Documento de consenso sobre el tratamiento antimicrobiano de las infecciones bacterianas odontogénicas / Consensus statement on antimicrobial treatment of odontogenic bacterial infections

Las infecciones de la cavidad bucal son un problema de salud pública frecuente y motivo constante de prescripción antibiótica; el 10% de los antibióticos se emplean para tratar este problema. Sin embargo, hasta la fecha son pocos los estudios realizados para determinar su incidencia. Asimismo, su relación con ciertas enfermedades sistémicas (cardiacas, endocrinas, etc...) confiere a estas patologías una importancia vital. A pesar de la reconocida frecuencia e importancia de las infecciones odontogénicas, llama la atención la actual dispersión de criterio en varios aspectos referentes a su clasificación, terminología y recomendaciones terapéuticas. El objetivo principal de este documento, realizado con el consenso de especialistas en microbiología y odontología, es establecer unas recomendaciones útiles para todos los profesionales implicados en el manejo clínico de estas patologías. Recibe especial atención el aumento de la prevalencia de resistencias bacterianas observado durante los últimos años y, en concreto, la proliferación de cepas productoras de betalactamasas. Otro factor causal importante de la aparición de resistencias es la falta de cumplimiento terapéutico, en especial en lo que respecta a la dosis y a la duración del tratamiento. Así pues, estas patologías constituyen un problema complejo cuyo abordaje requiere la instauración de antimicrobianos de amplio espectro, con adecuados parámetros farmacocinéticos, con buena tolerancia y una posología cómoda que permita que el paciente reciba la dosis adecuada durante el tiempo necesario. Amoxicilina/ácido clavulánico a dosis altas (2000mg/ 125mg) ha demostrado buenos resultados y capacidad para superar resistencias. Otros agentes como metronidazol y clindamicina, seguidos de claritromicina y azitromicina han demostrado también ser activos frente a la mayoría de los microorganismos responsables de las infecciones odontogénicas (AU)

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc…) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg / 125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection (AU)

[Bacterial content of the enucleated prostate gland]. / Contenido bacteriano de la glándula prostática enucleada.

OBJECTIVE: To determine the prevalence of prostatic colonization or infection in patients undergoing prostatic surgery for obstructive symptoms due to benign hyperplasia of the prostate (BPH), to identify and quantitate the microorganisms isolated in quantitative bacterial tissue cultures, and to determine the influence of open surgery vs endoscopy on the microbiological findings. METHODS: A prospective study was conducted on 175 patients undergoing surgery for BPH. All patients were entered into a study protocol that included quantitative bacterial cultures of prostatic tissue. Data of previously defined variables were entered into a data base for subsequent analysis comprised of redefinition of the variables and descriptive and analytical studies. RESULTS: 44 of the 175 patients (25.1%) had a positive bacterial culture of prostatic tissue. Histological lesions indicating prostatitis associated with BPH were found in 68 of the 175 patients (38.9%), regardless of the presence or absence of bacteria. Of these 68 patients with histologically demonstrated prostatic inflammation, only 19 (27.9%) had a positive prostatic tissue culture. The incidence of granulomatous prostatitis was 1.1%. CONCLUSIONS: The presence of bacteria was demonstrated in prostates of a significant number of patients (25.1%) undergoing prostatectomy for BPH. The microorganisms most frequently isolated in the quantitative bacterial cultures were, by order of frequency, coagulase negative Staphylococci, Escherichia coli and Enterococcus faecalis, which were present in concentrations of at least 10(4) CFU/Gm in prostatic tissue of 79.6% of the cases. No differences were found between the type of procedure the patient underwent and the presence or absence of prostatic infection.

[Inflammatory changes in the obstructed prostate: the correlation between the bacteriological and histological findings]. / Cambios inflamatorios en la glándula prostática obstructiva: correlación entre los hallazgos bacteriológicos e histológicos.

OBJECTIVES: To analyze the incidence and nature of the prostatic inflammatory changes, to determine the prevalence of prostatic colonization or infection in patients undergoing surgery for benign hyperplasia of the prostate (BPH) and to correlate the inflammatory lesions with the bacteriological findings. METHODS: A prospective study was conducted on 175 patients undergoing surgery for BPH. All patients were entered into a study protocol that included quantitative bacterial cultures of the prostatic tissue and histological analyses of the surgical specimens. Data of previously defined variables were entered into a data base for subsequent analysis comprised of a descriptive and an analytical study. RESULTS: 44 of the 175 patients (25.1%) had a positive bacterial culture of prostatic tissue. Histological lesions indicating prostatitis associated with BPH were found in 68 of the 175 patients (38.9%), regardless of the presence or absence of bacteria. Of these 68 patients with a histologically demonstrated inflammation of the prostate, only 19 (27.9%) had positive prostatic tissue cultures. The incidence of granulomatous prostatitis was 1.1%. CONCLUSIONS: Histological lesions indicating prostatitis associated with BPH were found in 68 of the 175 patients (38.9%). The presence of bacteria was demonstrated in the prostates of a significant number of patients (25.1%) who underwent adenomectomy for BPH. No differences were found between the patients with a positive or negative bacterial culture and histological evidence of prostatitis.

[Relationship between preoperative urine cultures and prostatic gland cultures in patients treated for benign prostatic hyperplasia]. / Relación entre los cultivos de orina preoperatorios y los cultivos de la glándula prostática en pacientes intervenidos de HBP.

