Bacterial resistance

The widespread use of ␤-lactam antimicrobial agents as first-line therapy for the treatment of serious infections has led to the development of various resistances that have compromised the use of some agents. In certain countries, the lack of local or national surveillance programs limits the ability to detect these resistant strains and prevent their dissemination. A 10 medical center study in India was initiated to benchmark prevailing resistance rates for a range of bacterial pathogens to ␤-lactams, and it found high rates of ␤-lactamase-mediated resistance in Escherichia coli and Klebsiella spp. These rates included: cephalosporins (55.6-61.3% resistance), with extended-spectrum ␤-lactamase (ESBL) phenotypes noted in over 60% of E. coli isolates and in Salmonella spp. (3.2-8.1%). Imipenem, a carbapenem, was the only antimicrobial agent tested with 100% activity against Enterobacteriaceae. Cefpirome was the most active of the tested cephalosporins, and all were fully active against methicillin-susceptible staphylococci with the exception of ceftazidime. Molecular and susceptibility characterization of 52 selected ESBL-producing strains showed a high level of co-resistance with aminoglycosides and fluoroquinolones, and clonal dissemination of resistant strains within medical centers. Collaborative studies, such as those presented here, can accurately detect changes in resistance patterns, and their continued use may help limit the further development and spread of bacterial resistances in India.

Abstract The use of antimicrobial agents in aquaculture has resulted in the increase in the frequency of strains resistant to these agents. Potentially these resistant strains can have an impact on the therapy of fish diseases, the therapy of human diseases, or the environment ...

1 920 patients hospitalized in ICUs for an aggregate of 9 997 days acquired 249 DAIs, accounting for a rate of 13.0% and 24.9 DAIs per 1 000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 31.3 per 1 000 ventilator-days; the central venous catheter-associated bloodstream infections (CVC-BSI) rate was 7.7 cases per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 5.1 cases per 1 000 catheter-days. Extra mortality for VAP was 24.5% (RR 2.07, P < 0.001); for CVC-BSI the rate was 15.0% (RR 2.75, P = 0.028). Methicillinresistant strains accounted for 73.5% of all Staphylococcus aureus DAIs; 40.5% of the Enterobacteriaceae were resistant to ceftriaxone, 40.8% were resistant to ceftazidime, and 32.0% were resistant to piperacillin-tazobactam. Sixty-five percent of Pseudomonas aeruginosa isolates were resistant to ciprofloxacin, 62.0% were resistant to ceftazidime, 29.4% were resistant to piperacillin-tazobactam, and 36.1% were resistant to imipenem. Conclusions. The high rates of DAIs in the Peruvian hospitals in this study indicate the need for active infection control. Programs consisting of surveillance of DAIs and implementation of guidelines for infection prevention can ensure improved patient safety in the ICUs and throughout hospitals. ABSTRACT Key words Espichan MJ, et al. Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium. Rev Panam Salud Publica. 2008;24(1):16-24.

Sulfonamide antibiotics are persistent pollutants of aquatic bodies, known to induce high levels of bacterial resistance. We investigated the adsorption of sulfadiazine, sulfamethazine, and sulfachloropyridazine sulfonamides into a highly dealuminated faujasite zeolite (Y) with cage window sizes comparable to sulfonamide dimensions. At maximal solubility the antibiotics were almost completely (>90%) and quickly (t < 1 min) removed from the water by zeolite. The maximal amount of sulfonamides adsorbed was 18-26% DW of dry zeolite weight, as evidenced by thermogravimetric analyses and accounted for about one antibiotic molecule per zeolitic cage. The presence of this organic inside the cage was revealed by unit cell parameter variations and structural deformations obtained by X-ray structure analyses carried out using the Rietveld method on exhausted zeolite. The most evident deformation effects were the lowering of the Fd-3m real symmetry in the parent zeolite to Fd-3 and the remarkable deformations which occurred in the 12-membered ring cage window after sulfadiazine or sulfachloropyridazine adsorption. After sulfamethazine adsorption, zeolite deformation caused a lowering in symmetry up to the monoclinic P2/m space group. The effective and irreversible adsorption of sulfonamides into organophylic Y zeolite makes this cheap and environmentally friendly material a suitable candidate for removing sulfonamides from water.

