What do beta-lactams add to vancomycin or daptomycin in the treatment of patients with methicillin-resistant Staphylococcus aureus bacteraemia? A review.

Several studies have documented the synergy between vancomycin/daptomycin and various beta-lactams, and clinical studies have studied this combination therapy in humans. We review the published literature on this topic to know the utility of the combined treatment with beta-lactams in treating bacteraemia methicillin-resistant Staphylococcus aureus (MRSA) infections. Fifteen observational studies, three randomised clinical trials and three systematics reviews are analysed in this article. Observational studies used ceftaroline, cefazolin, piperacillin/tazobactam or cefepime among the beta-lactams. Clinical trials used cloxacillin or flucloxacillin as the most used beta-lactam in two trials and ceftaroline in one. Three systematic reviews are published. One of them only includes studies with vancomycin and included six studies. The other two systematic reviews include patients with daptomycin or vancomycin and included 15 and 9 studies, respectively. Adding a beta-lactam to vancomycin or daptomycin may help shorten bacteraemia and avoid recurrences in patients with MRSA bacteraemia. There is no evidence that combined therapy improves mortality. Nephrotoxicity in clinical trials precludes the use of combination therapy mainly with cloxacillin or flucloxacillin, but systematic reviews have not found a significant difference in this point in observational studies with other beta-lactams. The role of other beta-lactams such as ceftaroline should be thoroughly studied in these patients.

Current Evidence on the Antimicrobial Treatment and Chemoprophylaxis of Human Leptospirosis: A Meta-Analysis.

BACKGROUND: Leptospirosis is a worldwide zoonotic infection, and its management needs to be refined. This study aims to discern which antibiotic would be the best option to treat leptospirosis disease and analyze the efficacy of chemoprophylaxis regimens to prevent this illness. METHODS: systematic review and meta-analysis on the efficacy of antibiotic treatment and chemoprophylaxis of leptospirosis in humans. RESULTS: Ten clinical trials compared an antibiotic treatment with placebo or other antibiotic treatments in leptospirosis (the most recent one was published in 2007). The meta-analysis shows no effect of penicillin treatment on mortality compared to placebo (OR 1.65; 95% CI 0.76-3.57; p = 0.21). There are no differences between penicillin and cephalosporins or doxycycline. Penicillin does not reduce the time of defervescence (MD-0.16; 95% CI (-1.4) -1.08; p = 0.80) nor hospital stay (MD 0.15; 95% CI (-0.75)-1.06; p = 0.74). Besides, the data did not demonstrate any effectiveness of the use of penicillin in terms of the incidence of oliguria/anuria, the need for dialysis treatment, time to creatinine normalization, incidence of jaundice, or the liver function normalization time. Eight trials have assessed prophylactic treatment against leptospirosis with different strategies. A weekly dose of 200 mg of doxycycline does not show benefit versus placebo regarding the number of new cases of symptomatic leptospirosis (OR 0.20; 95% CI 0.02-1.87; p = 0.16). A single dose of doxycycline at exposure to flood water could have a beneficial effect (OR 0.23; 95% CI 0.07-0.77; p = 0.02). None of the other chemoprophylaxis regimens tested have shown a statistically significant effect on the number of new symptomatic cases. CONCLUSION: There is no evidence that antibiotics are a better treatment than placebo regarding mortality, shortening of fever, liver and kidney function, or reduction in the hospital stay. On the other hand, neither doxycycline nor penicillin, nor azithromycin have shown statistically significant differences in preventing symptomatic infection. Well-designed clinical trials, including other antibiotics such as quinolones or aminoglycosides, are urgently needed to improve our understanding of the treatment for this infection, which continues to be a neglected disease.

Pancreatitis Aguda Recidivante por Ascaris Lumbricoides / Acute necrotising pancreatitis by ascaris lumbricoides

La ascariasis es la parasitosis más frecuente de todas las helmintiasis en humanos. Los efectos patológicosproducidos por los áscaris en el hombre se presentan en lugares diversos, de acuerdo con la localizaciónde sus distintas formas evolutivas. La ascariasis biliar en una de las complicaciones más severas.Presentamos un caso de pancreatitis aguda producida por infestación por Áscaris

Ascariasis is the commonest parasitosis of all human helminths. The pathological effects that ascaris producesin man manifest in different locations, in accordance with the location of its different evolutionaryforms. Biliary ascaris is one of the severest complications. We present a case of acute pancreatitis produced by Ascaris infestation

Neumonía recurrente como manifestación de infección por Nocardia / Recurrent pneumonia as a manifestation of Norcardia infection

La nocardiosis es una enfermedad invasiva producida por especies del género Nocardia, bien a travésde la inhalación o la inoculación cutánea. Se presentan dos casos de neumonía por Nocardia en pacientes inmunodeprimidos

Nocardiosis is an invasive disease caused by the Norcardia species, either through inhalation orcutaneous inoculation. We report two cases of pneumonia caused by Norcadia in immunodepressed patients

Cefalea crónica como manifestación de Cisticercosis / Chronic headaches as a manifestation of C ysticercosis

La cisticercosis es una enfermedad parasitaria que ocurre como consecuencia de la infección por el estado invasivo de la taenia solium, que se produce cuando el hombre se convierte, de forma accidental, en el huésped intermediario al ingerir huevos en la carne de cerdo contaminado. Presentamos un caso de neurocisticercosis con clínica de cefalea crónica (AU)

Cysticercosis is a parasitic disease that occurs as a consequence of infection by the invasive stage of taenia solium, which occurs when man accidentally becomes an intermediate host after ingesting the eggs in pork from contaminated pigs. We present a case of neurocysticercosis with chronic clinical headache (AU)

[Incidence of infectious spondylitis in the province of Albacete (Spain)]. / Incidencia de la espondilitis infecciosa en la provincia de Albacete.