OBJECTIVES: 1.--Investigate the bacteriuria preoperative in patients who will be operate on for Being Prostatic Hyperplasia (BPH). 2.--Define the prevalence of the prostatic colonization or infection. 3.--Try to correlate the bacteriological findings of urine and prostate, and find the degree of concordance between the microorganisms which can be commonly found in urine and prostatic tissue. METHOD AND MATERIALS: Prospective series of 175 patients undergoing prostatectomy for obstructive symptoms. The protocol revealed, among others variables: the preoperative urine culture; the presence or the absence of catheter; and the quantitative bacteriological culture of prostatic tissue. The information could be analised and its results could be obtained later on. The analysis stages consisted of both a descriptive and an analytic study. RESULTS AND CONCLUSIONS: 1.--Only 36 patients (20.6%) presented bacteriological increase of microorganisms (> or = 10(4) UFC/ml) in the preoperative urine culture. The Escherichia coli was the most common microorganism, followed by the Enterococcus faecalis, coagulase-negative Staphylococcus and the Pseudomona aeruginosa. A single microorganism grew in 31 out of the 36 positive cultures. 2.--The prevalence of the infection or colonization of the prostatic tissue was 25.1% (44 patients). The most common isolated microorganism was the coagulase-negative Staphylococcus followed by the Escherichia coli and the Enterococcus faecalis, in concentrations of at least 10(4) UFC/gr of tissue in the 79.6%. A single microorganism was isolated in 32 out of 44 patients. 3.--The proportion of positive prostatic cultures, in patients with positive urine culture (38.3%), was significantly higher than the one obtained in patients with negative urine cultures (16.5%) (p < 0.0001). Nevertheless, 52.3% of the 44 patients with positive prostatic cultures had negative urine culture, and only 21 (58.3%) out of the 36 patients with positive urine cultures presented a bacteriological growth in prostate. The degree of concordance (Kappa index) between the microorganisms which were found in preoperative urine and prostatic tissue is low or none for the majority of them.

["In vitro" study of the bacteriocinogenic capacity of Streptococcus mutans]. / Estudio "in vitro" de la capacidad bacteriocinógena de Streptococci mutans.

In our paper the bacteriocinogen ability of some subspecies of Streptococci mutans has been studied. We have obtained a production percentage of 50%. That production ability was bigger for subspecies mutans than sobrinus in a significative way, who strength the increasing differences between these microorganisms. A brief revision of the role that bacteriocins look like to play in oral ecologist equilibrium and their feasible utilization in dental caries prevention has been done.

[Bacteriocins of Streptococcus mutans: mutacins]. / Bacteriocinas de Streptococcus mutans: mutacinas.

A bioliographic survey about the production of a certain bactericidal substance (mutacins) by Streptococcus mutans has been done. The importance of bacteriocins of this micro-organism is due to its utility as a possible anti-caries agent performing as an influential factor in the colonization of the oral cavity, and also for serving for the typing of bacteria as an epidemiological "finger printing", determining the way of transmission of this micro-organism. Besides of stressing its clinical and epidemiological utility, we develop a review of other microbiological aspects.

Aplicación epidemiológica de un nuevo esquema de bacteriocinotipia para Proteus mirabilis / Epidemiological application of a new scheme of bacteriocinotyping for Proteus mirabilis

Se realizó un estudio epidemiológico de 81 enfermos infectados por Proteus mirabilis mediante la aplicación de un nuevo esquema de bacteriocinotipia, obteniéndose un 72.83% de tipificación y un total de 31 bacteriocinotipos. Se aplicó el mismo esquema a cepas de Proteus mirabilis aisladas, de los citados enfermos, de heces y/o faringe demostrando que 27,16% de los casos presentan coincidencia del tipo original con el obtenido en los otros especímenes, en un 72.84% no se detecta esta coincidencia

[Immunological profile against the hepatitis B virus in different population groups (author's transl)]. / Determinación del perfil immunológico frente al virus HVB en grupos de población.

To study the immunological profile against the hepatitis B virus 742 sera (107 from the Renal Unit and 635 from other hospital services) were assayed for HBsAg, HBsAc, and HBcAc. The results obtained appear to indicate that the simultaneous determination of the three tests is unnecessary for diagnosis, although it is important for follow-up and prognosis. The isolated measurement of HBsAg is a good diagnostic test, but although it appears early it lasts little, a reason why it should perhaps be complemented with the other tests when considering the time factor. If only one technique is to be made available HBcAc determination seems necessary because it appears simultaneously with the HBsAg and it persists for a long time thereafter. A high degree of positivity of HBsAc and HBcAc was found in dialysis patients, a fact apparent also in the other population groups.

Actividad heterologa de las bacteriocinas de Klebsiella pneumoniae. / Heterologous activity of bacteriocins from Klebsiella pneumoniae

Se estudia la actividad de 8 cepas bacteriocinogenas de K. pneumoniae frente a 294 microorganismos pertenecientes a diversas especies bacterianas. Salmonella spp.,Arizona hinshawii, Citrobacter spp., S. marcescens, E. aerogenes, E. cloacae, Y. enterocolitica, E. coli y Shigella spp. fueron sensibles a una o mas cepas productoras de K. pneumoniae ensayadas

[Bacteriocinotyping of Klebsiella. A new scheme (author's transl)]. / Bactériocinotypie du genre Klebsiella. A propos d'un nouveau schéma.

A new typing scheme of the genus Klebsiella for studying the production and different sensitivities towards some standard strains is here proposed. Owing to it, 120 Klebsiellae could be classified. The most frequently bacteriocinotypes found were 778 and 768. The overall amount obtained was of 57 different models of activity. As six clinical experiences have confirmed its efficacy, the practical use may now be faced.