Solution behaviour of enrofloxacin complexes with copper(II), nickel(II), cobalt(II) and zinc(II) in the presence and absence of 1, 10-phenanthroline was studied in aqueous solution, by potentiometry. The results obtained show that under physiological conditions (micromolar concentration range and pH 7.4) only copper(II) forms stable complexes. Binary copper(II)/enrofloxacin and ternary copper(II)/enrofloxacin/phenanthroline complexes were synthesised and characterized by elemental analysis, UV-visible spectroscopy and FTIR. The antimicrobial activity of these complexes and of copper(II)/enrofloxacin and copper(II)/enrofloxacin/ phenanthroline solutions, prepared by mixing of the individual components in the same stoichiometric proportion and concentration range used for the synthesised complexes, was tested against two different Escherichia coli strains. Although, at a glance, the results point to a possible use of both complexes as metalloantibiotics, a detailed analysis shows that, at biological concentrations, the copper(II) binary complex does not exist and the antimicrobial activity observed is a consequence of its dissociation into free enrofloxacin. Consequently, only the ternary complex seems worth pursuing as a possible antimicrobial agent candidate. Moreover, as the biological studies showed, both the synthesised complexes and the solutions prepared by mixing the components exhibited the same behaviour. Hence, a new, faster and accurate methodology to screen metalloantibiotics prior to synthesis of the complexes is proposed.

Our study examines the efficacy of Computer Assisted Scoring (CAS) of open-response text relative to expert human scoring within the complex domain of evolutionary biology. Specifically, we explored whether CAS can diagnose the explanatory elements (or Key Concepts) that comprise undergraduate students' explanatory models of natural selection with equal fidelity as expert human scorers in a sample of [1,000 essays. We used SPSS Text Analysis 3.0 to perform our CAS and measure Kappa values (inter-rater reliability) of KC detection (i.e., computer-human rating correspondence). Our first analysis indicated that the text analysis functions (or extraction rules) developed and deployed in SPSSTA to extract individual Key Concepts (KCs) from three different items differing in several surface features (e.g., taxon, trait, type of evolutionary change) produced ''substantial'' (Kappa 0.61-0.80) or ''almost perfect'' (0.81-1.00) agreement. The second analysis explored the measurement of humancomputer correspondence for KC diversity (the number of different accurate knowledge elements) in the combined sample of all 827 essays. Here we found outstanding correspondence; extraction rules generated using one prompt type are broadly applicable to other evolutionary scenarios (e.g., bacterial resistance, cheetah running speed, etc.). This result is encouraging, as it suggests that the development of new item sets may not necessitate the development of new text analysis rules. Overall, our findings suggest that CAS tools such as SPSS Text Analysis may compensate for some of the intrinsic limitations of currently used multiplechoice Concept Inventories designed to measure student knowledge of natural selection.

The increase of productivity in aquaculture has been accompanied by ecological impacts including emergence of a large variety of pathogens and bacterial resistance. These impacts are in part due to the indiscriminate use of chemotherapeutic agents as a result of management practices in production cycles. This review provides a summary of the use of probiotics for prevention of bacterial diseases in aquaculture, with a critical evaluation of results obtained to date. #

Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients. Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials. Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection. Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures. The cornerstones in the management of complicated intra-abdominal infections are both source control and antibiotic therapy. The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections, because inadequate and late control of septic source may have a negative effect on the outcomes. Recent advances in interventional and more aggressive techniques could significantly decrease the morbidity and mortality of physiologically severe complicated intra-abdominal infections, even if these are still being debated and are yet not validated by limited prospective trials. Empiric antimicrobial therapy is nevertheless important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance. Antimicrobial management is generally standardised and many regimens, either with monotherapy or combination therapy, have proven their efficacy. Routine coverage especially against Enterococci and candida spp is not always recommended, but can be useful in particular clinical conditions. A de escalation approach may be recommended in patients with specific risk factors for multidrug resistant infections such as immunodeficiency and prolonged antibacterial exposure. Therapy should focus on the obtainment of adequate source control and adequate use of antimicrobial therapy dictated by individual patient risk factors. Other critical issues remain debated and more controversies are still open mainly because of the limited number of randomized controlled trials.

