[Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain)]. / Sensibilidad de Streptococcus pneumoniae en niños portadores sanos en Murcia (España).

INTRODUCTION AND OBJECTIVES: Streptococcus pneumoniae (SP) is a human pathogen that involves a high use of antibiotics. The objective of the study was to determine the susceptibility to commonly used antibiotics and their associated risk factors, in order to promote rational use of antibiotics. PATIENTS AND METHODS: In A multicentre study was conducted in summer 2009 and winter 2010 on children attending paediatric clinics in the Region of Murcia. A nasopharyngeal sample was collected and an epidemiological questionnaire was completed. The study included 1562 children aged 1 and 4 years old. RESULTS: Almost one-third (31.3%, 489/1562) of children were nasal carriers. A sensitivity study was carried out on 376 isolates, of which 343 were serotyped. Almost two-thirds (61.7%, 964/1562) of children had received at least one dose of PCV7 (heptavalent pneumococcal conjugate vaccine), and 12.8% (44/343) of the isolates belonged to PCV7 serotypes. The prevalence rates of penicillin resistance (meningitis infections criteria CMI>0.06mg/L) were 28.1%; however, this percentage was 54% in PCV7 serotypes. None of the isolates had (MIC >2mg/L), so prevalence rates of susceptibility with non-meningitis infections criteria were 100%. There was a high percentage of erythromycin resistance (45.7%). The factors favouring resistance to penicillin and cefotaxime were the consumption of antibiotics in the previous month and the carrying of vaccine serotypes. On the other hand, the age of 4 years old was a protective factor of resistance. The 14, 35B, 19A, 15A, and 19F serotypes were less susceptible to penicillin. CONCLUSIONS: Both oral amoxicillin given to outpatients and intravenous penicillin or ampicillin to hospitalized patients are excellent options for the treatment of non-meningeal infections, as seen with pneumonia in these kinds of environments, where there is low incidence of isolates highly resistant to penicillin (CMI ≥ 2mg/L).

[Analysis of the bacteriologic data obtained with a double-lumen distally-plugged telescopic catheter in the diagnosis of pulmonary infiltrates in patients on low mechanical ventilation]. / Análisis de la información bacteriológica aportada mediante catéter telescopado de doble luz y oclusión distal en el diagnóstico de infiltrados pulmonares en pacientes bajo ventilación mecánica.

In order to assess the bacteriology of bronchial secretion samples, 40 patients in the intensive care unit who had developed fever and pulmonary infiltrates during mechanical ventilation have been studied. In each patient bronchial secretion samples were obtained by a double lumen distally-plugged telescopic catheter (DTC) inserted under direct view through the fiber bronchoscope (FB) as well as from simple bronchial aspiration (SBA) done simultaneously. A week later DTC and SBA were repeated. A statistically significant difference was found between the positive cultures obtained by SBA and those obtained by DTC (p less than 0.005). However, in 9 samples (14.27%) other microorganisms were isolated with DTC which were not detected by SBA and a lower number of colonizing microorganisms were found by DTC (p less than 0.05). The isolation of microorganisms by DTC allowed more precise management and moreover, a better clinical course was observed in those patients in whom chemotherapy was based on the data given by DTC. The relationship between the cultures obtained by DTC and the previous antibiotic treatment was statistically significant, finding a greater number of positive cultures when they were taken 2 hours after the last doses of the antibiotic. This relationship was not found in the cultures obtained with SBA. The most frequently isolated microorganisms were diverse types of Pseudomonas and Acinetobacter. No complication caused by the techniques arose.