboration between epidemiologists and clinicians facing an emerging infectious disease health alert]. / Prise en charge de 90 patients suspects de syndrome respiratoire aigu sévère. Expérience d'une collaboration épidémioclinique en situation d'alerte sanitaire liée à une infection émergente.

OBJECTIVE: The characteristics of patients with a suspected SARS hospitalized in a Paris hospital were studied to analyze the hypothetic differences between epidemiologic and clinical teams in the management of an epidemic emerging disease, and to gather experience for the management of the next outbreak. STUDY DESIGN: All 90 patients hospitalized between March 16 and April 30, 2003, were included. Epidemiological and clinical data were shared with the French National Institute for Health. Cases were classified according to both the official definition ("possible", "probable", "excluded") and a local one, adapted from the official definition but including an additional level of suspicion ("equivocal"), intermediate between "possible" and "excluded". RESULTS: The initial assessment was different in 39% of the cases (n=35), according to epidemiological (n=24) or clinical (n=11) elements. The final assessment diverged in 54% of the cases (n=47). All patients were officially considered as "excluded" for epidemiologists, while 47 remained as "possible" or "equivocal" cases of SARS according to the clinicians. CONCLUSION: The risk assessment was different in almost 40% of the cases, with no impact on epidemic diffusion or hospital-borne exposure as no probable case of SARS was diagnosed among these patients or their households. The confrontation of these different but complementary points of view will thus enrich the interdisciplinary management of eventual future outbreaks.