La flora vaginal normal está constituida principalmente por especies de lactobacilos, estos y sus productos metabólicos son los garantes del equilibrio y protección del medio ambiente vaginal. Cuando existe un sobrecrecimiento de estos microorganismos, se genera un desbalance del ecosistema vaginal y se produce la entidad clínica denominada vaginosis citolítica, que se caracteriza por ocasionar un cuadro clínico indistinguible de la vulvovaginitis candidiásica. Existen muy pocos estudios sobre la fisiopatología y prevalencia de la vaginosis citolítica, lo que ha conllevado a que esta afección sea poco conocida y por ende, diagnosticada y tratada de forma incorrecta, ocasionando que las pacientes acudan repetidamente a su médico con un cuadro clínico recidivante de difícil manejo que constituye un verdadero problema tanto para las pacientes como para el clínico.

The skin changes in pregnancy can be either physiological (hormonal), changes in pre-existing skin diseases or development of new pregnancy specifi c dermatoses. Pregnancy-specifi c skin dermatoses include an ill-defi ned heterogeneous group of pruritic skin eruptions which are seen only in pregnancy. These include Atopic eruption of pregnancy, Polymorphic eruption of pregnancy, Pemphigoid gestationis and intrahepatic cholestasis of pregnancy. Atopic eruption of pregnancy is the most common of these disorders. Most skin eruptions resolve postpartum and require only symptomatic treatment. Antepartum surveillance is recommended for patients with pemphigoid gestationis and intrahepatic cholestasis of pregnancy as they carry fetal risk. This article deals with the classifi cation, clinical features and treatment of the specifi c dermatoses of pregnancy.

The increase of productivity in aquaculture has been accompanied by ecological impacts including emergence of a large variety of pathogens and bacterial resistance. These impacts are in part due to the indiscriminate use of chemotherapeutic agents as a result of management practices in production cycles. This review provides a summary of the use of probiotics for prevention of bacterial diseases in aquaculture, with a critical evaluation of results obtained to date. #

clinically relevant pathogens at high frequency. These results demonstrate that otherwise phenotypically sensitive strains may still be a genetic source for the evolution of resistance to clinically relevant antibiotics through integron-mediated recombination events.

Most studies related to healthcare-associated infection (HAI) were conducted in the developed countries. We sought to determine healthcare-associated infection rates, microbiological profile, bacterial resistance, length of stay (LOS), and extra mortality in one ICU of a hospital member of the International Infection Control Consortium (INICC) in Morocco.

Oxidising and non-oxidising biocides are commonly used in an attempt to control biofouling in industrial water systems. Many of these programmes, however, fail due to the incorrect selection and application of these chemical compounds. Knowledge of the organisms to be eliminated and system hydraulics are important operational parameters in ensuring the successful application of chemical control programmes. A further complicating factor is the build up of bacterial resistance to many of these compounds. One way of limiting resistance is the alternation of oxidising and non-oxidising biocides at the correct miminum inhibitory concentration and using these in combination with surface active compounds to dislodge any biofilm. A variety of surface monitoring techniques are in use in order to monitor the success of biofouling control programmes. Unfortunately none of these techniques are ideal and results have to be considered very carefully.

The longstanding, successful use of herbal drug combinations in traditional medicine makes it necessary to find a rationale for the pharmacological and therapeutic superiority of many of them in comparison to isolated single constituents. This review describes many examples of how modern molecular-biological methods (including new genomic technologies) can enable us to understand the various synergistic mechanisms underlying these effects. Synergistic effects can be produced if the constituents of an extract affect different targets or interact with one another in order to improve the solubility and thereby enhance the bioavailability of one or several substances of an extract. A special synergy effect can occur when antibiotics are combined with an agent that antagonizes bacterial resistance mechanisms. The verification of real synergy effects can be achieved through detailed pharmacological investigations and by means of controlled clinical studies performed in comparison with synthetic reference drugs. All the new ongoing projects aim at the development of a new generation of phytopharmaceuticals which can be used alone or in combination with synthetic drugs or antibiotics. This new generation of phytopharmaceuticals could lend phytotherapy a new legitimacy and enable their use to treat diseases which have hitherto been treated using synthetic drugs alone.