BACKGROUND: Infectious spondylitis (IS) is an infrequent disease, although there are few data on its real incidence. To date, only one study, carried out in Denmark, that rigorously assesses the incidence of this disease has been published. OBJECTIVES: To determine the incidence of IS in the nonpediatric population of the province of Albacete, and to analyze differences according to etiology, age, sex, and geographical area. METHODS: We carried out a retrospective search of all the IS cases diagnosed in the province of Albacete during the period 1990-2002 and calculated the adjusted incidence rates using census data. RESULTS: The incidence of IS was 2.40 cases/10(5) inhabitants/year. Brucellar spondylitis had an incidence of 1.18 cases/10(5) inhabitants/year, with a predominance in the rural area and in men. Distribution by age was bimodal, with a first peak around 40 years old and a second peak around 60 years old. The incidence has significantly decreased in the last few years. Pyogenic spondylitis (incidence of 0.64 cases/10(5) inhabitants/year) showed a maximum incidence at around 60 years old, while its distribution by sex and geographical area was more uniform. Tuberculous spondylitis had an incidence of 0.45 cases/10(5) inhabitants/year and its frequency increased with age. CONCLUSION: The incidence rates of IS were higher than those reported in most previous studies, although they were similar to those observed in the most rigorous reports. These findings suggest that the frequency of IS could have been underestimated. The three etiologic groups analyzed showed distinct epidemiological profiles.

Incidencia de la espondilitis infecciosa en la provincia de Albacete / Incidence of infectious spondylitis in the province of Albacete (Spain)

Antecedentes. La espondilitis infecciosa es una enfermedad infrecuente, aunque existen pocos datos sobre su incidencia real. Hasta la fecha, sólo se ha publicado un estudio, realizado en Dinamarca, que valora de forma rigurosa su incidencia. Objetivos. Conocer la incidencia de espondilitis infecciosa en la población no pediátrica de la provincia de Albacete, así como el comportamiento por etiologías, grupos de edad y sexo y zonas geográficas. Métodos. Búsqueda retrospectiva de todos los casos diagnosticados de espondilitis infecciosa en la provincia de Albacete durante el período 1990-2002, calculando las tasas de incidencia ajustadas, a partir de los datos censales. Resultados. La incidencia de espondilitis infecciosa fue de 2,40 casos/10 5 habitantes/año. La incidencia de la espondilitis infecciosa brucelar fue 1,18 casos/10 5 habitantes/año, con predominio en la zona rural y en varones y con una distribución por edad bimodal (con un primer pico de incidencia alrededor de los 40 años y un segundo a los 60 años). Su incidencia se ha reducido de forma importante en los últimos años. La espondilitis infecciosa piógena (incidencia de 0,64 casos/10 5 habitantes/año) mostró un pico de incidencia alrededor de los 60 años y un comportamiento por sexo y por zonas geográficas mucho más uniforme. La espondilitis infecciosa tuberculosa tuvo una incidencia de 0,45 casos/10 5 habitantes/año y su frecuencia aumentó con la edad. Conclusión. Se obtuvieron tasas de incidencia superiores a la mayoría de los estudios previos y sólo comparables a los estudios más rigurosos, lo que sugiere que la incidencia de espondilitis infecciosa puede haber sido subestimada. Los tres grupos etiológicos del estudio mostraron un comportamiento epidemiológico distinto (AU)

Background. Infectious spondylitis (IS) is an infrequent disease, although there are few data on its real incidence. To date, only one study, carried out in Denmark, that rigorously assesses the incidence of this disease has been published. Objectives. To determine the incidence of IS in the nonpediatric population of the province of Albacete, and to analyze differences according to etiology, age, sex, and geographical area. Methods. We carried out a retrospective search of all the IS cases diagnosed in the province of Albacete during the period 1990-2002 and calculated the adjusted incidence rates using census data.Results. The incidence of IS was 2.40 cases/10 5 inhabitants/year. Brucellar spondylitis had an incidence of 1.18 cases/10 5 inhabitants/year, with a predominance in the rural area and in men. Distribution by age was bimodal, with a first peak around 40 years old and a second peak around 60 years old. The incidence has significantly decreased in the last few years. Pyogenic spondylitis (incidence of 0.64 cases/10 5 inhabitants/year) showed a maximum incidence at around 60 years old, while its distribution by sex and geographical area was more uniform. Tuberculous spondylitis had an incidence of 0.45 cases/10 5 inhabitants/year and its frequency increased with age. Conclusion. The incidence rates of IS were higher than those reported in most previous studies, although they were similar to those observed in the most rigorous reports. These findings suggest that the frequency of IS could have been underestimated. The three etiologic groups analyzed showed distinct epidemiological profiles (AU)