Bactibilia and Antibiotic Resistance in Elective Cholecysctectomy: An Updated Ecologic Survey.

BACKGROUND: The role of bactibilia as a risk factor for an unfavorable outcome during biliary disease or surgical procedures remains obscure. Our aim was to identify possible risk factors for bactibilia and their possible relations to complications after elective cholecystectomy. As secondary aims, composition and antibiotic resistance patterns were studied. METHODS: Bile and gallbladder mucosa samples from 358 elective cholecystectomies were collected prospectively between June 2009 and June 2012. Ordinary microbiologic cultures and antibiograms were performed. All pre-operative factors associated with bactibilia were studied by stepwise logistic regression multivariable analysis. RESULTS: The bacteria isolated most frequently from 103 positive cultures were Escherichia coli (21.3%), Enterococcus spp. (14.7%), and Enterobacter spp. (14.7%) with a global amoxicillin-clavulanic acid resistance rate of 53.7%. Age >65 y, male gender, previous instrumentation or disease of the biliary tract, and high American Society of Anesthesiologists score were independent risk factors. No correlation was found between bactibilia and surgical complications. CONCLUSIONS: Although the influence of bactibilia in developing surgical complications is limited, its composition and the high rate of resistance can be influential enough to modify antibiotic treatment in biliary tract infections, especially in high-risk patients.

[Serologic diagnosis of Mycoplasma pneumoniae infections]. / Diagnóstico serológico de las infecciones por Mycoplasma pneumoniae.

Mycoplasma pneumoniae is a human pathogen with worldwide distribution. This microorganism is a common cause (10-30%) of community-acquired pneumonia, also called primary atypical pneumonia because of the spectrum of clinical and radiological findings. The immune response is mainly based on rapid antibody production against peptide and glycolipid antigens derived from this microorganism. During the primary infection, IgM levels generally rise within the first week, and are then followed by an IgG response. Titers of IgG and IgA increase in reinfections. Microbiological diagnosis is based on specific antibody detection. Polymerase chain reaction (PCR) techniques performed on sputum or pharyngeal/nasopharyngeal exudates, as well as the development of multiplex PCR reactions allowing identification of M. pneumoniae and other respiratory pathogens, would by highly useful in routine diagnosis. The most common serological techniques are complement fixation, immunofluorescence, particle agglutination, and enzyme immunoassay. Diagnosis should be performed by selecting the most appropriate test according to functional criteria and population groups. Specific detection of IgM antibodies should not be included in the differential diagnosis in adults and young people. Diagnostic criteria including seroconversion or rising IgG titers may not be clinically useful, because of the time delay and the difficulty of obtaining a second serum specimen for testing, given the mildness of the clinical symptoms.

Diagnóstico serológico de las infecciones por Mycoplasma pneumoniae / Serologic diagnosis of Mycoplasma pneumoniae infections

Mycoplasma pneumoniae es un patógeno exclusivamente humano y de distribución universal. Es causa del 10-30% de las neumonías adquiridas en la comunidad que, por su forma de presentación clinicorradiológica, se denomina neumonían atípica primaria. La respuesta inmunitaria se manifiesta por la rápida producción de anticuerpos frente a antígenos proteicos y glucolipídicos del microorganismo. En la primoinfección se produce un incremento en forma de IgM durante la primera semana, seguido de IgG, y en las reinfecciones se genera una respuesta de IgG e IgA. El diagnóstico microbiológico se ha basado en la demostración de anticuerpos específicos. La aplicación de técnicas de reacción en cadena de la polimerasa en muestras de esputo o exudado faríngeo/nasofaríngeo y el desarrollo de técnicas de reacción en cadena de la polimerasa múltiple, que permiten detectar M. pneumoniae y otros patógenos respiratorios, pueden ser de elevada utilidad en laboratorios de diagnóstico clínico. Las técnicas serológicas aplicables más usuales son la fijación del complemento, la inmunofluorescencia, la aglutinación de partículas y el enzimoinmunoanálisis. Para realizar el diagnóstico se deben seleccionar las técnicas por criterios funcionales y, sobre todo, adecuado al grupo poblacional. La detección específica de IgM no se debe aplicar en infecciones en niños mayores ni en adultos. Tampoco el diagnóstico basado en la seroconversión o el incremento del título de IgG resulta práctico, pues es tardío y, además, es difícil obtener una segunda muestra de suero, dada la levedad del cuadro clínico

Mycoplasma pneumoniae is a human pathogen with worldwide distribution. This microorganism is a common cause (10-30%) of community-acquired pneumonia, also called primary atypical pneumonia because of the spectrum of clinical and radiological findings. The immune response is mainly based on rapid antibody production against peptide and glycolipid antigens derived from this microorganism. During the primary infection, IgM levels generally rise within the first week, and are then followed by an IgG response. Titers of IgG and IgA increase in reinfections. Microbiological diagnosis is based on specific antibody detection. Polymerase chain reaction (PCR) techniques performed on sputum or pharyngeal/nasopharyngeal exudates, as well as the development of multiplex PCR reactions allowing identification of M. pneumoniae and other respiratory pathogens, would by highly useful in routine diagnosis. The most common serological techniques are complement fixation, immunofluorescence, particle agglutination, and enzyme immunoassay. Diagnosis should be performed by selecting the most appropriate test according to functional criteria and population groups. Specific detection of IgM antibodies should not be included in the differential diagnosis in adults and young people. Diagnostic criteria including seroconversion or rising IgG titers may not be clinically useful, because of the time delay and the difficulty of obtaining a second serum specimen for testing, given the mildness of the clinical symptoms