frecuentes fueron: Staphylococcus epidermidis (38,3%), Staphylococcus aureus (12%), Klebsiella sp (10%), Alcaligenes fecalis (4,6%), Acinetobacter sp (4%) y Pseudomonas aeruginosa (4%). S. epidermidis mostró sensibilidad de 100% a vancomicina, 90% a cefotaxima, 50% a amikacina y ampicilina y 37% a oxacilina. Klebsiella mostró sensibilidad de 100% a ciprofloxacina e imipenen, 44% a ceftriaxona, 20% a ceftazidima y 14% a ampicilina;

The problem of antimicrobial resistance surveillance in Europe has been debated extensively in many excellent documents issued by national committees that often assume the value of national guidelines. However, a comprehensive document addressing the whole matter from a European perspective, as well as reviewing its present status and drafting future perspectives, has been lacking. The present recommendations have been produced by the ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS) through a consensus process involving all members of the Study Group. The recommendations focus on the detection of bacterial resistance and its reporting to clinicians, public health officers and a wider-and ever-increasing-audience. The leading concept is that the basis for resistance monitoring is microbiological diagnostics. The prerequisites for resistance monitoring are findings of adequate quality and quantity, which have been recorded properly and evaluated correctly. Different types of surveillance studies should fulfil different requirements with regard to data collection and reporting, the expected use of data, and the prerequisites for networking such activities. To generate relevant indicators, bacterial resistance data should be reported using adequate denominators and stratification. Reporting of antimicrobial resistance data is necessary for selection of empirical therapy at the local level, for assessing the scale of the resistance problem at the local, national or international levels, for monitoring changes in resistance rates, and for detecting the emergence and spread of new resistances types. Any type of surveillance study should conclude, where appropriate, with a proposal for intervention based on the data obtained.

care units (ICUs) in three Brazilian hospitals that are members of the International Nosocomial Infection Control Consortium (INICC). Methods. Prospective cohort surveillance of DAIs was conducted in five ICUs in three city hospitals in Brazil by applying the definitions of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS). Results. Between April 2003 and February 2006, 1 031 patients hospitalized in five ICUs for an aggregate 10 293 days acquired 307 DAIs, a rate of 29.8% or 29.8 DAIs per 1 000 ICUdays. The ventilator-associated pneumonia (VAP) rate was 20.9 per 1 000 ventilator-days; the rate for central venous catheter-associated bloodstream infections (CVC-BSI) was 9.1 per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 9.6 per 1 000 catheter-days. Ninety-five percent of all Staphylococcus aureus DAIs were caused by methicillin-resistant strains. Infections caused by Enterobacteriaceae were resistant to ceftriaxone in 96.7% of cases, resistant to ceftazidime in 79.3% of cases, and resistant to piperacillintazobactam in 85.7% of cases. Pseudomonas aeruginosa DAIs were resistant to ciprofloxacin in 71.3% of cases, resistant to ceftazidime in 75.5% of cases, and resistant to imipenem in 27.7% of cases. Patients with DAIs in the ICUs of the hospitals included in this study presented extra mortality rates of 15.3% (RR 1.79, P = 0.0149) for VAP, 27.8% (RR 2.44, P = 0.0004) for CVC-BSI, and 10.7% (RR 1.56, P = 0.2875) for CAUTI. Conclusion. The DAI rates were high in the ICUs of the Brazilian hospitals included in this study. Patient safety can be improved through the implementation of an active infection control program comprising surveillance of DAIs and infection prevention guidelines. These actions should become a priority in every country. ABSTRACT Key words

More than two decades ago, enrofloxacin, a fluoroquinolone, was first used in Mexico and Latin America. This agent was and still is, regarded as the most potent antibacterial agent available in veterinary medicine. At first, it was dosed at a rate of 5 mg/kg/day and it was retailed in a 5% solution. Today the dose has been increased to 10 mg/kg/day, and it is commercially available in 10% solutions. This trend indicates a tendency towards increasing bacterial resistance, which coincides with vast amount, and unpublished communications of lack of clinical trials and reports of demonstrated bacterial resistance. Additionally, the availability in the market pharmaceutical analogs of uncontrolled quality, plus the careless use of the drug under field conditions may be more relevant to the perceived clinical failure than a hypothetical bacterial resistance surge. In this paper, an overview on the use and abuse of enrofloxacin is presented. Considering that understanding enrofloxacin is the most potent antibacterial so far found for veterinary medicine, authors regarded as important present the current status of the use of enrofloxacin in the poultry industry. The main pharmacological features of this drug are presented within the context of its use in Mexico and many Latin American settings, hoping with this, to improve the way in which enrofloxacin is given in daily clinical practice.

