Antibioterapia empírica en el pie diabético y no diabético / Empirical antibiotic therapy for diabetic and non-diabetic foot

Introducción. La neuropatía, la isquemia y la infección son los tres factores directamente relacionados con la aparición y desarrollo de las úlceras en los pacientes diabéticos. La infección definida mediante parámetros clínicos y apoyada por cultivos microbiológicos es el principal factor pronóstico de la lesión. Objetivo. Estudiar la etiología infecciosa de las úlceras en pacientes diabéticos y no diabéticos, así como la sensibilidad in vitro a antimicrobianos de los microorganismos aislados, nos permitirá establecer la mejor pauta antibiótica empírica en nuestro medio asistencial. Pacientes y métodos. Estudio observacional, transversal y prospectivo de 200 pacientes consecutivos, diabéticos y no diabéticos, ingresados por la presencia de úlceras isquémicas o neuropáticas con signos locales de infección. Toma de tres muestras microbiológicas el día del ingreso previa administración del tratamiento empírico (ciprofloxacino + clindamicina) y valoración de su respuesta clínica y sus modificaciones a específico por resistencia de los microorganismos. Resultados. En la mayoría de los cultivos se aisló microbiota polimicrobiana con predominio de aerobios-anaerobios gramnegativos y aerobios grampositivos. Staphylococcus aureus (10,6%), Pseudomonas aeruginosa y Bacteroides fragilis fueron los microorganismos más frecuentemente aislados. La terapia empírica tuvo que modificarse en más del 50% de los casos por resistencia. La mayor sensibilidad in vitro para los microorganismos grampositivos fue para la vancomicina, seguida de cloxacilina y amoxicilina/clavulánico. En el caso de aerobios-anaerobios gramnegativos, fue para meropenem, tobramicina e imipenem, y para los anaerobios, imipenem, cefoxitina y amoxicilina/clavulánico. Conclusiones. La administración de amoxicilina/clavulánico solo o asociado a tobramicina constituye una pauta antibiótica con amplio espectro para los pacientes ambulatorios. En régimen de ingreso el antibiótico de elección sería imipenem, seguido de piperacilina/tazobactam

Introduction. Neuropathy, ischaemia and infection are the three factors directly related to the appearance and development of ulcers in diabetic patients. Infection defined by means of clinical parameters and backed up by microbiological cultures is the main prognostic factor of the lesion. Aims. To study the infectious causation of ulcers in diabetic and non-diabetic patients, in addition to the in vitro sensitivity to antimicrobials of the microorganisms that were recovered, in order to enable us to develop a better empirical antibiotic regimen in our health care area. Patients and methods. We conducted a prospective, cross-sectional, observational study involving 200 consecutive diabetic and non-diabetic patients who were admitted to hospital due to the presence of ischaemic or neuropathic ulcers with local signs of infection. Three microbiological samples were taken on the day of admission before administration of the empirical treatment (ciprofloxacin + clindamycin) and their clinical response and modifications in the specific due to resistance of the microorganisms were evaluated. Results. Polymicrobial microbiota were recovered from most of the cultures, with predominance of gram-negative aerobic-anaerobics and gram-positive aerobics. Staphylococcus aureus (10.6%), Pseudomonas aeruginosa and Bacteroides fragilis were the most frequently recovered micro-organisms. The empirical therapy had to be modified in over 50% of cases due to resistance. The highest sensitivity in vitro for the grampositive micro-organisms was to vancomycin, followed by cloxacillin and amoxicillin/clavulanic acid. In the case of gram-negative aerobic-anaerobics, it was found to be meropenem, tobramycin and imipenem, while the anaerobics were seen to be more sensitive to imipenem, cefoxitin and amoxicillin/clavulanic acid. Conclusions. Administration of amoxicillin/ clavulanic acid alone or in association with tobramycin constitutes a wide-spectrum antibiotic regimen for outpatients. If the patient is hospitalised, the preferred antibiotic would be imipenem, followed by piperacillin/ tazobactam

Endophthalmitis caused by Mycobacterium abscessus.

PURPOSE: To describe the clinical and laboratory features of a case of endophthalmitis caused by Mycobacterium abscessus in a patient immunocompetent. METHODS: case report. A 65-year-old woman with bilateral cataracts was treated by surgery with phacoemulsification and posterior chamber lens implantation. RESULTS: The funduscopic examination showed vitreous cells over the optic nerve head, chorioretinal infiltrates, and focal vasculitis. Vitreous humor aspirate disclosed acid-fast bacilli. In the culture on Löwenstein-Jensen medium grew colonies identified as M. abscessus. CONCLUSIONS: M. abscessus is cause of endophthalmitis and crystalline keratopathy. Risk factor include surgical intervention or exogenous contamination. Our patient has no systemic pathology predisposing to the development of endophthalmitis.

Microbiological characteristics and susceptibility patterns of strains of Rhodotorula isolated from clinical samples.

The members of the genus Rhodotorula show a marked ubiquity. In man, they have been isolated from faeces, nails, skin, sputum, digestive tract and adenoids, forming part of the normal human flora, although in recent years cases have been reported of both local and systemic infection by this yeast. There are virtually no studies in the literature on the sensitivity of this genus to the antifungal agents in common clinical use. Therefore, it is considered of interest to study the microbiological characteristics and the susceptibility patterns of Rhodotorula isolated from clinical samples. A total of 35 different strains of Rhodotorula were studied. In vitro susceptibility testing to 5-fluorocytosine, amphotericin B, ketoconazole, fluconazole and itraconazole was performed. All the strains were considered sensitive to 5-fluorocytosine, amphotericin B, ketoconazole and itraconazole and resistant to fluconazole. As a conclusion, we can state that all the antifungal agents tested, except fluconazole, are useful medicaments for the treatment of infections by the Rhodotorula genus.