L o sviluppo della resistenza agli antibiotici mediata dalle beta-lattamasi a spettro esteso (ESBL) ha un impatto clinico significativo e rappresenta attualmente un importante problema di salute pubblica e fonte di preoccupazione per le autorità sanitarie. Le ESBL sono enzimi prodotti dai batteri Gram negativi che conferiscono resistenza alle penicilline, a tutte le cefalosporine e ad aztreonam, ma non ai carbapenemi e alle cefamicine e sono, inoltre, inibite dagli inibitori di beta-lattamasi [1-3]. L'insorgenza delle ESBL è stata associata all'introduzione, e all'uso diffuso, di cefalosporine ad ampio spettro e di aztreonam. La prima ESBL è stata scoperta in Germania nel 1983 e, da allora, il numero di ESBL descritte è aumentato drasticamente, così come la loro diffusione in tutto il mondo. Sebbene il consumo di antibiotici beta-lattamici sia universale, la distribuzione degli enterobatteri produttori di ESBL non è uniforme nelle diverse aree geografiche . Attualmente, le ESBL costituiscono un grave problema terapeutico ed epidemiologico, in particolare per le infezioni sostenute da Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca e Proteus mirabilis, ma anche da Salmonella spp., Proteus spp., Citro-bacter spp., Enterobacter spp., Morganella morganii, Serratia marcescens, Shigella dysenteriae, Pseudomonas aeruginosa e Burkholderia cepacia. I geni che codificano per questi tipi di enzimi sono facilmente trasmissibili, mediante plasmidi, fra organismi di generi e specie diversi, facilitandone la diffusione . Tra i fattori di rischio per lo sviluppo di infezioni sostenute da enterobatteri produttori di ESBL, sono da citare la somministrazione indiscriminata di cefalosporine di terza generazione, in particolare ceftazidime, la pregressa somministrazione di fluorochinoloni e aminoglicosidi, la degenza ospedaliera prolungata, la permanenza prolungata nelle Unità di Terapia Intensiva (UTI), la presenza di cateteri intravascolari e/o urinari, la ventilazione meccanica, l'emodialisi, le ulcere da decubito e la denutrizione. I batteri produttori di ESBL, contraddistinti da multiresistenza agli antibiotici e responsabili di infezioni ospedaliere, soprattutto nelle UTI, pongono notevoli difficoltà terapeutiche e aumentano la morbilità e la mortalità in ambito ospedaliero . K. pneumoniae ed E. coli sono i principali enterobatteri produttori di ESBL, con caratteristiche epidemiologiche diverse. La diffusione dei ceppi di K. pneumoniae produttori di ESBL è epidemica, generalmente clonale, e i fattori di rischio sono chiaramente correlati alle comorbilità del

Objective To systematically review the literature and, where appropriate, meta-analyse studies investigating subsequent antibiotic resistance in individuals prescribed antibiotics in primary care. Design Systematic review with meta-analysis. Data sources Observational and experimental studies identified through Medline, Embase, and Cochrane searches. Review methods Electronic searches using MeSH terms and text words identified 4373 papers. Two independent reviewers assessed quality of eligible studies and extracted data. Meta-analyses were conducted for studies presenting similar outcomes. Results The review included 24 studies; 22 involved patients with symptomatic infection and two involved healthy volunteers; 19 were observational studies (of which two were prospective) and five were randomised trials. In five studies of urinary tract bacteria (14 348 participants), the pooled odds ratio (OR) for resistance was 2.5 (95% confidence interval 2.1 to 2.9) within 2 months of antibiotic treatment and 1.33 (1.2 to 1.5) within 12 months. In seven studies of respiratory tract bacteria (2605 participants), pooled ORs were 2.4 (1.4 to 3.9) and 2.4 (1.3 to 4.5) for the same periods, respectively. Studies reporting the quantity of antibiotic prescribed found that longer duration and multiple courses were associated with higher rates of resistance. Studies comparing the potential for different antibiotics to induce resistance showed no consistent effects. Only one prospective study reported changes in resistance over a long period; pooled ORs fell from 12.2 (6.8 to 22.1) at 1 week to 6.1 (2.8 to 13.4) at 1 month, 3.6 (2.2 to 6.0) at 2 months, and 2.2 (1.3 to 3.6) at 6 months. Conclusions Individuals prescribed an antibiotic in primary care for a respiratory or urinary infection develop bacterial resistance to that antibiotic. The effect is greatest in the month immediately after treatment but may persist for up to 12 months. This effect not only increases the population carriage of organisms resistant to first line antibiotics, but also creates the conditions for increased use of second line antibiotics in the community.

Heavy metals are toxic to living organisms. Some have no known beneficial biological function, while others have essential roles in physiological reactions. Mechanisms which deal with heavy metal stress must protect against the deleterious effects of heavy metals, yet avoid depleting the cell of a heavy metal which is also an essential nutrient. We describe the mechanisms of resistance in Escherichia coli to two different heavy metals, mercury and copper. Resistance of E. coli to mercury is reasonably well understood and is known to occur by transport of mercuric ions into the cytoplasmic compartment of the bacterial cell and subsequent reductive detoxification of mercuric ions.

The antibiotic resistance among gram-positive and gram-negative pathogenic bacteria is of global health concern. This has prompted the development of new effective drugs. But the discovery and development of new drugs is slow, and the emergence of resistance to such new drugs, on the other hand, is rapid as well as continuous among the bacteria. Therefore, in tackling the emergence of antibiotic resistant pathogenic bacteria finding alternative ways is vital. This communication, based on the published scientific data, summarizes the antibacterial capacity of some naturally derived agents such as honey, phytocomponents, probiotics, and antimicrobial peptides that might bring new essence in biomedicine.

RESUMEn: Los Bancos de Leche Humana son centros especializados que garantizan un producto bacteriológicamente seguro a los niños que la reciben. Objetivo: Evaluar la calidad microbiológica de la leche humana procesada en el Banco de Leche del Hospital " Ruiz y Páez " , Ciudad Bolívar. Método: Se recolectaron 30 muestras de leche obtenidas por extracción mecánica, durante el período agosto-noviembre del año 2004, se analizaron microbiológicamente antes y después de su pasteurización. Los parámetros investigados fueron recuento de Bacterias Aerobias Mesófilas, Coliformes Totales, Coliformes Fecales, Escherichia coli, y Estafilococos coagulasa positivos. Resultados: La leche humana sin pasteurizar mostró una carga microbiana total con un máximo de 105 UFC/ml, representado por el recuento de aerobios mesófilos. En cuanto al recuento de estafilococos, en 76,7% (23 muestras) creció hasta 10 UFC/ml y Staphylococcus aureus, en 16,7% (5 muestras) se presentó en el orden de 10 UFC/ml. Con relación a los Coliformes Totales, sus recuentos fueron menor o igual 102 NMP/ml, Coliformes Fecales menor a 10 NMP/ml, no se encontró Escherichia coli. Luego de efectuar el proceso de pasteurización, se determinó la ausencia de microorganismos en todas las muestras analizadas. Conclusión: La leche humana distribuida a los niños de este hospital se encuentra dentro de los estándares microbiológicos demostrando ser apropiadas las condiciones bajo las cuales se pasteuriza la leche humana en el Banco de leche del Hospital " Ruiz y Páez ". Arch Venez Pueric Pediatr 71 (1): 05-12 Palabras Clave: Bancos de leche humana, Pasteurización, Leche materna, Calidad microbiológica. SUMMARY: The Human Milk Banks are specialized centers that guarantee a bacteriologicaly safe product for those children who receive it. Objective: To evaluate the microbiological quality of processed human milk at the Milk Bank of the Hospital Ruiz y Páez, of Ciudad Bolivar. Method: 30 milk samples were collected by mechanical extraction, during the period of August-November 2004. The samples were microbiologically analyzed before and after its pasteurization. The investigated parameters were counts of Aerobic Bacteria Mesophyla, Total Coliforms, Fecal Coliforms, Escherichia coli, and positive coagulase Staphylococci. Results: Human milk prior pasteurization showed a total microbial load with a maximum of 10º UFC/ml, which was represented by the count of mesophile aerobes. The count of Staphylococci, reached 10 UFC/ml in 76,7 % (23 samples), Staphylococcus aureus was present up to10 UFC/ml in 16,7% (5 samples). In relation with the total Coliforms, their counts were under or equal to 10 NMP/ml and fecal Coliforms under 10 NMP/ml. Escherichia coli was not found. After pasteurization, all samples were free from any type of microorganism. Conclusion: The human milk distributed to children of this hospital, is within microbiological standards, indicating that the conditions under which human milk is pasteurized at the Milk Bank of the Hospital Ruiz and Páez are appropriate. Arch Venez Pueric Pediatr 71 (1): 05-12