Multivariate analysis of risk factors for infection due to penicillin-resistant and multidrug-resistant Streptococcus pneumoniae: a multicenter study.

Pneumococcal disease was studied prospectively to determine the risk factors associated with resistance to penicillin and other antibiotics. One hundred twelve clinically significant pneumococcal isolates were recovered from 95 patients. Approximately one-half (49.47%) of the cases were due to penicillin-resistant strains. Multivariate analysis showed that previous use of beta-lactam antibiotics (odds ratio [OR], 2.81; 95% confidence interval [CI], 0.95-8.27), alcoholism (OR, 5.22; 95% CI, 1.43-19.01), and noninvasive disease (OR, 4.53; 95% CI, 1.54-13.34) were associated with penicillin resistance, whereas intravenous drug use (OR, 0.14; 95% CI, 0.03-0.74) was not. Statistical analyses of the variables associated with resistance to multiple antibiotics detected age of younger than 5 years (OR, 16.79; 95% CI, 1.60-176.34) or of 65 years or older (OR, 4.33; 95% CI, 1.42-13.21) and previous use of beta-lactam antibiotics by patients with noninvasive disease (OR, 7.92; 95% CI, 1.84-34.06) as parameters associated with increased risk. We conclude that multivariate analysis provides clues for empirical therapy for pneumococcal infection.

[Nocardiosis in a patient with AIDS]. / Nocardiosis en paciente con SIDA.

A young drug addict with positive anti-HIV antibodies, OKT4/OKT8 ratio below 1, oropharingeal candidiasis and pulmonary Pneumocystis carinii infection, dies due to a cerebral abscess with a septic status. The postmortem microbiologic study shows pulmonary abscesses and Nocardia asteroides is isolated from lung tissue and spinal fluid. We note out the rareness of this pathology and its relation to AIDS.

[Atypical epidemic outbreak of gastroenteritis caused by rotavirus]. / Brote epidémico atípico de gastroenteritis por rotavirus.

An outbreak of Rotavirus gastroenteritis in children from 1 month to 7 years of age, detected during the summer months with the highest incidence being in August, is described here. After studying the different factors which may be related to this outbreak, it appears that the humid climatic characteristics together with the social habits of our region may have been the causes which unleashed the epidemic.

[Branhamella catarrhalis in respiratory infections]. / Branhamella catarrhalis en infecciones respiratorias.

Given the increasing interest that Branhamella catarrhalis is acquiring as a possible pathogen of the respiratory tract, we have studied 81 sputum samples of patients with respiratory problems with the aim of evaluating its clinical significance. In 22 of these patients (27.2%) the implication of B. catarrhalis could be established, either as a primary pathogen (40.9%) or in association with other pathogens, especially with Haemophilus influenzae (36.4%). Chronic bronchitis and bronchopneumonia were the clinical manifestations more frequently associated with B. catarrhalis. 79.0% of the strains were beta-lactamase producers, although only 58.0% of them were resistant to ampicillin.

[Clostridium septicum bacteremia in a diabetic patient (author's transl)]. / Bacteriemia por Clostridium septicum en un paciente diabético.

This report concerns the clinical and bacteriological study of a female diabetic who presented with a febrile illness of sudden onset and acute toxemia. Physical examination at admission was unrewarding. A few hours after admission lesions characteristic of gas gangrene appeared in the right upper limb without prior trauma, and a clostridial infection was suspected. Bacteriological studies of the exudate and of the patient's blood led to the isolation of Clostridium septicum, thus confirming the clinical suspicion. The disease had a precipitous course and the patient died 12 hours after admission in spite of the administration of high doses of intravenous penicillin. While waiting for bacteriological data, early antibiotic treatment appears to be indicated in any diabetic patient with an acute toxic syndrome and absence of localized infection.

[Antibiotic resistance of Shigella strains isolated in Cádiz (author's transl)]. / Resistencia a los antibióticos en cepas de Shigella aisladas en Cádiz.

The incidence of shigellosis at the Residencia Sanitaria Fernando Zamacola (Cáciz, Spain) and the antibiotic sensitivity of 94 strains of Shigella sonnei and 40 strains of Shigella flexneri, isolated during the year 1979, has been studied taking into account the present status of strain resistance to the major antibiotics. Three epidemic bouts of shigellosis were detected: one in february by Shigella sonnei (16 cases), and two others in august-september and november due to Shigella flexneri (43 and 29 cases). Children 2 to 5 years old had the highest incidence of Shigella infection. Almost all strains isolated were resistant to the sulphonamides (99.77%). Ampicillin and chloramphenicol had little efficacy against Shigella flexneri (95.00 and 92.50% resistance). The percent resistance of Shigella sonnei strains to phosphomycin was elevated (44.69%). All strains studied were sensitive to colimycin and showed little resistance to the combination trimethoprim-sulfamethoxazol (16.42%).

[Epidemic outbreak of bacillary dysentery by "Shigella sonnei" in a kindergarten (author's transl)]. / Brote epidémico de disentería bacilar con Shigella sonnei en una guardería.

An epidemic outbreak, caused by "Shigella sonnei" in a kindergarten, affecting a high percentage of children aged two to seven years is described. On searching into the sensitivity is isolated strains to a wide range of antibiotics, it was observed that all them showed resistance to sulphonamides and a 57.19% were also resistant to phosphomycin. After doing the pertinent investigations and epidemiological analysis possible mechanisms of illness, transmission and dissemination are studied, evaluating the clinical symptoms that these children showed as well as the clinical course after treatment with ampicillin.