It is now a universally acknowledged fact that maggot therapy can be used successfully to treat chronic, long-standing, infected wounds, which have previously failed to respond to conventional treatment. Such wounds are typically characterized by the presence of necrotic tissue, underlying infection and poor healing. Maggot therapy employs the use of freshly emerged, sterile larvae of the common green- bottle

Bacterial pathogens are a potential cause when a mare fails to conceive to a fertile stallion on a well-managed breeding farm on one or more cycles in the same season. Furthermore, emerging bacterial resistance to commonly used (topical) antibiotics has been demonstrated. In this study, a total of 586 uterine swabs from mares with fertility problems were evaluated and the bacterial isolates were identified and measured for resistance to 10 antibiotics most commonly used during bacterial equine infection. Forty-nine percent of the examined mares were positive at bacteriological investigations. Amongst 347 successful isolations, 31.7% were Streptococcus group C and 18.4% Escherichia (E.) coli, both considered frequently associated with fertility problems. Determination of the antibiotic susceptibility pattern of Streptococcus group C (110 organisms) revealed that only the amoxicillin/clavulanic acid was highly active with 82.7% of the isolates being inhibited. For E. coli, a major number of drugs displayed a high potency.

Background: Recurrent acute pharyngotonsillitis remains a common illness in children and young adults and can lead to serious complications if not treated. cefpodoxime proxetil is a second-generation oral cephalosporin, which shows potent antibacterial activity against both Gram-positive and Gram-negative bacteria and high stability in the presence of beta-lactamases. Objective: We aimed to evaluate the efficacy of second-generation cephalosporins in the prophylaxis of recurrent pharyngotonsillitis in children. Methods: A total of 180 children aged between 4 and 14 years with recurrent pharyngotonsillitis were randomized to receive either cefpodoxime proxetil (100 mg twice a day, 6 days a month for 6 months) or placebo (at the same dosage). Results and conclusions: Our results show that treatment with cefpodoxime proxetil may be effective in reducing symptoms of recurrent pharyngotonsillitis and preventing recurrences without causing side effects or developing bacterial resistance.

Antimicrobial resistance of marine heterotrophic bacteria to different antimicrobials agents were evaluated in seawater, dry and wet sands from three marine recreational beaches with different pollution levels. In all studied beaches, the greatest frequencies of resistance were found in relation to penicillin. On Gonzaguinha, the most polluted beach, 72.3% of all isolated strains showed simple resistance, whilst 8.33% had multiple resistance. The values found on Ilha Porchat beach, were 70.8% and 6.9% for simple and multiple resistances, respectively. On Guaraú, the less polluted beach, only 35.3% of isolated strains had simple resistance. Multiple resistance was not observed. While samples from Gonzaguinha and Ilha Porchat beach showed isolated strains resistant to seven and six different antimicrobial agents, respectively, samples from Guaraú beach were resistant only to penicillin and erytromicin. The positive correlations obtained between the degree of seawater contamination and frequency and variability of bacterial resistance indicate that polluted marine recreational waters and sands are sources of resistant bacteria contributing thus, to the dissemination of bacterial resistance.

Background: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance. Methods: GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention. Results: A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%. Conclusion: A multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.

Researchers increasingly believe that microbial, molecular and synthetic biology techniques along with genetic engineering will facilitate the treatment of persistent infectious diseases. However, such therapy has been plagued by the emergence of antibiotic-resistant bacteria, resulting in significant obstacles to treatment. Phage therapy is one promising alternative to antibiotics, especially now that recent modifications to ubiquitous phages have made them more controllable. Additionally, convincing in vitro and in vivo studies of genetically modified lytic phages and engineered non-lytic phages have confirmed the advantages of novel, specific bactericidal agents over antibiotics in some cases. There is still a need for a better understanding of phage therapy, however, before it can be adopted widely.

Bacterial resistance poses a major challenge to the development of new antimicrobial agents. Conventional antibiotics have an inherent obsolescence because they select for development of resistance. Bacterial infections have again become a serious threat in developed countries. Particularly, elderly, immunocompromised, and hospitalized patients are susceptible to infections caused by bacteria such as Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis. These bacteria form chronic, biofilm-based infections, which are challenging because bacterial cells living as biofilms are more tolerant to antibiotics than their planktonic counterparts. Therefore, research should identify new antimicrobial agents and their corresponding targets to decrease the biofilm-forming capability or persistence of the infectious bacteria. Here, we review one such drug target: bacterial cell-to-cell communication systems, or quorum sensing.

A systematic review of the published literature on bacterial resistance in Central Africa between 1955 and 2008 was performed. Eighty-three publications from seven countries were retrieved, the majority presenting data on enteric and other Gramnegative pathogens. Despite methodological limitations in many studies, alarming resistance rates are noted in nearly all pathogens. Of special concern are multidrug resistance in Shigella and Salmonella spp. and the emergence of meticillin-resistant Staphylococcus aureus, high-level penicillin-resistant Streptococcus pneumoniae and extended-spectrum -lactamases among Gram-negative pathogens. These findings make clear that the Central African region shares the worldwide trend of increasing antimicrobial resistance and is in urgent need of sound surveillance based on competent and affordable microbiology to provide clear data on antimicrobial resistance. These data could enable redaction of local treatment guidelines and fuel national and regional policies to contain antimicrobial resistance.

Chronic bacterial prostatitis (CBP, NIH category II) is a difficult to eradicate , recurring, chronic infection of the prostate, often characterized by disabling symptoms, significantly reducing the quality of life of patients. Fluoroquinolones have been for many years first-line agents for treatment of this condition. However, mounting pathogen resistance trends (especially in Mediterranean countries like Greece and Italy) are progressively restricting the usage of fluoroquinolones for treating many Gram-positive or Gram-negative infections in the urological field, and clinicians are increasingly treating bacterial prostatitis by empirically administering agents which have not been adequately tested in the frame of clinical trials. In recent years, reports on the efficacy of the bactericidal antibiotic fosfomycin on CBP have been published. Most articles published so far are case reports, and only few case series or cohort studies are available. The aim of this article is to review the information published so far concerning the usage and dosage of fosfomycin for treatment of chronic bacterial prostatitis.

Las infecciones intrahospitalarias por el uso de catéteres venosos centrales son causa importante de morbi-mortalidad en países desarrollados y en vías de desarrollo, siendo la más frecuente la bacteriemia nosocomial. Objetivo: Determinar la frecuencia de las infecciones intrahospitalarias relacionadas al uso de catéteres venosos centrales en pacientes del Complejo Hospitalario Universitario "Ruíz y Páez" de Ciudad Bolívar. Venezuela. Metodología: Se estudiaron 31 pacientes portadores de catéteres venosos centrales en los servicios de Cirugía, Medicina, Emergencia de Adultos, Unidad de Cuidados Intensivos y Unidad de Diálisis; durante el período Mayo-Septiembre de 2008. Resultados: Se observó que 13 (41,90%) pacientes presentaron algún tipo de infección intrahospitalaria, siendo las bacteriemias nosocomiales las de mayor frecuencia en 6 (46,15%) pacientes, seguida de la infección del punto de entrada o conexión del CVC con 4 (30,80%) de los pacientes. Los microorganismos más frecuentes son bacterias Gram positivas, predominando Staphylococcus aureus y Estafilococos coagulasa negativo. El servicio con mayor incidencia de casos fue Unidad de Cuidados Intensivos con 30,80%. Los factores de riesgo más importantes fueron el tiempo de permanencia del catéter ³4 días, severidad de enfermedad de base, entre otros. Conclusiones: Las infecciones intrahospitalarias por el uso de catéteres venosos centrales son frecuentes en el complejo hospitalario, debiendo ser diagnosticadas por clínica y resulta-K asmera 41(1): 7 -15, 2013